payment.financemomentum.com
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Submission: On July 07 via automatic, source certstream-suspicious — Scanned from DE
Submission: On July 07 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
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<form action="javascript:;" class="donate-other-items-form ui form" data-form="payment">
<div class="centered" data-widget="heading">
<h2 class="heading">Pay FINANCE MOMENTUM</h2>
<p class="text">Please fill out the form below to make a payment.</p>
</div>
<fieldset class="mb-3">
<legend>Personal Info</legend>
<div class="two fields">
<div class="field">
<label for="first_name">First name <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="first_name" class="ui input" id="first_name" placeholder="Enter first name" required="">
</div>
<div class="field">
<label for="other_names">Last name <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="last_name" class="ui input" id="other_names" placeholder="Enter last name" required="">
</div>
</div>
<div class="two fields">
<div class="field">
<label for="nationality">Nationality <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="nationality" id="nationality" list="listNationalities" placeholder="Search country..." required="">
<datalist id="listNationalities">
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</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="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua And Barbuda">Antigua And Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</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="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</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="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic">Congo, Democratic Republic</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'Ivoire">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</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="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="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</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 Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</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="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</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="Heard Island & Mcdonald Islands">Heard Island & Mcdonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</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, Islamic Republic Of">Iran, Islamic Republic Of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle Of Man">Isle Of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea">Korea</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</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="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States Of">Micronesia, Federated States Of</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</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="Netherlands Antilles">Netherlands Antilles</option>
<option value="New Caledonia">New Caledonia</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="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</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="Palestinian Territory, Occupied">Palestinian Territory, Occupied</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="Pitcairn">Pitcairn</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="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Kitts And Nevis">Saint Kitts And Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin">Saint Martin</option>
<option value="Saint Pierre And Miquelon">Saint Pierre And Miquelon</option>
<option value="Saint Vincent And Grenadines">Saint Vincent And 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="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="South Georgia And Sandwich Isl.">South Georgia And Sandwich Isl.</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard And Jan Mayen">Svalbard And Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</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="Turks And Caicos Islands">Turks And Caicos Islands</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="United States Outlying Islands">United States Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis And Futuna">Wallis And Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</datalist>
</div>
<div class="field">
<label for="org">Organization</label>
<input type="text" name="organization" class="ui input" id="org" placeholder="Enter name of your organization">
</div>
</div>
</fieldset>
<fieldset class="mb-3">
<legend>Contact Info</legend>
<div class="ui three fields">
<div class="field">
<label for="email">Email address <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="email" class="ui input" id="email" placeholder="Enter email address" required="">
</div>
<div class="field">
<label for="dialingCode">Dialing code <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="dialing_code" class="ui input" id="dialingCode" list="listCountryCodes" autocomplete="off" placeholder="Search by country..." required="">
<datalist id="listCountryCodes">
<option value="+93">+93(Afghanistan)</option>
<option value="+358">+358(Aland Islands)</option>
<option value="+355">+355(Albania)</option>
<option value="+213">+213(Algeria)</option>
<option value="+1684">+1684(American Samoa)</option>
<option value="+376">+376(Andorra)</option>
<option value="+244">+244(Angola)</option>
<option value="+1264">+1264(Anguilla)</option>
<option value="+672">+672(Antarctica)</option>
<option value="+1268">+1268(Antigua And Barbuda)</option>
<option value="+54">+54(Argentina)</option>
<option value="+374">+374(Armenia)</option>
<option value="+297">+297(Aruba)</option>
<option value="+61">+61(Australia)</option>
<option value="+43">+43(Austria)</option>
<option value="+994">+994(Azerbaijan)</option>
<option value="+1242">+1242(Bahamas)</option>
<option value="+973">+973(Bahrain)</option>
<option value="+880">+880(Bangladesh)</option>
<option value="+1246">+1246(Barbados)</option>
<option value="+375">+375(Belarus)</option>
<option value="+32">+32(Belgium)</option>
<option value="+501">+501(Belize)</option>
<option value="+229">+229(Benin)</option>
<option value="+1441">+1441(Bermuda)</option>
<option value="+975">+975(Bhutan)</option>
<option value="+591">+591(Bolivia)</option>
<option value="+387">+387(Bosnia And Herzegovina)</option>
<option value="+267">+267(Botswana)</option>
<option value="+47">+47(Bouvet Island)</option>
<option value="+55">+55(Brazil)</option>
<option value="+246">+246(British Indian Ocean Territory)</option>
<option value="+673">+673(Brunei Darussalam)</option>
<option value="+359">+359(Bulgaria)</option>
<option value="+226">+226(Burkina Faso)</option>
<option value="+257">+257(Burundi)</option>
<option value="+855">+855(Cambodia)</option>
<option value="+237">+237(Cameroon)</option>
<option value="+1">+1(Canada)</option>
<option value="+238">+238(Cape Verde)</option>
<option value="+1345">+1345(Cayman Islands)</option>
<option value="+236">+236(Central African Republic)</option>
<option value="+235">+235(Chad)</option>
<option value="+56">+56(Chile)</option>
<option value="+86">+86(China)</option>
<option value="+61">+61(Christmas Island)</option>
<option value="+61">+61(Cocos (Keeling) Islands)</option>
<option value="+57">+57(Colombia)</option>
<option value="+269">+269(Comoros)</option>
<option value="+242">+242(Congo)</option>
<option value="+243">+243(Congo, Democratic Republic)</option>
<option value="+682">+682(Cook Islands)</option>
<option value="+506">+506(Costa Rica)</option>
<option value="+225">+225(Cote D'Ivoire)</option>
<option value="+385">+385(Croatia)</option>
<option value="+53">+53(Cuba)</option>
<option value="+357">+357(Cyprus)</option>
<option value="+420">+420(Czech Republic)</option>
<option value="+45">+45(Denmark)</option>
<option value="+253">+253(Djibouti)</option>
<option value="+1767">+1767(Dominica)</option>
<option value="+1849">+1849(Dominican Republic)</option>
<option value="+593">+593(Ecuador)</option>
<option value="+20">+20(Egypt)</option>
<option value="+503">+503(El Salvador)</option>
<option value="+240">+240(Equatorial Guinea)</option>
<option value="+291">+291(Eritrea)</option>
<option value="+372">+372(Estonia)</option>
<option value="+251">+251(Ethiopia)</option>
<option value="+500">+500(Falkland Islands (Malvinas))</option>
<option value="+298">+298(Faroe Islands)</option>
<option value="+679">+679(Fiji)</option>
<option value="+358">+358(Finland)</option>
<option value="+33">+33(France)</option>
<option value="+594">+594(French Guiana)</option>
<option value="+689">+689(French Polynesia)</option>
<option value="+262">+262(French Southern Territories)</option>
<option value="+241">+241(Gabon)</option>
<option value="+220">+220(Gambia)</option>
<option value="+995">+995(Georgia)</option>
<option value="+49">+49(Germany)</option>
<option value="+233">+233(Ghana)</option>
<option value="+350">+350(Gibraltar)</option>
<option value="+30">+30(Greece)</option>
<option value="+299">+299(Greenland)</option>
<option value="+1473">+1473(Grenada)</option>
<option value="+590">+590(Guadeloupe)</option>
<option value="+1671">+1671(Guam)</option>
<option value="+502">+502(Guatemala)</option>
<option value="+44">+44(Guernsey)</option>
<option value="+224">+224(Guinea)</option>
<option value="+245">+245(Guinea-Bissau)</option>
<option value="+592">+592(Guyana)</option>
<option value="+509">+509(Haiti)</option>
<option value="011">011(Heard Island & Mcdonald Islands)</option>
<option value="+379">+379(Holy See (Vatican City State))</option>
<option value="+504">+504(Honduras)</option>
<option value="+852">+852(Hong Kong)</option>
<option value="+36">+36(Hungary)</option>
<option value="+354">+354(Iceland)</option>
<option value="+91">+91(India)</option>
<option value="+62">+62(Indonesia)</option>
<option value="+98">+98(Iran, Islamic Republic Of)</option>
<option value="+964">+964(Iraq)</option>
<option value="+353">+353(Ireland)</option>
<option value="+44">+44(Isle Of Man)</option>
<option value="+972">+972(Israel)</option>
<option value="+39">+39(Italy)</option>
<option value="+1876">+1876(Jamaica)</option>
<option value="+81">+81(Japan)</option>
<option value="+44">+44(Jersey)</option>
<option value="+962">+962(Jordan)</option>
<option value="+77">+77(Kazakhstan)</option>
<option value="+254">+254(Kenya)</option>
<option value="+686">+686(Kiribati)</option>
<option value="+82">+82(Korea)</option>
<option value="+965">+965(Kuwait)</option>
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<option value="+856">+856(Lao People's Democratic Republic)</option>
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<option value="+230">+230(Mauritius)</option>
<option value="+262">+262(Mayotte)</option>
<option value="+52">+52(Mexico)</option>
<option value="+691">+691(Micronesia, Federated States Of)</option>
<option value="+373">+373(Moldova)</option>
<option value="+377">+377(Monaco)</option>
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<option value="+382">+382(Montenegro)</option>
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<option value="+212">+212(Morocco)</option>
<option value="+258">+258(Mozambique)</option>
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<option value="+264">+264(Namibia)</option>
<option value="+674">+674(Nauru)</option>
<option value="+977">+977(Nepal)</option>
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<option value="+599">+599(Netherlands Antilles)</option>
<option value="+687">+687(New Caledonia)</option>
<option value="+64">+64(New Zealand)</option>
<option value="+505">+505(Nicaragua)</option>
<option value="+227">+227(Niger)</option>
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<option value="+683">+683(Niue)</option>
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<option value="+1670">+1670(Northern Mariana Islands)</option>
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<option value="+92">+92(Pakistan)</option>
<option value="+680">+680(Palau)</option>
<option value="+970">+970(Palestinian Territory, Occupied)</option>
<option value="+507">+507(Panama)</option>
<option value="+675">+675(Papua New Guinea)</option>
<option value="+595">+595(Paraguay)</option>
<option value="+51">+51(Peru)</option>
<option value="+63">+63(Philippines)</option>
<option value="+872">+872(Pitcairn)</option>
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<option value="+351">+351(Portugal)</option>
<option value="+1939">+1939(Puerto Rico)</option>
<option value="+974">+974(Qatar)</option>
<option value="+262">+262(Reunion)</option>
<option value="+40">+40(Romania)</option>
<option value="+7">+7(Russian Federation)</option>
<option value="+250">+250(Rwanda)</option>
<option value="+590">+590(Saint Barthelemy)</option>
<option value="+290">+290(Saint Helena)</option>
<option value="+1869">+1869(Saint Kitts And Nevis)</option>
<option value="+1758">+1758(Saint Lucia)</option>
<option value="+590">+590(Saint Martin)</option>
<option value="+508">+508(Saint Pierre And Miquelon)</option>
<option value="+1784">+1784(Saint Vincent And Grenadines)</option>
<option value="+685">+685(Samoa)</option>
<option value="+378">+378(San Marino)</option>
<option value="+239">+239(Sao Tome And Principe)</option>
<option value="+966">+966(Saudi Arabia)</option>
<option value="+221">+221(Senegal)</option>
<option value="+381">+381(Serbia)</option>
<option value="+248">+248(Seychelles)</option>
<option value="+232">+232(Sierra Leone)</option>
<option value="+65">+65(Singapore)</option>
<option value="+421">+421(Slovakia)</option>
<option value="+386">+386(Slovenia)</option>
<option value="+677">+677(Solomon Islands)</option>
<option value="+252">+252(Somalia)</option>
<option value="+27">+27(South Africa)</option>
<option value="+500">+500(South Georgia And Sandwich Isl.)</option>
<option value="+34">+34(Spain)</option>
<option value="+94">+94(Sri Lanka)</option>
<option value="+249">+249(Sudan)</option>
<option value="+597">+597(Suriname)</option>
<option value="+47">+47(Svalbard And Jan Mayen)</option>
<option value="+268">+268(Swaziland)</option>
<option value="+46">+46(Sweden)</option>
<option value="+41">+41(Switzerland)</option>
<option value="+963">+963(Syrian Arab Republic)</option>
<option value="+886">+886(Taiwan)</option>
<option value="+992">+992(Tajikistan)</option>
<option value="+255">+255(Tanzania)</option>
<option value="+66">+66(Thailand)</option>
<option value="+670">+670(Timor-Leste)</option>
<option value="+228">+228(Togo)</option>
<option value="+690">+690(Tokelau)</option>
<option value="+676">+676(Tonga)</option>
<option value="+1868">+1868(Trinidad And Tobago)</option>
<option value="+216">+216(Tunisia)</option>
<option value="+90">+90(Turkey)</option>
<option value="+993">+993(Turkmenistan)</option>
<option value="+1649">+1649(Turks And Caicos Islands)</option>
<option value="+688">+688(Tuvalu)</option>
<option value="+256">+256(Uganda)</option>
<option value="+380">+380(Ukraine)</option>
<option value="+971">+971(United Arab Emirates)</option>
<option value="+44">+44(United Kingdom)</option>
<option value="+1">+1(United States)</option>
<option value="+246">+246(United States Outlying Islands)</option>
<option value="+598">+598(Uruguay)</option>
<option value="+998">+998(Uzbekistan)</option>
<option value="+678">+678(Vanuatu)</option>
<option value="+58">+58(Venezuela)</option>
<option value="+84">+84(Viet Nam)</option>
<option value="+1284">+1284(Virgin Islands, British)</option>
<option value="+1340">+1340(Virgin Islands, U.S.)</option>
<option value="+681">+681(Wallis And Futuna)</option>
<option value="+212">+212(Western Sahara)</option>
<option value="+967">+967(Yemen)</option>
<option value="+260">+260(Zambia)</option>
<option value="+263">+263(Zimbabwe)</option>
</datalist>
</div>
<div class="field">
<label for="phone">Phone number <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="phone" class="ui input" id="phone" placeholder="Enter Phone Number" required="">
</div>
</div>
</fieldset>
<fieldset class="mb-3">
<legend>Residence</legend>
<div class="three fields">
<div class="field">
<label>Street Address <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="address" class="ui input" placeholder="Enter Address" required="">
</div>
<div class="field">
<label>City <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="city" class="ui input" placeholder="Enter City" required="">
</div>
<div class="field">
<label for="country">Country of Residence <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="text" name="country" id="country" list="listCountries" placeholder="Search country..." required="">
<datalist id="listCountries">
<option value="Afghanistan">Afghanistan</option>
<option value="Aland Islands">Aland Islands</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="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua And Barbuda">Antigua And Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</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="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</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="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic">Congo, Democratic Republic</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote D'Ivoire">Cote D'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</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="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="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</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 Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</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="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</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="Heard Island & Mcdonald Islands">Heard Island & Mcdonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</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, Islamic Republic Of">Iran, Islamic Republic Of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle Of Man">Isle Of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea">Korea</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</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="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States Of">Micronesia, Federated States Of</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</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="Netherlands Antilles">Netherlands Antilles</option>
<option value="New Caledonia">New Caledonia</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="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</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="Palestinian Territory, Occupied">Palestinian Territory, Occupied</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="Pitcairn">Pitcairn</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="Reunion">Reunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Kitts And Nevis">Saint Kitts And Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin">Saint Martin</option>
<option value="Saint Pierre And Miquelon">Saint Pierre And Miquelon</option>
<option value="Saint Vincent And Grenadines">Saint Vincent And 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="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="South Georgia And Sandwich Isl.">South Georgia And Sandwich Isl.</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard And Jan Mayen">Svalbard And Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</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="Turks And Caicos Islands">Turks And Caicos Islands</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="United States Outlying Islands">United States Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis And Futuna">Wallis And Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</datalist>
</div>
</div>
</fieldset>
<fieldset class="mb-3">
<legend>Amount</legend>
<div class="two fields">
<div class="field">
<label>Currency <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<select name="currency" class="ui input" required="">
<option value="USD" selected="">USD</option>
<option value="EUR">EUR</option>
<option value="GBP">GBP</option>
<option value="CAD">CAD</option>
<option value="AUD">AUD</option>
<option value="KES">KES</option>
</select>
</div>
<div class="field">
<label>Amount <span class="required-asterisk"><sup style="color:tomato;">*</sup></span></label>
<input type="number" min="1" max="10000000.00" step=".01" name="amount" class="ui input" required="" placeholder="Amount">
</div>
</div>
</fieldset>
<div class="submit-wrapper">
<button type="submit" class="ui positive button mt-3 mb-5"> Pay Now </button>
</div>
<div class="payment-logos">
<img src="/views/11917590ff52b2fe9bc0.png" alt="">
</div>
</form>Text Content
PAY FINANCE MOMENTUM Please fill out the form below to make a payment. Personal Info First name * Last name * Nationality * AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, Democratic RepublicCook IslandsCosta RicaCote D'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island & Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic OfIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKoreaKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts And NevisSaint LuciaSaint MartinSaint Pierre And MiquelonSaint Vincent And GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And Sandwich Isl.SpainSri LankaSudanSurinameSvalbard And Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis And FutunaWestern SaharaYemenZambiaZimbabwe Organization Contact Info Email address * Dialing code * +93(Afghanistan)+358(Aland Islands)+355(Albania)+213(Algeria)+1684(American Samoa)+376(Andorra)+244(Angola)+1264(Anguilla)+672(Antarctica)+1268(Antigua And Barbuda)+54(Argentina)+374(Armenia)+297(Aruba)+61(Australia)+43(Austria)+994(Azerbaijan)+1242(Bahamas)+973(Bahrain)+880(Bangladesh)+1246(Barbados)+375(Belarus)+32(Belgium)+501(Belize)+229(Benin)+1441(Bermuda)+975(Bhutan)+591(Bolivia)+387(Bosnia And Herzegovina)+267(Botswana)+47(Bouvet Island)+55(Brazil)+246(British Indian Ocean Territory)+673(Brunei Darussalam)+359(Bulgaria)+226(Burkina Faso)+257(Burundi)+855(Cambodia)+237(Cameroon)+1(Canada)+238(Cape Verde)+1345(Cayman Islands)+236(Central African Republic)+235(Chad)+56(Chile)+86(China)+61(Christmas Island)+61(Cocos (Keeling) Islands)+57(Colombia)+269(Comoros)+242(Congo)+243(Congo, Democratic Republic)+682(Cook Islands)+506(Costa Rica)+225(Cote D'Ivoire)+385(Croatia)+53(Cuba)+357(Cyprus)+420(Czech Republic)+45(Denmark)+253(Djibouti)+1767(Dominica)+1849(Dominican Republic)+593(Ecuador)+20(Egypt)+503(El Salvador)+240(Equatorial Guinea)+291(Eritrea)+372(Estonia)+251(Ethiopia)+500(Falkland Islands (Malvinas))+298(Faroe Islands)+679(Fiji)+358(Finland)+33(France)+594(French Guiana)+689(French Polynesia)+262(French Southern Territories)+241(Gabon)+220(Gambia)+995(Georgia)+49(Germany)+233(Ghana)+350(Gibraltar)+30(Greece)+299(Greenland)+1473(Grenada)+590(Guadeloupe)+1671(Guam)+502(Guatemala)+44(Guernsey)+224(Guinea)+245(Guinea-Bissau)+592(Guyana)+509(Haiti)011(Heard Island & Mcdonald Islands)+379(Holy See (Vatican City State))+504(Honduras)+852(Hong Kong)+36(Hungary)+354(Iceland)+91(India)+62(Indonesia)+98(Iran, Islamic Republic Of)+964(Iraq)+353(Ireland)+44(Isle Of Man)+972(Israel)+39(Italy)+1876(Jamaica)+81(Japan)+44(Jersey)+962(Jordan)+77(Kazakhstan)+254(Kenya)+686(Kiribati)+82(Korea)+965(Kuwait)+996(Kyrgyzstan)+856(Lao People's Democratic Republic)+371(Latvia)+961(Lebanon)+266(Lesotho)+231(Liberia)+218(Libyan Arab Jamahiriya)+423(Liechtenstein)+370(Lithuania)+352(Luxembourg)+853(Macao)+389(Macedonia)+261(Madagascar)+265(Malawi)+60(Malaysia)+960(Maldives)+223(Mali)+356(Malta)+692(Marshall Islands)+596(Martinique)+222(Mauritania)+230(Mauritius)+262(Mayotte)+52(Mexico)+691(Micronesia, Federated States Of)+373(Moldova)+377(Monaco)+976(Mongolia)+382(Montenegro)+1664(Montserrat)+212(Morocco)+258(Mozambique)+95(Myanmar)+264(Namibia)+674(Nauru)+977(Nepal)+31(Netherlands)+599(Netherlands Antilles)+687(New Caledonia)+64(New Zealand)+505(Nicaragua)+227(Niger)+234(Nigeria)+683(Niue)+672(Norfolk Island)+1670(Northern Mariana Islands)+47(Norway)+968(Oman)+92(Pakistan)+680(Palau)+970(Palestinian Territory, Occupied)+507(Panama)+675(Papua New Guinea)+595(Paraguay)+51(Peru)+63(Philippines)+872(Pitcairn)+48(Poland)+351(Portugal)+1939(Puerto Rico)+974(Qatar)+262(Reunion)+40(Romania)+7(Russian Federation)+250(Rwanda)+590(Saint Barthelemy)+290(Saint Helena)+1869(Saint Kitts And Nevis)+1758(Saint Lucia)+590(Saint Martin)+508(Saint Pierre And Miquelon)+1784(Saint Vincent And Grenadines)+685(Samoa)+378(San Marino)+239(Sao Tome And Principe)+966(Saudi 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