wiserinc.hr-portal.net
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34.233.197.209
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Submitted URL: http://wiserinc.hr-portal.net/
Effective URL: https://wiserinc.hr-portal.net/
Submission Tags: @phish_report
Submission: On October 05 via api from FI — Scanned from FI
Effective URL: https://wiserinc.hr-portal.net/
Submission Tags: @phish_report
Submission: On October 05 via api from FI — Scanned from FI
Form analysis 4 forms found in the DOM
<form id="step1Form" class="steps-form" style="display: block;" novalidate="novalidate">
<div class="text-info-warning">
<img src="/static/images/icons/info-warning.png" alt="reg">
<p class="warning_btn">Registration conditions, <a href="#openTextInfoWarning" data-effect="mfp-zoom-in" class="openTextInfoWarningBTN">
click here!
</a>
</p>
<p class="warning_btn_mobile">Registration conditions, <a href="#" data-effect="mfp-zoom-in" id="openTextInfoWarningBTN">
click here!
</a>
</p>
<div id="openTextInfoWarning" class="white-popup mfp-with-anim mfp-hide">
<div class="popup-main">
<div class="container">
<div class="popup-title-text">
<h2>To finish the contract request make sure you have following documents.</h2>
</div>
<ul>
<li>Driving license</li>
<li>Vehicle registration</li>
<li>Voided check</li>
<li>Driving record</li>
<li>D3 pictures of your truck</li>
<li>Insurance certificat</li>
</ul>
<div class="popup-title-text">
<h2>Insurance requirements</h2>
</div>
<ul>
<li>$1,000,000 Primary Liability Commercial Auto CSL</li>
<li>$100,000 Broad Form Cargo with $1,000 deductible max.</li>
<li>Unlimited Radius of Operations</li>
<li>Certificates must also show listed Vehicles (Year, Make, VIN#) as well as all listed drivers. </li>
<li>Wiser Inc shall be listed as additional insured and certificate holder </li>
</ul>
<div class="btns">
<button type="submit" href="#" class="btn btn-close" data-effect="mfp-zoom-in">
<img src="/static/images/icons/back-arrow.svg" alt="reg" class="mr-2"> Back </button>
</div>
</div>
</div>
</div>
</div>
<div class="step-item">
<h3 class="step-title">Company info</h3>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="company_name">Company name <span class="red"> * </span></label>
<input type="text" name="company_name" id="company_name" class="form-control" placeholder="Company name" required="">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="company_phone">Phone number <span class="red"> * </span></label>
<input type="text" name="company_phone" id="company_phone" class="form-control" placeholder="Phone number" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="company_doing_business">Doing business as: <span class="red"> * </span></label>
<input type="text" name="company_doing_business" id="company_doing_business" class="form-control" placeholder="Business name" required="">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="company_employer_id">Employer ID number<span class="red"> * </span></label>
<input type="text" name="company_employer_id" id="company_employer_id" class="form-control" placeholder="Number" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="company_type">Business type<span class="red"> * </span></label>
<div class="dropdown bootstrap-select form-control"><select onchange="businessType()" autocomplete="off" name="company_type" id="company_type" class="form-control selectpicker" title="Choose only one of the following seven items."
required="" tabindex="-98">
<option class="bs-title-option" value=""></option>
<option value="1">Individual/sole proprietor or single-member LLC</option>
<option value="2">C Corporation</option>
<option value="3">S Corporation</option>
<option value="4">Partnership</option>
<option value="5">Trust/Estate</option>
<option value="6">Limited Liability Company</option>
<option value="7">Other</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="combobox" aria-owns="bs-select-1" aria-haspopup="listbox" aria-expanded="false" data-id="company_type"
title="Choose only one of the following seven items.">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Choose only one of the following seven items.</div>
</div>
</div>
</button>
<div class="dropdown-menu " style="max-height: 635px; overflow: hidden; min-height: 176px;">
<div class="inner show" role="listbox" id="bs-select-1" tabindex="-1" style="max-height: 617px; overflow-y: auto; min-height: 158px;">
<ul class="dropdown-menu inner show" role="presentation" style="margin-top: 0px; margin-bottom: 0px;">
<li><a role="option" class="dropdown-item" id="bs-select-1-0" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Individual/sole proprietor or single-member LLC</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-1-1" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">C Corporation</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-1-2" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">S Corporation</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-1-3" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Partnership</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-1-4" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Trust/Estate</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-1-5" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Limited Liability Company</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-1-6" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Other</span></a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="company_zip">ZIP code <span class="red"> * </span></label>
<input type="text" name="company_zip" id="company_zip" class="form-control pac-target-input" placeholder="ZIP code" required="" autocomplete="off">
</div>
</div>
<div class="col-sm-6">
<div class="form-group">
<label for="company_State">State <span class="red"> * </span></label>
<div class="dropdown bootstrap-select form-control"><select autocomplete="off" name="company_State" id="company_State" class="form-control selectpicker" title="State" data-live-search="true" required="" tabindex="-98">
<option class="bs-title-option" value=""></option>
<option value="alabama" data-id="1">Alabama</option>
<option value="alaska" data-id="2">Alaska</option>
<option value="american samoa" data-id="3">American Samoa</option>
<option value="arizona" data-id="4">Arizona</option>
<option value="arkansas" data-id="5">Arkansas</option>
<option value="california" data-id="6">California</option>
<option value="colorado" data-id="7">Colorado</option>
<option value="connecticut" data-id="8">Connecticut</option>
<option value="delaware" data-id="9">Delaware</option>
<option value="district of columbia" data-id="10">District Of Columbia</option>
<option value="federated states of micronesia" data-id="11">Federated States Of Micronesia</option>
<option value="florida" data-id="12">Florida</option>
<option value="georgia" data-id="13">Georgia</option>
<option value="guam" data-id="14">Guam</option>
<option value="hawaii" data-id="15">Hawaii</option>
<option value="idaho" data-id="16">Idaho</option>
<option value="illinois" data-id="17">Illinois</option>
<option value="indiana" data-id="18">Indiana</option>
<option value="iowa" data-id="19">Iowa</option>
<option value="kansas" data-id="20">Kansas</option>
<option value="kentucky" data-id="21">Kentucky</option>
<option value="louisiana" data-id="22">Louisiana</option>
<option value="maine" data-id="23">Maine</option>
<option value="marshall islands" data-id="24">Marshall Islands</option>
<option value="maryland" data-id="25">Maryland</option>
<option value="massachusetts" data-id="26">Massachusetts</option>
<option value="michigan" data-id="27">Michigan</option>
<option value="minnesota" data-id="28">Minnesota</option>
<option value="mississippi" data-id="29">Mississippi</option>
<option value="missouri" data-id="30">Missouri</option>
<option value="montana" data-id="31">Montana</option>
<option value="nebraska" data-id="32">Nebraska</option>
<option value="nevada" data-id="33">Nevada</option>
<option value="new hampshire" data-id="34">New Hampshire</option>
<option value="new jersey" data-id="35">New Jersey</option>
<option value="new mexico" data-id="36">New Mexico</option>
<option value="new york" data-id="37">New York</option>
<option value="north carolina" data-id="38">North Carolina</option>
<option value="north dakota" data-id="39">North Dakota</option>
<option value="northern mariana islands" data-id="40">Northern Mariana Islands</option>
<option value="ohio" data-id="41">Ohio</option>
<option value="oklahoma" data-id="42">Oklahoma</option>
<option value="oregon" data-id="43">Oregon</option>
<option value="palau" data-id="44">Palau</option>
<option value="pennsylvania" data-id="45">Pennsylvania</option>
<option value="puerto rico" data-id="46">Puerto Rico</option>
<option value="rhode island" data-id="47">Rhode Island</option>
<option value="south carolina" data-id="48">South Carolina</option>
<option value="south dakota" data-id="49">South Dakota</option>
<option value="tennessee" data-id="50">Tennessee</option>
<option value="texas" data-id="51">Texas</option>
<option value="utah" data-id="52">Utah</option>
<option value="vermont" data-id="53">Vermont</option>
<option value="virgin islands" data-id="54">Virgin Islands</option>
<option value="virginia" data-id="55">Virginia</option>
<option value="washington" data-id="56">Washington</option>
<option value="west virginia" data-id="57">West Virginia</option>
<option value="wisconsin" data-id="58">Wisconsin</option>
<option value="wyoming" data-id="59">Wyoming</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="combobox" aria-owns="bs-select-2" aria-haspopup="listbox" aria-expanded="false" data-id="company_State" title="State">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">State</div>
</div>
</div>
</button>
<div class="dropdown-menu " style="max-height: 635px; overflow: hidden; min-height: 220px;">
<div class="bs-searchbox"><input type="search" class="form-control" autocomplete="off" role="combobox" aria-label="Search" aria-controls="bs-select-2" aria-autocomplete="list"></div>
<div class="inner show" role="listbox" id="bs-select-2" tabindex="-1" style="max-height: 573px; overflow-y: auto; min-height: 158px;">
<ul class="dropdown-menu inner show" role="presentation" style="margin-top: 0px; margin-bottom: 0px;">
<li><a role="option" class="dropdown-item" id="bs-select-2-0" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Alabama</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-1" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Alaska</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-2" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">American Samoa</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-3" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Arizona</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-4" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Arkansas</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-5" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">California</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-6" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Colorado</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-7" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Connecticut</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-8" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Delaware</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-9" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">District Of Columbia</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-10" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Federated States Of Micronesia</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-11" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Florida</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-12" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Georgia</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-13" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Guam</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-14" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Hawaii</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-15" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Idaho</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-16" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Illinois</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-17" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Indiana</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-18" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Iowa</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-19" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Kansas</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-20" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Kentucky</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-21" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Louisiana</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-22" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Maine</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-23" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Marshall Islands</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-24" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Maryland</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-25" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Massachusetts</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-26" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Michigan</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-27" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Minnesota</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-28" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Mississippi</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-29" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Missouri</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-30" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Montana</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-31" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Nebraska</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-32" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Nevada</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-33" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">New Hampshire</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-34" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">New Jersey</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-35" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">New Mexico</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-36" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">New York</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-37" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">North Carolina</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-38" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">North Dakota</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-39" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Northern Mariana Islands</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-40" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Ohio</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-41" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Oklahoma</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-42" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Oregon</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-43" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Palau</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-44" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Pennsylvania</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-45" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Puerto Rico</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-46" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Rhode Island</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-47" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">South Carolina</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-48" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">South Dakota</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-49" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Tennessee</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-50" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Texas</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-51" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Utah</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-52" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Vermont</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-53" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Virgin Islands</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-54" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Virginia</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-55" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Washington</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-56" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">West Virginia</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-57" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Wisconsin</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-2-58" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Wyoming</span></a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-12" id="limited-liability" hidden="">
<div class="form-group">
<label for="limited_liability">Limited liability company<span class="red"> * </span></label>
<div class="dropdown bootstrap-select form-control"><select autocomplete="off" name="limited_liability" id="limited_liability" class="form-control selectpicker" title="Enter the tax classification" tabindex="-98">
<option class="bs-title-option" value=""></option>
<option value="C">C Corporation</option>
<option value="S">S Corporation</option>
<option value="P">Partnership</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="combobox" aria-owns="bs-select-3" aria-haspopup="listbox" aria-expanded="false" data-id="limited_liability"
title="Enter the tax classification">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Enter the tax classification</div>
</div>
</div>
</button>
<div class="dropdown-menu " style="max-height: 1178px; overflow: hidden; min-height: 0px;">
<div class="inner show" role="listbox" id="bs-select-3" tabindex="-1" style="max-height: 1160px; overflow-y: auto; min-height: 0px;">
<ul class="dropdown-menu inner show" role="presentation" style="margin-top: 0px; margin-bottom: 0px;">
<li><a role="option" class="dropdown-item" id="bs-select-3-0" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">C Corporation</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-3-1" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">S Corporation</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-3-2" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Partnership</span></a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
<div class="col-12" id="other-text" hidden="">
<div class="form-group">
<label for="other_text">Other<span class="red"> * </span></label>
<input type="text" name="other_text" id="other_text" class="form-control">
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="company_city">City <span class="red"> * </span></label>
<input type="text" name="company_city" id="company_city" class="form-control" placeholder="City" required="">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="company_address">Address<span class="red"> * </span></label>
<input type="text" name="company_address" id="company_address" class="form-control" placeholder="Address" required="">
</div>
</div>
</div>
<hr class="mt-0">
<div class="row">
<div class="col-lg-6">
<div class="row">
<div class="col-sm-6">
<div class="form-group">
<label for="company_applicant_first_name"> First name<span class="red"> * </span>
</label>
<input type="text" name="company_applicant_first_name" id="company_applicant_first_name" class="form-control" placeholder="First name" required="">
</div>
</div>
<div class="col-sm-6">
<div class="form-group">
<label for="company_applicant_last_name"> Last name<span class="red"> * </span>
</label>
<input type="text" name="company_applicant_last_name" id="company_applicant_last_name" class="form-control" placeholder="Last name" required="">
</div>
</div>
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label for="company_email">Email <span class="red"> * </span></label>
<input type="email" name="company_email" id="company_email" class="form-control" placeholder="youremail@service.com" required="">
</div>
</div>
</div>
<hr class="mt-0">
<div class="row">
<div class="col-6 mb-3">
<div class="align-items-center d-flex">
<label for="tax_exempt" class="mb-0 mr-2">Tax exempt?</label>
<input type="checkbox" id="tax_exempt">
</div>
</div>
</div>
<div id="tax_exempt_block" hidden="">
<hr class="mt-0">
<p class="text-exemption-1">Exemptions</p>
<p class="text-exemption-2"> (codes apply only to certain entities, not individuals; <br>
<a href="/static/files/fw9-3.png" data-fancybox="gallery">see instructions on page 3</a>)
</p>
<div class="row">
<div class="col-lg-6">
<div class="form-group">
<label for="exempt_payee_code">Exempt payee code (if any)</label>
<input type="text" name="exempt_payee_code" id="exempt_payee_code" class="form-control" placeholder="Сode">
</div>
</div>
<div class="col-lg-6">
<div class="form-group">
<label for="exempt_reporting_code"> Exemption from FATCA reporting code (if any) </label>
<input type="text" name="exempt_reporting_code" id="exempt_reporting_code" class="form-control" placeholder="Сode">
</div>
</div>
</div>
</div>
</div>
<div class="step-btns">
<button id="openStep2" type="submit" class="btn btn-next text-capitalize d-flex align-items-center justify-content-center">
<span id="btn_step_text_1">Next</span>
<span id="btn_step_text_11" style="display: none">
<span class="spinner-border spinner-border-sm mr-2" role="status" aria-hidden="true"></span> Loading... </span>
</button>
</div>
</form><form id="step2Form" class="form-main" style="display: none;" novalidate="novalidate">
<div class="step-item">
<h3 class="step-title">Vehicle info</h3>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="vehicle_make">Make and Model <span class="red"> * </span></label>
<input type="text" name="vehicle_make" id="vehicle_make" class="form-control" placeholder="Make" required="">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="vehicle_model" class="opacity-0">/</label>
<input type="text" name="vehicle_model" id="vehicle_model" class="form-control" placeholder="Model" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="vehicle_door_width">Door Dimensions <span class="red"> * </span></label>
<input type="number" name="vehicle_door_width" id="vehicle_door_width" class="form-control" placeholder="Width" required="">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="vehicle_door_height" class="opacity-0">/</label>
<input type="number" name="vehicle_door_height" id="vehicle_door_height" class="form-control" placeholder="Height" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="vehicle_equipment">Equipment & Dock Height <span class="red"> * </span></label>
<div class="dropdown bootstrap-select show-tick form-control"><select autocomplete="off" name="vehicle_equipment" id="vehicle_equipment" class="form-control selectpicker" title="Equipment" multiple="" tabindex="-98">
<option value="1">PPE</option>
<option value="2">Straps</option>
<option value="3">Dolly</option>
<option value="4">Bulkhead</option>
<option value="5">Temp Control</option>
<option value="6">Air Ride</option>
<option value="7">Lift-Gate</option>
<option value="8">Pallet Jack</option>
<option value="9">Tent</option>
<option value="10">Side Loading</option>
<option value="11">Load Bars</option>
<option value="12">E-Tracks</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="combobox" aria-owns="bs-select-4" aria-haspopup="listbox" aria-expanded="false" data-id="vehicle_equipment"
title="Equipment">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Equipment</div>
</div>
</div>
</button>
<div class="dropdown-menu " style="max-height: 1178px; overflow: hidden; min-height: 176px;">
<div class="inner show" role="listbox" id="bs-select-4" tabindex="-1" aria-multiselectable="true" style="max-height: 1160px; overflow-y: auto; min-height: 158px;">
<ul class="dropdown-menu inner show" role="presentation" style="margin-top: 0px; margin-bottom: 0px;">
<li><a role="option" class="dropdown-item" id="bs-select-4-0" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">PPE</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-1" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Straps</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-2" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Dolly</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-3" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Bulkhead</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-4" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Temp Control</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-5" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Air Ride</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-6" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Lift-Gate</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-7" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Pallet Jack</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-8" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Tent</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-9" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Side Loading</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-10" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">Load Bars</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-4-11" tabindex="0" aria-selected="false"><span class=" bs-ok-default check-mark"></span><span class="text">E-Tracks</span></a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="vehicle_dock" class="opacity-0">/</label>
<div class="dropdown bootstrap-select form-control"><select autocomplete="off" name="vehicle_dock" id="vehicle_dock" class="form-control selectpicker" title="Dock height" tabindex="-98">
<option class="bs-title-option" value=""></option>
<option value="1">True</option>
<option value="2">Ramps</option>
<option value="3">Landing Gear</option>
<option value="4">No</option>
</select><button type="button" class="btn dropdown-toggle bs-placeholder btn-light" data-toggle="dropdown" role="combobox" aria-owns="bs-select-5" aria-haspopup="listbox" aria-expanded="false" data-id="vehicle_dock" title="Dock height">
<div class="filter-option">
<div class="filter-option-inner">
<div class="filter-option-inner-inner">Dock height</div>
</div>
</div>
</button>
<div class="dropdown-menu " style="max-height: 1178px; overflow: hidden; min-height: 176px;">
<div class="inner show" role="listbox" id="bs-select-5" tabindex="-1" style="max-height: 1160px; overflow-y: auto; min-height: 158px;">
<ul class="dropdown-menu inner show" role="presentation" style="margin-top: 0px; margin-bottom: 0px;">
<li><a role="option" class="dropdown-item" id="bs-select-5-0" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">True</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-5-1" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Ramps</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-5-2" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">Landing Gear</span></a></li>
<li><a role="option" class="dropdown-item" id="bs-select-5-3" tabindex="0"><span class=" bs-ok-default check-mark"></span><span class="text">No</span></a></li>
</ul>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label for="vehicle_useful_cargo_length">Useful Cargo Dimensions (Inches) <span class="red"> * </span></label>
<input type="number" name="vehicle_useful_cargo_length" id="vehicle_useful_cargo_length" class="form-control" placeholder="Lenght" required="">
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label for="vehicle_useful_cargo_width" class="opacity-0">/</label>
<input type="number" name="vehicle_useful_cargo_width" id="vehicle_useful_cargo_width" class="form-control" placeholder="Width" required="">
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label for="vehicle_useful_cargo_height" class="opacity-0">/</label>
<input type="number" name="vehicle_useful_cargo_height" id="vehicle_useful_cargo_height" class="form-control" placeholder="Height" required="">
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="vehicle_payload_lbs">Payload and GVW <span class="red"> * </span></label>
<input type="number" name="vehicle_payload_lbs" id="vehicle_payload_lbs" class="form-control" placeholder="Payload (lbs)" required="">
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="vehicle_GVW_lbs" class="opacity-0">/</label>
<input type="number" name="vehicle_GVW_lbs" id="vehicle_GVW_lbs" class="form-control" placeholder="GVW (lbs)" required="">
</div>
</div>
</div>
</div>
<div class="step-btns">
<button id="openStep3" type="submit" class="btn btn-next text-capitalize d-flex align-items-center justify-content-center">
<span id="btn_step_text_2">Next</span>
<span id="btn_step_text_22" style="display: none">
<span class="spinner-border spinner-border-sm mr-2" role="status" aria-hidden="true"></span> Loading... </span>
</button>
</div>
</form><form id="step3Form" class="form-main" style="display: none;">
<div class="step-item mt-0 mb-0">
<p class="warning_btn">* Optional (You can upload documents later)</p>
<h3 class="step-title">Company</h3>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="">Void Check</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-void-check" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-jcprrzbag" name="filepond" aria-controls="filepond--assistant-jcprrzbag"
aria-labelledby="filepond--drop-label-jcprrzbag" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-jcprrzbag" id="filepond--drop-label-jcprrzbag" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-jcprrzbag" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for=""> MC and USDOT (optional)</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-ms-usdot" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-7rt49az3n" name="filepond" aria-controls="filepond--assistant-7rt49az3n"
aria-labelledby="filepond--drop-label-7rt49az3n" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-7rt49az3n" id="filepond--drop-label-7rt49az3n" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-7rt49az3n" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="step-item mb-0">
<h3 class="step-title mt-0">Driver</h3>
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="">Driver License</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-driver-license" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-6qxgerhew" name="filepond" aria-controls="filepond--assistant-6qxgerhew"
aria-labelledby="filepond--drop-label-6qxgerhew" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-6qxgerhew" id="filepond--drop-label-6qxgerhew" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-6qxgerhew" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group">
<label for="">Driving Record </label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-driver-record" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-oppto1u0p" name="filepond" aria-controls="filepond--assistant-oppto1u0p"
aria-labelledby="filepond--drop-label-oppto1u0p" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-oppto1u0p" id="filepond--drop-label-oppto1u0p" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-oppto1u0p" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="step-item mb-0">
<h3 class="step-title mt-0">Vehicle</h3>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label for="file-insurance">Insurance</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-insurance" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-o08rx8hp6" name="filepond" aria-controls="filepond--assistant-o08rx8hp6"
aria-labelledby="filepond--drop-label-o08rx8hp6" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-o08rx8hp6" id="filepond--drop-label-o08rx8hp6" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-o08rx8hp6" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label for="file-vehicle-registration">Vehicle Registration</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-vehicle-registration" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-vef6qndi0" name="filepond" aria-controls="filepond--assistant-vef6qndi0"
aria-labelledby="filepond--drop-label-vef6qndi0" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-vef6qndi0" id="filepond--drop-label-vef6qndi0" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-vef6qndi0" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label for="file-green-card">Green card & Passport</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-green-card" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-88mqgam5k" name="filepond" aria-controls="filepond--assistant-88mqgam5k"
aria-labelledby="filepond--drop-label-88mqgam5k" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-88mqgam5k" id="filepond--drop-label-88mqgam5k" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-88mqgam5k" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="step-item mb-0">
<h3 class="step-title mt-0">Upload your vehicle photos</h3>
<div class="row">
<div class="col-md-4">
<div class="form-group">
<label for="file-photo-left-side">Photo Left Side</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-photo-left-side" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-18hzjlbdh" name="filepond" aria-controls="filepond--assistant-18hzjlbdh"
aria-labelledby="filepond--drop-label-18hzjlbdh" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-18hzjlbdh" id="filepond--drop-label-18hzjlbdh" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-18hzjlbdh" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label for="file-photo-right-side">Photo Right Side</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-photo-right-side" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-xksc5vl4g" name="filepond" aria-controls="filepond--assistant-xksc5vl4g"
aria-labelledby="filepond--drop-label-xksc5vl4g" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-xksc5vl4g" id="filepond--drop-label-xksc5vl4g" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-xksc5vl4g" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label for="">Cargo space phot</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-cargo-space-photo" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-h36lyeyrv" name="filepond" aria-controls="filepond--assistant-h36lyeyrv"
aria-labelledby="filepond--drop-label-h36lyeyrv" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-h36lyeyrv" id="filepond--drop-label-h36lyeyrv" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-h36lyeyrv" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<hr>
<div class="step-item">
<div class="row">
<div class="col-md-6">
<div class="form-group">
<label for="">Extra attachments file</label>
<div class="parent">
<div class="parent-form-group">
<div class="filepond--root filepond filepond--hopper" id="file-extra-attachments" data-style-button-remove-item-position="left" data-style-button-process-item-position="right" data-style-load-indicator-position="right"
data-style-progress-indicator-position="right" data-style-button-remove-item-align="false"><input class="filepond--browser" type="file" id="filepond--browser-1asuj8xom" name="filepond" aria-controls="filepond--assistant-1asuj8xom"
aria-labelledby="filepond--drop-label-1asuj8xom" accept="" multiple="">
<div style="height: 100%;"></div>
<div class="filepond--drop-label" style="transform: translate3d(0px, 0px, 0px); opacity: 1;"><label for="filepond--browser-1asuj8xom" id="filepond--drop-label-1asuj8xom" aria-hidden="true">Choose your <span
class="filepond--label-action" tabindex="0">file</span></label></div>
<div class="filepond--list-scroller">
<ul class="filepond--list" role="list"></ul>
</div>
<div class="filepond--panel filepond--panel-root" data-scalable="true">
<div class="filepond--panel-top filepond--panel-root"></div>
<div class="filepond--panel-center filepond--panel-root"></div>
<div class="filepond--panel-bottom filepond--panel-root"></div>
</div><span class="filepond--assistant" id="filepond--assistant-1asuj8xom" role="status" aria-live="polite" aria-relevant="additions"></span>
<div class="filepond--drip"></div>
<fieldset class="filepond--data"></fieldset>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="step-btns">
<button id="openStep4" class="btn btn-next modal_btn_save">Next</button>
</div>
</form><form id="step4Form" class="steps-form" style="display: none;">
<h3 class="step-title">Documents for signature</h3>
<div class="documents-block mt-4">
<div id="viewer1" class="pdf_1 mr-3"></div>
<div id="viewer2" class="pdf_1"></div>
</div>
<hr>
<p class="text-exemption-4"><span> * </span> Your signature will only be used to sign the contract, <br> and will not be saved </p>
<div class="step-item">
<h3 class="step-title">Please sign below <span class="red"> * </span></h3>
<div class="below" aria-required="true">
<canvas class="sign" style="touch-action: none;"></canvas>
<button id="signature-trash">
<img src="/static/images/icons/signatute-trash.svg" alt="signature-trash">
</button>
</div>
</div>
<div class="step-btns">
<button id="step4_btn" type="submit" class="btn btn-next text-capitalize d-flex align-items-center justify-content-center">
<span id="btn_step_text_4">Finish</span>
<span id="btn_step_text_44" style="display: none">
<span class="spinner-border spinner-border-sm mr-2" role="status" aria-hidden="true"></span> Loading... </span>
</button>
</div>
</form>Text Content
REGISTRATION 1 2 3 4 Registration conditions, click here! Registration conditions, click here! TO FINISH THE CONTRACT REQUEST MAKE SURE YOU HAVE FOLLOWING DOCUMENTS. * Driving license * Vehicle registration * Voided check * Driving record * D3 pictures of your truck * Insurance certificat INSURANCE REQUIREMENTS * $1,000,000 Primary Liability Commercial Auto CSL * $100,000 Broad Form Cargo with $1,000 deductible max. * Unlimited Radius of Operations * Certificates must also show listed Vehicles (Year, Make, VIN#) as well as all listed drivers. * Wiser Inc shall be listed as additional insured and certificate holder Back COMPANY INFO Company name * Phone number * Doing business as: * Employer ID number * Business type * Individual/sole proprietor or single-member LLC C Corporation S Corporation Partnership Trust/Estate Limited Liability Company Other Choose only one of the following seven items. * Individual/sole proprietor or single-member LLC * C Corporation * S Corporation * Partnership * Trust/Estate * Limited Liability Company * Other ZIP code * State * Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming State * Alabama * Alaska * American Samoa * Arizona * Arkansas * California * Colorado * Connecticut * Delaware * District Of Columbia * Federated States Of Micronesia * Florida * Georgia * Guam * Hawaii * Idaho * Illinois * Indiana * Iowa * Kansas * Kentucky * Louisiana * Maine * Marshall Islands * Maryland * Massachusetts * Michigan * Minnesota * Mississippi * Missouri * Montana * Nebraska * Nevada * New Hampshire * New Jersey * New Mexico * New York * North Carolina * North Dakota * Northern Mariana Islands * Ohio * Oklahoma * Oregon * Palau * Pennsylvania * Puerto Rico * Rhode Island * South Carolina * South Dakota * Tennessee * Texas * Utah * Vermont * Virgin Islands * Virginia * Washington * West Virginia * Wisconsin * Wyoming Limited liability company * C Corporation S Corporation Partnership Enter the tax classification * C Corporation * S Corporation * Partnership Other * City * Address * -------------------------------------------------------------------------------- First name * Last name * Email * -------------------------------------------------------------------------------- Tax exempt? -------------------------------------------------------------------------------- Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3) Exempt payee code (if any) Exemption from FATCA reporting code (if any) Next Loading... VEHICLE INFO Make and Model * / Door Dimensions * / Equipment & Dock Height * PPE Straps Dolly Bulkhead Temp Control Air Ride Lift-Gate Pallet Jack Tent Side Loading Load Bars E-Tracks Equipment * PPE * Straps * Dolly * Bulkhead * Temp Control * Air Ride * Lift-Gate * Pallet Jack * Tent * Side Loading * Load Bars * E-Tracks / True Ramps Landing Gear No Dock height * True * Ramps * Landing Gear * No Useful Cargo Dimensions (Inches) * / / Payload and GVW * / Next Loading... * Optional (You can upload documents later) COMPANY Void Check Choose your file MC and USDOT (optional) Choose your file DRIVER Driver License Choose your file Driving Record Choose your file VEHICLE Insurance Choose your file Vehicle Registration Choose your file Green card & Passport Choose your file UPLOAD YOUR VEHICLE PHOTOS Photo Left Side Choose your file Photo Right Side Choose your file Cargo space phot Choose your file -------------------------------------------------------------------------------- Extra attachments file Choose your file Next DOCUMENTS FOR SIGNATURE -------------------------------------------------------------------------------- * Your signature will only be used to sign the contract, and will not be saved PLEASE SIGN BELOW * Finish Loading... REGISTRATION IS COMPLETE Thank you for choosing us! You can view all your signed documents in our portal How did you find out about us? YouTube Facebook Indeed Google ads Select an item * YouTube * Facebook * Indeed * Google ads Submit Loading... TO FINISH THE CONTRACT REQUEST MAKE SURE YOU HAVE FOLLOWING DOCUMENTS. * Driving license * Vehicle registration * Voided check * Driving record * D3 pictures of your truck * Insurance certificat INSURANCE REQUIREMENTS * $1,000,000 Primary Liability Commercial Auto CSL * $100,000 Broad Form Cargo with $1,000 deductible max. * Unlimited Radius of Operations * Certificates must also show listed Vehicles (Year, Make, VIN#) as well as all listed drivers. Back YOUR COMPANY IS ALREADY IN THE DATABASE! Please check, is this you? No, continue filling in Send code again 2:00 © 2023 All Rights Reserved. Wiser Inc Powered by: