apply.primeramfbank.com Open in urlscan Pro
162.240.216.164  Public Scan

URL: https://apply.primeramfbank.com/
Submission: On August 22 via automatic, source certstream-suspicious — Scanned from US

Form analysis 1 forms found in the DOM

Name: create_register_formPOST https://apply.primeramfbank.com/registers

<form method="POST" action="https://apply.primeramfbank.com/registers" accept-charset="UTF-8" id="create_register_form" name="create_register_form" class="needs-validation" novalidate="">
  <input type="hidden" name="_token" value="ATpomn2o9ivtdgMakLDLA6CcVksdjLRw8x24hvzC">
  <div class="row">
    <div class="form-group col-lg-6 ">
      <div class="input-label">
        <label for="first_name">First Name <span class="required_red">*</span></label>
      </div>
      <input class="form-control" name="first_name" type="text" id="first_name" value="" required="true" placeholder="Enter first name here...">
    </div>
    <input name="referralemail" type="hidden" id="referralemail" value="">
    <div class="form-group col-lg-6 ">
      <div class="input-label">
        <label for="last_name">Last Name <span class="required_red">*</span></label>
      </div>
      <input class="form-control" name="last_name" type="text" id="last_name" value="" required="true" placeholder="Enter last name here...">
    </div>
    <div class="form-group col-lg-6 ">
      <div class="input-label">
        <label for="phone_number">Phone Number <span class="required_red">*</span></label>
      </div>
      <input class="form-control" name="phone_number" type="number" id="phone_number" value="" required="true" placeholder="Enter phone number here...">
    </div>
    <div class="form-group col-lg-6 ">
      <div class="input-label">
        <label for="email">Email <span class="required_red">*</span></label>
      </div>
      <input class="form-control" name="email" type="email" id="email" value="" required="true" placeholder="Enter email here...">
    </div>
    <div class="form-group col-lg-6 ">
      <div class="input-label">
        <label for="dob">Date of Birth <span class="required_red">*</span></label>
      </div>
      <input name="dob" class="flatpickr-dob form-control flatpickr-input" type="text" placeholder="Select Date of Birth.." readonly="readonly" id="dob" value="">
    </div>
    <div class="form-group col-lg-6 ">
      <div class="input-label">
        <label for="sector_id">Employer Sector (Who do you work with?) <span class="required_red">*</span></label>
      </div>
      <select class="form-control select2 select2-hidden-accessible" id="sector_id" name="sector_id" required="true" data-select2-id="sector_id" tabindex="-1" aria-hidden="true">
        <option value="" style="display: none;" selected="" disabled="" data-select2-id="2">Select sector</option>
        <option value="1"> Public Sector ( Federal Worker ) </option>
        <option value="2"> Public Sector ( State Worker ) </option>
        <option value="3"> Private Sector (Salary Earner) </option>
        <option value="4"> Education Finance </option>
      </select><span class="select2 select2-container select2-container--classic" dir="ltr" data-select2-id="1" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
            aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-labelledby="select2-sector_id-container"><span class="select2-selection__rendered" id="select2-sector_id-container" role="textbox" aria-readonly="true"
              title="Select sector">Select sector</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
    </div>
    <div class="form-group col-lg-6 ">
      <div class="input-label">
        <label for="loan_amount">Loan Amount <span class="required_red">*</span></label>
      </div>
      <input class="form-control" name="loan_amount" type="number" id="loan_amount" value="" required="true" min="50000" placeholder="Enter loan amount here...">
    </div>
    <div class="form-group col-lg-6 ">
      <div class="input-label">
        <label for="tenor">Loan Tenor <span class="required_red">*</span></label>
      </div>
      <select class="form-control select2 select2-hidden-accessible" id="tenor" name="tenor" required="true" data-select2-id="tenor" tabindex="-1" aria-hidden="true">
        <option value="" style="display: none;" selected="" disabled="" data-select2-id="4">Select Tenor</option>
        <option value="3">3 Months</option>
        <option value="4">4 Months</option>
        <option value="5">5 Months</option>
        <option value="6">6 Months</option>
        <option value="7">7 Months</option>
        <option value="8">8 Months</option>
        <option value="9">9 Months</option>
        <option value="10">10 Months</option>
        <option value="11">11 Months</option>
        <option value="12">12 Months</option>
        <option value="13">13 Months</option>
        <option value="14">14 Months</option>
        <option value="15">15 Months</option>
        <option value="16">16 Months</option>
        <option value="17">17 Months</option>
        <option value="18">18 Months</option>
        <option value="19">19 Months</option>
        <option value="20">20 Months</option>
        <option value="21">21 Months</option>
        <option value="22">22 Months</option>
        <option value="23">23 Months</option>
        <option value="24">24 Months</option>
      </select><span class="select2 select2-container select2-container--classic" dir="ltr" data-select2-id="3" style="width: 100%;"><span class="selection"><span class="select2-selection select2-selection--single" role="combobox"
            aria-haspopup="true" aria-expanded="false" tabindex="0" aria-disabled="false" aria-labelledby="select2-tenor-container"><span class="select2-selection__rendered" id="select2-tenor-container" role="textbox" aria-readonly="true"
              title="Select Tenor">Select Tenor</span><span class="select2-selection__arrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
    </div>
    <div class="form-group col-lg-12">
      <div class="form-check" style="font-size: 12px"> By clicking Apply, you agree to our <a href="https://primeramfbank.com/privacy-policy">Terms and Conditions </a> and <a href="https://primeramfbank.com/privacy-policy"> Privacy Policy </a>.
      </div>
    </div>
    <div class="form-group col-lg-12">
      <button type="submit" class="submit-btn">APPLY NOW</button>
    </div>
  </div>
</form>

Text Content

ONLINE LOAN APPLICATION


First Name *
Last Name *
Phone Number *
Email *
Date of Birth *
Employer Sector (Who do you work with?) *
Select sector Public Sector ( Federal Worker ) Public Sector ( State Worker )
Private Sector (Salary Earner) Education Finance Select sector
Loan Amount *
Loan Tenor *
Select Tenor 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 10
Months 11 Months 12 Months 13 Months 14 Months 15 Months 16 Months 17 Months 18
Months 19 Months 20 Months 21 Months 22 Months 23 Months 24 Months Select Tenor
By clicking Apply, you agree to our Terms and Conditions and Privacy Policy .
APPLY NOW
© 2020 Primera Microfinance Bank
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