[de_fb_form title=”Registro de proveedor” form_id=”registro_proveedor” form_type=”register” register_wrong_password_text=”Las contraseñas no coinciden” default_user_role=”proveedor_wp” auto_login=”on” submit_button_text=”Registrarme” redirect_after_success=”on” redirect_url_after_submission=”/mi-cuenta/dashboard/” use_custom_email=”off” custom_contact_email=”AMSI@AMSIPR.COM” email_title=”AMSI WEB || Nuevo proveedor registrado” email_template_html=”on” email_template=”

Registro de nuevo proveedor

Un nuevo proveedor se ha registrado en su sitio web.

Datos del usuario:

Nombre: %%form_provider_name%%

Teléfono proveedor: %%form_provider_phone1%%

Email proveedor: %%form_provider_email%%

Persona de contacto: %%form_provider_contact_person%%

Persona de contacto email: %%form_provider_contact_person_email%%

AMSI INC.
® Todos los derechos reservados

” select2=”on” multistep_enabled=”on” multistep_step_circle_radius=”50px” multistep_show_progress_bar_step_title=”on” multistep_enter_go_next=”on” admin_label=”Form – proveedor – ESP” _builder_version=”4.22.1″ _module_preset=”default” form_field_background_color=”#FFFFFF” form_field_focus_background_color=”gcid-5bec4aa9-d7ee-467f-b76e-172ef9b7bd3c” form_field_focus_text_color=”gcid-d48d641a-7f8d-4a2f-a421-98ed1b673d8a” form_field_custom_margin=”||||false|false” form_field_custom_padding=”||||false|false” form_title_font=”|800||on|||||” form_title_text_color=”gcid-42f9da1b-3760-4de5-a125-a511238c9571″ label_text_font=”|700|||||||” placeholder_text_text_color=”RGBA(255,255,255,0)” field_description_font=”|300|on||||||” field_description_text_color=”gcid-d48d641a-7f8d-4a2f-a421-98ed1b673d8a” progress_bar_step_title_font=”|700|||||||” progress_bar_step_title_text_align=”center” progress_bar_step_title_font_size=”0.7rem” progress_bar_step_number_font=”|800|||||||” 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theme_builder_area=”post_content”][de_fb_form_field field_title=”Información del proveedor” admin_title=”Paso 1 – Información del proveedor” field_id=”from_amsi_provider_next1″ field_type=”step” step_prev_text=”Anterior” step_next_text=”Siguiente” step_icon=”||fa||900″ _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Seguro social Patronal” admin_title=”ProviderSSN” field_id=”form_provider_ssn” required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_meta” user_field_name=”provider_SSN” field_label_position=”top” field_placeholder=” ” description_text=”on” description_text_location=”below” description_text_text=”Ingrese solo números.” enable_autocomplete=”off” _builder_version=”4.19.5″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Correo electrónico” admin_title=”Correo electrónico” field_id=”form_provider_email” field_type=”email” email_message=”Ingrese una dirección de correo válida.” required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_default” user_default_field=”user_login” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=” ” enable_autocomplete=”off” _builder_version=”4.20.2″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Confirmación correo electrónico” admin_title=”Confirmación correo electrónico” field_id=”form_provider_emailconf” field_type=”email” email_message=” Ingrese una dirección de correo válida. ” required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_default” user_default_field=”user_email” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=” ” enable_autocomplete=”off” _builder_version=”4.19.5″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Contraseña” admin_title=”Contraseña” field_id=”form_provider_password” field_type=”password” required_mark=”on” field_mapping_type=”user_default” user_default_field=”user_pass” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=” ” description_text=”on” description_text_location=”below” description_text_text=”La contraseña debe tener al menos 8 caracteres, incluyendo una letra mayúscula, una letra minúscula, un número y un símbolo.” enable_autocomplete=”off” _builder_version=”4.19.5″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Confirmar 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description_text_text=”Ingrese código o nombre prestación NAICS” _builder_version=”4.22.1″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” custom_padding=”||||false|false” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Teléfono 1″ admin_title=”Teléfono 1″ field_id=”form_provider_phone1″ required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_meta” user_field_name=”provider_telephone_1″ field_grid_column=”et_pb_column_1_3″ field_label_position=”top” field_placeholder=” ” description_text=”on” description_text_location=”below” description_text_text=”Ingrese solo números.” enable_autocomplete=”off” _builder_version=”4.19.5″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Teléfono 2″ admin_title=”Teléfono 2″ field_id=”form_provider_phone2″ field_mapping_type=”user_meta” user_field_name=”provider_telephone_2″ field_grid_column=”et_pb_column_1_3″ field_label_position=”top” field_placeholder=” ” description_text=”on” description_text_location=”below” description_text_text=”Ingrese solo números.” enable_autocomplete=”off” _builder_version=”4.19.5″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Teléfono 3″ admin_title=”Teléfono 3″ field_id=”form_provider_phone3″ field_mapping_type=”user_meta” user_field_name=”provider_telephone_3″ field_grid_column=”et_pb_column_1_3″ field_label_position=”top” field_placeholder=” ” description_text=”on” description_text_location=”below” description_text_text=”Ingrese solo números.” enable_autocomplete=”off” _builder_version=”4.19.5″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Persona de Contacto” admin_title=”Paso 2 – Persona de Contacto” field_id=”from_amsi_provider_next2″ field_type=”step” step_prev_text=”Anterior” step_next_text=”Siguiente” step_icon=”||fa||900″ _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Nombre persona de contacto” admin_title=”Nombre persona de contacto” field_id=”form_provider_contact_person” required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_meta” user_field_name=”provider_contact_person” field_label_position=”top” field_placeholder=” ” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Email persona de contacto” admin_title=”Email persona de contacto” field_id=”form_provider_contact_person_email” field_type=”email” email_message=”Ingrese una dirección de correo válida.” required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_meta” user_field_name=”provider_contact_person_email” field_label_position=”top” field_placeholder=” ” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Dirección física” admin_title=”Paso 3 – Dirección física” field_id=”from_amsi_provider_next3″ field_type=”step” step_prev_text=”Anterior” step_next_text=”Siguiente” step_icon=”||divi||400″ _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Dirección Física Línea 1″ admin_title=”Dirección Física Línea 1″ field_id=”form_provider_physical_address_1″ required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_meta” user_field_name=”physical_address_1″ field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.19.5″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Dirección Física Línea 2″ admin_title=”Dirección Física Línea 2″ field_id=”form_provider_physical_address_2″ field_mapping_type=”user_meta” user_field_name=”physical_address_2″ field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Zip Code” admin_title=”Zip Code” field_id=”form_provider_physical_address_zipcode” select_options=”%91{%22value%22:%22%22,%22checked%22:0,%22dragID%22:1}%93″ required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_meta” user_field_name=”physical_address_zipcode” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=” ” description_text=”on” description_text_location=”below” description_text_text=”Escriba el número de zipcode.” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Extensión” admin_title=”Extensión” field_id=”form_provider_physical_address_code_extension” max_length=”4″ allowed_symbols=”numbers” pattern_message=”Ingrese sólo números” field_mapping_type=”user_meta” user_field_name=”physical_address_code_extension” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.22.1″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Estado” admin_title=”State” field_id=”form_provider_physical_address_state” field_mapping_type=”user_meta” user_field_name=”physical_address_state” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” form_field_background_color=”gcid-5bec4aa9-d7ee-467f-b76e-172ef9b7bd3c” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Ciudad” admin_title=”City” field_id=”form_provider_physical_address_city” field_mapping_type=”user_meta” user_field_name=”physical_address_city” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” form_field_background_color=”gcid-5bec4aa9-d7ee-467f-b76e-172ef9b7bd3c” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Dirección postal” admin_title=”Paso 4 – Dirección postal” field_id=”from_amsi_provider_next4″ field_type=”step” step_prev_text=”Anterior” step_next_text=”Siguiente” step_icon=”||fa||900″ _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”¿Desea mantener su dirección física como dirección postal?” admin_title=”¿Desea mantener su dirección física como dirección postal?” field_id=”form_provider_match_fields” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22Si%22,%22checked%22:0,%22dragID%22:-1,%22link_url%22:%22%22,%22link_text%22:%22%22}%93″ field_label_position=”top” radio_checkbox_checked_color=”gcid-42f9da1b-3760-4de5-a125-a511238c9571″ 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field_id=”form_provider_postal_address_2″ field_mapping_type=”user_meta” user_field_name=”postal_address_2″ field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Zip Code” admin_title=”Zip Code” field_id=”form_provider_postal_address_zipcode” select_options=”%91{%22value%22:%22%22,%22checked%22:0,%22dragID%22:1}%93″ required_mark=”on” required_message=”Este campo es requerido.” field_mapping_type=”user_meta” user_field_name=”postal_address_zipcode” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” field_placeholder=” ” description_text=”on” description_text_location=”below” description_text_text=”Escriba el número de zipcode.” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Extensión” admin_title=”Extensión” field_id=”form_provider_postal_address_code_extension” max_length=”4″ allowed_symbols=”numbers” pattern_message=”Ingrese sólo números” field_mapping_type=”user_meta” user_field_name=”postal_address_code_extension” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.22.1″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Estado” admin_title=”State” field_id=”form_provider_postal_address_state” field_mapping_type=”user_meta” user_field_name=”postal_address_state” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” form_field_background_color=”gcid-5bec4aa9-d7ee-467f-b76e-172ef9b7bd3c” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field field_title=”Ciudad” admin_title=”City” field_id=”form_provider_postal_address_city” field_mapping_type=”user_meta” user_field_name=”postal_address_city” field_grid_column=”et_pb_column_1_2″ field_label_position=”top” enable_autocomplete=”off” _builder_version=”4.21.0″ _module_preset=”0d3387d6-faa1-4275-bf35-fa94ca13490e” form_field_background_color=”gcid-5bec4aa9-d7ee-467f-b76e-172ef9b7bd3c” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field admin_title=”hidden_provider_id” field_id=”form_provider_hidden_provider_id” field_type=”hidden” hidden_value=”custom” hidden_value_custom=”-1″ field_mapping_type=”user_meta” user_field_name=”provider_sync_id” _builder_version=”4.22.1″ _module_preset=”default” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field admin_title=”hidden_provider_localoffice_id” field_id=”form_provider_hidden_provider_localoffice_id” field_type=”hidden” hidden_value=”custom” hidden_value_custom=”-1″ field_mapping_type=”user_meta” user_field_name=”provider_localoffice_id” _builder_version=”4.20.2″ _module_preset=”default” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field admin_title=”hidden_smc_sync” field_id=”form_provider_hidden_smc_sync” field_type=”hidden” hidden_value=”acf” hidden_value_acf=”field_647bd2d8fb1b8″ field_mapping_type=”user_meta” user_field_name=”smc_sync” _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][de_fb_form_field admin_title=”hidden_unique_individual_identifier” field_id=”form_provider_unique_individual_identifier” field_mapping_type=”user_meta” user_field_name=”unique_individual_identifier” _builder_version=”4.21.0″ _module_preset=”default” custom_css_main_element=”display:none;” global_colors_info=”%91%93″ theme_builder_area=”post_content”][/de_fb_form_field][/de_fb_form]