valiley.com
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111.90.156.167
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URL:
http://valiley.com/secure/enroll-now-step3
Submission Tags: advance fee fraud malicious bank Search All
Submission: On May 30 via api from ZA — Scanned from DE
Submission Tags: advance fee fraud malicious bank Search All
Submission: On May 30 via api from ZA — Scanned from DE
Form analysis
1 forms found in the DOMPOST #
<form action="#" class="form-register" method="post" enctype="multipart/form-data" id="acclogin">
<div id="form-total">
<!-- SECTION 1 -->
<section style="width100%; align:center; padding:10px;">
<div class="inner">
<div class="errorMessage" align="center"> </div>
<div class="wizard-header">
<h3 class="heading">Account Information</h3>
<p>Please enter your information and proceed to the next step so we can build your accounts. </p>
</div>
<h3 style="font-weight:700; color:Purple;">Basic User information </h3>
<div class="form-row">
<div class="form-holder">
<span id="sprytf_firstname">
<fieldset>
<legend>First Name</legend>
<input type="text" class="form-control" id="firstname" name="firstname" autocomplete="off" placeholder="First Name" required="">
</fieldset>
</span>
</div>
<div class="form-holder">
<span id="sprytf_lastname">
<fieldset>
<legend>Last Name</legend>
<input type="text" class="form-control" id="lastname" name="lastname" autocomplete="off" placeholder="Last Name" required="">
</fieldset>
<br>
</span>
</div>
</div>
<div class="form-row">
<div class="form-holder">
<span id="sprytf_firstname">
<fieldset>
<legend>Other name</legend>
<input type="text" class="form-control" id="middlename" name="middlename" autocomplete="off" placeholder="Middle name" required="">
</fieldset>
</span>
</div>
<div class="form-holder">
<span id="sprytf_lastname">
<fieldset>
<legend>Nick Name or Maiden name</legend>
<input type="text" class="form-control" id="nickname" name="nickname" autocomplete="off" placeholder="Nick name" required="">
</fieldset>
<br>
</span>
</div>
</div>
<div class="form-row">
<div class="form-holder">
<span id="sprytf_email">
<fieldset>
<legend>Your Email</legend>
<input type="text" name="email" id="email" class="form-control" pattern="[^@]+@[^@]+.[a-zA-Z]{2,6}" autocomplete="off" placeholder="example@email.com" required="">
</fieldset>
<br>
</span>
</div>
<div class="form-holder">
<span id="sprytf_phone">
<fieldset>
<legend>Phone Number</legend>
<input type="text" class="form-control" id="phone" name="phone" autocomplete="off" placeholder="+18655356754" required="">
</fieldset>
<br>
</span>
</div>
</div>
<div class="form-row">
<div class="form-holder">
<span id="sprytf_dob">
<fieldset>
<legend>Date of Birth</legend>
<input type="date" class="form-control" id="dob" name="dob" autocomplete="off" placeholder="Date of Birth" required="">
</fieldset>
<br>
</span>
</div>
<div class="form-holder">
<span id="sprytf_zip">
<fieldset>
<legend>Zipcode</legend>
<input type="text" class="form-control" id="zipcode" name="zipcode" autocomplete="off" placeholder="Zip/Postal Code" required="">
</fieldset>
<br>
</span>
</div>
</div>
<div class="form-row">
<div class="form-holder">
<span id="spryselect_gender">
<legend>Title</legend>
<select required="" name="title" id="title">
<option value="">Please select your Title</option>
<option value="Male">Mr.</option>
<option value="Female">Mrs.</option>
<option value="Female">Mr&Mrs.</option>
<option value="Female">Ms.</option>
<option value="Female">Miss.</option>
</select>
<br>
<span class="selectRequiredMsg">Please select your Title.</span>
</span>
</div>
<div class="form-holder">
<span id="spryselect_gender">
<legend>Gender</legend>
<select required="" name="gender" id="gender">
<option value="">Please select your gender</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
<option>Others</option>
</select>
<br>
</span>
</div>
</div>
<div class="form-row-8">
<div class="form-holder">
<input type="text" class="form-control" id="address" name="address" autocomplete="off" placeholder="Residential Address" required="">
<br>
</div>
</div>
<div class="form-row">
<script type="text/javascript" src="reg-assets\js\countries.js"></script>
<div class="form-holder">
<span>
<legend>Country</legend>
<select required="" name="country" id="country">
<option value="-1">Select Country</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="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antartica">Antartica</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="Ashmore and Cartier Island">Ashmore and Cartier Island</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="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burma">Burma</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="Clipperton Island">Clipperton Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</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="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="Czeck Republic">Czeck 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="Europa Island">Europa Island</option>
<option value="Falkland Islands (Islas Malvinas)">Falkland Islands (Islas 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 and Antarctic Lands">French Southern and Antarctic Lands</option>
<option value="Gabon">Gabon</option>
<option value="Gambia, The">Gambia, The</option>
<option value="Gaza Strip">Gaza Strip</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Glorioso Islands">Glorioso Islands</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 and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City)">Holy See (Vatican City)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Howland Island">Howland Island</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="Ireland, Northern">Ireland, Northern</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Jan Mayen">Jan Mayen</option>
<option value="Japan">Japan</option>
<option value="Jarvis Island">Jarvis Island</option>
<option value="Jersey">Jersey</option>
<option value="Johnston Atoll">Johnston Atoll</option>
<option value="Jordan">Jordan</option>
<option value="Juan de Nova Island">Juan de Nova Island</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, North">Korea, North</option>
<option value="Korea, South">Korea, South</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="Macau">Macau</option>
<option value="Macedonia, Former Yugoslav Republic of">Macedonia, Former Yugoslav Republic of</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="Man, Isle of">Man, Isle of</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="Midway Islands">Midway Islands</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</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="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="Pitcaim Islands">Pitcaim Islands</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="Romainia">Romainia</option>
<option value="Russia">Russia</option>
<option value="Rwanda">Rwanda</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 Pierre and Miquelon">Saint Pierre and Miquelon</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="Scotland">Scotland</option>
<option value="Senegal">Senegal</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 South Sandwich Islands">South Georgia and South Sandwich Islands</option>
<option value="Spain">Spain</option>
<option value="Spratly Islands">Spratly Islands</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard">Svalbard</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="Tobago">Tobago</option>
<option value="Toga">Toga</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad">Trinidad</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="Uruguay">Uruguay</option>
<option value="USA">USA</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Virgin Islands">Virgin Islands</option>
<option value="Wales">Wales</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="West Bank">West Bank</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Yugoslavia">Yugoslavia</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
<br>
</span>
</div>
<div class="form-holder">
<span>
<legend>State</legend>
<select required="" name="state" id="state">
<option value="">Please select State</option>
</select>
<br>
</span>
<script language="javascript">
populateCountries("country", "state"); // first parameter is id of country drop-down and second parameter is id of state drop-down
populateCountries("country2");
populateCountries("country2");
</script>
</div>
</div>
<div class="form-row">
<div class="form-holder">
<span id="sprytf_city">
<fieldset>
<legend>City Name</legend>
<input type="text" class="form-control" id="city" name="city" autocomplete="off" placeholder="City" required="">
</fieldset>
<br>
</span>
</div>
<div class="form-holder">
<span id="spryta_address">
<fieldset>
<legend>State Security Number(SSN, NI, SIN etc.)</legend>
<input type="text" class="form-control" id="ssn" name="ssn" autocomplete="off" placeholder="State Security Number" required="">
</fieldset>
<br>
</span>
</div>
</div>
<div class="form-row">
<div class="form-holder">
<legend>Currency Type</legend>
<span id="spryselect_acctype">
<select required="" name="usercurrency" id="usercurrency">
<option selected="" value="">Select Account Currency</option>
<option value="USD">America (United States) Dollars – USD</option>
<option value="AFN">Afghanistan Afghanis – AFN</option>
<option value="ALL">Albania Leke – ALL</option>
<option value="DZD">Algeria Dinars – DZD</option>
<option value="ARS">Argentina Pesos – ARS</option>
<option value="AUD">Australia Dollars – AUD</option>
<option value="ATS">Austria Schillings – ATS</option>
<option value="BSD">Bahamas Dollars – BSD</option>
<option value="BHD">Bahrain Dinars – BHD</option>
<option value="BDT">Bangladesh Taka – BDT</option>
<option value="BBD">Barbados Dollars – BBD</option>
<option value="BEF">Belgium Francs – BEF</option>
<option value="BMD">Bermuda Dollars – BMD</option>
<option value="BRL">Brazil Reais – BRL</option>
<option value="BGN">Bulgaria Leva – BGN</option>
<option value="CAD">Canada Dollars – CAD</option>
<option value="XOF">CFA BCEAO Francs – XOF</option>
<option value="XAF">CFA BEAC Francs – XAF</option>
<option value="CLP">Chile Pesos – CLP</option>
<option value="CNY">China Yuan Renminbi – CNY</option>
<option value="CNY">RMB (China Yuan Renminbi) – CNY</option>
<option value="COP">Colombia Pesos – COP</option>
<option value="XPF">CFP Francs – XPF</option>
<option value="CRC">Costa Rica Colones – CRC</option>
<option value="HRK">Croatia Kuna – HRK</option>
<option value="CYP">Cyprus Pounds – CYP</option>
<option value="CZK">Czech Republic Koruny – CZK</option>
<option value="DKK">Denmark Kroner – DKK</option>
<option value="DEM">Deutsche (Germany) Marks – DEM</option>
<option value="DOP">Dominican Republic Pesos – DOP</option>
<option value="NLG">Dutch (Netherlands) Guilders – NLG</option>
<option value="XCD">Eastern Caribbean Dollars – XCD</option>
<option value="EGP">Egypt Pounds – EGP</option>
<option value="EEK">Estonia Krooni – EEK</option>
<option value="EUR">Euro – EUR</option>
<option value="FJD">Fiji Dollars – FJD</option>
<option value="FIM">Finland Markkaa – FIM</option>
<option value="FRF*">France Francs – FRF*</option>
<option value="DEM">Germany Deutsche Marks – DEM</option>
<option value="XAU">Gold Ounces – XAU</option>
<option value="GRD">Greece Drachmae – GRD</option>
<option value="GTQ">Guatemalan Quetzal – GTQ</option>
<option value="NLG">Holland (Netherlands) Guilders – NLG</option>
<option value="HKD">Hong Kong Dollars – HKD</option>
<option value="HUF">Hungary Forint – HUF</option>
<option value="ISK">Iceland Kronur – ISK</option>
<option value="XDR">IMF Special Drawing Right – XDR</option>
<option value="INR">India Rupees – INR</option>
<option value="IDR">Indonesia Rupiahs – IDR</option>
<option value="IRR">Iran Rials – IRR</option>
<option value="IQD">Iraq Dinars – IQD</option>
<option value="IEP*">Ireland Pounds – IEP*</option>
<option value="ILS">Israel New Shekels – ILS</option>
<option value="ITL*">Italy Lire – ITL*</option>
<option value="JMD">Jamaica Dollars – JMD</option>
<option value="JPY">Japan Yen – JPY</option>
<option value="JOD">Jordan Dinars – JOD</option>
<option value="KES">Kenya Shillings – KES</option>
<option value="KRW">Korea (South) Won – KRW</option>
<option value="KWD">Kuwait Dinars – KWD</option>
<option value="LBP">Lebanon Pounds – LBP</option>
<option value="LUF">Luxembourg Francs – LUF</option>
<option value="MYR">Malaysia Ringgits – MYR</option>
<option value="MTL">Malta Liri – MTL</option>
<option value="MUR">Mauritius Rupees – MUR</option>
<option value="MXN">Mexico Pesos – MXN</option>
<option value="MAD">Morocco Dirhams – MAD</option>
<option value="NLG">Netherlands Guilders – NLG</option>
<option value="NZD">New Zealand Dollars – NZD</option>
<option value="NGN">Nigeria Naira – NGN</option>
<option value="NOK">Norway Kroner – NOK</option>
<option value="OMR">Oman Rials – OMR</option>
<option value="PKR">Pakistan Rupees – PKR</option>
<option value="XPD">Palladium Ounces – XPD</option>
<option value="PEN">Peru Nuevos Soles – PEN</option>
<option value="PHP">Philippines Pesos – PHP</option>
<option value="XPT">Platinum Ounces – XPT</option>
<option value="PLN">Poland Zlotych – PLN</option>
<option value="PTE">Portugal Escudos – PTE</option>
<option value="QAR">Qatar Riyals – QAR</option>
<option value="RON">Romania New Lei – RON</option>
<option value="ROL">Romania Lei – ROL</option>
<option value="RUB">Russia Rubles – RUB</option>
<option value="SAR">Saudi Arabia Riyals – SAR</option>
<option value="XAG">Silver Ounces – XAG</option>
<option value="SGD">Singapore Dollars – SGD</option>
<option value="SKK">Slovakia Koruny – SKK</option>
<option value="SIT">Slovenia Tolars – SIT</option>
<option value="ZAR">South Africa Rand – ZAR</option>
<option value="KRW">South Korea Won – KRW</option>
<option value="ESP">Spain Pesetas – ESP</option>
<option value="SDD">Sudan Dinars – SDD</option>
<option value="SEK">Sweden Kronor – SEK</option>
<option value="CHF">Switzerland Francs – CHF</option>
<option value="TWD">Taiwan New Dollars – TWD</option>
<option value="THB">Thailand Baht – THB</option>
<option value="TTD">Trinidad and Tobago Dollars – TTD</option>
<option value="TND">Tunisia Dinars – TND</option>
<option value="TRY">Turkey New Lira – TRY</option>
<option value="AED">United Arab Emirates Dirhams – AED</option>
<option value="GBP">United Kingdom Pounds – GBP</option>
<option value="USD">United States Dollars – USD</option>
<option value="VEB">Venezuela Bolivares – VEB</option>
<option value="VND">Vietnam Dong – VND</option>
<option value="ZMK">Zambia Kwacha – ZMK</option>
</select>
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<option value="Checking Account">Checking Account</option>
<option value="Savings Account">Saving Account</option>
<option value="Fixed Deposit Account">Fixed Deposit Account</option>
<option value="Current Account">Current Account</option>
<option value="Business Account">Business Account</option>
<option value="Non Resident Account">Non Resident Account</option>
<option value="Cooperate Business Account">Cooperate Business Account</option>
<option value="Investment Account">Investment Account</option>
</select>
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