{"id":21,"date":"2022-10-17T19:06:11","date_gmt":"2022-10-17T22:06:11","guid":{"rendered":"https:\/\/wpdemo.cenas-support.com\/?p=21"},"modified":"2022-10-17T19:06:11","modified_gmt":"2022-10-17T22:06:11","slug":"formulario-clientes","status":"publish","type":"post","link":"https:\/\/wpdemo.cenas-support.com\/?p=21","title":{"rendered":"Formulario Clientes"},"content":{"rendered":"\n            <div id=bitforms_1_submit_21_1><div id=\"f-1\">\n    <form novalidate id=\"form-bitforms_1_submit_21_1\" class=\"_frm-bg-1\" action=\"\" enctype=\"multipart\/form-data\" method='post'>\n        <input type=\"hidden\" name=\"bitforms_token\" value=\"dc7a208dea\">\n        <input type=\"hidden\" name=\"bitforms_id\" value=\"bitforms_1\">\n        <div class=\"_frm-1\">\n          <div class=\"_frm-g _frm-g-1\">\n                  <div class=\"btcd-fld-itm bf1-18 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-18'>Cliente Asegurado<\/label>\n                    <input id=\"bf1-18\" class=\"fld fld-1 no-drg\" type=\"username\" name='bf1-18' placeholder='Placeholder Text...'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-18-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-4 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-4'>CI\/RUT<\/label>\n                    <input id=\"bf1-4\" class=\"fld fld-1 no-drg\" type=\"text\" name='bf1-4' placeholder='Placeholder Text...'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-4-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-6 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-6'>Razon Social<\/label>\n                    <input id=\"bf1-6\" class=\"fld fld-1 no-drg\" type=\"text\" name='bf1-6' placeholder='Placeholder Text...'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-6-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-5 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-5'>Localidad<\/label>\n                    <input id=\"bf1-5\" class=\"fld fld-1 no-drg\" type=\"text\" name='bf1-5' placeholder='Placeholder Text...'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-5-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-19 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-19'>Telefono<\/label>\n                    <input id=\"bf1-19\" class=\"fld fld-1 no-drg\" type=\"number\" name='bf1-19' placeholder='Number Input'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-19-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-7 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-7'>Departamento<\/label>\n                    <input id=\"bf1-7\" class=\"fld fld-1 no-drg\" type=\"text\" name='bf1-7' placeholder='Placeholder Text...'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-7-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-16 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-16'>Email Field<\/label>\n                    <input id=\"bf1-16\" class=\"fld fld-1 no-drg\" type=\"email\" name='bf1-16' placeholder='example@mail.com'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-16-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-12 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-12'>Ejecutivo<\/label>\n                    <input id=\"bf1-12\" class=\"fld fld-1 no-drg\" type=\"text\" name='bf1-12' placeholder='Placeholder Text...'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-12-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-22 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-22'>Fecha Nacimiento<\/label>\n                    <input id=\"bf1-22\" class=\"fld fld-1 no-drg\" type=\"date\" name='bf1-22'       \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-22-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-23 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-23'>Tipo de Seguro<\/label>\n                  <div class=\"msl-wrp msl-vars no-drg  fld fld-1 dpd\" style=\"width: 100%;\">\n          <input name=\"bf1-23\" type=\"hidden\" value=\"\">\n            <div data-msl=\"true\" class=\"msl\">\n              <div data-msl=\"true\" class=\"msl-input-wrp\" tabindex=\"0\">\n                <div data-msl='true' data-placeholder='Select...' class='msl-input' contenteditable='true'><\/div>\n              <\/div>\n                <div class=\"msl-actions msl-flx\">\n                  <div role=\"button\" aria-label=\"toggle-menu\" class=\"msl-btn msl-arrow-btn msl-flx\"><\/div>\n                <\/div>\n            <\/div>\n            <div class=\"msl-options\">\n              <option title='Renovaci\u00f3n' class='msl-option vis-n  ' value='Renovaci\u00f3n'>Renovaci\u00f3n<\/option><option title='Nuevo' class='msl-option vis-n  ' value='Nuevo'>Nuevo<\/option>\n            <\/div>\n          <\/div>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-23-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-27 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-27'>Compa\u00f1ia de Seguro<\/label>\n                  <div class=\"msl-wrp msl-vars no-drg  fld fld-1 dpd\" style=\"width: 100%;\">\n          <input name=\"bf1-27\" type=\"hidden\" value=\"\">\n            <div data-msl=\"true\" class=\"msl\">\n              <div data-msl=\"true\" class=\"msl-input-wrp\" tabindex=\"0\">\n                <div data-msl='true' data-placeholder='Select...' class='msl-input' contenteditable='true'><\/div>\n              <\/div>\n                <div class=\"msl-actions msl-flx\">\n                  <div role=\"button\" aria-label=\"toggle-menu\" class=\"msl-btn msl-arrow-btn msl-flx\"><\/div>\n                <\/div>\n            <\/div>\n            <div class=\"msl-options\">\n              <option title='BSE' class='msl-option vis-n  ' value='BSE'>BSE<\/option><option title='Sancor' class='msl-option vis-n  ' value='Sancor'>Sancor<\/option><option title='Sura' class='msl-option vis-n  ' value='Sura'>Sura<\/option><option title='HDI' class='msl-option vis-n  ' value='HDI'>HDI<\/option><option title='Berkley' class='msl-option vis-n  ' value='Berkley'>Berkley<\/option><option title='Mapfre' class='msl-option vis-n  ' value='Mapfre'>Mapfre<\/option><option title='Assist Card' class='msl-option vis-n  ' value='Assist Card'>Assist Card<\/option><option title='SBI' class='msl-option vis-n  ' value='SBI'>SBI<\/option><option title='Porto' class='msl-option vis-n  ' value='Porto'>Porto<\/option>\n            <\/div>\n          <\/div>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-27-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-26 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-26'>Ramo<\/label>\n                  <div class=\"msl-wrp msl-vars no-drg  fld fld-1 dpd\" style=\"width: 100%;\">\n          <input name=\"bf1-26\" type=\"hidden\" value=\"\">\n            <div data-msl=\"true\" class=\"msl\">\n              <div data-msl=\"true\" class=\"msl-input-wrp\" tabindex=\"0\">\n                <div data-msl='true' data-placeholder='Select...' class='msl-input' contenteditable='true'><\/div>\n              <\/div>\n                <div class=\"msl-actions msl-flx\">\n                  <div role=\"button\" aria-label=\"toggle-menu\" class=\"msl-btn msl-arrow-btn msl-flx\"><\/div>\n                <\/div>\n            <\/div>\n            <div class=\"msl-options\">\n              <option title='Bici' class='msl-option vis-n  ' value='Bici'>Bici<\/option><option title='Multiriegos' class='msl-option vis-n  ' value='Multiriegos'>Multiriegos<\/option><option title='Vehiculos' class='msl-option vis-n  ' value='Vehiculos'>Vehiculos<\/option><option title='Hogar' class='msl-option vis-n  ' value='Hogar'>Hogar<\/option><option title='Incendio' class='msl-option vis-n  ' value='Incendio'>Incendio<\/option><option title='Riesgos Varios' class='msl-option vis-n  ' value='Riesgos Varios'>Riesgos Varios<\/option><option title='Viajeros' class='msl-option vis-n  ' value='Viajeros'>Viajeros<\/option><option title='Comercios' class='msl-option vis-n  ' value='Comercios'>Comercios<\/option><option title='Resp. Civil' class='msl-option vis-n  ' value='Resp. Civil'>Resp. Civil<\/option><option title='Rurales' class='msl-option vis-n  ' value='Rurales'>Rurales<\/option><option title='Transporte' class='msl-option vis-n  ' value='Transporte'>Transporte<\/option>\n            <\/div>\n          <\/div>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-26-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-24 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-24'>Vigencia desde<\/label>\n                    <input id=\"bf1-24\" class=\"fld fld-1 no-drg\" type=\"date\" name='bf1-24'       \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-24-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-25 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-25'>Vigencia hasta<\/label>\n                    <input id=\"bf1-25\" class=\"fld fld-1 no-drg\" type=\"date\" name='bf1-25'       \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-25-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-29 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-29'>Moneda<\/label>\n                  <div class=\"msl-wrp msl-vars no-drg  fld fld-1 dpd\" style=\"width: 100%;\">\n          <input name=\"bf1-29\" type=\"hidden\" value=\"\">\n            <div data-msl=\"true\" class=\"msl\">\n              <div data-msl=\"true\" class=\"msl-input-wrp\" tabindex=\"0\">\n                <div data-msl='true' data-placeholder='Select...' class='msl-input' contenteditable='true'><\/div>\n              <\/div>\n                <div class=\"msl-actions msl-flx\">\n                  <div role=\"button\" aria-label=\"toggle-menu\" class=\"msl-btn msl-arrow-btn msl-flx\"><\/div>\n                <\/div>\n            <\/div>\n            <div class=\"msl-options\">\n              <option title='UYU' class='msl-option vis-n  ' value='UYU'>UYU<\/option><option title='USD' class='msl-option vis-n  ' value='USD'>USD<\/option>\n            <\/div>\n          <\/div>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-29-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-28 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-28'>Monto Premio<\/label>\n                    <input id=\"bf1-28\" class=\"fld fld-1 no-drg\" type=\"number\" name='bf1-28' placeholder='Number Input'      \/>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-28-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-21 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          <label class='fld-lbl fld-lbl-1' for='bf1-21'>File Upload<\/label>\n                        <div class=\"btcd-f-input\">\n                <div class=\"btcd-f-wrp\">\n                  <div class=\"btn-wrp\">\n                    <button class=\"btcd-inpBtn\" type=\"button\">\n                      <svg viewBox=\"0 0 15 15\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"15\" height=\"15\"><path d=\"M13.5 7.5l-5.757 5.757a4.243 4.243 0 01-6-6l5.929-5.929a2.828 2.828 0 014 4l-5.758 5.758a1.414 1.414 0 01-2-2L9.5 3.5\" stroke=\"currentColor\" \/><\/svg>\n                      <span>Attach File<\/span>\n                    <\/button>\n                  <\/div>\n                  <span class=\"btcd-f-title\">No File Chosen<\/span>\n                  <small class=\"f-max\"><\/small>\n                  <input id=\"bf1-21\" name=\"bf1-21\"     type=\"file\" \/>\n                <\/div>\n              <\/div>\n                  <div class=\"error-wrapper\" >\n          <div id=\"bf1-21-error\" class=\"error-txt\"><\/div>\n        <\/div>\n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-20 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          \n                  <div class=\"btcd-flx j-c-c\" style=\"min-height='inherit'\"><\/div>\n          \n        <\/div>\n      <\/div>      <div class=\"btcd-fld-itm bf1-1 \">\n        <div class=\"fld-wrp fld-wrp-1 drag\">\n          \n                <div class='btcd-frm-sub j-c-e'>\n        <button\n          class='btcd-sub-btn btcd-sub btcd-btn-md '\n          type='submit'\n           name='bitforms_1_submit_21_1'\n          \n        >\n          Submit\n        <\/button>\n      <\/div>\n          \n        <\/div>\n      <\/div>\n          <\/div>\n        <\/div>\n    <\/form>\n<\/div>            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