{"id":1533,"date":"2015-03-24T09:02:01","date_gmt":"2015-03-24T13:02:01","guid":{"rendered":"http:\/\/hstrelief.metrosolutions.net\/?page_id=1533"},"modified":"2017-01-17T20:55:21","modified_gmt":"2017-01-18T01:55:21","slug":"apply","status":"publish","type":"page","link":"https:\/\/hstrelief.ca\/apply\/","title":{"rendered":"Apply Now"},"content":{"rendered":"\n                <div class='gf_browser_unknown gform_wrapper' id='gform_wrapper_1' style='display:none'><a id='gf_1' class='gform_anchor' ><\/a><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1'  action='\/wp-json\/wp\/v2\/pages\/1533#gf_1'>\n                        <div class='gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id='field_1_2' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>MORTGAGE DETAILS<\/h2><\/li><li id='field_1_1' class='gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_1' >Type of Loan<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_1_1' onchange='gf_apply_rules(1,[0]);' class='large gfield_select' tabindex='1'  aria-required=\"true\" aria-invalid=\"false\"><option value='' selected='selected' class='gf_placeholder'>Choose<\/option><option value='Approval' >Approval<\/option><option value='Pre-Approval' >Pre-Approval<\/option><\/select><\/div><\/li><li id='field_1_3' class='gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_3' >Purpose of Loan<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_1_3' onchange='gf_apply_rules(1,[0]);' class='large gfield_select' tabindex='2'  aria-required=\"true\" aria-invalid=\"false\"><option value='' selected='selected' class='gf_placeholder'>Choose<\/option><option value='Purchase' >Purchase<\/option><option value='Refinance' >Refinance<\/option><option value='Switch\/Tranfer' >Switch\/Tranfer<\/option><\/select><\/div><\/li><li id='field_1_4' class='gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_4' >Value of Home<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_4' id='input_1_4' type='number' step='any'   value='' class='large' tabindex='3' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'    aria-required=\"true\" aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_5' class='gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_5' >Mortgage Amount Required<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_5' id='input_1_5' type='number' step='any'   value='' class='large' tabindex='4' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'    aria-required=\"true\" aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_6' class='gfield gf_right_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_6' >Date Funds Required<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_6' id='input_1_6' type='text' value='03\/24\/2022' class='datepicker medium mdy datepicker_no_icon' tabindex='5'  \/>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_6' class='gform_hidden' value='https:\/\/hstrelief.ca\/wp-content\/plugins\/gravityforms\/images\/calendar.png'\/><\/li><li id='field_1_7' class='gfield gsection form_Title field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>PERSONAL INFORMATION<\/h2><\/li><li id='field_1_13' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><h5 style=\"text-decoration:underline;\"><strong>IDENTIFICATION<\/strong><\/h4><\/li><li id='field_1_8' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_1_8_2' >Name<span class='gfield_required'>*<\/span><\/label><div class='ginput_complex ginput_container has_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_4 ginput_container_name gfield_trigger_change' id='input_1_8'>\n                            <span id='input_1_8_2_container' class='name_prefix name_prefix_select' >\n                                                    <select name='input_8.2' id='input_1_8_2' aria-label='Name prefix' tabindex='6' >\n                          <option value=''><\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Miss' >Miss<\/option><option value='Ms.' >Ms.<\/option><option value='Dr.' >Dr.<\/option><option value='Prof.' >Prof.<\/option><option value='Rev.' >Rev.<\/option>\n                      <\/select>\n                                                    <label for='input_1_8_2' >Prefix<\/label>\n                                                  <\/span>\n                            <span id='input_1_8_3_container' class='name_first' >\n                                                    <input type='text' name='input_8.3' id='input_1_8_3' value='' aria-label='First name' tabindex='7'  aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_1_8_3' >First<\/label>\n                                                <\/span>\n                            <span id='input_1_8_4_container' class='name_middle' >\n                                                    <input type='text' name='input_8.4' id='input_1_8_4' value='' aria-label='Middle name' tabindex='8'  aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_1_8_4' >Middle<\/label>\n                                                <\/span>\n                            <span id='input_1_8_6_container' class='name_last' >\n                                                    <input type='text' name='input_8.6' id='input_1_8_6' value='' aria-label='Last name' tabindex='9'  aria-required=\"true\" aria-invalid=\"false\" \/>\n                                                    <label for='input_1_8_6' >Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id='field_1_12' class='gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_12' >Email<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_12' id='input_1_12' type='email' value='' class='medium' tabindex='11' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'  \/>\n                        <\/div><\/li><li id='field_1_10' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_10' >SIN Number<\/label><div class='ginput_container ginput_container_number'><input name='input_10' id='input_1_10' type='number' step='any'   value='' class='medium' tabindex='12' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'     aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_9' class='gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_9' >Date of Birth<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_1_9' type='text' value='03\/24\/2022' class='datepicker medium mdy datepicker_no_icon' tabindex='13'  \/>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_9' class='gform_hidden' value='https:\/\/hstrelief.ca\/wp-content\/plugins\/gravityforms\/images\/calendar.png'\/><\/li><li id='field_1_11' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_11' >Marital Status<\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_1_11' onchange='gf_apply_rules(1,[0]);' class='large gfield_select' tabindex='14'   aria-invalid=\"false\"><option value='' selected='selected' class='gf_placeholder'>Choose<\/option><option value='Single' >Single<\/option><option value='Married' >Married<\/option><option value='Common Law' >Common Law<\/option><option value='Separated' >Separated<\/option><option value='Divorced' >Divorced<\/option><option value='Widowed' >Widowed<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id='field_1_14' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><h5 style=\"padding-top:35px; text-decoration:underline;\"><strong>CURRENT LIVING ADDRESS<\/strong><\/h5><\/li><li id='field_1_15' class='gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_1_15_1' >Address<span class='gfield_required'>*<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gfield_trigger_change' id='input_1_15' >\n                         <span class='ginput_full address_line_1' id='input_1_15_1_container' >\n                                        <input type='text' name='input_15.1' id='input_1_15_1' value='' tabindex='15'  \/>\n                                        <label for='input_1_15_1' id='input_1_15_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_1_15_2_container' >\n                                        <input type='text' name='input_15.2' id='input_1_15_2' value='' tabindex='16'  \/>\n                                        <label for='input_1_15_2' id='input_1_15_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_1_15_3_container' >\n                                    <input type='text' name='input_15.3' id='input_1_15_3' value='' tabindex='17'  \/>\n                                    <label for='input_1_15_3' id='input_1_15_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_1_15_4_container' >\n                                        <input type='text' name='input_15.4' id='input_1_15_4' value='' tabindex='19'    \/>\n                                        <label for='input_1_15_4' id='input_1_15_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_1_15_5_container' >\n                                    <input type='text' name='input_15.5' id='input_1_15_5' value='' tabindex='20'  \/>\n                                    <label for='input_1_15_5' id='input_1_15_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country' id='input_1_15_6_container' >\n                                        <select name='input_15.6' id='input_1_15_6' tabindex='21' ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' selected='selected'>Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select>\n                                        <label for='input_1_15_6' id='input_1_15_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_1_16' class='gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_16' >Home Phone<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_16' id='input_1_16' type='tel' value='' class='medium' tabindex='22' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'  aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_17' class='gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_17' >Cell Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_1_17' type='tel' value='' class='medium' tabindex='23' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_18' class='gfield gf_right_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_18' >Time At This Address<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_18' id='input_1_18' type='number' step='any'   value='' class='medium' tabindex='24' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='(YYMM) (Eg. 4 Year &amp; 2 Months = 0402)' aria-required=\"true\" aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_19' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><h5 style=\"padding-top:35px; text-decoration:underline;\"><strong>PREVIOUS ADDRESS<\/strong><\/h5><\/li><li id='field_1_20' class='gfield gf_list_inline gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label'  >Do you have a previous address within the last three years<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_20'><li class='gchoice_1_20_0'><input name='input_20' type='radio' value='Yes'  id='choice_1_20_0' tabindex='25'  onclick='gf_apply_rules(1,[0,21,22,23]);' onkeypress='gf_apply_rules(1,[0,21,22,23]);'  \/><label for='choice_1_20_0' id='label_1_20_0'>Yes<\/label><\/li><li class='gchoice_1_20_1'><input name='input_20' type='radio' value='No'  id='choice_1_20_1' tabindex='26'  onclick='gf_apply_rules(1,[0,21,22,23]);' onkeypress='gf_apply_rules(1,[0,21,22,23]);'  \/><label for='choice_1_20_1' id='label_1_20_1'>No<\/label><\/li><\/ul><\/div><\/li><li id='field_1_21' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_1_21_1' >Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gfield_trigger_change' id='input_1_21' >\n                         <span class='ginput_full address_line_1' id='input_1_21_1_container' >\n                                        <input type='text' name='input_21.1' id='input_1_21_1' value='' tabindex='27'  \/>\n                                        <label for='input_1_21_1' id='input_1_21_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_1_21_2_container' >\n                                        <input type='text' name='input_21.2' id='input_1_21_2' value='' tabindex='28'  \/>\n                                        <label for='input_1_21_2' id='input_1_21_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_1_21_3_container' >\n                                    <input type='text' name='input_21.3' id='input_1_21_3' value='' tabindex='29'  \/>\n                                    <label for='input_1_21_3' id='input_1_21_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_1_21_4_container' >\n                                        <input type='text' name='input_21.4' id='input_1_21_4' value='' tabindex='31'    \/>\n                                        <label for='input_1_21_4' id='input_1_21_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_1_21_5_container' >\n                                    <input type='text' name='input_21.5' id='input_1_21_5' value='' tabindex='32'  \/>\n                                    <label for='input_1_21_5' id='input_1_21_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country' id='input_1_21_6_container' >\n                                        <select name='input_21.6' id='input_1_21_6' tabindex='33' ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select>\n                                        <label for='input_1_21_6' id='input_1_21_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_1_22' class='gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_22' >Time At This Address<\/label><div class='ginput_container ginput_container_number'><input name='input_22' id='input_1_22' type='number' step='any'   value='' class='medium' tabindex='34' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='(YYMM) (Eg. 4 Year &amp; 2 Months = 0402)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_23' class='gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_23' >Residential Status<\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_1_23' onchange='gf_apply_rules(1,[0]);' class='medium gfield_select' tabindex='35'   aria-invalid=\"false\"><option value='Own' >Own<\/option><option value='Rent' >Rent<\/option><option value='Live With Parents' >Live With Parents<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id='field_1_24' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><h5 style=\"padding-top:35px; text-decoration:underline;\"><strong>PRESENT EMPLOYER<\/strong><\/h5><\/li><li id='field_1_25' class='gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_25' >Occupation Type<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_1_25' onchange='gf_apply_rules(1,[0]);' class='medium gfield_select' tabindex='36'  aria-required=\"true\" aria-invalid=\"false\"><option value='' selected='selected' class='gf_placeholder'>Choose<\/option><option value='Management' >Management<\/option><option value='Clerical' >Clerical<\/option><option value='Labour\/Tradeperson' >Labour\/Tradeperson<\/option><option value='Retired' >Retired<\/option><option value='Professional' >Professional<\/option><option value='Self-Employed' >Self-Employed<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id='field_1_26' class='gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_26' >Name of Employer<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_1_26' type='text' value='' class='medium'  tabindex='37' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'  aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_27' class='gfield gf_right_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_27' >Job Title<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_1_27' type='text' value='' class='medium'  tabindex='38' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'  aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_28' class='gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_28' >Work Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_28' id='input_1_28' type='tel' value='' class='medium' tabindex='39' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_29' class='gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_29' >Length of Employment<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_1_29' type='text' value='' class='medium'  tabindex='40' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='(YYMM) (Eg. 4 Year &amp; 2 Months = 0402)' aria-required=\"true\" aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_30' class='gfield gf_right_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_30' >Annual Number<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_30' id='input_1_30' type='number' step='any'   value='' class='medium' tabindex='41' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'    aria-required=\"true\" aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_31' class='gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_31' >Type of Income<span class='gfield_required'>*<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_1_31' onchange='gf_apply_rules(1,[0]);' class='medium gfield_select' tabindex='42'  aria-required=\"true\" aria-invalid=\"false\"><option value='' selected='selected' class='gf_placeholder'>Choose<\/option><option value='Salary' >Salary<\/option><option value='Hourly' >Hourly<\/option><option value='Hourly + Commissions' >Hourly + Commissions<\/option><option value='Commissions' >Commissions<\/option><option value='Pension' >Pension<\/option><option value='Alimony' >Alimony<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id='field_1_32' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>FINANCIAL INFORMATION<\/h2><\/li><li id='field_1_34' class='gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_34' >Cash Savings<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_1_34' type='text' value='' class='medium'  tabindex='43' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_35' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_35' ><\/label><div class='ginput_container ginput_container_number'><input name='input_35' id='input_1_35' type='number' step='any'   value='' class='medium' tabindex='44' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Amount\/Value (#)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_36' class='gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_36' >RRSP<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_1_36' type='text' value='' class='medium'  tabindex='45' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_37' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_37' ><\/label><div class='ginput_container ginput_container_number'><input name='input_37' id='input_1_37' type='number' step='any'   value='' class='medium' tabindex='46' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Amount\/Value (#)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_38' class='gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_38' >Stocks\/Bonds\/Mutual<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_1_38' type='text' value='' class='medium'  tabindex='47' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_39' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_39' ><\/label><div class='ginput_container ginput_container_number'><input name='input_39' id='input_1_39' type='number' step='any'   value='' class='medium' tabindex='48' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Amount\/Value (#)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_40' class='gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_40' >Automotive: Present Value<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_1_40' type='text' value='' class='medium'  tabindex='49' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_41' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_41' ><\/label><div class='ginput_container ginput_container_number'><input name='input_41' id='input_1_41' type='number' step='any'   value='' class='medium' tabindex='50' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Amount\/Value (#)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_44' class='gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_44' >Other<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_1_44' type='text' value='' class='medium'  tabindex='51' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_45' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_45' ><\/label><div class='ginput_container ginput_container_number'><input name='input_45' id='input_1_45' type='number' step='any'   value='' class='medium' tabindex='52' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Amount\/Value (#)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_47' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_47' >Value of Present Home (If Owned)<\/label><div class='ginput_container ginput_container_number'><input name='input_47' id='input_1_47' type='number' step='any'   value='' class='medium' tabindex='53' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Amount\/Value (#)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_48' class='gfield gf_right_half gfield_calculation field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_48' >Total<\/label><div class='ginput_container ginput_container_number'><input name='input_48' id='input_1_48' type='text' step='any'   value='' class='medium' tabindex='54' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' readonly=\"readonly\"  placeholder='Amount\/Value (#)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_49' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><h5 style=\"padding-top:35px; text-decoration:underline;\"><strong>LIABILITIES<\/strong><\/h5><\/li><li id='field_1_50' class='gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_50' >Debts\/Loans<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_1_50' type='text' value='' class='medium'  tabindex='55' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_51' class='gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_51' ><\/label><div class='ginput_container ginput_container_number'><input name='input_51' id='input_1_51' type='number' step='any'   value='' class='medium' tabindex='56' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Balance Owing ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_52' class='gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_52' ><\/label><div class='ginput_container ginput_container_number'><input name='input_52' id='input_1_52' type='number' step='any'   value='' class='medium' tabindex='57' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Monthly Payments ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_53' class='gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_53' >Credit Cards<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_1_53' type='text' value='' class='medium'  tabindex='58' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_54' class='gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_54' ><\/label><div class='ginput_container ginput_container_number'><input name='input_54' id='input_1_54' type='number' step='any'   value='' class='medium' tabindex='59' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Balance Owing ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_55' class='gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_55' ><\/label><div class='ginput_container ginput_container_number'><input name='input_55' id='input_1_55' type='number' step='any'   value='' class='medium' tabindex='60' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Monthly Payments ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_56' class='gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_56' >Amount Owing on Current Mortgage(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_1_56' type='text' value='' class='medium'  tabindex='61' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_57' class='gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_57' ><\/label><div class='ginput_container ginput_container_number'><input name='input_57' id='input_1_57' type='number' step='any'   value='' class='medium' tabindex='62' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Balance Owing ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_58' class='gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_58' ><\/label><div class='ginput_container ginput_container_number'><input name='input_58' id='input_1_58' type='number' step='any'   value='' class='medium' tabindex='63' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Monthly Payments ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_59' class='gfield gf_left_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_59' >Finance Company Loans and Other Debts<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='text' value='' class='medium'  tabindex='64' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' placeholder='Where\/Financial Institution(s)'  aria-invalid=\"false\" \/><\/div><\/li><li id='field_1_60' class='gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_60' ><\/label><div class='ginput_container ginput_container_number'><input name='input_60' id='input_1_60' type='number' step='any'   value='' class='medium' tabindex='65' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Balance Owing ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_61' class='gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_61' ><\/label><div class='ginput_container ginput_container_number'><input name='input_61' id='input_1_61' type='number' step='any'   value='' class='medium' tabindex='66' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   placeholder='Monthly Payments ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_62' class='gfield gf_left_third gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><span style=\"font-size:14px;\"><strong>Total<\/strong><\/span><\/li><li id='field_1_63' class='gfield gf_middle_third gfield_calculation field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_63' ><\/label><div class='ginput_container ginput_container_number'><input name='input_63' id='input_1_63' type='text' step='any'   value='' class='medium' tabindex='67' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' readonly=\"readonly\"  placeholder='Balance Owing ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_64' class='gfield gf_right_third gfield_calculation field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_64' ><\/label><div class='ginput_container ginput_container_number'><input name='input_64' id='input_1_64' type='text' step='any'   value='' class='medium' tabindex='68' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' readonly=\"readonly\"  placeholder='Monthly Payments ($)'  aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_65' class='gfield gfield_calculation field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_65' >NET WORTH (TOTAL ASSETS - TOTAL LIABILITIES)<\/label><div class='ginput_container ginput_container_number'><input name='input_65' id='input_1_65' type='text' step='any'   value='' class='large' tabindex='69' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);' readonly=\"readonly\"    aria-invalid=\"false\"\/><\/div><\/li><li id='field_1_66' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>CURRENT MORTGAGES \/ PROPERTIES OWNED<\/h2><\/li><li id='field_1_67' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label gfield_label_before_complex' for='input_1_67_1' >Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gfield_trigger_change' id='input_1_67' >\n                         <span class='ginput_full address_line_1' id='input_1_67_1_container' >\n                                        <input type='text' name='input_67.1' id='input_1_67_1' value='' tabindex='70'  \/>\n                                        <label for='input_1_67_1' id='input_1_67_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2' id='input_1_67_2_container' >\n                                        <input type='text' name='input_67.2' id='input_1_67_2' value='' tabindex='71'  \/>\n                                        <label for='input_1_67_2' id='input_1_67_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city' id='input_1_67_3_container' >\n                                    <input type='text' name='input_67.3' id='input_1_67_3' value='' tabindex='72'  \/>\n                                    <label for='input_1_67_3' id='input_1_67_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state' id='input_1_67_4_container' >\n                                        <input type='text' name='input_67.4' id='input_1_67_4' value='' tabindex='74'    \/>\n                                        <label for='input_1_67_4' id='input_1_67_4_label' >State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip' id='input_1_67_5_container' >\n                                    <input type='text' name='input_67.5' id='input_1_67_5' value='' tabindex='75'  \/>\n                                    <label for='input_1_67_5' id='input_1_67_5_label' >ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country' id='input_1_67_6_container' >\n                                        <select name='input_67.6' id='input_1_67_6' tabindex='76' ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='North Korea' >North Korea<\/option><option value='South Korea' >South Korea<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select>\n                                        <label for='input_1_67_6' id='input_1_67_6_label' >Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id='field_1_68' class='gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_68' >Existing Mortgage Bank\/Lender<\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_1_68' type='text' value='' class='medium'  tabindex='77' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   aria-invalid=\"false\" \/><\/div><div class='gfield_description'>*Required if have current mortgage<\/div><\/li><li id='field_1_69' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_69' >Mortgage Rate %<\/label><div class='ginput_container ginput_container_number'><input name='input_69' id='input_1_69' type='number' step='any'   value='' class='medium' tabindex='78' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'     aria-invalid=\"false\"\/><\/div><div class='gfield_description'>*Required if have current mortgage<\/div><\/li><li id='field_1_70' class='gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_70' >Monthly Payments<\/label><div class='ginput_container ginput_container_number'><input name='input_70' id='input_1_70' type='number' step='any'   value='' class='medium' tabindex='79' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'     aria-invalid=\"false\"\/><\/div><div class='gfield_description'>*Required if have current mortgage<\/div><\/li><li id='field_1_71' class='gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_71' >Mortgage Balance<\/label><div class='ginput_container ginput_container_number'><input name='input_71' id='input_1_71' type='number' step='any'   value='' class='medium' tabindex='80' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'     aria-invalid=\"false\"\/><\/div><div class='gfield_description'>*Required if have current mortgage<\/div><\/li><li id='field_1_72' class='gfield gsection field_sublabel_below field_description_below gfield_visibility_visible' ><h2 class='gsection_title'>OTHER INFORMATION<\/h2><\/li><li id='field_1_74' class='gfield field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_1_74' >ADDITIONAL NOTE FOR FINANCIAL INFORMATION: (MAX. 500 CHARACTERS)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_74' id='input_1_74' class='textarea medium' tabindex='81' onchange='gf_apply_rules(1,[0]);' onkeyup='clearTimeout(__gf_timeout_handle); __gf_timeout_handle = setTimeout(\"gf_apply_rules(1,[0])\", 300);'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id='field_1_75' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' >I\/we warrant and confirm that the information given in the mortgage application form is true and correct and I\/we understand that it is being used to determine my\/our credit responsibility. You are authorized to obtain any information you may require for these purposes from other sources (including, for example, credit bureau) and each such source is hereby authorized to provide you with such information. I\/we also understand that the information given in the mortgage application form as well as other information you obtain in relation to my credit history may be disclosed to potential mortgage lenders, financial intermediary and mortgage insurers, organizations providing technological or other support services required in relation to this application and any other parties with whom I\/we propose to have a financial relationship.<\/li><li id='field_1_76' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><br\/><strong>ONLINE APPLICATIONS<\/strong>\nPlease read the paragraph above prior to sending completed application. By transmitting the online mortgage application you are accepting the terms of the paragraph noted above.<\/li><li id='field_1_77' class='gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible' ><br\/><strong>CANADA'S ANTI-SPAM LEGISLATION<\/strong>\n<a href=\"http:\/\/fightspam.gc.ca\/eic\/site\/030.nsf\/eng\/home\" target=\"_blank\">CANADA'S ANTI-SPAM LEGISLATION<\/a> was effective as of July 1, 2014. 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