app.loanspq.com Open in urlscan Pro
52.159.160.204 Public Scan

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Submitted URL:
http://ndfcudebtrelief.com/
Effective URL:
https://app.loanspq.com/pl/PersonalLoan.aspx?enc=Kw21Wblm1yxpjJabdoZaD3ySOZHCqvnLFEDvkGJUfzlGdYZvrd-zvZFfDEHTNMyKYLpndD7...
Submission Tags: @ecarlesi possiblethreat phishing Search All
Submission: On March 28 via api (March 28th 2024, 10:55:01 am UTC) from IT — Scanned from IT

Form analysis
10 forms found in the DOM

POST /handler/AutoFillHandler.aspx

<form target="if_ApplicantInfo" method="post" action="/handler/AutoFillHandler.aspx" id="frm_ApplicantInfo" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <div id="divScanDocument" style="margin-top: 2px;padding: 10px 0px;">
    <a href="#scandocs" data-rel="dialog" data-transition="pop" style="display: inline-block;" class="img-btn">
            <div class="scandocs-box">
	            <div class="caption-text">
                    <p class="caption">Click or tap here to pre-fill information with your driver's license</p>
                    <div class="pull-right">
                        <img src="/images/avatar.jpg" alt="avatar" class="img-responsive">
                    </div>
			        </div>
            </div>
	        </a>
  </div>
  <div class="sub_section_header header_theme" style="color: rgb(6, 6, 6); font-family: Roboto-light, sans-serif; font-weight: lighter;">
    <div class="svg-icon " id="svgPersonIcon"><svg width="40" height="40" preserveAspectRatio="xMinYMin" viewBox="-10 -5 123 123" style="fill: rgb(6, 6, 6);">
        <path d="M50.2,58.6c12.2,0,23.4-7.8,27.5-19.3c4.2-11.5,0.6-24.8-8.8-32.6
			C59.4-1.2,45.6-2.2,35,4.2C24.6,10.5,19.1,23,21.5,35c2.4,11.9,12.2,21.3,24.2,23.2C47.1,58.5,48.7,58.6,50.2,58.6z"></path>
        <path d="M72.3,55.5C62.6,63.7,48.8,65.9,37,61c-3.2-1.3-6.3-3.2-8.9-5.4
			C12.1,63.8,0.8,80.7,0,100.4h100.4C99.6,80.7,88.3,63.8,72.3,55.5C66.3,60.6,88.3,63.8,72.3,55.5z"></path>
      </svg></div>
    <div class="section-title rename-able " data-renameid="e_6bmxlw6wt2l">Personal Information</div>
  </div>
  <div id="divEmployeeOfLender">
    <div data-role="fieldcontain">
      <label for="ddlEmployeeOfLender" data-renameid="e_h81yzmaahcj">Are you an employee of <span class="bold">New Dimensions FCU?</span></label>
      <select id="ddlEmployeeOfLender">
        <option class="rename-able" value="NONE" data-renameid="e_zx984ed92aq">No, I am not an Employee of New Dimensions F.C.U.</option>
        <option class="rename-able" value="EMPLOYEE" data-renameid="e_t7xew3lxmtk">Yes, I am an Employee of New Dimensions F.C.U.</option>
      </select>
    </div>
  </div>
  <div data-role="fieldcontain">
    <label for="txtFName" class="RequiredIcon" data-renameid="e_qkcpfrj7hc">First Name</label>
    <input type="text" id="txtFName" name="fname" autocomplete="given-name" class="FirstName" maxlength="50" value="">
  </div>
  <div data-role="fieldcontain">
    <label for="txtMName" data-renameid="e_v5wy2l1glt">Middle Name</label>
    <input type="text" id="txtMName" maxlength="50" name="mname" autocomplete="additional-name" value="">
  </div>
  <div data-role="fieldcontain">
    <label for="txtLName" class="RequiredIcon" data-renameid="e_ntg8bedtmlq">Last Name</label>
    <input type="text" id="txtLName" maxlength="50" name="lname" autocomplete="family-name" value="">
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="if_ContactInfo" method="post" action="/handler/AutoFillHandler.aspx" id="frm_ContactInfo" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <div data-role="fieldcontain">
    <label id="lblPreferedMethod" for="preferredContactMethod" data-renameid="e_kka3axz526">Preferred Contact Method</label>
    <select name="preferredContactMethod" id="preferredContactMethod" data-prev-value="" onchange=" updateContactInfo(this)">
      <option value="">--Please Select--</option>
      <option class="rename-able" value="EMAIL" data-renameid="e_at35mz2ylp9">Email</option>
      <option class="rename-able" value="HOME" data-renameid="e_lebh92xggod">Home</option>
      <option class="rename-able" value="CELL" data-renameid="e_ojeje4ccc3">Cell</option>
      <option class="rename-able" value="WORK" data-renameid="e_h1fjxlcqfgc">Work</option>
    </select>
  </div>
  <div data-role="fieldcontain">
    <label id="lblEmail" for="txtEmail" class="RequiredIcon" data-renameid="e_vb46y1xm4ne">Email</label>
    <input type="email" name="email" autocomplete="email" id="txtEmail" maxlength="50" value="">
  </div>
  <div data-role="fieldcontain" id="divHomePhone">
    <div>
      <div style="display: inline-block;"><label id="lblHomePhone" for="txtHomePhone" class="RequiredIcon" style="white-space: nowrap;" data-renameid="e_hvlgxkdw4i">Home Phone</label></div>
      <div style="display: inline-block;"><label class="phone_format rename-able" for="txtHomePhone" style="white-space: nowrap; font-style: italic;" data-renameid="e_0qxc35364p1g">(xxx) xxx-xxxx</label></div>
    </div>
    <input type="text" pattern="[0-9]*" autocomplete="tel" name="phone" id="txtHomePhone" class="inphone" maxlength="14" value="">
  </div>
  <div data-role="fieldcontain" id="divMobilePhone">
    <div>
      <div style="display: inline-block;"><label id="lblMobilePhone" for="txtMobilePhone" class="" style="white-space: nowrap;" data-renameid="e_npkl1z6ew5k">Cell Phone</label></div>
      <div style="display: inline-block;"><label class="phone_format rename-able" for="txtMobilePhone" style="white-space: nowrap; font-style: italic;" data-renameid="e_ods09uhsft">(xxx) xxx-xxxx</label></div>
    </div>
    <input type="text" pattern="[0-9]*" autocomplete="tel" name="mobile" id="txtMobilePhone" class="inphone" maxlength="14" value="">
  </div>
  <div data-role="fieldcontain" id="divWorkPhone">
    <div>
      <div style="display: inline-block;"><label id="lblWorkPhone" for="txtWorkPhone" style="white-space: nowrap;" data-renameid="e_nkem9kx2xsj">Work Phone</label></div>
      <div style="display: inline-block;"><label class="phone_format rename-able" for="txtWorkPhone" style="white-space: nowrap; font-style: italic;" data-renameid="e_0ucvzj1ug2">(xxx) xxx-xxxx</label></div>
    </div>
    <input type="text" pattern="[0-9]*" autocomplete="off" name="workphone" id="txtWorkPhone" class="inphone" maxlength="14" value="">
  </div>
  <div data-role="fieldcontain" class="hidden">
    <label for="txtWorkPhoneExt" data-renameid="e_64d4mcwb9m9">Work Phone Extension</label>
    <input type="text" pattern="[0-9]*" id="txtWorkPhoneExt" name="ext" autocomplete="off" maxlength="5" value="" class="numeric">
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="if_Address" method="post" action="/handler/AutoFillHandler.aspx" id="frm_Address" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <input type="hidden" id="hdAddressVerifiedDate">
  <input type="hidden" id="hdPreviousAddressVerifiedDate">
  <input type="hidden" id="hdMailingAddressVerifiedDate">
  <!--move copy primary address for joint-->
  <div style="display: none; " id="divCopyAddress">
    <div style="margin-top: 15.6px;">
      <a href="#" class="header_theme2 shadow-btn chevron-circle-right-before" name="btnCopyAddress" id="btnCopyAddress" onclick="CopyPrimaryAddress(event);showHideState();" data-renameid="e_54pusu3wrhf" style="color: rgb(0, 139, 154);">Copy the Primary Applicant's Address</a>
    </div>
  </div>
  <div id="div_ddl_country" style="display: none;">
    <div data-role="fieldcontain">
      <label for="ddlCountry" class="RequiredIcon" data-renameid="e_eh5t53x2he">Country</label>
      <select id="ddlCountry" name="country" autocomplete="country" onchange="showHideState()">
        <option value="USA" selected="selected">USA</option>
        <option value="FRANCE">France</option>
        <option value="GERMANY">Germany</option>
        <option value="ITALY">Italy</option>
        <option value="SPAIN">Spain</option>
        <option value="UNITED KINGDOM">United Kingdom</option>
        <option value="AALAND">Aaland</option>
        <option value="ABKHAZIA">Abkhazia</option>
        <option value="AFGHANISTAN">Afghanistan</option>
        <option value="ALBANIA">Albania</option>
        <option value="ALGERIA">Algeria</option>
        <option value="AMERICAN SAMOA">American Samoa</option>
        <option value="ANDORRA">Andorra</option>
        <option value="ANGOLA">Angola</option>
        <option value="ANGUILLA">Anguilla</option>
        <option value="ANTARCTICA">Antarctica</option>
        <option value="ANTIGUA_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_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">British Indian Ocean Territory</option>
        <option value="BRITISH_VIRGIN_ILND">British Virgin Islands</option>
        <option value="BRUNEI">Brunei</option>
        <option value="BULGARIA">Bulgaria</option>
        <option value="BURKINA FASO">Burkina Faso</option>
        <option value="BURUNDI">Burundi</option>
        <option value="CAMBODIA">Cambodia</option>
        <option value="CAMEROON">Cameroon</option>
        <option value="CANADA">Canada</option>
        <option value="CAPE VERDE">Cape Verde</option>
        <option value="CAYMAN ISLANDS">Cayman Islands</option>
        <option value="CENTRAL AFRICAN REP">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 ISLANDS">Cocos Islands</option>
        <option value="COLOMBIA">Colombia</option>
        <option value="COMOROS">Comoros</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="DEMOCRATIC_REP_CONGO">Democratic Republic Of The Congo</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="TIMOR-LESTE">East Timor</option>
        <option value="ECUADOR">Ecuador</option>
        <option value="EGYPT">Egypt</option>
        <option value="EL SALVADOR">El Salvador</option>
        <option value="EQUATORIAL GUINEA">Equatorial Guinea</option>
        <option value="ERITREA">Eritrea</option>
        <option value="ESTONIA">Estonia</option>
        <option value="ETHIOPIA">Ethiopia</option>
        <option value="FALKLAND ISLANDS">Falkland Islands</option>
        <option value="FAROE ISLANDS">Faroe Islands</option>
        <option value="FIJI">Fiji</option>
        <option value="FINLAND">Finland</option>
        <option value="FRENCH GUIANA">French Guiana</option>
        <option value="FRENCH POLYNESIA">French Polynesia</option>
        <option value="FRENCH_SOUTHERN_TERR">French Southern Territories</option>
        <option value="GABON">Gabon</option>
        <option value="GAMBIA">Gambia</option>
        <option value="GEORGIA">Georgia</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_MCDONALD_ILND">Heard Island And Mcdonald Islands</option>
        <option value="HONDURAS">Honduras</option>
        <option value="HONG KONG">Hong Kong</option>
        <option value="HUNGARY">Hungary</option>
        <option value="ICELAND">Iceland</option>
        <option value="INDIA">India</option>
        <option value="INDONESIA">Indonesia</option>
        <option value="IRAN">Iran</option>
        <option value="IRAQ">Iraq</option>
        <option value="IRELAND">Ireland</option>
        <option value="ISLE OF MAN">Isle Of Man</option>
        <option value="ISRAEL">Israel</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="KOSOVO">Kosovo</option>
        <option value="KUWAIT">Kuwait</option>
        <option value="KYRGYZSTAN">Kyrgyzstan</option>
        <option value="LAOS">Laos</option>
        <option value="LATVIA">Latvia</option>
        <option value="LEBANON">Lebanon</option>
        <option value="LESOTHO">Lesotho</option>
        <option value="LIBERIA">Liberia</option>
        <option value="LIBYA">Libya</option>
        <option value="LIECHTENSTEIN">Liechtenstein</option>
        <option value="LITHUANIA">Lithuania</option>
        <option value="LUXEMBOURG">Luxembourg</option>
        <option value="MACAU">Macau</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">Micronesia</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="NAGORNO-KARABAKH">Nagorno-Karabakh</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="NORTH KOREA">North Korea</option>
        <option value="NORTHERN CYPRUS">Northern Cyprus</option>
        <option value="NORTHERN_MARIANA_ILN">Northern Mariana Islands</option>
        <option value="NORWAY">Norway</option>
        <option value="OMAN">Oman</option>
        <option value="PAKISTAN">Pakistan</option>
        <option value="PALAU">Palau</option>
        <option value="PALESTINE">Palestine</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="CONGO">Republic Of The Congo</option>
        <option value="REUNION">Reunion</option>
        <option value="ROMANIA">Romania</option>
        <option value="RUSSIA">Russia</option>
        <option value="RWANDA">Rwanda</option>
        <option value="SAINT BARTHELEMY">Saint Barthelemy</option>
        <option value="SAINT HELENA">Saint Helena</option>
        <option value="SAINT_KITTS_NEVIS">Saint Kitts And Nevis</option>
        <option value="SAINT LUCIA">Saint Lucia</option>
        <option value="SAINT_VINCENT_GREN">Saint Vincent And The Grenadines</option>
        <option value="SAINT-MARTIN">Saint-Martin</option>
        <option value="SAINTPIERRE_MIQUELON">Saint-Pierre And Miquelon</option>
        <option value="SAMOA">Samoa</option>
        <option value="SAN MARINO">San Marino</option>
        <option value="SAO_TOME_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="SOMALILAND">Somaliland</option>
        <option value="SOUTH AFRICA">South Africa</option>
        <option value="S_GEORGIA_SANDWICH">South Georgia And The South Sandwich Islands</option>
        <option value="SOUTH KOREA">South Korea</option>
        <option value="SOUTH OSSETIA">South Ossetia</option>
        <option value="SRI LANKA">Sri Lanka</option>
        <option value="SUDAN">Sudan</option>
        <option value="SURINAME">Suriname</option>
        <option value="SVALBARD_JAN_MAYEN">Svalbard And Jan Mayen</option>
        <option value="SWAZILAND">Swaziland</option>
        <option value="SWEDEN">Sweden</option>
        <option value="SWITZERLAND">Switzerland</option>
        <option value="SYRIA">Syria</option>
        <option value="TAIWAN">Taiwan</option>
        <option value="TAJIKISTAN">Tajikistan</option>
        <option value="TANZANIA">Tanzania</option>
        <option value="THAILAND">Thailand</option>
        <option value="TOGO">Togo</option>
        <option value="TOKELAU">Tokelau</option>
        <option value="TONGA">Tonga</option>
        <option value="TRANSNISTRIA">Transnistria</option>
        <option value="TRINIDAD AND TOBAGO">Trinidad And Tobago</option>
        <option value="TRISTAN DA CUNHA">Tristan Da Cunha</option>
        <option value="TUNISIA">Tunisia</option>
        <option value="TURKEY">Turkey</option>
        <option value="TURKMENISTAN">Turkmenistan</option>
        <option value="TURKS_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="US_MINOR_ISLANDS">United States Minor Outlying Islands</option>
        <option value="US_VIRGIN_ISLANDS">United States Virgin Islands</option>
        <option value="URUGUAY">Uruguay</option>
        <option value="UZBEKISTAN">Uzbekistan</option>
        <option value="VANUATU">Vanuatu</option>
        <option value="VATICAN CITY">Vatican City</option>
        <option value="VENEZUELA">Venezuela</option>
        <option value="VIETNAM">Vietnam</option>
        <option value="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>
      </select>
    </div>
  </div>
  <div data-role="fieldcontain">
    <label for="txtAddress" class="RequiredIcon" data-renameid="e_eazn7fekf76">Address</label>
    <input type="text" id="txtAddress" maxlength="100" name="address1" autocomplete="street-address" value="" onchange="verifyAddress('');">
  </div>
  <div data-role="fieldcontain" id="divAddress2" style="display: none;">
    <label for="txtAddress2" data-renameid="e_hn8snimoh5">Address Line 2</label>
    <input type="text" id="txtAddress2" maxlength="100" name="address2" autocomplete="address-line2" value="" onchange="verifyAddress('');">
  </div>
  <div data-role="fieldcontain">
    <label for="txtZip" id="lblZipTitle" class="RequiredIcon" data-renameid="e_ksbvd33lkb">Zip</label>
    <input type="text" id="txtZip" maxlength="10" pattern="[0-9]*" name="zip" autocomplete="postal-code" value="" onchange="verifyAddress('');">
  </div>
  <div data-role="fieldcontain">
    <label for="txtCity" id="lblCityTitle" class="RequiredIcon" data-renameid="e_f5qp8aizms">City</label>
    <input type="text" id="txtCity" maxlength="50" name="city" autocomplete="address-level2" value="" onchange="verifyAddress('');">
  </div>
  <div class="div_ddl_state">
    <div data-role="fieldcontain">
      <label for="ddlState" class="RequiredIcon" data-renameid="e_x0pszuljui">State</label>
      <select id="ddlState" name="state" autocomplete="address-level1" onchange="verifyAddress('');">
        <option class="rename-able" value="" data-renameid="e_poqq5ys8jd8">--Please Select--</option>
        <option class="rename-able" value="AL" data-renameid="e_pwma0hxv89">Alabama</option>
        <option class="rename-able" value="AK" data-renameid="e_fso5qpaaafn">Alaska</option>
        <option class="rename-able" value="AS" data-renameid="e_hblrvppwzun">American Samoa</option>
        <option class="rename-able" value="AZ" data-renameid="e_2yekrbj26l8">Arizona</option>
        <option class="rename-able" value="AR" data-renameid="e_zswc4rckyq">Arkansas</option>
        <option class="rename-able" value="AA" data-renameid="e_qhz4ism0ikd">Armed Forces - Americas</option>
        <option class="rename-able" value="AE" data-renameid="e_rw4vh61trif">Armed Forces - Europe</option>
        <option class="rename-able" value="AP" data-renameid="e_uonjmnirpu">Armed Forces - Pacific</option>
        <option class="rename-able" value="CA" data-renameid="e_je6897ziv6d">California</option>
        <option class="rename-able" value="CO" data-renameid="e_hbqj5z7lua4">Colorado</option>
        <option class="rename-able" value="CT" data-renameid="e_vbnqke337o">Connecticut</option>
        <option class="rename-able" value="DE" data-renameid="e_ll25wcdryc">Delaware</option>
        <option class="rename-able" value="DC" data-renameid="e_wg85k04k9j">District Of Columbia</option>
        <option class="rename-able" value="FL" data-renameid="e_poycself5e">Florida</option>
        <option class="rename-able" value="FM" data-renameid="e_wwgahqptj6c">Federated States of Micronesia</option>
        <option class="rename-able" value="GA" data-renameid="e_qi5ui4yuhs8">Georgia</option>
        <option class="rename-able" value="GU" data-renameid="e_j3hc9xeop0e">Guam</option>
        <option class="rename-able" value="HI" data-renameid="e_h5kududd8va">Hawaii</option>
        <option class="rename-able" value="ID" data-renameid="e_k4mmp5cw72b">Idaho</option>
        <option class="rename-able" value="IL" data-renameid="e_zkmdxgc700g">Illinois</option>
        <option class="rename-able" value="IN" data-renameid="e_qrdacelnqt">Indiana</option>
        <option class="rename-able" value="IA" data-renameid="e_wk4andcjwxt">Iowa</option>
        <option class="rename-able" value="KS" data-renameid="e_ur9ataj6ey">Kansas</option>
        <option class="rename-able" value="KY" data-renameid="e_w2pmuf7tfza">Kentucky</option>
        <option class="rename-able" value="LA" data-renameid="e_mexbfk8f3im">Louisiana</option>
        <option class="rename-able" value="ME" data-renameid="e_mt5522gz7h">Maine</option>
        <option class="rename-able" value="MD" data-renameid="e_2bwshnwbkk6">Maryland</option>
        <option class="rename-able" value="MA" data-renameid="e_3b1m51sew46">Massachusetts</option>
        <option class="rename-able" value="MH" data-renameid="e_q38u9qzygg9">Marshall Islands</option>
        <option class="rename-able" value="MI" data-renameid="e_m08xagqyrfq">Michigan</option>
        <option class="rename-able" value="MN" data-renameid="e_smuxmeqqmzg">Minnesota</option>
        <option class="rename-able" value="MS" data-renameid="e_cxwu1ntc77d">Mississippi</option>
        <option class="rename-able" value="MO" data-renameid="e_ixbqbrkximn">Missouri</option>
        <option class="rename-able" value="MP" data-renameid="e_l0663mhf9so">Northern Mariana Islands</option>
        <option class="rename-able" value="MT" data-renameid="e_1xlx9vq5bgp">Montana</option>
        <option class="rename-able" value="NE" data-renameid="e_6srvq4f18h7">Nebraska</option>
        <option class="rename-able" value="NV" data-renameid="e_4xiip9vznip">Nevada</option>
        <option class="rename-able" value="NH" data-renameid="e_coua19b2dvn">New Hampshire</option>
        <option class="rename-able" value="NJ" data-renameid="e_5zn22mwbjal">New Jersey</option>
        <option class="rename-able" value="NM" data-renameid="e_c3en9yntf4l">New Mexico</option>
        <option class="rename-able" value="NY" data-renameid="e_uyr6e781p4c">New York</option>
        <option class="rename-able" value="NC" data-renameid="e_7fsvsx4mfcv">North Carolina</option>
        <option class="rename-able" value="ND" data-renameid="e_u0wnfuom0hq">North Dakota</option>
        <option class="rename-able" value="OH" data-renameid="e_msb74hiusea">Ohio</option>
        <option class="rename-able" value="OK" data-renameid="e_uyfj4op5j1">Oklahoma</option>
        <option class="rename-able" value="OR" data-renameid="e_kc6vnfiraw">Oregon</option>
        <option class="rename-able" value="PA" data-renameid="e_oot4kp1hhve">Pennsylvania</option>
        <option class="rename-able" value="PR" data-renameid="e_ns95xftbui">Puerto Rico</option>
        <option class="rename-able" value="PW" data-renameid="e_uvd1okx30mn">Palau</option>
        <option class="rename-able" value="RI" data-renameid="e_oiks26rwis">Rhode Island</option>
        <option class="rename-able" value="SC" data-renameid="e_28hbqjgu9gh">South Carolina</option>
        <option class="rename-able" value="SD" data-renameid="e_x73qdlff7l">South Dakota</option>
        <option class="rename-able" value="TN" data-renameid="e_95ngl6phiql">Tennessee</option>
        <option class="rename-able" value="TX" data-renameid="e_bptse93mdh">Texas</option>
        <option class="rename-able" value="UT" data-renameid="e_dx6h9z346cu">Utah</option>
        <option class="rename-able" value="VT" data-renameid="e_mxmmrcblo7r">Vermont</option>
        <option class="rename-able" value="VI" data-renameid="e_fr84o341om6">Virgin Islands</option>
        <option class="rename-able" value="VA" data-renameid="e_alof11ombqb">Virginia</option>
        <option class="rename-able" value="WA" data-renameid="e_zjk8xfobva">Washington</option>
        <option class="rename-able" value="WV" data-renameid="e_lhzst1csp6s">West Virginia</option>
        <option class="rename-able" value="WI" data-renameid="e_k261zw3r76s">Wisconsin</option>
        <option class="rename-able" value="WY" data-renameid="e_wr178471e1e">Wyoming</option>
      </select>
    </div>
  </div>
  <div><span id="spVerifyMessage" class="require-span" style="display: none;">Unable to validate address</span> </div>
  <div id="divOccupancyStatusSection">
    <div data-role="fieldcontain">
      <label for="ddlOccupyingStatus" class="RequiredIcon" data-renameid="e_yfo8s3erzop">Occupancy Status</label>
      <select id="ddlOccupyingStatus" onchange="HandleOccupancyStatusChange(false)">
        <option class="rename-able" value=" " data-renameid="e_4wsph8oukm8">--Please Select--</option>
        <option class="rename-able" value="BUYING/OWN WITH MORTGAGE" data-renameid="e_vpew2vkcia9">Buying/Own With Mortgage</option>
        <option class="rename-able" value="LIVE WITH PARENTS" data-renameid="e_w4qlgvyludf">Live With Parents</option>
        <option class="rename-able" value="OWN - FREE AND CLEAR" data-renameid="e_kdv1fa1hx3">Own - Free And Clear</option>
        <option class="rename-able" value="RENT" data-renameid="e_je6u5tyyl2m">Rent</option>
        <option class="rename-able" value="GOVERNMENT QUARTERS" data-renameid="e_u49b94mn8sq">Government Quarters</option>
        <option class="rename-able" value="OTHER" data-renameid="e_ijf45pfsxg">Other</option>
      </select>
    </div>
    <div data-role="fieldcontain">
      <label id="lblOccupancyDuration" class="rename-able RequiredIcon" data-renameid="e_z34n33o750k">Occupancy Duration</label>
      <div id="divOccupancyDuration" class="ui-input-horizal row">
        <div class="col-xs-6">
          <!--input type="text"  pattern="[0-9]*" id="txtOccupancyDurationYear" maxlength="2" class="numeric inyear" /-->
          <select id="ddlOccupancyDurationYear" class="OccupancyDuration" aria-labelledby="lblOccupancyDuration">
            <option value=" " class="rename-able" data-renameid="e_j8u3xesfuhn">Years</option>
            <option class="rename-able" value="0" data-renameid="e_mebv0qvl7nd">0</option>
            <option class="rename-able" value="1" data-renameid="e_7051sgj5kvo">1</option>
            <option class="rename-able" value="2" data-renameid="e_mus7hu6opwm">2</option>
            <option class="rename-able" value="3" data-renameid="e_tqbjkge0u3">3</option>
            <option class="rename-able" value="4" data-renameid="e_702awdc08xk">4</option>
            <option class="rename-able" value="5" data-renameid="e_l2y62jm5jp8">5</option>
            <option class="rename-able" value="6" data-renameid="e_4kr94t9zuyw">6</option>
            <option class="rename-able" value="7" data-renameid="e_723i4kkhdwp">7</option>
            <option class="rename-able" value="8" data-renameid="e_9fzrn3z3hjl">8</option>
            <option class="rename-able" value="9" data-renameid="e_592pfxca72n">9</option>
            <option class="rename-able" value="10" data-renameid="e_n609n7cepb">10</option>
            <option class="rename-able" value="11" data-renameid="e_05v9a0vg5qv3">11</option>
            <option class="rename-able" value="12" data-renameid="e_oxx9xraxnhe">12</option>
            <option class="rename-able" value="13" data-renameid="e_vsdu1kbhmq9">13</option>
            <option class="rename-able" value="14" data-renameid="e_e2e921658dk">14</option>
            <option class="rename-able" value="15" data-renameid="e_uai632hxbfk">15</option>
            <option class="rename-able" value="16" data-renameid="e_bcljmyvfanq">16</option>
            <option class="rename-able" value="17" data-renameid="e_p4nt7lij8ag">17</option>
            <option class="rename-able" value="18" data-renameid="e_l48hjrgg56m">18</option>
            <option class="rename-able" value="19" data-renameid="e_0t5ifu8mk2c">19</option>
            <option class="rename-able" value="20" data-renameid="e_u10zmg4nqo8">20</option>
            <option class="rename-able" value="21" data-renameid="e_h2i2601ipbe">21</option>
            <option class="rename-able" value="22" data-renameid="e_0nais10wsvc">22</option>
            <option class="rename-able" value="23" data-renameid="e_24pv14eu88o">23</option>
            <option class="rename-able" value="24" data-renameid="e_pnls7hoeumf">24</option>
            <option class="rename-able" value="25" data-renameid="e_nu7xukf00ic">25</option>
            <option class="rename-able" value="26" data-renameid="e_pkq26d4hztc">26</option>
            <option class="rename-able" value="27" data-renameid="e_yjmkmlk857k">27</option>
            <option class="rename-able" value="28" data-renameid="e_99jky9o55kr">28</option>
            <option class="rename-able" value="29" data-renameid="e_7pn7xyxec0l">29</option>
            <option class="rename-able" value="30" data-renameid="e_xrfd4nqq97a">30</option>
            <option class="rename-able" value="31" data-renameid="e_as7tdjgaohk">31</option>
            <option class="rename-able" value="32" data-renameid="e_u7ysztl95q">32</option>
            <option class="rename-able" value="33" data-renameid="e_gr7v4kljamp">33</option>
            <option class="rename-able" value="34" data-renameid="e_rmfa9afnard">34</option>
            <option class="rename-able" value="35" data-renameid="e_862hk16pazl">35</option>
            <option class="rename-able" value="36" data-renameid="e_vchkkgtnjcl">36</option>
            <option class="rename-able" value="37" data-renameid="e_vzt7uaon0sn">37</option>
            <option class="rename-able" value="38" data-renameid="e_lrt31mqil6l">38</option>
            <option class="rename-able" value="39" data-renameid="e_2fyan6ujpor">39</option>
            <option class="rename-able" value="40" data-renameid="e_0fcsyaeuul5b">40</option>
            <option class="rename-able" value="41" data-renameid="e_2wnyzy512mm">41</option>
            <option class="rename-able" value="42" data-renameid="e_4atoinznkg4">42</option>
            <option class="rename-able" value="43" data-renameid="e_eugkpp5bgil">43</option>
            <option class="rename-able" value="44" data-renameid="e_dz0ah6brdri">44</option>
            <option class="rename-able" value="45" data-renameid="e_m0f1tfcnh6r">45</option>
            <option class="rename-able" value="46" data-renameid="e_232obr9vwgg">46</option>
            <option class="rename-able" value="47" data-renameid="e_qtnqrm4ko6r">47</option>
            <option class="rename-able" value="48" data-renameid="e_37coxzufg1g">48</option>
            <option class="rename-able" value="49" data-renameid="e_wcbms92aju">49</option>
            <option class="rename-able" value="50" data-renameid="e_s8ic3v8piws">50</option>
            <option class="rename-able" value="51" data-renameid="e_l60csqcp1hb">51</option>
            <option class="rename-able" value="52" data-renameid="e_ayl5sn4p7vb">52</option>
            <option class="rename-able" value="53" data-renameid="e_mk9l0b9tspc">53</option>
            <option class="rename-able" value="54" data-renameid="e_hv4a6gxxk99">54</option>
            <option class="rename-able" value="55" data-renameid="e_lorwj9oim3p">55</option>
            <option class="rename-able" value="56" data-renameid="e_0duc0jgg4kit">56</option>
            <option class="rename-able" value="57" data-renameid="e_ezoeg96xdc4">57</option>
            <option class="rename-able" value="58" data-renameid="e_ou4qch9bvi">58</option>
            <option class="rename-able" value="59" data-renameid="e_6ly306fd2ho">59</option>
            <option class="rename-able" value="60" data-renameid="e_db1u6ytgu1o">60</option>
            <option class="rename-able" value="61" data-renameid="e_6lx2g32r8xm">61</option>
            <option class="rename-able" value="62" data-renameid="e_9nx001apjf">62</option>
            <option class="rename-able" value="63" data-renameid="e_4knaq7agppb">63</option>
            <option class="rename-able" value="64" data-renameid="e_m5iaj9tsalh">64</option>
            <option class="rename-able" value="65" data-renameid="e_gvz8njkrs2u">65</option>
            <option class="rename-able" value="66" data-renameid="e_j83gcanyxat">66</option>
            <option class="rename-able" value="67" data-renameid="e_igy59j20jkl">67</option>
            <option class="rename-able" value="68" data-renameid="e_j5yw90skdpp">68</option>
            <option class="rename-able" value="69" data-renameid="e_1o878jqediei">69</option>
            <option class="rename-able" value="70" data-renameid="e_alj7ut5ykfd">70</option>
            <option class="rename-able" value="71" data-renameid="e_5hjsg0u57qs">71</option>
            <option class="rename-able" value="72" data-renameid="e_bq06wmp14gg">72</option>
            <option class="rename-able" value="73" data-renameid="e_oj0ri9xoa5l">73</option>
            <option class="rename-able" value="74" data-renameid="e_er55pcses15">74</option>
            <option class="rename-able" value="75" data-renameid="e_mc7ot6w35z">75</option>
            <option class="rename-able" value="76" data-renameid="e_yqg40k8dr3">76</option>
            <option class="rename-able" value="77" data-renameid="e_t1y1magr0th">77</option>
            <option class="rename-able" value="78" data-renameid="e_0l84oa8ww6ih">78</option>
            <option class="rename-able" value="79" data-renameid="e_78rdr7kv6mp">79</option>
            <option class="rename-able" value="80" data-renameid="e_dwgplxv42gc">80</option>
            <option class="rename-able" value="81" data-renameid="e_ar8rv8twuz9">81</option>
            <option class="rename-able" value="82" data-renameid="e_tr175o7r2r">82</option>
            <option class="rename-able" value="83" data-renameid="e_m1a3k9xmjyq">83</option>
            <option class="rename-able" value="84" data-renameid="e_c5e9dgvypmu">84</option>
            <option class="rename-able" value="85" data-renameid="e_ewvlw8jr4x7">85</option>
            <option class="rename-able" value="86" data-renameid="e_iwkiychxxwo">86</option>
            <option class="rename-able" value="87" data-renameid="e_a1bo3amyr9">87</option>
            <option class="rename-able" value="88" data-renameid="e_802ma1z2z9r">88</option>
            <option class="rename-able" value="89" data-renameid="e_vom08cl2xe8">89</option>
            <option class="rename-able" value="90" data-renameid="e_kch19zkntal">90</option>
            <option class="rename-able" value="91" data-renameid="e_dia10rh521">91</option>
            <option class="rename-able" value="92" data-renameid="e_yye48f7c89">92</option>
            <option class="rename-able" value="93" data-renameid="e_cu3j0j5z1df">93</option>
            <option class="rename-able" value="94" data-renameid="e_0r15udrdhg0c">94</option>
            <option class="rename-able" value="95" data-renameid="e_v8m36gy1nw9">95</option>
            <option class="rename-able" value="96" data-renameid="e_7zl0chrfd73">96</option>
            <option class="rename-able" value="97" data-renameid="e_7mbqyc3zrnk">97</option>
            <option class="rename-able" value="98" data-renameid="e_qhyss2etxup">98</option>
            <option class="rename-able" value="99" data-renameid="e_d60y2dzacwf">99</option>
          </select>
        </div>
        <div class="col-xs-6">
          <select id="ddlOccupancyDurationMonth" class="OccupancyDuration" aria-labelledby="lblOccupancyDuration">
            <option value=" " class="rename-able" data-renameid="e_brjz27rw68">Months</option>
            <option class="rename-able" value="0" data-renameid="e_gxdou9tl9x">0</option>
            <option class="rename-able" value="1" data-renameid="e_zntukrukdr">1</option>
            <option class="rename-able" value="2" data-renameid="e_30uc0er37be">2</option>
            <option class="rename-able" value="3" data-renameid="e_cdhlj6qj8o9">3</option>
            <option class="rename-able" value="4" data-renameid="e_xt5i34b47x">4</option>
            <option class="rename-able" value="5" data-renameid="e_p8xcti0sxh9">5</option>
            <option class="rename-able" value="6" data-renameid="e_q5rp07ye74s">6</option>
            <option class="rename-able" value="7" data-renameid="e_20v7x22nz8v">7</option>
            <option class="rename-able" value="8" data-renameid="e_c6kc1fn0er">8</option>
            <option class="rename-able" value="9" data-renameid="e_e1abfriquw">9</option>
            <option class="rename-able" value="10" data-renameid="e_bhvhg8c78cl">10</option>
            <option class="rename-able" value="11" data-renameid="e_846gw9wht9k">11</option>
          </select>
        </div>
      </div>
    </div>
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="if_Address" method="post" action="/handler/AutoFillHandler.aspx" id="frm_PreviousAdress" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <div id="divPreviousAddress" style="display:none">
    <br>
    <div style="font-size:17px;font-weight :bold">Previous Address</div>
    <div id="div_ddl_previous_country" style="display:none" data-role="fieldcontain">
      <label for="ddlPreviousCountry" class="RequiredIcon" data-renameid="e_vsf2jcg0mpq">Country</label>
      <select id="ddlPreviousCountry" name="country" autocomplete="country" onchange="showHidePreviousState()">
        <option value="USA" selected="selected">USA</option>
      </select>
    </div>
    <div data-role="fieldcontain">
      <label for="txtPreviousAddress" class="RequiredIcon" data-renameid="e_zskhytyleh">Address</label>
      <input type="text" id="txtPreviousAddress" value="" maxlength="100" name="address1" autocomplete="street-address" onchange="verifyAddress('Previous');">
    </div>
    <div data-role="fieldcontain" id="divPreviousAddress2" style="display: none;">
      <label for="txtPreviousAddress2" data-renameid="e_fnw9cq4n80l">Address Line 2</label>
      <input type="text" id="txtPreviousAddress2" value="" maxlength="100" name="address2" autocomplete="address-line2" onchange="verifyAddress('Previous');">
    </div>
    <div data-role="fieldcontain">
      <label for="txtPreviousZip" id="lblPreviousZipTitle" class="RequiredIcon" data-renameid="e_tur8nn6e7nn">Zip</label>
      <input type="text" id="txtPreviousZip" value="" pattern="[0-9]*" maxlength="10" name="zip" autocomplete="postal-code" onchange="verifyAddress('Previous');">
    </div>
    <div data-role="fieldcontain">
      <label for="txtPreviousCity" id="lblPreviousCityTitle" class="RequiredIcon" data-renameid="e_370nv08mug3">City</label>
      <input type="text" id="txtPreviousCity" value="" maxlength="50" name="city" autocomplete="address-level2" onchange="verifyAddress('Previous');">
    </div>
    <div class="div_ddl_previous_state">
      <div data-role="fieldcontain">
        <label for="ddlPreviousState" class="RequiredIcon" data-renameid="e_kga3i9icgrk">State</label>
        <select id="ddlPreviousState" value="" name="state" autocomplete="address-level1" onchange="verifyAddress('Previous');">
          <option class="rename-able" value="" data-renameid="e_u9vjrkw1m">--Please Select--</option>
          <option class="rename-able" value="AL" data-renameid="e_9ybjyvfxxo">Alabama</option>
          <option class="rename-able" value="AK" data-renameid="e_1i57gs0ebuo">Alaska</option>
          <option class="rename-able" value="AS" data-renameid="e_k8x115n0gcc">American Samoa</option>
          <option class="rename-able" value="AZ" data-renameid="e_ptgy2n7yw6j">Arizona</option>
          <option class="rename-able" value="AR" data-renameid="e_atvvsr0lc3">Arkansas</option>
          <option class="rename-able" value="AA" data-renameid="e_ozed4w1pujn">Armed Forces - Americas</option>
          <option class="rename-able" value="AE" data-renameid="e_xsuuq33pkx">Armed Forces - Europe</option>
          <option class="rename-able" value="AP" data-renameid="e_fgpie2zzycq">Armed Forces - Pacific</option>
          <option class="rename-able" value="CA" data-renameid="e_a7jw10w5id7">California</option>
          <option class="rename-able" value="CO" data-renameid="e_hd6him6wvdc">Colorado</option>
          <option class="rename-able" value="CT" data-renameid="e_phha0fdc5nr">Connecticut</option>
          <option class="rename-able" value="DE" data-renameid="e_riy63xubx5h">Delaware</option>
          <option class="rename-able" value="DC" data-renameid="e_wniiemsua3m">District Of Columbia</option>
          <option class="rename-able" value="FL" data-renameid="e_fpkaycqhzs8">Florida</option>
          <option class="rename-able" value="FM" data-renameid="e_io1xrghbuqa">Federated States of Micronesia</option>
          <option class="rename-able" value="GA" data-renameid="e_bbe48qpnn57">Georgia</option>
          <option class="rename-able" value="GU" data-renameid="e_5gvwl0b516a">Guam</option>
          <option class="rename-able" value="HI" data-renameid="e_krv6r8dpvl">Hawaii</option>
          <option class="rename-able" value="ID" data-renameid="e_d66kb2vswdo">Idaho</option>
          <option class="rename-able" value="IL" data-renameid="e_42w32vq9vfa">Illinois</option>
          <option class="rename-able" value="IN" data-renameid="e_jdrric7x0rl">Indiana</option>
          <option class="rename-able" value="IA" data-renameid="e_q7vg4fow6xn">Iowa</option>
          <option class="rename-able" value="KS" data-renameid="e_u4qm69cec3">Kansas</option>
          <option class="rename-able" value="KY" data-renameid="e_pcv3j0cf2j">Kentucky</option>
          <option class="rename-able" value="LA" data-renameid="e_3l14az2i4l9">Louisiana</option>
          <option class="rename-able" value="ME" data-renameid="e_07mb9tsqn69">Maine</option>
          <option class="rename-able" value="MD" data-renameid="e_bnkrd52z88f">Maryland</option>
          <option class="rename-able" value="MA" data-renameid="e_gq21o83woj4">Massachusetts</option>
          <option class="rename-able" value="MH" data-renameid="e_huqozg0parb">Marshall Islands</option>
          <option class="rename-able" value="MI" data-renameid="e_qdygipp4nt">Michigan</option>
          <option class="rename-able" value="MN" data-renameid="e_cr5xp68sjon">Minnesota</option>
          <option class="rename-able" value="MS" data-renameid="e_r425ylu6zvm">Mississippi</option>
          <option class="rename-able" value="MO" data-renameid="e_pzu2yq2tba">Missouri</option>
          <option class="rename-able" value="MP" data-renameid="e_rbrwsgnw24">Northern Mariana Islands</option>
          <option class="rename-able" value="MT" data-renameid="e_ghxcqeiqpt8">Montana</option>
          <option class="rename-able" value="NE" data-renameid="e_a1zxqbekbwg">Nebraska</option>
          <option class="rename-able" value="NV" data-renameid="e_i4k707xbdts">Nevada</option>
          <option class="rename-able" value="NH" data-renameid="e_k5twtny1rdn">New Hampshire</option>
          <option class="rename-able" value="NJ" data-renameid="e_enfsgb0836h">New Jersey</option>
          <option class="rename-able" value="NM" data-renameid="e_ggpboousuvh">New Mexico</option>
          <option class="rename-able" value="NY" data-renameid="e_x5y7f97n4n">New York</option>
          <option class="rename-able" value="NC" data-renameid="e_lp32xsdfjer">North Carolina</option>
          <option class="rename-able" value="ND" data-renameid="e_2u9gykjf0k7">North Dakota</option>
          <option class="rename-able" value="OH" data-renameid="e_p69djyurjg">Ohio</option>
          <option class="rename-able" value="OK" data-renameid="e_mrsvj79vg4">Oklahoma</option>
          <option class="rename-able" value="OR" data-renameid="e_58d76n4yocd">Oregon</option>
          <option class="rename-able" value="PA" data-renameid="e_iklx4ia2nc">Pennsylvania</option>
          <option class="rename-able" value="PR" data-renameid="e_lgc7zuc0jna">Puerto Rico</option>
          <option class="rename-able" value="PW" data-renameid="e_e7q4ar47r2w">Palau</option>
          <option class="rename-able" value="RI" data-renameid="e_aokqad68nc">Rhode Island</option>
          <option class="rename-able" value="SC" data-renameid="e_7cv6kzxxws7">South Carolina</option>
          <option class="rename-able" value="SD" data-renameid="e_llw51ptmrct">South Dakota</option>
          <option class="rename-able" value="TN" data-renameid="e_zbfwdbt4zt">Tennessee</option>
          <option class="rename-able" value="TX" data-renameid="e_69lq8cwljoq">Texas</option>
          <option class="rename-able" value="UT" data-renameid="e_ddioctzajf">Utah</option>
          <option class="rename-able" value="VT" data-renameid="e_p3lt6eha33a">Vermont</option>
          <option class="rename-able" value="VI" data-renameid="e_iyum0xbbsbd">Virgin Islands</option>
          <option class="rename-able" value="VA" data-renameid="e_m8badh2qaf">Virginia</option>
          <option class="rename-able" value="WA" data-renameid="e_jwppcvw30l9">Washington</option>
          <option class="rename-able" value="WV" data-renameid="e_v6d6cskl8a">West Virginia</option>
          <option class="rename-able" value="WI" data-renameid="e_bfv8ftx73z">Wisconsin</option>
          <option class="rename-able" value="WY" data-renameid="e_etii155zan7">Wyoming</option>
        </select>
      </div>
    </div>
    <div><span id="spVerifyPreviousMessage" class="require-span" style="display: none;"> Unable to validate address</span></div>
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="if_Address" method="post" action="/handler/AutoFillHandler.aspx" id="frm_mailingAddress" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <div id="divMailingAddress">
    <div style="margin-top: 10px;">
      <a id="lnkHasMaillingAddress" href="#" data-mode="self-handle-event" status="N" style="cursor: pointer; font-weight: bold; color: rgb(0, 139, 154);" class="header_theme2 shadow-btn ui-link chevron-circle-right-before" data-renameid="e_pywdgw6dxi">Use different address for mailing</a>
    </div>
  </div>
  <div id="divMailingAddressForm" style="display :none">
    <br>
    <div style="font-size:17px;font-weight :bold">Mailing Address</div>
    <div id="div_ddl_mailing_country" data-role="fieldcontain" style="display: none;">
      <label for="ddlMailingCountry" class="RequiredIcon" data-renameid="e_xcs6nzaq40f">Country</label>
      <select id="ddlMailingCountry" name="country" autocomplete="country" onchange="showHideMailingState()">
        <option value="USA" selected="selected">USA</option>
        <option value="FRANCE">France</option>
        <option value="GERMANY">Germany</option>
        <option value="ITALY">Italy</option>
        <option value="SPAIN">Spain</option>
        <option value="UNITED KINGDOM">United Kingdom</option>
        <option value="AALAND">Aaland</option>
        <option value="ABKHAZIA">Abkhazia</option>
        <option value="AFGHANISTAN">Afghanistan</option>
        <option value="ALBANIA">Albania</option>
        <option value="ALGERIA">Algeria</option>
        <option value="AMERICAN SAMOA">American Samoa</option>
        <option value="ANDORRA">Andorra</option>
        <option value="ANGOLA">Angola</option>
        <option value="ANGUILLA">Anguilla</option>
        <option value="ANTARCTICA">Antarctica</option>
        <option value="ANTIGUA_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_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">British Indian Ocean Territory</option>
        <option value="BRITISH_VIRGIN_ILND">British Virgin Islands</option>
        <option value="BRUNEI">Brunei</option>
        <option value="BULGARIA">Bulgaria</option>
        <option value="BURKINA FASO">Burkina Faso</option>
        <option value="BURUNDI">Burundi</option>
        <option value="CAMBODIA">Cambodia</option>
        <option value="CAMEROON">Cameroon</option>
        <option value="CANADA">Canada</option>
        <option value="CAPE VERDE">Cape Verde</option>
        <option value="CAYMAN ISLANDS">Cayman Islands</option>
        <option value="CENTRAL AFRICAN REP">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 ISLANDS">Cocos Islands</option>
        <option value="COLOMBIA">Colombia</option>
        <option value="COMOROS">Comoros</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="DEMOCRATIC_REP_CONGO">Democratic Republic Of The Congo</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="TIMOR-LESTE">East Timor</option>
        <option value="ECUADOR">Ecuador</option>
        <option value="EGYPT">Egypt</option>
        <option value="EL SALVADOR">El Salvador</option>
        <option value="EQUATORIAL GUINEA">Equatorial Guinea</option>
        <option value="ERITREA">Eritrea</option>
        <option value="ESTONIA">Estonia</option>
        <option value="ETHIOPIA">Ethiopia</option>
        <option value="FALKLAND ISLANDS">Falkland Islands</option>
        <option value="FAROE ISLANDS">Faroe Islands</option>
        <option value="FIJI">Fiji</option>
        <option value="FINLAND">Finland</option>
        <option value="FRENCH GUIANA">French Guiana</option>
        <option value="FRENCH POLYNESIA">French Polynesia</option>
        <option value="FRENCH_SOUTHERN_TERR">French Southern Territories</option>
        <option value="GABON">Gabon</option>
        <option value="GAMBIA">Gambia</option>
        <option value="GEORGIA">Georgia</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_MCDONALD_ILND">Heard Island And Mcdonald Islands</option>
        <option value="HONDURAS">Honduras</option>
        <option value="HONG KONG">Hong Kong</option>
        <option value="HUNGARY">Hungary</option>
        <option value="ICELAND">Iceland</option>
        <option value="INDIA">India</option>
        <option value="INDONESIA">Indonesia</option>
        <option value="IRAN">Iran</option>
        <option value="IRAQ">Iraq</option>
        <option value="IRELAND">Ireland</option>
        <option value="ISLE OF MAN">Isle Of Man</option>
        <option value="ISRAEL">Israel</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="KOSOVO">Kosovo</option>
        <option value="KUWAIT">Kuwait</option>
        <option value="KYRGYZSTAN">Kyrgyzstan</option>
        <option value="LAOS">Laos</option>
        <option value="LATVIA">Latvia</option>
        <option value="LEBANON">Lebanon</option>
        <option value="LESOTHO">Lesotho</option>
        <option value="LIBERIA">Liberia</option>
        <option value="LIBYA">Libya</option>
        <option value="LIECHTENSTEIN">Liechtenstein</option>
        <option value="LITHUANIA">Lithuania</option>
        <option value="LUXEMBOURG">Luxembourg</option>
        <option value="MACAU">Macau</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">Micronesia</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="NAGORNO-KARABAKH">Nagorno-Karabakh</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="NORTH KOREA">North Korea</option>
        <option value="NORTHERN CYPRUS">Northern Cyprus</option>
        <option value="NORTHERN_MARIANA_ILN">Northern Mariana Islands</option>
        <option value="NORWAY">Norway</option>
        <option value="OMAN">Oman</option>
        <option value="PAKISTAN">Pakistan</option>
        <option value="PALAU">Palau</option>
        <option value="PALESTINE">Palestine</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="CONGO">Republic Of The Congo</option>
        <option value="REUNION">Reunion</option>
        <option value="ROMANIA">Romania</option>
        <option value="RUSSIA">Russia</option>
        <option value="RWANDA">Rwanda</option>
        <option value="SAINT BARTHELEMY">Saint Barthelemy</option>
        <option value="SAINT HELENA">Saint Helena</option>
        <option value="SAINT_KITTS_NEVIS">Saint Kitts And Nevis</option>
        <option value="SAINT LUCIA">Saint Lucia</option>
        <option value="SAINT_VINCENT_GREN">Saint Vincent And The Grenadines</option>
        <option value="SAINT-MARTIN">Saint-Martin</option>
        <option value="SAINTPIERRE_MIQUELON">Saint-Pierre And Miquelon</option>
        <option value="SAMOA">Samoa</option>
        <option value="SAN MARINO">San Marino</option>
        <option value="SAO_TOME_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="SOMALILAND">Somaliland</option>
        <option value="SOUTH AFRICA">South Africa</option>
        <option value="S_GEORGIA_SANDWICH">South Georgia And The South Sandwich Islands</option>
        <option value="SOUTH KOREA">South Korea</option>
        <option value="SOUTH OSSETIA">South Ossetia</option>
        <option value="SRI LANKA">Sri Lanka</option>
        <option value="SUDAN">Sudan</option>
        <option value="SURINAME">Suriname</option>
        <option value="SVALBARD_JAN_MAYEN">Svalbard And Jan Mayen</option>
        <option value="SWAZILAND">Swaziland</option>
        <option value="SWEDEN">Sweden</option>
        <option value="SWITZERLAND">Switzerland</option>
        <option value="SYRIA">Syria</option>
        <option value="TAIWAN">Taiwan</option>
        <option value="TAJIKISTAN">Tajikistan</option>
        <option value="TANZANIA">Tanzania</option>
        <option value="THAILAND">Thailand</option>
        <option value="TOGO">Togo</option>
        <option value="TOKELAU">Tokelau</option>
        <option value="TONGA">Tonga</option>
        <option value="TRANSNISTRIA">Transnistria</option>
        <option value="TRINIDAD AND TOBAGO">Trinidad And Tobago</option>
        <option value="TRISTAN DA CUNHA">Tristan Da Cunha</option>
        <option value="TUNISIA">Tunisia</option>
        <option value="TURKEY">Turkey</option>
        <option value="TURKMENISTAN">Turkmenistan</option>
        <option value="TURKS_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="US_MINOR_ISLANDS">United States Minor Outlying Islands</option>
        <option value="US_VIRGIN_ISLANDS">United States Virgin Islands</option>
        <option value="URUGUAY">Uruguay</option>
        <option value="UZBEKISTAN">Uzbekistan</option>
        <option value="VANUATU">Vanuatu</option>
        <option value="VATICAN CITY">Vatican City</option>
        <option value="VENEZUELA">Venezuela</option>
        <option value="VIETNAM">Vietnam</option>
        <option value="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>
      </select>
    </div>
    <div data-role="fieldcontain">
      <label for="txtMailingAddress" class="RequiredIcon" data-renameid="e_6rssnco1q5a">Address</label>
      <input type="text" id="txtMailingAddress" value="" maxlength="100" name="address" autocomplete="street-address" onchange="verifyAddress('Mailing');">
    </div>
    <div data-role="fieldcontain" id="divMailingAddress2" style="display: none;">
      <label for="txtMailingAddress2" data-renameid="e_7kfdlgwialp">Address Line 2</label>
      <input type="text" id="txtMailingAddress2" value="" maxlength="100" name="address2" autocomplete="address-line2" onchange="verifyAddress('Mailing');">
    </div>
    <div data-role="fieldcontain">
      <label for="txtMailingZip" id="lblMailingZipTitle" class="RequiredIcon" data-renameid="e_s5w4lgjkbe">Zip</label>
      <input type="text" id="txtMailingZip" value="" pattern="[0-9]*" maxlength="10" name="zip" autocomplete="postal-code" onchange="verifyAddress('Mailing');">
    </div>
    <div data-role="fieldcontain">
      <label for="txtMailingCity" id="lblMailingCityTitle" class="RequiredIcon" data-renameid="e_jo4vzt79u6">City</label>
      <input type="text" id="txtMailingCity" value="" name="city" autocomplete="address-level2" maxlength="50" onchange="verifyAddress('Mailing');">
    </div>
    <div class="div_ddl_mailing_state">
      <div data-role="fieldcontain">
        <label for="ddlMailingState" class="RequiredIcon" data-renameid="e_vduaudtfdr">State</label>
        <select id="ddlMailingState" value="" name="state" autocomplete="address-level1" onchange="verifyAddress('Mailing');">
          <option class="rename-able" value="" data-renameid="e_e87ncre8epw">--Please Select--</option>
          <option class="rename-able" value="AL" data-renameid="e_w330aifojxq">Alabama</option>
          <option class="rename-able" value="AK" data-renameid="e_z3jgnb14yv8">Alaska</option>
          <option class="rename-able" value="AS" data-renameid="e_cgo8aimp3qg">American Samoa</option>
          <option class="rename-able" value="AZ" data-renameid="e_0xjdr6hh1wo9">Arizona</option>
          <option class="rename-able" value="AR" data-renameid="e_x2nkr7687gj">Arkansas</option>
          <option class="rename-able" value="AA" data-renameid="e_8nzw7txenir">Armed Forces - Americas</option>
          <option class="rename-able" value="AE" data-renameid="e_bocr5c0rcbs">Armed Forces - Europe</option>
          <option class="rename-able" value="AP" data-renameid="e_yd471s3gdk">Armed Forces - Pacific</option>
          <option class="rename-able" value="CA" data-renameid="e_fvdtdjo4dbs">California</option>
          <option class="rename-able" value="CO" data-renameid="e_oshlf0xezf">Colorado</option>
          <option class="rename-able" value="CT" data-renameid="e_yylqdp63c3m">Connecticut</option>
          <option class="rename-able" value="DE" data-renameid="e_hf5qdjwzoau">Delaware</option>
          <option class="rename-able" value="DC" data-renameid="e_criw2jbzffg">District Of Columbia</option>
          <option class="rename-able" value="FL" data-renameid="e_mlurxpf98c">Florida</option>
          <option class="rename-able" value="FM" data-renameid="e_j2r8jshszlg">Federated States of Micronesia</option>
          <option class="rename-able" value="GA" data-renameid="e_log3ckx15aq">Georgia</option>
          <option class="rename-able" value="GU" data-renameid="e_jq9lbwd25tp">Guam</option>
          <option class="rename-able" value="HI" data-renameid="e_zfqlkhvnk9">Hawaii</option>
          <option class="rename-able" value="ID" data-renameid="e_lvmyaoiwcmd">Idaho</option>
          <option class="rename-able" value="IL" data-renameid="e_jkt8mlpxtxj">Illinois</option>
          <option class="rename-able" value="IN" data-renameid="e_1kj0nf1o7p8">Indiana</option>
          <option class="rename-able" value="IA" data-renameid="e_qqijzg6q5ta">Iowa</option>
          <option class="rename-able" value="KS" data-renameid="e_7xq4ridy9hh">Kansas</option>
          <option class="rename-able" value="KY" data-renameid="e_h6wp9to1am">Kentucky</option>
          <option class="rename-able" value="LA" data-renameid="e_9cku6qgzgt5">Louisiana</option>
          <option class="rename-able" value="ME" data-renameid="e_9zk1h1thebi">Maine</option>
          <option class="rename-able" value="MD" data-renameid="e_fxuaagwfmms">Maryland</option>
          <option class="rename-able" value="MA" data-renameid="e_ufnnu7wkah">Massachusetts</option>
          <option class="rename-able" value="MH" data-renameid="e_5c3n2k5yrzo">Marshall Islands</option>
          <option class="rename-able" value="MI" data-renameid="e_cs48wc9xdeb">Michigan</option>
          <option class="rename-able" value="MN" data-renameid="e_4o2zrk1atp5">Minnesota</option>
          <option class="rename-able" value="MS" data-renameid="e_g26cy0ocpng">Mississippi</option>
          <option class="rename-able" value="MO" data-renameid="e_b0o31mpmakn">Missouri</option>
          <option class="rename-able" value="MP" data-renameid="e_lgraow2y9od">Northern Mariana Islands</option>
          <option class="rename-able" value="MT" data-renameid="e_khu5z2qs99">Montana</option>
          <option class="rename-able" value="NE" data-renameid="e_6238m4xw9bh">Nebraska</option>
          <option class="rename-able" value="NV" data-renameid="e_ppp9qfz7xkp">Nevada</option>
          <option class="rename-able" value="NH" data-renameid="e_mk1n8l0v5c">New Hampshire</option>
          <option class="rename-able" value="NJ" data-renameid="e_nb7qn7f254j">New Jersey</option>
          <option class="rename-able" value="NM" data-renameid="e_gmzoupwo7dh">New Mexico</option>
          <option class="rename-able" value="NY" data-renameid="e_c4aog9d1qs">New York</option>
          <option class="rename-able" value="NC" data-renameid="e_jpklxq7av8b">North Carolina</option>
          <option class="rename-able" value="ND" data-renameid="e_lvbribs5uq">North Dakota</option>
          <option class="rename-able" value="OH" data-renameid="e_q877hzgrfsa">Ohio</option>
          <option class="rename-able" value="OK" data-renameid="e_romve13kpse">Oklahoma</option>
          <option class="rename-able" value="OR" data-renameid="e_nb2x2w876h">Oregon</option>
          <option class="rename-able" value="PA" data-renameid="e_vbxg9xlnlh">Pennsylvania</option>
          <option class="rename-able" value="PR" data-renameid="e_vnztvtr1ef8">Puerto Rico</option>
          <option class="rename-able" value="PW" data-renameid="e_xosi4uze2xb">Palau</option>
          <option class="rename-able" value="RI" data-renameid="e_ikv079jq2ac">Rhode Island</option>
          <option class="rename-able" value="SC" data-renameid="e_apyx7pwhikp">South Carolina</option>
          <option class="rename-able" value="SD" data-renameid="e_o11ej22ye7m">South Dakota</option>
          <option class="rename-able" value="TN" data-renameid="e_5pky2dozd7x">Tennessee</option>
          <option class="rename-able" value="TX" data-renameid="e_0p0io3oejhe">Texas</option>
          <option class="rename-able" value="UT" data-renameid="e_kdmdpazh1mj">Utah</option>
          <option class="rename-able" value="VT" data-renameid="e_5d8klmps89">Vermont</option>
          <option class="rename-able" value="VI" data-renameid="e_khypj7ldy4d">Virgin Islands</option>
          <option class="rename-able" value="VA" data-renameid="e_5etavmy9f6d">Virginia</option>
          <option class="rename-able" value="WA" data-renameid="e_qf1h68nwqm">Washington</option>
          <option class="rename-able" value="WV" data-renameid="e_g73vxjnty9p">West Virginia</option>
          <option class="rename-able" value="WI" data-renameid="e_ynah1s3hqfg">Wisconsin</option>
          <option class="rename-able" value="WY" data-renameid="e_jok5qexgq8j">Wyoming</option>
        </select>
      </div>
    </div>
    <div><span id="spVerifyMailingMessage" class="require-span" style="display: none;"> Unable to validate address</span></div>
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="co_if_ApplicantInfo" method="post" action="/handler/AutoFillHandler.aspx" id="co_frm_ApplicantInfo" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <div id="co_divScanDocument" style="margin-top: 2px;padding: 10px 0px;">
    <a href="#co_scandocs" data-rel="dialog" data-transition="pop" style="display: inline-block;" class="img-btn">
            <div class="scandocs-box">
	            <div class="caption-text">
                    <p class="caption">Click or tap here to pre-fill information with your driver's license</p>
                    <div class="pull-right">
                        <img src="/images/avatar.jpg" alt="avatar" class="img-responsive">
                    </div>
			        </div>
            </div>
	        </a>
  </div>
  <div class="sub_section_header header_theme" style="color: rgb(6, 6, 6); font-family: Roboto-light, sans-serif; font-weight: lighter;">
    <div class="svg-icon " id="svgPersonIcon"><svg width="40" height="40" preserveAspectRatio="xMinYMin" viewBox="-10 -5 123 123" style="fill: rgb(6, 6, 6);">
        <path d="M50.2,58.6c12.2,0,23.4-7.8,27.5-19.3c4.2-11.5,0.6-24.8-8.8-32.6
			C59.4-1.2,45.6-2.2,35,4.2C24.6,10.5,19.1,23,21.5,35c2.4,11.9,12.2,21.3,24.2,23.2C47.1,58.5,48.7,58.6,50.2,58.6z"></path>
        <path d="M72.3,55.5C62.6,63.7,48.8,65.9,37,61c-3.2-1.3-6.3-3.2-8.9-5.4
			C12.1,63.8,0.8,80.7,0,100.4h100.4C99.6,80.7,88.3,63.8,72.3,55.5C66.3,60.6,88.3,63.8,72.3,55.5z"></path>
      </svg></div>
    <div class="section-title rename-able " data-renameid="e_p7wsszjbec8">Personal Information</div>
  </div>
  <div id="co_divEmployeeOfLender">
    <div data-role="fieldcontain">
      <label for="co_ddlEmployeeOfLender" data-renameid="e_7chtek8097">Are you an employee of <span class="bold">New Dimensions FCU?</span></label>
      <select id="co_ddlEmployeeOfLender">
        <option class="rename-able" value="NONE" data-renameid="e_c720ce742d">No, I am not an Employee of New Dimensions F.C.U.</option>
        <option class="rename-able" value="EMPLOYEE" data-renameid="e_2cmolfo3axu">Yes, I am an Employee of New Dimensions F.C.U.</option>
      </select>
    </div>
  </div>
  <div data-role="fieldcontain">
    <label for="co_txtFName" class="RequiredIcon" data-renameid="e_nh5ld2xowp">First Name</label>
    <input type="text" id="co_txtFName" name="fname" autocomplete="given-name" class="FirstName" maxlength="50" value="">
  </div>
  <div data-role="fieldcontain">
    <label for="co_txtMName" data-renameid="e_pa4sptxvorp">Middle Name</label>
    <input type="text" id="co_txtMName" maxlength="50" name="mname" autocomplete="additional-name" value="">
  </div>
  <div data-role="fieldcontain">
    <label for="co_txtLName" class="RequiredIcon" data-renameid="e_rh3ugttr9se">Last Name</label>
    <input type="text" id="co_txtLName" maxlength="50" name="lname" autocomplete="family-name" value="">
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="co_if_ContactInfo" method="post" action="/handler/AutoFillHandler.aspx" id="co_frm_ContactInfo" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <div data-role="fieldcontain">
    <label id="co_lblPreferedMethod" for="co_preferredContactMethod" data-renameid="e_tafneauwtc">Preferred Contact Method</label>
    <select name="preferredContactMethod" id="co_preferredContactMethod" data-prev-value="" onchange=" co_updateContactInfo(this)">
      <option value="">--Please Select--</option>
      <option class="rename-able" value="EMAIL" data-renameid="e_jpsb1gwp8nh">Email</option>
      <option class="rename-able" value="HOME" data-renameid="e_l6rl45ud6yg">Home</option>
      <option class="rename-able" value="CELL" data-renameid="e_1az22tpipo4">Cell</option>
      <option class="rename-able" value="WORK" data-renameid="e_q4jg8sl7wjg">Work</option>
    </select>
  </div>
  <div data-role="fieldcontain">
    <label id="co_lblEmail" for="co_txtEmail" class="RequiredIcon" data-renameid="e_b0q9icw3tu9">Email</label>
    <input type="email" name="email" autocomplete="email" id="co_txtEmail" maxlength="50" value="">
  </div>
  <div data-role="fieldcontain" id="co_divHomePhone">
    <div>
      <div style="display: inline-block;"><label id="co_lblHomePhone" for="co_txtHomePhone" class="RequiredIcon" style="white-space: nowrap;" data-renameid="e_90y8c02p9n">Home Phone</label></div>
      <div style="display: inline-block;"><label class="phone_format rename-able" for="co_txtHomePhone" style="white-space: nowrap; font-style: italic;" data-renameid="e_hyntj6bk24v">(xxx) xxx-xxxx</label></div>
    </div>
    <input type="text" pattern="[0-9]*" autocomplete="tel" name="phone" id="co_txtHomePhone" class="inphone" maxlength="14" value="">
  </div>
  <div data-role="fieldcontain" id="co_divMobilePhone">
    <div>
      <div style="display: inline-block;"><label id="co_lblMobilePhone" for="co_txtMobilePhone" class="" style="white-space: nowrap;" data-renameid="e_pnjhvhk0d0d">Cell Phone</label></div>
      <div style="display: inline-block;"><label class="phone_format rename-able" for="co_txtMobilePhone" style="white-space: nowrap; font-style: italic;" data-renameid="e_1zxtpn5lnoe">(xxx) xxx-xxxx</label></div>
    </div>
    <input type="text" pattern="[0-9]*" autocomplete="tel" name="mobile" id="co_txtMobilePhone" class="inphone" maxlength="14" value="">
  </div>
  <div data-role="fieldcontain" id="co_divWorkPhone">
    <div>
      <div style="display: inline-block;"><label id="co_lblWorkPhone" for="co_txtWorkPhone" style="white-space: nowrap;" data-renameid="e_7ujrq04siuw">Work Phone</label></div>
      <div style="display: inline-block;"><label class="phone_format rename-able" for="co_txtWorkPhone" style="white-space: nowrap; font-style: italic;" data-renameid="e_792cm4mu7pm">(xxx) xxx-xxxx</label></div>
    </div>
    <input type="text" pattern="[0-9]*" autocomplete="off" name="workphone" id="co_txtWorkPhone" class="inphone" maxlength="14" value="">
  </div>
  <div data-role="fieldcontain" class="hidden">
    <label for="co_txtWorkPhoneExt" data-renameid="e_3f7hbggaisv">Work Phone Extension</label>
    <input type="text" pattern="[0-9]*" id="co_txtWorkPhoneExt" name="ext" autocomplete="off" maxlength="5" value="" class="numeric">
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="co_if_Address" method="post" action="/handler/AutoFillHandler.aspx" id="co_frm_Address" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <input type="hidden" id="co_hdAddressVerifiedDate">
  <input type="hidden" id="co_hdPreviousAddressVerifiedDate">
  <input type="hidden" id="co_hdMailingAddressVerifiedDate">
  <!--move copy primary address for joint-->
  <div style="display: block;" id="co_divCopyAddress">
    <div style="margin-top: 15.6px;">
      <a href="#" class="header_theme2 shadow-btn chevron-circle-right-before" name="btnCopyAddress" id="co_btnCopyAddress" onclick="co_CopyPrimaryAddress(event);co_showHideState();" data-renameid="e_i0g8nqvrdu9" style="color: rgb(0, 139, 154);">Copy the Primary Applicant's Address</a>
    </div>
  </div>
  <div id="co_div_ddl_country" style="display: none;">
    <div data-role="fieldcontain">
      <label for="co_ddlCountry" class="RequiredIcon" data-renameid="e_zu83je8nk4g">Country</label>
      <select id="co_ddlCountry" name="country" autocomplete="country" onchange="co_showHideState()">
        <option value="USA" selected="selected">USA</option>
        <option value="FRANCE">France</option>
        <option value="GERMANY">Germany</option>
        <option value="ITALY">Italy</option>
        <option value="SPAIN">Spain</option>
        <option value="UNITED KINGDOM">United Kingdom</option>
        <option value="AALAND">Aaland</option>
        <option value="ABKHAZIA">Abkhazia</option>
        <option value="AFGHANISTAN">Afghanistan</option>
        <option value="ALBANIA">Albania</option>
        <option value="ALGERIA">Algeria</option>
        <option value="AMERICAN SAMOA">American Samoa</option>
        <option value="ANDORRA">Andorra</option>
        <option value="ANGOLA">Angola</option>
        <option value="ANGUILLA">Anguilla</option>
        <option value="ANTARCTICA">Antarctica</option>
        <option value="ANTIGUA_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_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">British Indian Ocean Territory</option>
        <option value="BRITISH_VIRGIN_ILND">British Virgin Islands</option>
        <option value="BRUNEI">Brunei</option>
        <option value="BULGARIA">Bulgaria</option>
        <option value="BURKINA FASO">Burkina Faso</option>
        <option value="BURUNDI">Burundi</option>
        <option value="CAMBODIA">Cambodia</option>
        <option value="CAMEROON">Cameroon</option>
        <option value="CANADA">Canada</option>
        <option value="CAPE VERDE">Cape Verde</option>
        <option value="CAYMAN ISLANDS">Cayman Islands</option>
        <option value="CENTRAL AFRICAN REP">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 ISLANDS">Cocos Islands</option>
        <option value="COLOMBIA">Colombia</option>
        <option value="COMOROS">Comoros</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="DEMOCRATIC_REP_CONGO">Democratic Republic Of The Congo</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="TIMOR-LESTE">East Timor</option>
        <option value="ECUADOR">Ecuador</option>
        <option value="EGYPT">Egypt</option>
        <option value="EL SALVADOR">El Salvador</option>
        <option value="EQUATORIAL GUINEA">Equatorial Guinea</option>
        <option value="ERITREA">Eritrea</option>
        <option value="ESTONIA">Estonia</option>
        <option value="ETHIOPIA">Ethiopia</option>
        <option value="FALKLAND ISLANDS">Falkland Islands</option>
        <option value="FAROE ISLANDS">Faroe Islands</option>
        <option value="FIJI">Fiji</option>
        <option value="FINLAND">Finland</option>
        <option value="FRENCH GUIANA">French Guiana</option>
        <option value="FRENCH POLYNESIA">French Polynesia</option>
        <option value="FRENCH_SOUTHERN_TERR">French Southern Territories</option>
        <option value="GABON">Gabon</option>
        <option value="GAMBIA">Gambia</option>
        <option value="GEORGIA">Georgia</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_MCDONALD_ILND">Heard Island And Mcdonald Islands</option>
        <option value="HONDURAS">Honduras</option>
        <option value="HONG KONG">Hong Kong</option>
        <option value="HUNGARY">Hungary</option>
        <option value="ICELAND">Iceland</option>
        <option value="INDIA">India</option>
        <option value="INDONESIA">Indonesia</option>
        <option value="IRAN">Iran</option>
        <option value="IRAQ">Iraq</option>
        <option value="IRELAND">Ireland</option>
        <option value="ISLE OF MAN">Isle Of Man</option>
        <option value="ISRAEL">Israel</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="KOSOVO">Kosovo</option>
        <option value="KUWAIT">Kuwait</option>
        <option value="KYRGYZSTAN">Kyrgyzstan</option>
        <option value="LAOS">Laos</option>
        <option value="LATVIA">Latvia</option>
        <option value="LEBANON">Lebanon</option>
        <option value="LESOTHO">Lesotho</option>
        <option value="LIBERIA">Liberia</option>
        <option value="LIBYA">Libya</option>
        <option value="LIECHTENSTEIN">Liechtenstein</option>
        <option value="LITHUANIA">Lithuania</option>
        <option value="LUXEMBOURG">Luxembourg</option>
        <option value="MACAU">Macau</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">Micronesia</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="NAGORNO-KARABAKH">Nagorno-Karabakh</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="NORTH KOREA">North Korea</option>
        <option value="NORTHERN CYPRUS">Northern Cyprus</option>
        <option value="NORTHERN_MARIANA_ILN">Northern Mariana Islands</option>
        <option value="NORWAY">Norway</option>
        <option value="OMAN">Oman</option>
        <option value="PAKISTAN">Pakistan</option>
        <option value="PALAU">Palau</option>
        <option value="PALESTINE">Palestine</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="CONGO">Republic Of The Congo</option>
        <option value="REUNION">Reunion</option>
        <option value="ROMANIA">Romania</option>
        <option value="RUSSIA">Russia</option>
        <option value="RWANDA">Rwanda</option>
        <option value="SAINT BARTHELEMY">Saint Barthelemy</option>
        <option value="SAINT HELENA">Saint Helena</option>
        <option value="SAINT_KITTS_NEVIS">Saint Kitts And Nevis</option>
        <option value="SAINT LUCIA">Saint Lucia</option>
        <option value="SAINT_VINCENT_GREN">Saint Vincent And The Grenadines</option>
        <option value="SAINT-MARTIN">Saint-Martin</option>
        <option value="SAINTPIERRE_MIQUELON">Saint-Pierre And Miquelon</option>
        <option value="SAMOA">Samoa</option>
        <option value="SAN MARINO">San Marino</option>
        <option value="SAO_TOME_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="SOMALILAND">Somaliland</option>
        <option value="SOUTH AFRICA">South Africa</option>
        <option value="S_GEORGIA_SANDWICH">South Georgia And The South Sandwich Islands</option>
        <option value="SOUTH KOREA">South Korea</option>
        <option value="SOUTH OSSETIA">South Ossetia</option>
        <option value="SRI LANKA">Sri Lanka</option>
        <option value="SUDAN">Sudan</option>
        <option value="SURINAME">Suriname</option>
        <option value="SVALBARD_JAN_MAYEN">Svalbard And Jan Mayen</option>
        <option value="SWAZILAND">Swaziland</option>
        <option value="SWEDEN">Sweden</option>
        <option value="SWITZERLAND">Switzerland</option>
        <option value="SYRIA">Syria</option>
        <option value="TAIWAN">Taiwan</option>
        <option value="TAJIKISTAN">Tajikistan</option>
        <option value="TANZANIA">Tanzania</option>
        <option value="THAILAND">Thailand</option>
        <option value="TOGO">Togo</option>
        <option value="TOKELAU">Tokelau</option>
        <option value="TONGA">Tonga</option>
        <option value="TRANSNISTRIA">Transnistria</option>
        <option value="TRINIDAD AND TOBAGO">Trinidad And Tobago</option>
        <option value="TRISTAN DA CUNHA">Tristan Da Cunha</option>
        <option value="TUNISIA">Tunisia</option>
        <option value="TURKEY">Turkey</option>
        <option value="TURKMENISTAN">Turkmenistan</option>
        <option value="TURKS_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="US_MINOR_ISLANDS">United States Minor Outlying Islands</option>
        <option value="US_VIRGIN_ISLANDS">United States Virgin Islands</option>
        <option value="URUGUAY">Uruguay</option>
        <option value="UZBEKISTAN">Uzbekistan</option>
        <option value="VANUATU">Vanuatu</option>
        <option value="VATICAN CITY">Vatican City</option>
        <option value="VENEZUELA">Venezuela</option>
        <option value="VIETNAM">Vietnam</option>
        <option value="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>
      </select>
    </div>
  </div>
  <div data-role="fieldcontain">
    <label for="co_txtAddress" class="RequiredIcon" data-renameid="e_5bqn55f3cex">Address</label>
    <input type="text" id="co_txtAddress" maxlength="100" name="address1" autocomplete="street-address" value="" onchange="co_verifyAddress('');">
  </div>
  <div data-role="fieldcontain" id="co_divAddress2" style="display: none;">
    <label for="co_txtAddress2" data-renameid="e_nhjv9ia137">Address Line 2</label>
    <input type="text" id="co_txtAddress2" maxlength="100" name="address2" autocomplete="address-line2" value="" onchange="co_verifyAddress('');">
  </div>
  <div data-role="fieldcontain">
    <label for="co_txtZip" id="co_lblZipTitle" class="RequiredIcon" data-renameid="e_s1g9lk7gkys">Zip</label>
    <input type="text" id="co_txtZip" maxlength="10" pattern="[0-9]*" name="zip" autocomplete="postal-code" value="" onchange="co_verifyAddress('');">
  </div>
  <div data-role="fieldcontain">
    <label for="co_txtCity" id="co_lblCityTitle" class="RequiredIcon" data-renameid="e_0j6qxaeg20h">City</label>
    <input type="text" id="co_txtCity" maxlength="50" name="city" autocomplete="address-level2" value="" onchange="co_verifyAddress('');">
  </div>
  <div class="co_div_ddl_state">
    <div data-role="fieldcontain">
      <label for="co_ddlState" class="RequiredIcon" data-renameid="e_hfb33pugym">State</label>
      <select id="co_ddlState" name="state" autocomplete="address-level1" onchange="co_verifyAddress('');">
        <option class="rename-able" value="" data-renameid="e_rpnp1ww7qf">--Please Select--</option>
        <option class="rename-able" value="AL" data-renameid="e_9mz2z7pcff">Alabama</option>
        <option class="rename-able" value="AK" data-renameid="e_pey9gadk1z">Alaska</option>
        <option class="rename-able" value="AS" data-renameid="e_7vzh2de10ux">American Samoa</option>
        <option class="rename-able" value="AZ" data-renameid="e_cwfc8dtod4l">Arizona</option>
        <option class="rename-able" value="AR" data-renameid="e_3afx0rtbvgt">Arkansas</option>
        <option class="rename-able" value="AA" data-renameid="e_g42fjsnhrve">Armed Forces - Americas</option>
        <option class="rename-able" value="AE" data-renameid="e_lc1to5arfvl">Armed Forces - Europe</option>
        <option class="rename-able" value="AP" data-renameid="e_tg6xydi9tx">Armed Forces - Pacific</option>
        <option class="rename-able" value="CA" data-renameid="e_84eqx7z70ql">California</option>
        <option class="rename-able" value="CO" data-renameid="e_3i4jr07pl91">Colorado</option>
        <option class="rename-able" value="CT" data-renameid="e_v5cu46in23j">Connecticut</option>
        <option class="rename-able" value="DE" data-renameid="e_8q9wzcfxh58">Delaware</option>
        <option class="rename-able" value="DC" data-renameid="e_8qjf578mcmw">District Of Columbia</option>
        <option class="rename-able" value="FL" data-renameid="e_1aq6ft8p2c5">Florida</option>
        <option class="rename-able" value="FM" data-renameid="e_owoxi5seu6">Federated States of Micronesia</option>
        <option class="rename-able" value="GA" data-renameid="e_wye8ga6nt1">Georgia</option>
        <option class="rename-able" value="GU" data-renameid="e_63rpj4i8he9">Guam</option>
        <option class="rename-able" value="HI" data-renameid="e_sxodnqevzh">Hawaii</option>
        <option class="rename-able" value="ID" data-renameid="e_c8ni94ua6nr">Idaho</option>
        <option class="rename-able" value="IL" data-renameid="e_mjxvolg7yzc">Illinois</option>
        <option class="rename-able" value="IN" data-renameid="e_8senuxmbc5">Indiana</option>
        <option class="rename-able" value="IA" data-renameid="e_q5mqu72bmxg">Iowa</option>
        <option class="rename-able" value="KS" data-renameid="e_of00w4jqgvg">Kansas</option>
        <option class="rename-able" value="KY" data-renameid="e_y2z6hjblt1">Kentucky</option>
        <option class="rename-able" value="LA" data-renameid="e_edg2t7s1gw">Louisiana</option>
        <option class="rename-able" value="ME" data-renameid="e_unaqs724uk">Maine</option>
        <option class="rename-able" value="MD" data-renameid="e_6y892txqng">Maryland</option>
        <option class="rename-able" value="MA" data-renameid="e_vsljwf9skq">Massachusetts</option>
        <option class="rename-able" value="MH" data-renameid="e_kvbxapvon58">Marshall Islands</option>
        <option class="rename-able" value="MI" data-renameid="e_m3rjdjddy3m">Michigan</option>
        <option class="rename-able" value="MN" data-renameid="e_7wu9748a09v">Minnesota</option>
        <option class="rename-able" value="MS" data-renameid="e_8npqyncxg4">Mississippi</option>
        <option class="rename-able" value="MO" data-renameid="e_269a77a8y2g">Missouri</option>
        <option class="rename-able" value="MP" data-renameid="e_4uor5pmvqpx">Northern Mariana Islands</option>
        <option class="rename-able" value="MT" data-renameid="e_6mv95ury81l">Montana</option>
        <option class="rename-able" value="NE" data-renameid="e_2v4u6agqlqh">Nebraska</option>
        <option class="rename-able" value="NV" data-renameid="e_7j1o7hkku52">Nevada</option>
        <option class="rename-able" value="NH" data-renameid="e_u1yjpzv7h8">New Hampshire</option>
        <option class="rename-able" value="NJ" data-renameid="e_n2lccrbb0rd">New Jersey</option>
        <option class="rename-able" value="NM" data-renameid="e_arght12w7tu">New Mexico</option>
        <option class="rename-able" value="NY" data-renameid="e_hb0kzugxxws">New York</option>
        <option class="rename-able" value="NC" data-renameid="e_96ajovxs2ff">North Carolina</option>
        <option class="rename-able" value="ND" data-renameid="e_k8c6z49x37">North Dakota</option>
        <option class="rename-able" value="OH" data-renameid="e_3620acrurbr">Ohio</option>
        <option class="rename-able" value="OK" data-renameid="e_hywcdbfvt08">Oklahoma</option>
        <option class="rename-able" value="OR" data-renameid="e_egg0rerqssr">Oregon</option>
        <option class="rename-able" value="PA" data-renameid="e_59snvljsl4f">Pennsylvania</option>
        <option class="rename-able" value="PR" data-renameid="e_81er4u3ztlo">Puerto Rico</option>
        <option class="rename-able" value="PW" data-renameid="e_zaptmh37fs">Palau</option>
        <option class="rename-able" value="RI" data-renameid="e_v11undyjhyj">Rhode Island</option>
        <option class="rename-able" value="SC" data-renameid="e_b7nepi0wa9c">South Carolina</option>
        <option class="rename-able" value="SD" data-renameid="e_q8j4vpu7cq">South Dakota</option>
        <option class="rename-able" value="TN" data-renameid="e_m308d4uv8k">Tennessee</option>
        <option class="rename-able" value="TX" data-renameid="e_nzvzvpy1pb">Texas</option>
        <option class="rename-able" value="UT" data-renameid="e_25s34yv6dky">Utah</option>
        <option class="rename-able" value="VT" data-renameid="e_41t29ww6lw3">Vermont</option>
        <option class="rename-able" value="VI" data-renameid="e_0tvoakqu0f5">Virgin Islands</option>
        <option class="rename-able" value="VA" data-renameid="e_vd3vlq9z5ys">Virginia</option>
        <option class="rename-able" value="WA" data-renameid="e_apvar5bymp9">Washington</option>
        <option class="rename-able" value="WV" data-renameid="e_5ti76or3zvs">West Virginia</option>
        <option class="rename-able" value="WI" data-renameid="e_024qsmigtg19">Wisconsin</option>
        <option class="rename-able" value="WY" data-renameid="e_27f1x1quv84">Wyoming</option>
      </select>
    </div>
  </div>
  <div><span id="co_spVerifyMessage" class="require-span" style="display: none;">Unable to validate address</span> </div>
  <div id="co_divOccupancyStatusSection">
    <div data-role="fieldcontain">
      <label for="co_ddlOccupyingStatus" class="RequiredIcon" data-renameid="e_43nzgnq4m4f">Occupancy Status</label>
      <select id="co_ddlOccupyingStatus" onchange="co_HandleOccupancyStatusChange(false)">
        <option class="rename-able" value=" " data-renameid="e_3033zyroy5w">--Please Select--</option>
        <option class="rename-able" value="BUYING/OWN WITH MORTGAGE" data-renameid="e_qjioumky8sn">Buying/Own With Mortgage</option>
        <option class="rename-able" value="LIVE WITH PARENTS" data-renameid="e_ls6ahnidmn">Live With Parents</option>
        <option class="rename-able" value="OWN - FREE AND CLEAR" data-renameid="e_ztzwlf2bcoc">Own - Free And Clear</option>
        <option class="rename-able" value="RENT" data-renameid="e_ifxjguyghia">Rent</option>
        <option class="rename-able" value="GOVERNMENT QUARTERS" data-renameid="e_c4iqpil2oi">Government Quarters</option>
        <option class="rename-able" value="OTHER" data-renameid="e_klvqvvvh84r">Other</option>
      </select>
    </div>
    <div data-role="fieldcontain">
      <label id="co_lblOccupancyDuration" class="rename-able RequiredIcon" data-renameid="e_1yv9cidcclv">Occupancy Duration</label>
      <div id="co_divOccupancyDuration" class="ui-input-horizal row">
        <div class="col-xs-6">
          <!--input type="text"  pattern="[0-9]*" id="co_txtOccupancyDurationYear" maxlength="2" class="numeric inyear" /-->
          <select id="co_ddlOccupancyDurationYear" class="co_OccupancyDuration" aria-labelledby="co_lblOccupancyDuration">
            <option value=" " class="rename-able" data-renameid="e_licahdl1sg">Years</option>
            <option class="rename-able" value="0" data-renameid="e_4y3agosef37">0</option>
            <option class="rename-able" value="1" data-renameid="e_6wmoqkr7kjh">1</option>
            <option class="rename-able" value="2" data-renameid="e_ph6fsotfjao">2</option>
            <option class="rename-able" value="3" data-renameid="e_79vr56exbt2">3</option>
            <option class="rename-able" value="4" data-renameid="e_8y1nos7k2xw">4</option>
            <option class="rename-able" value="5" data-renameid="e_civlalj8nyd">5</option>
            <option class="rename-able" value="6" data-renameid="e_nf2mlzczv2k">6</option>
            <option class="rename-able" value="7" data-renameid="e_yitphc01aro">7</option>
            <option class="rename-able" value="8" data-renameid="e_r3pvy8ztjnk">8</option>
            <option class="rename-able" value="9" data-renameid="e_4i2iioql2il">9</option>
            <option class="rename-able" value="10" data-renameid="e_cifvke1vzsi">10</option>
            <option class="rename-able" value="11" data-renameid="e_nh51xt5ums">11</option>
            <option class="rename-able" value="12" data-renameid="e_yrqtinxozci">12</option>
            <option class="rename-able" value="13" data-renameid="e_x9q6as3az8">13</option>
            <option class="rename-able" value="14" data-renameid="e_5lz1odz6pi3">14</option>
            <option class="rename-able" value="15" data-renameid="e_oojv3lwu4ys">15</option>
            <option class="rename-able" value="16" data-renameid="e_xsaszsmsml">16</option>
            <option class="rename-able" value="17" data-renameid="e_qqsepno7lpf">17</option>
            <option class="rename-able" value="18" data-renameid="e_i55d36no6co">18</option>
            <option class="rename-able" value="19" data-renameid="e_yj4agld8kfn">19</option>
            <option class="rename-able" value="20" data-renameid="e_7r5dw6cdq58">20</option>
            <option class="rename-able" value="21" data-renameid="e_wnmrhkytfal">21</option>
            <option class="rename-able" value="22" data-renameid="e_vn005ppocfc">22</option>
            <option class="rename-able" value="23" data-renameid="e_7q5vnbkewgs">23</option>
            <option class="rename-able" value="24" data-renameid="e_txjx3bvbirh">24</option>
            <option class="rename-able" value="25" data-renameid="e_6a3qv3tpbtw">25</option>
            <option class="rename-able" value="26" data-renameid="e_12x1abvw7q6i">26</option>
            <option class="rename-able" value="27" data-renameid="e_4q1urzid83v">27</option>
            <option class="rename-able" value="28" data-renameid="e_8cmpnw4f4h3">28</option>
            <option class="rename-able" value="29" data-renameid="e_76vf8fx8uar">29</option>
            <option class="rename-able" value="30" data-renameid="e_zn56edjck4p">30</option>
            <option class="rename-able" value="31" data-renameid="e_bvf3w3z8xs">31</option>
            <option class="rename-able" value="32" data-renameid="e_0acnnxo7v5cr">32</option>
            <option class="rename-able" value="33" data-renameid="e_uu9p0t3mwfg">33</option>
            <option class="rename-able" value="34" data-renameid="e_tpoplk4xek9">34</option>
            <option class="rename-able" value="35" data-renameid="e_0ux2lt1h4bo9">35</option>
            <option class="rename-able" value="36" data-renameid="e_nrpxq7juoq">36</option>
            <option class="rename-able" value="37" data-renameid="e_et8gssp1bjc">37</option>
            <option class="rename-able" value="38" data-renameid="e_jpgkwcasmbc">38</option>
            <option class="rename-able" value="39" data-renameid="e_v1g9gf3j1m">39</option>
            <option class="rename-able" value="40" data-renameid="e_1eqj8g1h0mn">40</option>
            <option class="rename-able" value="41" data-renameid="e_7ls462zngfx">41</option>
            <option class="rename-able" value="42" data-renameid="e_wtmckpt8z">42</option>
            <option class="rename-able" value="43" data-renameid="e_rd9r0s5uedo">43</option>
            <option class="rename-able" value="44" data-renameid="e_i8g4a4pbund">44</option>
            <option class="rename-able" value="45" data-renameid="e_2loxtf3grqr">45</option>
            <option class="rename-able" value="46" data-renameid="e_bt1g8sga0oe">46</option>
            <option class="rename-able" value="47" data-renameid="e_lugbjuy3lw">47</option>
            <option class="rename-able" value="48" data-renameid="e_3zi6j55zsdy">48</option>
            <option class="rename-able" value="49" data-renameid="e_2zd31tdpg3l">49</option>
            <option class="rename-able" value="50" data-renameid="e_6c2qevvx37h">50</option>
            <option class="rename-able" value="51" data-renameid="e_quu6ylaf4t">51</option>
            <option class="rename-able" value="52" data-renameid="e_ygcaq0zsgud">52</option>
            <option class="rename-able" value="53" data-renameid="e_tn813yiv2b">53</option>
            <option class="rename-able" value="54" data-renameid="e_pm4pma2gouq">54</option>
            <option class="rename-able" value="55" data-renameid="e_ujbyh1f3vmj">55</option>
            <option class="rename-able" value="56" data-renameid="e_zxdt36huqar">56</option>
            <option class="rename-able" value="57" data-renameid="e_6gfxkrvkcyn">57</option>
            <option class="rename-able" value="58" data-renameid="e_ijwsrnoek8">58</option>
            <option class="rename-able" value="59" data-renameid="e_jwgwb7jhp8p">59</option>
            <option class="rename-able" value="60" data-renameid="e_jkyxz9naai">60</option>
            <option class="rename-able" value="61" data-renameid="e_8wlp2uf14fv">61</option>
            <option class="rename-able" value="62" data-renameid="e_kjtknbpyzo">62</option>
            <option class="rename-able" value="63" data-renameid="e_ts0ghnlltce">63</option>
            <option class="rename-able" value="64" data-renameid="e_qdq1u0h1gr">64</option>
            <option class="rename-able" value="65" data-renameid="e_4a1r2i9xy">65</option>
            <option class="rename-able" value="66" data-renameid="e_essdr2gze">66</option>
            <option class="rename-able" value="67" data-renameid="e_yga2gdjdib">67</option>
            <option class="rename-able" value="68" data-renameid="e_bnbzb8xv4gq">68</option>
            <option class="rename-able" value="69" data-renameid="e_08uzncazvxab">69</option>
            <option class="rename-able" value="70" data-renameid="e_cogpanqssmw">70</option>
            <option class="rename-able" value="71" data-renameid="e_nv2gppglqt">71</option>
            <option class="rename-able" value="72" data-renameid="e_i0py56npe8f">72</option>
            <option class="rename-able" value="73" data-renameid="e_toygx64j8yn">73</option>
            <option class="rename-able" value="74" data-renameid="e_648pttjvt4g">74</option>
            <option class="rename-able" value="75" data-renameid="e_7t80fkywovv">75</option>
            <option class="rename-able" value="76" data-renameid="e_7bafotpw39i">76</option>
            <option class="rename-able" value="77" data-renameid="e_8at80xezejf">77</option>
            <option class="rename-able" value="78" data-renameid="e_9f7n3fvuxt">78</option>
            <option class="rename-able" value="79" data-renameid="e_w6yr0jilty">79</option>
            <option class="rename-able" value="80" data-renameid="e_2mdevzt9ajr">80</option>
            <option class="rename-able" value="81" data-renameid="e_w2ylnjg8i1">81</option>
            <option class="rename-able" value="82" data-renameid="e_7j2t70ltjp4">82</option>
            <option class="rename-able" value="83" data-renameid="e_yqzctqwulu">83</option>
            <option class="rename-able" value="84" data-renameid="e_on26q6wqav">84</option>
            <option class="rename-able" value="85" data-renameid="e_w0bvxutict">85</option>
            <option class="rename-able" value="86" data-renameid="e_8ub0rl9lvgq">86</option>
            <option class="rename-able" value="87" data-renameid="e_hqdvh1xvqna">87</option>
            <option class="rename-able" value="88" data-renameid="e_t99lwis7vnb">88</option>
            <option class="rename-able" value="89" data-renameid="e_lhem5he7t8k">89</option>
            <option class="rename-able" value="90" data-renameid="e_mqj8990gl6r">90</option>
            <option class="rename-able" value="91" data-renameid="e_r4uohk04h2s">91</option>
            <option class="rename-able" value="92" data-renameid="e_fy1m3yzn9nm">92</option>
            <option class="rename-able" value="93" data-renameid="e_0w4mi8o78zvb">93</option>
            <option class="rename-able" value="94" data-renameid="e_u4pk2sf2wtf">94</option>
            <option class="rename-able" value="95" data-renameid="e_lfm0qrboi6n">95</option>
            <option class="rename-able" value="96" data-renameid="e_60x3r882rv">96</option>
            <option class="rename-able" value="97" data-renameid="e_i1z8qd7xc4n">97</option>
            <option class="rename-able" value="98" data-renameid="e_lrydrmaeuqe">98</option>
            <option class="rename-able" value="99" data-renameid="e_7xbe2yrdon">99</option>
          </select>
        </div>
        <div class="col-xs-6">
          <select id="co_ddlOccupancyDurationMonth" class="co_OccupancyDuration" aria-labelledby="co_lblOccupancyDuration">
            <option value=" " class="rename-able" data-renameid="e_ifedc2ywio">Months</option>
            <option class="rename-able" value="0" data-renameid="e_viibm5ei3z">0</option>
            <option class="rename-able" value="1" data-renameid="e_i8fpb3vx7j">1</option>
            <option class="rename-able" value="2" data-renameid="e_n2ux8t0esfj">2</option>
            <option class="rename-able" value="3" data-renameid="e_4umxoet3yv6">3</option>
            <option class="rename-able" value="4" data-renameid="e_kq8i0e6w6v">4</option>
            <option class="rename-able" value="5" data-renameid="e_rj55o6uoyqh">5</option>
            <option class="rename-able" value="6" data-renameid="e_wb76814zjbn">6</option>
            <option class="rename-able" value="7" data-renameid="e_2ug5lajkt9m">7</option>
            <option class="rename-able" value="8" data-renameid="e_l6vi739g4me">8</option>
            <option class="rename-able" value="9" data-renameid="e_c2wa9p1b9ne">9</option>
            <option class="rename-able" value="10" data-renameid="e_sif3jy5t1cm">10</option>
            <option class="rename-able" value="11" data-renameid="e_nmrhmmlbumq">11</option>
          </select>
        </div>
      </div>
    </div>
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="co_if_Address" method="post" action="/handler/AutoFillHandler.aspx" id="co_frm_PreviousAdress" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <div id="co_divPreviousAddress" style="display:none">
    <br>
    <div style="font-size:17px;font-weight :bold">Previous Address</div>
    <div id="co_div_ddl_previous_country" style="display:none" data-role="fieldcontain">
      <label for="co_ddlPreviousCountry" class="RequiredIcon" data-renameid="e_52z3ij6n0qr">Country</label>
      <select id="co_ddlPreviousCountry" name="country" autocomplete="country" onchange="co_showHidePreviousState()">
        <option value="USA" selected="selected">USA</option>
      </select>
    </div>
    <div data-role="fieldcontain">
      <label for="co_txtPreviousAddress" class="RequiredIcon" data-renameid="e_c65etskdwlf">Address</label>
      <input type="text" id="co_txtPreviousAddress" value="" maxlength="100" name="address1" autocomplete="street-address" onchange="co_verifyAddress('Previous');">
    </div>
    <div data-role="fieldcontain" id="co_divPreviousAddress2" style="display: none;">
      <label for="co_txtPreviousAddress2" data-renameid="e_ebomt40ywc">Address Line 2</label>
      <input type="text" id="co_txtPreviousAddress2" value="" maxlength="100" name="address2" autocomplete="address-line2" onchange="co_verifyAddress('Previous');">
    </div>
    <div data-role="fieldcontain">
      <label for="co_txtPreviousZip" id="co_lblPreviousZipTitle" class="RequiredIcon" data-renameid="e_rs47aiamcrr">Zip</label>
      <input type="text" id="co_txtPreviousZip" value="" pattern="[0-9]*" maxlength="10" name="zip" autocomplete="postal-code" onchange="co_verifyAddress('Previous');">
    </div>
    <div data-role="fieldcontain">
      <label for="co_txtPreviousCity" id="co_lblPreviousCityTitle" class="RequiredIcon" data-renameid="e_2zcn25mr9oy">City</label>
      <input type="text" id="co_txtPreviousCity" value="" maxlength="50" name="city" autocomplete="address-level2" onchange="co_verifyAddress('Previous');">
    </div>
    <div class="co_div_ddl_previous_state">
      <div data-role="fieldcontain">
        <label for="co_ddlPreviousState" class="RequiredIcon" data-renameid="e_j1q20dlt9os">State</label>
        <select id="co_ddlPreviousState" value="" name="state" autocomplete="address-level1" onchange="co_verifyAddress('Previous');">
          <option class="rename-able" value="" data-renameid="e_qu2pdh2es1r">--Please Select--</option>
          <option class="rename-able" value="AL" data-renameid="e_baoscmuh01c">Alabama</option>
          <option class="rename-able" value="AK" data-renameid="e_rei2tzge9uh">Alaska</option>
          <option class="rename-able" value="AS" data-renameid="e_qn5zof273j">American Samoa</option>
          <option class="rename-able" value="AZ" data-renameid="e_p20mv5iqo2">Arizona</option>
          <option class="rename-able" value="AR" data-renameid="e_cslhxnkze8h">Arkansas</option>
          <option class="rename-able" value="AA" data-renameid="e_d4pfws7y02n">Armed Forces - Americas</option>
          <option class="rename-able" value="AE" data-renameid="e_d45yukgqtbk">Armed Forces - Europe</option>
          <option class="rename-able" value="AP" data-renameid="e_s5yrwdk4t4">Armed Forces - Pacific</option>
          <option class="rename-able" value="CA" data-renameid="e_7x6mlhvxyep">California</option>
          <option class="rename-able" value="CO" data-renameid="e_7xyukb4jy9n">Colorado</option>
          <option class="rename-able" value="CT" data-renameid="e_exrbqnr3h3">Connecticut</option>
          <option class="rename-able" value="DE" data-renameid="e_ufqakgd16f">Delaware</option>
          <option class="rename-able" value="DC" data-renameid="e_nx8vbs7neh">District Of Columbia</option>
          <option class="rename-able" value="FL" data-renameid="e_3ndecjrri6h">Florida</option>
          <option class="rename-able" value="FM" data-renameid="e_xzo1ue7imi">Federated States of Micronesia</option>
          <option class="rename-able" value="GA" data-renameid="e_vi43dez3szh">Georgia</option>
          <option class="rename-able" value="GU" data-renameid="e_tteiktn4y8">Guam</option>
          <option class="rename-able" value="HI" data-renameid="e_su8271zmsvh">Hawaii</option>
          <option class="rename-able" value="ID" data-renameid="e_m55v50a2xz">Idaho</option>
          <option class="rename-able" value="IL" data-renameid="e_sbl3h6ogue">Illinois</option>
          <option class="rename-able" value="IN" data-renameid="e_gfjkp9ogzt6">Indiana</option>
          <option class="rename-able" value="IA" data-renameid="e_jcw23sj4cdf">Iowa</option>
          <option class="rename-able" value="KS" data-renameid="e_nbccylun4w">Kansas</option>
          <option class="rename-able" value="KY" data-renameid="e_ubr3n51dfm">Kentucky</option>
          <option class="rename-able" value="LA" data-renameid="e_79icph5wjyk">Louisiana</option>
          <option class="rename-able" value="ME" data-renameid="e_aol93qxz0b4">Maine</option>
          <option class="rename-able" value="MD" data-renameid="e_0i0nu1sxt9c6">Maryland</option>
          <option class="rename-able" value="MA" data-renameid="e_xkxw9vp9n7">Massachusetts</option>
          <option class="rename-able" value="MH" data-renameid="e_ohaf23m03cd">Marshall Islands</option>
          <option class="rename-able" value="MI" data-renameid="e_xi7dohxr7yf">Michigan</option>
          <option class="rename-able" value="MN" data-renameid="e_g9cngqzvq9">Minnesota</option>
          <option class="rename-able" value="MS" data-renameid="e_5cfwn79t36g">Mississippi</option>
          <option class="rename-able" value="MO" data-renameid="e_v9f3d70w8a">Missouri</option>
          <option class="rename-able" value="MP" data-renameid="e_opqjmf3uejm">Northern Mariana Islands</option>
          <option class="rename-able" value="MT" data-renameid="e_7qq4vkafuit">Montana</option>
          <option class="rename-able" value="NE" data-renameid="e_9gftlo3hemo">Nebraska</option>
          <option class="rename-able" value="NV" data-renameid="e_db4ddmrfxna">Nevada</option>
          <option class="rename-able" value="NH" data-renameid="e_g3gxprrmspd">New Hampshire</option>
          <option class="rename-able" value="NJ" data-renameid="e_cj2d871qnrl">New Jersey</option>
          <option class="rename-able" value="NM" data-renameid="e_j6h8tiydx0a">New Mexico</option>
          <option class="rename-able" value="NY" data-renameid="e_8nk0sn4xqde">New York</option>
          <option class="rename-able" value="NC" data-renameid="e_q5wdm33gdk">North Carolina</option>
          <option class="rename-able" value="ND" data-renameid="e_qvotqrqwu2p">North Dakota</option>
          <option class="rename-able" value="OH" data-renameid="e_fiquth88b2">Ohio</option>
          <option class="rename-able" value="OK" data-renameid="e_7vieecmvzs">Oklahoma</option>
          <option class="rename-able" value="OR" data-renameid="e_xxf4bc1720i">Oregon</option>
          <option class="rename-able" value="PA" data-renameid="e_l4nx5q6u2vb">Pennsylvania</option>
          <option class="rename-able" value="PR" data-renameid="e_0gnrfidfs7ee">Puerto Rico</option>
          <option class="rename-able" value="PW" data-renameid="e_wv7atgtspuk">Palau</option>
          <option class="rename-able" value="RI" data-renameid="e_0pkv6em6zmb9">Rhode Island</option>
          <option class="rename-able" value="SC" data-renameid="e_q1xxa874jsn">South Carolina</option>
          <option class="rename-able" value="SD" data-renameid="e_3zg9eumsgsr">South Dakota</option>
          <option class="rename-able" value="TN" data-renameid="e_ladnh72xixp">Tennessee</option>
          <option class="rename-able" value="TX" data-renameid="e_7xbyf208siw">Texas</option>
          <option class="rename-able" value="UT" data-renameid="e_neehkjuu3y">Utah</option>
          <option class="rename-able" value="VT" data-renameid="e_gyywuo8ocph">Vermont</option>
          <option class="rename-able" value="VI" data-renameid="e_z214ksx7zd">Virgin Islands</option>
          <option class="rename-able" value="VA" data-renameid="e_5tqux8tv7et">Virginia</option>
          <option class="rename-able" value="WA" data-renameid="e_bhzruisit05">Washington</option>
          <option class="rename-able" value="WV" data-renameid="e_kfmdntojy08">West Virginia</option>
          <option class="rename-able" value="WI" data-renameid="e_1l7967a23f2">Wisconsin</option>
          <option class="rename-able" value="WY" data-renameid="e_91i8devf6h5">Wyoming</option>
        </select>
      </div>
    </div>
    <div><span id="co_spVerifyPreviousMessage" class="require-span" style="display: none;"> Unable to validate address</span></div>
  </div>
</form>

POST /handler/AutoFillHandler.aspx

<form target="co_if_Address" method="post" action="/handler/AutoFillHandler.aspx" id="co_frm_mailingAddress" novalidate="">
  <div class="hidden"><input type="submit"></div>
  <div id="co_divMailingAddress">
    <div style="margin-top: 10px;">
      <a id="co_lnkHasMaillingAddress" href="#" data-mode="self-handle-event" status="N" style="cursor: pointer; font-weight: bold; color: rgb(0, 139, 154);" class="header_theme2 shadow-btn ui-link chevron-circle-right-before" data-renameid="e_skr49afo3gh">Use different address for mailing</a>
    </div>
  </div>
  <div id="co_divMailingAddressForm" style="display :none">
    <br>
    <div style="font-size:17px;font-weight :bold">Mailing Address</div>
    <div id="co_div_ddl_mailing_country" data-role="fieldcontain" style="display: none;">
      <label for="co_ddlMailingCountry" class="RequiredIcon" data-renameid="e_84a6z7turs6">Country</label>
      <select id="co_ddlMailingCountry" name="country" autocomplete="country" onchange="co_showHideMailingState()">
        <option value="USA" selected="selected">USA</option>
        <option value="FRANCE">France</option>
        <option value="GERMANY">Germany</option>
        <option value="ITALY">Italy</option>
        <option value="SPAIN">Spain</option>
        <option value="UNITED KINGDOM">United Kingdom</option>
        <option value="AALAND">Aaland</option>
        <option value="ABKHAZIA">Abkhazia</option>
        <option value="AFGHANISTAN">Afghanistan</option>
        <option value="ALBANIA">Albania</option>
        <option value="ALGERIA">Algeria</option>
        <option value="AMERICAN SAMOA">American Samoa</option>
        <option value="ANDORRA">Andorra</option>
        <option value="ANGOLA">Angola</option>
        <option value="ANGUILLA">Anguilla</option>
        <option value="ANTARCTICA">Antarctica</option>
        <option value="ANTIGUA_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_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">British Indian Ocean Territory</option>
        <option value="BRITISH_VIRGIN_ILND">British Virgin Islands</option>
        <option value="BRUNEI">Brunei</option>
        <option value="BULGARIA">Bulgaria</option>
        <option value="BURKINA FASO">Burkina Faso</option>
        <option value="BURUNDI">Burundi</option>
        <option value="CAMBODIA">Cambodia</option>
        <option value="CAMEROON">Cameroon</option>
        <option value="CANADA">Canada</option>
        <option value="CAPE VERDE">Cape Verde</option>
        <option value="CAYMAN ISLANDS">Cayman Islands</option>
        <option value="CENTRAL AFRICAN REP">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 ISLANDS">Cocos Islands</option>
        <option value="COLOMBIA">Colombia</option>
        <option value="COMOROS">Comoros</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="DEMOCRATIC_REP_CONGO">Democratic Republic Of The Congo</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="TIMOR-LESTE">East Timor</option>
        <option value="ECUADOR">Ecuador</option>
        <option value="EGYPT">Egypt</option>
        <option value="EL SALVADOR">El Salvador</option>
        <option value="EQUATORIAL GUINEA">Equatorial Guinea</option>
        <option value="ERITREA">Eritrea</option>
        <option value="ESTONIA">Estonia</option>
        <option value="ETHIOPIA">Ethiopia</option>
        <option value="FALKLAND ISLANDS">Falkland Islands</option>
        <option value="FAROE ISLANDS">Faroe Islands</option>
        <option value="FIJI">Fiji</option>
        <option value="FINLAND">Finland</option>
        <option value="FRENCH GUIANA">French Guiana</option>
        <option value="FRENCH POLYNESIA">French Polynesia</option>
        <option value="FRENCH_SOUTHERN_TERR">French Southern Territories</option>
        <option value="GABON">Gabon</option>
        <option value="GAMBIA">Gambia</option>
        <option value="GEORGIA">Georgia</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_MCDONALD_ILND">Heard Island And Mcdonald Islands</option>
        <option value="HONDURAS">Honduras</option>
        <option value="HONG KONG">Hong Kong</option>
        <option value="HUNGARY">Hungary</option>
        <option value="ICELAND">Iceland</option>
        <option value="INDIA">India</option>
        <option value="INDONESIA">Indonesia</option>
        <option value="IRAN">Iran</option>
        <option value="IRAQ">Iraq</option>
        <option value="IRELAND">Ireland</option>
        <option value="ISLE OF MAN">Isle Of Man</option>
        <option value="ISRAEL">Israel</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="KOSOVO">Kosovo</option>
        <option value="KUWAIT">Kuwait</option>
        <option value="KYRGYZSTAN">Kyrgyzstan</option>
        <option value="LAOS">Laos</option>
        <option value="LATVIA">Latvia</option>
        <option value="LEBANON">Lebanon</option>
        <option value="LESOTHO">Lesotho</option>
        <option value="LIBERIA">Liberia</option>
        <option value="LIBYA">Libya</option>
        <option value="LIECHTENSTEIN">Liechtenstein</option>
        <option value="LITHUANIA">Lithuania</option>
        <option value="LUXEMBOURG">Luxembourg</option>
        <option value="MACAU">Macau</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">Micronesia</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="NAGORNO-KARABAKH">Nagorno-Karabakh</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="NORTH KOREA">North Korea</option>
        <option value="NORTHERN CYPRUS">Northern Cyprus</option>
        <option value="NORTHERN_MARIANA_ILN">Northern Mariana Islands</option>
        <option value="NORWAY">Norway</option>
        <option value="OMAN">Oman</option>
        <option value="PAKISTAN">Pakistan</option>
        <option value="PALAU">Palau</option>
        <option value="PALESTINE">Palestine</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="CONGO">Republic Of The Congo</option>
        <option value="REUNION">Reunion</option>
        <option value="ROMANIA">Romania</option>
        <option value="RUSSIA">Russia</option>
        <option value="RWANDA">Rwanda</option>
        <option value="SAINT BARTHELEMY">Saint Barthelemy</option>
        <option value="SAINT HELENA">Saint Helena</option>
        <option value="SAINT_KITTS_NEVIS">Saint Kitts And Nevis</option>
        <option value="SAINT LUCIA">Saint Lucia</option>
        <option value="SAINT_VINCENT_GREN">Saint Vincent And The Grenadines</option>
        <option value="SAINT-MARTIN">Saint-Martin</option>
        <option value="SAINTPIERRE_MIQUELON">Saint-Pierre And Miquelon</option>
        <option value="SAMOA">Samoa</option>
        <option value="SAN MARINO">San Marino</option>
        <option value="SAO_TOME_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="SOMALILAND">Somaliland</option>
        <option value="SOUTH AFRICA">South Africa</option>
        <option value="S_GEORGIA_SANDWICH">South Georgia And The South Sandwich Islands</option>
        <option value="SOUTH KOREA">South Korea</option>
        <option value="SOUTH OSSETIA">South Ossetia</option>
        <option value="SRI LANKA">Sri Lanka</option>
        <option value="SUDAN">Sudan</option>
        <option value="SURINAME">Suriname</option>
        <option value="SVALBARD_JAN_MAYEN">Svalbard And Jan Mayen</option>
        <option value="SWAZILAND">Swaziland</option>
        <option value="SWEDEN">Sweden</option>
        <option value="SWITZERLAND">Switzerland</option>
        <option value="SYRIA">Syria</option>
        <option value="TAIWAN">Taiwan</option>
        <option value="TAJIKISTAN">Tajikistan</option>
        <option value="TANZANIA">Tanzania</option>
        <option value="THAILAND">Thailand</option>
        <option value="TOGO">Togo</option>
        <option value="TOKELAU">Tokelau</option>
        <option value="TONGA">Tonga</option>
        <option value="TRANSNISTRIA">Transnistria</option>
        <option value="TRINIDAD AND TOBAGO">Trinidad And Tobago</option>
        <option value="TRISTAN DA CUNHA">Tristan Da Cunha</option>
        <option value="TUNISIA">Tunisia</option>
        <option value="TURKEY">Turkey</option>
        <option value="TURKMENISTAN">Turkmenistan</option>
        <option value="TURKS_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="US_MINOR_ISLANDS">United States Minor Outlying Islands</option>
        <option value="US_VIRGIN_ISLANDS">United States Virgin Islands</option>
        <option value="URUGUAY">Uruguay</option>
        <option value="UZBEKISTAN">Uzbekistan</option>
        <option value="VANUATU">Vanuatu</option>
        <option value="VATICAN CITY">Vatican City</option>
        <option value="VENEZUELA">Venezuela</option>
        <option value="VIETNAM">Vietnam</option>
        <option value="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>
      </select>
    </div>
    <div data-role="fieldcontain">
      <label for="co_txtMailingAddress" class="RequiredIcon" data-renameid="e_omd83nidrkn">Address</label>
      <input type="text" id="co_txtMailingAddress" value="" maxlength="100" name="address" autocomplete="street-address" onchange="co_verifyAddress('Mailing');">
    </div>
    <div data-role="fieldcontain" id="co_divMailingAddress2" style="display: none;">
      <label for="co_txtMailingAddress2" data-renameid="e_uwbare9adsp">Address Line 2</label>
      <input type="text" id="co_txtMailingAddress2" value="" maxlength="100" name="address2" autocomplete="address-line2" onchange="co_verifyAddress('Mailing');">
    </div>
    <div data-role="fieldcontain">
      <label for="co_txtMailingZip" id="co_lblMailingZipTitle" class="RequiredIcon" data-renameid="e_crxzy7c1c2g">Zip</label>
      <input type="text" id="co_txtMailingZip" value="" pattern="[0-9]*" maxlength="10" name="zip" autocomplete="postal-code" onchange="co_verifyAddress('Mailing');">
    </div>
    <div data-role="fieldcontain">
      <label for="co_txtMailingCity" id="co_lblMailingCityTitle" class="RequiredIcon" data-renameid="e_qjap8ejq1rs">City</label>
      <input type="text" id="co_txtMailingCity" value="" name="city" autocomplete="address-level2" maxlength="50" onchange="co_verifyAddress('Mailing');">
    </div>
    <div class="co_div_ddl_mailing_state">
      <div data-role="fieldcontain">
        <label for="co_ddlMailingState" class="RequiredIcon" data-renameid="e_wmdpmkqdrw">State</label>
        <select id="co_ddlMailingState" value="" name="state" autocomplete="address-level1" onchange="co_verifyAddress('Mailing');">
          <option class="rename-able" value="" data-renameid="e_4dwiv5mdhcn">--Please Select--</option>
          <option class="rename-able" value="AL" data-renameid="e_8ce18olcfno">Alabama</option>
          <option class="rename-able" value="AK" data-renameid="e_nz9oryhoht">Alaska</option>
          <option class="rename-able" value="AS" data-renameid="e_h2kzc242zwg">American Samoa</option>
          <option class="rename-able" value="AZ" data-renameid="e_fbvz25ec2t">Arizona</option>
          <option class="rename-able" value="AR" data-renameid="e_5oath8pm6b4">Arkansas</option>
          <option class="rename-able" value="AA" data-renameid="e_gx3z0212nqk">Armed Forces - Americas</option>
          <option class="rename-able" value="AE" data-renameid="e_0dbij8uae5pc">Armed Forces - Europe</option>
          <option class="rename-able" value="AP" data-renameid="e_9pcqvwmz5b7">Armed Forces - Pacific</option>
          <option class="rename-able" value="CA" data-renameid="e_m62m6m7w2h">California</option>
          <option class="rename-able" value="CO" data-renameid="e_rdq6hhncldi">Colorado</option>
          <option class="rename-able" value="CT" data-renameid="e_vy41p5ykfk8">Connecticut</option>
          <option class="rename-able" value="DE" data-renameid="e_swibbpyy8b">Delaware</option>
          <option class="rename-able" value="DC" data-renameid="e_vrx225gkcp9">District Of Columbia</option>
          <option class="rename-able" value="FL" data-renameid="e_nts0xybfvr">Florida</option>
          <option class="rename-able" value="FM" data-renameid="e_sgrg0ydizy8">Federated States of Micronesia</option>
          <option class="rename-able" value="GA" data-renameid="e_uwxlr110w1">Georgia</option>
          <option class="rename-able" value="GU" data-renameid="e_enqgi04u67n">Guam</option>
          <option class="rename-able" value="HI" data-renameid="e_ed9egn6fxd8">Hawaii</option>
          <option class="rename-able" value="ID" data-renameid="e_27oa9i1dc8cj">Idaho</option>
          <option class="rename-able" value="IL" data-renameid="e_uki2z1wju9m">Illinois</option>
          <option class="rename-able" value="IN" data-renameid="e_xexmt52tpar">Indiana</option>
          <option class="rename-able" value="IA" data-renameid="e_011oyzdlb1gze">Iowa</option>
          <option class="rename-able" value="KS" data-renameid="e_dzgh8a6nesf">Kansas</option>
          <option class="rename-able" value="KY" data-renameid="e_cxxzqegw3">Kentucky</option>
          <option class="rename-able" value="LA" data-renameid="e_z8wojwxre2s">Louisiana</option>
          <option class="rename-able" value="ME" data-renameid="e_i04m0mmb55">Maine</option>
          <option class="rename-able" value="MD" data-renameid="e_l32wr919zhk">Maryland</option>
          <option class="rename-able" value="MA" data-renameid="e_7iiz291zqrq">Massachusetts</option>
          <option class="rename-able" value="MH" data-renameid="e_1fzkxcjyu54">Marshall Islands</option>
          <option class="rename-able" value="MI" data-renameid="e_unzhi897s8b">Michigan</option>
          <option class="rename-able" value="MN" data-renameid="e_xmjexg4bf">Minnesota</option>
          <option class="rename-able" value="MS" data-renameid="e_oapu4b9uwsq">Mississippi</option>
          <option class="rename-able" value="MO" data-renameid="e_ztpljzbetgq">Missouri</option>
          <option class="rename-able" value="MP" data-renameid="e_xqhmeh8dufk">Northern Mariana Islands</option>
          <option class="rename-able" value="MT" data-renameid="e_fyms8dm4izb">Montana</option>
          <option class="rename-able" value="NE" data-renameid="e_xqvcp7aktop">Nebraska</option>
          <option class="rename-able" value="NV" data-renameid="e_6uvb6y5zd8j">Nevada</option>
          <option class="rename-able" value="NH" data-renameid="e_vbz26y62s8">New Hampshire</option>
          <option class="rename-able" value="NJ" data-renameid="e_hxsxpbpvj9l">New Jersey</option>
          <option class="rename-able" value="NM" data-renameid="e_tsl0bcnyezp">New Mexico</option>
          <option class="rename-able" value="NY" data-renameid="e_4y7ae8u3g6e">New York</option>
          <option class="rename-able" value="NC" data-renameid="e_f8rm2jjuscr">North Carolina</option>
          <option class="rename-able" value="ND" data-renameid="e_q6f45j62ig">North Dakota</option>
          <option class="rename-able" value="OH" data-renameid="e_77i2i0do8xa">Ohio</option>
          <option class="rename-able" value="OK" data-renameid="e_nsv8qe7nln">Oklahoma</option>
          <option class="rename-able" value="OR" data-renameid="e_jewh0mn4fg">Oregon</option>
          <option class="rename-able" value="PA" data-renameid="e_a1nw4rkhrdo">Pennsylvania</option>
          <option class="rename-able" value="PR" data-renameid="e_srelvt3fca">Puerto Rico</option>
          <option class="rename-able" value="PW" data-renameid="e_0cd2dmtccdva">Palau</option>
          <option class="rename-able" value="RI" data-renameid="e_40r05e0y4ml">Rhode Island</option>
          <option class="rename-able" value="SC" data-renameid="e_8uxmf47drxs">South Carolina</option>
          <option class="rename-able" value="SD" data-renameid="e_mp3shl08rol">South Dakota</option>
          <option class="rename-able" value="TN" data-renameid="e_frqt9xphvks">Tennessee</option>
          <option class="rename-able" value="TX" data-renameid="e_nvwyuve2pxg">Texas</option>
          <option class="rename-able" value="UT" data-renameid="e_wgnhaupzjy">Utah</option>
          <option class="rename-able" value="VT" data-renameid="e_efsomu0gn8s">Vermont</option>
          <option class="rename-able" value="VI" data-renameid="e_pjtgrlsi5m">Virgin Islands</option>
          <option class="rename-able" value="VA" data-renameid="e_atuyzrifuzc">Virginia</option>
          <option class="rename-able" value="WA" data-renameid="e_26osm4o4p6p">Washington</option>
          <option class="rename-able" value="WV" data-renameid="e_zguk5l9a0x">West Virginia</option>
          <option class="rename-able" value="WI" data-renameid="e_4fvww836js8">Wisconsin</option>
          <option class="rename-able" value="WY" data-renameid="e_xsaxircu4kb">Wyoming</option>
        </select>
      </div>
    </div>
    <div><span id="co_spVerifyMailingMessage" class="require-span" style="display: none;"> Unable to validate address</span></div>
  </div>
</form>

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PERSONAL LOAN INFORMATION

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APPLICANT INFORMATION

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Personal Information
Are you an employee of New Dimensions FCU? No, I am not an Employee of New
Dimensions F.C.U.Yes, I am an Employee of New Dimensions F.C.U.
First Name
Middle Name
Last Name
Suffix (Jr., Sr., etc.) NoneJRSRIIIIIIVVVIVIIVIII
SSN
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determine your account opening eligibility.
Date of Birth


Member Number
Citizenship Status --Please Select--US CITIZENPERMANENT RESIDENT
Reference Information
First Name
Last Name
Email
Phone
(xxx) xxx-xxxx
Relationship
Contact Information
Preferred Contact Method --Please Select-- EmailHomeCellWork
Email
Home Phone
(xxx) xxx-xxxx
Cell Phone
(xxx) xxx-xxxx
Work Phone
(xxx) xxx-xxxx
Work Phone Extension
Current Physical Address
Copy the Primary Applicant's Address
Country USA France Germany Italy Spain United Kingdom Aaland Abkhazia
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica
Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas
Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia
Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean
Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia
Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile
China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica
Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic Of The
Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El
Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe
Islands Fiji Finland French Guiana French Polynesia French Southern Territories
Gabon Gambia Georgia Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam
Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard Island And Mcdonald
Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland
Isle Of Man Israel Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo
Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein
Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali
Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia
Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar
Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New
Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea
Northern Cyprus Northern Mariana Islands Norway Oman Pakistan Palau Palestine
Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal
Puerto Rico Qatar Republic Of The Congo Reunion Romania Russia Rwanda Saint
Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Vincent And The
Grenadines Saint-Martin Saint-Pierre And Miquelon Samoa San Marino Sao Tome And
Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia
Slovenia Solomon Islands Somalia Somaliland South Africa South Georgia And The
South Sandwich Islands South Korea South Ossetia Sri Lanka Sudan Suriname
Svalbard And Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan
Tanzania Thailand Togo Tokelau Tonga Transnistria Trinidad And Tobago Tristan Da
Cunha Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine
United Arab Emirates United States Minor Outlying Islands United States Virgin
Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And
Futuna Western Sahara Yemen Zambia Zimbabwe
Address
Address Line 2
Zip
City
State --Please Select--AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces -
AmericasArmed Forces - EuropeArmed Forces -
PacificCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaFederated
States of
MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall
IslandsMichiganMinnesotaMississippiMissouriNorthern Mariana
IslandsMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth
CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode
IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin
IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
Unable to validate address
Occupancy Status --Please Select--Buying/Own With MortgageLive With ParentsOwn -
Free And ClearRentGovernment QuartersOther
Occupancy Duration
Years
0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899
Months 01234567891011


Previous Address
Country USA
Address
Address Line 2
Zip
City
State --Please Select--AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces -
AmericasArmed Forces - EuropeArmed Forces -
PacificCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaFederated
States of
MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall
IslandsMichiganMinnesotaMississippiMissouriNorthern Mariana
IslandsMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth
CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode
IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin
IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
Unable to validate address
Use different address for mailing


Mailing Address
Country USA France Germany Italy Spain United Kingdom Aaland Abkhazia
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica
Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas
Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia
Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean
Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia
Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile
China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica
Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic Of The
Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El
Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe
Islands Fiji Finland French Guiana French Polynesia French Southern Territories
Gabon Gambia Georgia Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam
Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard Island And Mcdonald
Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland
Isle Of Man Israel Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo
Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein
Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali
Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia
Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar
Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New
Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea
Northern Cyprus Northern Mariana Islands Norway Oman Pakistan Palau Palestine
Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal
Puerto Rico Qatar Republic Of The Congo Reunion Romania Russia Rwanda Saint
Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Vincent And The
Grenadines Saint-Martin Saint-Pierre And Miquelon Samoa San Marino Sao Tome And
Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia
Slovenia Solomon Islands Somalia Somaliland South Africa South Georgia And The
South Sandwich Islands South Korea South Ossetia Sri Lanka Sudan Suriname
Svalbard And Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan
Tanzania Thailand Togo Tokelau Tonga Transnistria Trinidad And Tobago Tristan Da
Cunha Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine
United Arab Emirates United States Minor Outlying Islands United States Virgin
Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And
Futuna Western Sahara Yemen Zambia Zimbabwe
Address
Address Line 2
Zip
City
State --Please Select--AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces -
AmericasArmed Forces - EuropeArmed Forces -
PacificCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaFederated
States of
MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall
IslandsMichiganMinnesotaMississippiMissouriNorthern Mariana
IslandsMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth
CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode
IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin
IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
Unable to validate address
Identification
ID Type
--Please Select----Please Select--BIRTH CERTIFICATEMILITARY IDPERMANENT RESIDENT
CARDSOCIAL SECURITY CARDSTATE ID
 * --Please Select--
 * BIRTH CERTIFICATE
 * MILITARY ID
 * PERMANENT RESIDENT CARD
 * SOCIAL SECURITY CARD
 * STATE ID

ID Number
ID State
--Please Select----Please Select--AlabamaAlaskaAmerican
SamoaArizonaArkansasArmed Forces - AmericasArmed Forces - EuropeArmed Forces -
PacificCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaFederated
States of
MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall
IslandsMichiganMinnesotaMississippiMissouriNorthern Mariana
IslandsMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth
CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode
IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin
IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
 * --Please Select--
 * Alabama
 * Alaska
 * American Samoa
 * Arizona
 * Arkansas
 * Armed Forces - Americas
 * Armed Forces - Europe
 * Armed Forces - Pacific
 * California
 * Colorado
 * Connecticut
 * Delaware
 * District Of Columbia
 * Florida
 * Federated States of Micronesia
 * Georgia
 * Guam
 * Hawaii
 * Idaho
 * Illinois
 * Indiana
 * Iowa
 * Kansas
 * Kentucky
 * Louisiana
 * Maine
 * Maryland
 * Massachusetts
 * Marshall Islands
 * Michigan
 * Minnesota
 * Mississippi
 * Missouri
 * Northern Mariana Islands
 * Montana
 * Nebraska
 * Nevada
 * New Hampshire
 * New Jersey
 * New Mexico
 * New York
 * North Carolina
 * North Dakota
 * Ohio
 * Oklahoma
 * Oregon
 * Pennsylvania
 * Puerto Rico
 * Palau
 * Rhode Island
 * South Carolina
 * South Dakota
 * Tennessee
 * Texas
 * Utah
 * Vermont
 * Virgin Islands
 * Virginia
 * Washington
 * West Virginia
 * Wisconsin
 * Wyoming

ID Country
USA--Please Select--USAFranceGermanyItalySpainUnited
KingdomAalandAbkhaziaAfghanistanAlbaniaAlgeriaAmerican
SamoaAndorraAngolaAnguillaAntarcticaAntigua And
BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia
And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish
Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape
VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos
IslandsColombiaComorosCook IslandsCosta RicaCote
D&#39;IvoireCroatiaCubaCyprusCzech RepublicDemocratic Republic Of The
CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe
IslandsFijiFinlandFrench GuianaFrench PolynesiaFrench Southern
TerritoriesGabonGambiaGeorgiaGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea
BissauGuyanaHaitiHeard Island And Mcdonald IslandsHondurasHong
KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of
ManIsraelJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands
AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth
KoreaNorthern CyprusNorthern Mariana
IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New
GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic Of
The CongoReunionRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts And
NevisSaint LuciaSaint Vincent And The GrenadinesSaint-MartinSaint-Pierre And
MiquelonSamoaSan MarinoSao Tome And PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSomalilandSouth AfricaSouth Georgia And The South Sandwich
IslandsSouth KoreaSouth OssetiaSri LankaSudanSurinameSvalbard And Jan
MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTransnistriaTrinidad
And TobagoTristan Da CunhaTunisiaTurkeyTurkmenistanTurks And Caicos
IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying
IslandsUnited States Virgin IslandsUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamWallis And FutunaWestern SaharaYemenZambiaZimbabwe
 * --Please Select--
 * USA
 * France
 * Germany
 * Italy
 * Spain
 * United Kingdom
 * Aaland
 * Abkhazia
 * Afghanistan
 * Albania
 * Algeria
 * American Samoa
 * Andorra
 * Angola
 * Anguilla
 * Antarctica
 * Antigua And Barbuda
 * Argentina
 * Armenia
 * Aruba
 * Australia
 * Austria
 * Azerbaijan
 * Bahamas
 * Bahrain
 * Bangladesh
 * Barbados
 * Belarus
 * Belgium
 * Belize
 * Benin
 * Bermuda
 * Bhutan
 * Bolivia
 * Bosnia And Herzegovina
 * Botswana
 * Bouvet Island
 * Brazil
 * British Indian Ocean Territory
 * British Virgin Islands
 * Brunei
 * Bulgaria
 * Burkina Faso
 * Burundi
 * Cambodia
 * Cameroon
 * Canada
 * Cape Verde
 * Cayman Islands
 * Central African Republic
 * Chad
 * Chile
 * China
 * Christmas Island
 * Cocos Islands
 * Colombia
 * Comoros
 * Cook Islands
 * Costa Rica
 * Cote D&#39;Ivoire
 * Croatia
 * Cuba
 * Cyprus
 * Czech Republic
 * Democratic Republic Of The Congo
 * Denmark
 * Djibouti
 * Dominica
 * Dominican Republic
 * East Timor
 * Ecuador
 * Egypt
 * El Salvador
 * Equatorial Guinea
 * Eritrea
 * Estonia
 * Ethiopia
 * Falkland Islands
 * Faroe Islands
 * Fiji
 * Finland
 * French Guiana
 * French Polynesia
 * French Southern Territories
 * Gabon
 * Gambia
 * Georgia
 * Ghana
 * Gibraltar
 * Greece
 * Greenland
 * Grenada
 * Guadeloupe
 * Guam
 * Guatemala
 * Guernsey
 * Guinea
 * Guinea Bissau
 * Guyana
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 * Heard Island And Mcdonald Islands
 * Honduras
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 * Indonesia
 * Iran
 * Iraq
 * Ireland
 * Isle Of Man
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 * Jersey
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 * Kiribati
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 * Kuwait
 * Kyrgyzstan
 * Laos
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 * Lesotho
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 * Liechtenstein
 * Lithuania
 * Luxembourg
 * Macau
 * Macedonia
 * Madagascar
 * Malawi
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 * Maldives
 * Mali
 * Malta
 * Marshall Islands
 * Martinique
 * Mauritania
 * Mauritius
 * Mayotte
 * Mexico
 * Micronesia
 * Moldova
 * Monaco
 * Mongolia
 * Montenegro
 * Montserrat
 * Morocco
 * Mozambique
 * Myanmar
 * Nagorno-Karabakh
 * Namibia
 * Nauru
 * Nepal
 * Netherlands
 * Netherlands Antilles
 * New Caledonia
 * New Zealand
 * Nicaragua
 * Niger
 * Nigeria
 * Niue
 * Norfolk Island
 * North Korea
 * Northern Cyprus
 * Northern Mariana Islands
 * Norway
 * Oman
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 * Palau
 * Palestine
 * Panama
 * Papua New Guinea
 * Paraguay
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 * Philippines
 * Pitcairn
 * Poland
 * Portugal
 * Puerto Rico
 * Qatar
 * Republic Of The Congo
 * Reunion
 * Romania
 * Russia
 * Rwanda
 * Saint Barthelemy
 * Saint Helena
 * Saint Kitts And Nevis
 * Saint Lucia
 * Saint Vincent And The Grenadines
 * Saint-Martin
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 * Samoa
 * San Marino
 * Sao Tome And Principe
 * Saudi Arabia
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 * Slovakia
 * Slovenia
 * Solomon Islands
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 * Somaliland
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 * Suriname
 * Svalbard And Jan Mayen
 * Swaziland
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 * Syria
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 * Tajikistan
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 * Thailand
 * Togo
 * Tokelau
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 * Transnistria
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 * Tunisia
 * Turkey
 * Turkmenistan
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 * Tuvalu
 * Uganda
 * Ukraine
 * United Arab Emirates
 * United States Minor Outlying Islands
 * United States Virgin Islands
 * Uruguay
 * Uzbekistan
 * Vanuatu
 * Vatican City
 * Venezuela
 * Vietnam
 * Wallis And Futuna
 * Western Sahara
 * Yemen
 * Zambia
 * Zimbabwe

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Financial Information

§Alimony, child support and separate maintenance income need not be revealed if
you do not wish to have them considered as a basis for repaying this obligation.
Gross Monthly Income (before taxes)
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Employment Status --Please Select--EmployedActive MilitaryHomemakerRetiredSelf
EmployedStudentUnemployedOtherRetired MilitaryGovernment/DOD


PREVIOUS EMPLOYMENT INFORMATION

Gross Monthly Income (before taxes)
Employment Status --Please Select--EmployedActive MilitaryHomemakerRetiredSelf
EmployedStudentUnemployedOtherRetired MilitaryGovernment/DOD

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MONTHLY EXPENSES

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Declaration

1. Do you currently have any outstanding judgments or have you ever filed for
bankruptcy, had a debt adjustment plan confirmed under Chapter 13, Had Property
Foreclosed Upon or Repossessed in the Last 7 yrs, or been a party in a lawsuit?
No Yes

2. Have you ever been declared bankrupt or filed a petition for chapter 7 or 13?
No Yes

3. Have you ever filed for bankruptcy or had a debt adjustment plan confirmed
under chapter 13 in the past 10 years?
No Yes

4. Have you any outstanding judgments?
No Yes

5. Are you a party to a lawsuit?
No Yes

6. Have you had property foreclosed upon or given a deed in lieu of foreclosure
in the last 7 years?
No Yes

7. Have you any obligations not listed?
No Yes

8. Are you a Co-maker, Co-signer or Guarantor on any loan?
No Yes

Primary Name
Creditor Name
Amount
9. Have you any suits pending, judgments filed, alimony or support awards
against you?
No Yes

10. Are you obligated to make Alimony, Support or Maintenance Payments?
No Yes

Recipient Name
Recipient Address
Alimony
Separate Maintenance
Child Support
Additional Information
Is any of your income generated from a cannabis-related business? (Marijuana,
Hemp, or CBD)*
NoneA Portion100%
Are you an employee or do you have ownership interest in the cannabis-related
business?*
EmployeeOwnership Interest
Do you have another applicant?
Yes
No
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Personal Information
Are you an employee of New Dimensions FCU? No, I am not an Employee of New
Dimensions F.C.U.Yes, I am an Employee of New Dimensions F.C.U.
First Name
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Suffix (Jr., Sr., etc.) NoneJRSRIIIIIIVVVIVIIVIII
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Reference Information
First Name
Last Name
Email
Phone
(xxx) xxx-xxxx
Relationship
Contact Information
Preferred Contact Method --Please Select-- EmailHomeCellWork
Email
Home Phone
(xxx) xxx-xxxx
Cell Phone
(xxx) xxx-xxxx
Work Phone
(xxx) xxx-xxxx
Work Phone Extension
Current Address
Copy the Primary Applicant's Address
Country USA France Germany Italy Spain United Kingdom Aaland Abkhazia
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica
Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas
Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia
Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean
Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia
Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile
China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica
Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic Of The
Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El
Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe
Islands Fiji Finland French Guiana French Polynesia French Southern Territories
Gabon Gambia Georgia Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam
Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard Island And Mcdonald
Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland
Isle Of Man Israel Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo
Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein
Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali
Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia
Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar
Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New
Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea
Northern Cyprus Northern Mariana Islands Norway Oman Pakistan Palau Palestine
Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal
Puerto Rico Qatar Republic Of The Congo Reunion Romania Russia Rwanda Saint
Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Vincent And The
Grenadines Saint-Martin Saint-Pierre And Miquelon Samoa San Marino Sao Tome And
Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia
Slovenia Solomon Islands Somalia Somaliland South Africa South Georgia And The
South Sandwich Islands South Korea South Ossetia Sri Lanka Sudan Suriname
Svalbard And Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan
Tanzania Thailand Togo Tokelau Tonga Transnistria Trinidad And Tobago Tristan Da
Cunha Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine
United Arab Emirates United States Minor Outlying Islands United States Virgin
Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And
Futuna Western Sahara Yemen Zambia Zimbabwe
Address
Address Line 2
Zip
City
State --Please Select--AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces -
AmericasArmed Forces - EuropeArmed Forces -
PacificCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaFederated
States of
MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall
IslandsMichiganMinnesotaMississippiMissouriNorthern Mariana
IslandsMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth
CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode
IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin
IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
Unable to validate address
Occupancy Status --Please Select--Buying/Own With MortgageLive With ParentsOwn -
Free And ClearRentGovernment QuartersOther
Occupancy Duration
Years
0123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899
Months 01234567891011


Previous Address
Country USA
Address
Address Line 2
Zip
City
State --Please Select--AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces -
AmericasArmed Forces - EuropeArmed Forces -
PacificCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaFederated
States of
MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall
IslandsMichiganMinnesotaMississippiMissouriNorthern Mariana
IslandsMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth
CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode
IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin
IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
Unable to validate address
Use different address for mailing


Mailing Address
Country USA France Germany Italy Spain United Kingdom Aaland Abkhazia
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica
Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas
Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia
Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean
Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia
Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile
China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica
Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic Of The
Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El
Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe
Islands Fiji Finland French Guiana French Polynesia French Southern Territories
Gabon Gambia Georgia Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam
Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard Island And Mcdonald
Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland
Isle Of Man Israel Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo
Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein
Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali
Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia
Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar
Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New
Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea
Northern Cyprus Northern Mariana Islands Norway Oman Pakistan Palau Palestine
Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal
Puerto Rico Qatar Republic Of The Congo Reunion Romania Russia Rwanda Saint
Barthelemy Saint Helena Saint Kitts And Nevis Saint Lucia Saint Vincent And The
Grenadines Saint-Martin Saint-Pierre And Miquelon Samoa San Marino Sao Tome And
Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia
Slovenia Solomon Islands Somalia Somaliland South Africa South Georgia And The
South Sandwich Islands South Korea South Ossetia Sri Lanka Sudan Suriname
Svalbard And Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan
Tanzania Thailand Togo Tokelau Tonga Transnistria Trinidad And Tobago Tristan Da
Cunha Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine
United Arab Emirates United States Minor Outlying Islands United States Virgin
Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis And
Futuna Western Sahara Yemen Zambia Zimbabwe
Address
Address Line 2
Zip
City
State --Please Select--AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces -
AmericasArmed Forces - EuropeArmed Forces -
PacificCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaFederated
States of
MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall
IslandsMichiganMinnesotaMississippiMissouriNorthern Mariana
IslandsMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth
CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode
IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin
IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
Unable to validate address
Identification
ID Type
--Please Select----Please Select--BIRTH CERTIFICATEMILITARY IDPERMANENT RESIDENT
CARDSOCIAL SECURITY CARDSTATE ID
 * --Please Select--
 * BIRTH CERTIFICATE
 * MILITARY ID
 * PERMANENT RESIDENT CARD
 * SOCIAL SECURITY CARD
 * STATE ID

ID Number
ID State
--Please Select----Please Select--AlabamaAlaskaAmerican
SamoaArizonaArkansasArmed Forces - AmericasArmed Forces - EuropeArmed Forces -
PacificCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaFederated
States of
MicronesiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMarshall
IslandsMichiganMinnesotaMississippiMissouriNorthern Mariana
IslandsMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth
CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoPalauRhode
IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin
IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming
 * --Please Select--
 * Alabama
 * Alaska
 * American Samoa
 * Arizona
 * Arkansas
 * Armed Forces - Americas
 * Armed Forces - Europe
 * Armed Forces - Pacific
 * California
 * Colorado
 * Connecticut
 * Delaware
 * District Of Columbia
 * Florida
 * Federated States of Micronesia
 * Georgia
 * Guam
 * Hawaii
 * Idaho
 * Illinois
 * Indiana
 * Iowa
 * Kansas
 * Kentucky
 * Louisiana
 * Maine
 * Maryland
 * Massachusetts
 * Marshall Islands
 * Michigan
 * Minnesota
 * Mississippi
 * Missouri
 * Northern Mariana Islands
 * Montana
 * Nebraska
 * Nevada
 * New Hampshire
 * New Jersey
 * New Mexico
 * New York
 * North Carolina
 * North Dakota
 * Ohio
 * Oklahoma
 * Oregon
 * Pennsylvania
 * Puerto Rico
 * Palau
 * Rhode Island
 * South Carolina
 * South Dakota
 * Tennessee
 * Texas
 * Utah
 * Vermont
 * Virgin Islands
 * Virginia
 * Washington
 * West Virginia
 * Wisconsin
 * Wyoming

ID Country
USA--Please Select--USAFranceGermanyItalySpainUnited
KingdomAalandAbkhaziaAfghanistanAlbaniaAlgeriaAmerican
SamoaAndorraAngolaAnguillaAntarcticaAntigua And
BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia
And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish
Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape
VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos
IslandsColombiaComorosCook IslandsCosta RicaCote
D&#39;IvoireCroatiaCubaCyprusCzech RepublicDemocratic Republic Of The
CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl
SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe
IslandsFijiFinlandFrench GuianaFrench PolynesiaFrench Southern
TerritoriesGabonGambiaGeorgiaGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea
BissauGuyanaHaitiHeard Island And Mcdonald IslandsHondurasHong
KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of
ManIsraelJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall
IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands
AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth
KoreaNorthern CyprusNorthern Mariana
IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New
GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic Of
The CongoReunionRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts And
NevisSaint LuciaSaint Vincent And The GrenadinesSaint-MartinSaint-Pierre And
MiquelonSamoaSan MarinoSao Tome And PrincipeSaudi
ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon
IslandsSomaliaSomalilandSouth AfricaSouth Georgia And The South Sandwich
IslandsSouth KoreaSouth OssetiaSri LankaSudanSurinameSvalbard And Jan
MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTransnistriaTrinidad
And TobagoTristan Da CunhaTunisiaTurkeyTurkmenistanTurks And Caicos
IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying
IslandsUnited States Virgin IslandsUruguayUzbekistanVanuatuVatican
CityVenezuelaVietnamWallis And FutunaWestern SaharaYemenZambiaZimbabwe
 * --Please Select--
 * USA
 * France
 * Germany
 * Italy
 * Spain
 * United Kingdom
 * Aaland
 * Abkhazia
 * Afghanistan
 * Albania
 * Algeria
 * American Samoa
 * Andorra
 * Angola
 * Anguilla
 * Antarctica
 * Antigua And Barbuda
 * Argentina
 * Armenia
 * Aruba
 * Australia
 * Austria
 * Azerbaijan
 * Bahamas
 * Bahrain
 * Bangladesh
 * Barbados
 * Belarus
 * Belgium
 * Belize
 * Benin
 * Bermuda
 * Bhutan
 * Bolivia
 * Bosnia And Herzegovina
 * Botswana
 * Bouvet Island
 * Brazil
 * British Indian Ocean Territory
 * British Virgin Islands
 * Brunei
 * Bulgaria
 * Burkina Faso
 * Burundi
 * Cambodia
 * Cameroon
 * Canada
 * Cape Verde
 * Cayman Islands
 * Central African Republic
 * Chad
 * Chile
 * China
 * Christmas Island
 * Cocos Islands
 * Colombia
 * Comoros
 * Cook Islands
 * Costa Rica
 * Cote D&#39;Ivoire
 * Croatia
 * Cuba
 * Cyprus
 * Czech Republic
 * Democratic Republic Of The Congo
 * Denmark
 * Djibouti
 * Dominica
 * Dominican Republic
 * East Timor
 * Ecuador
 * Egypt
 * El Salvador
 * Equatorial Guinea
 * Eritrea
 * Estonia
 * Ethiopia
 * Falkland Islands
 * Faroe Islands
 * Fiji
 * Finland
 * French Guiana
 * French Polynesia
 * French Southern Territories
 * Gabon
 * Gambia
 * Georgia
 * Ghana
 * Gibraltar
 * Greece
 * Greenland
 * Grenada
 * Guadeloupe
 * Guam
 * Guatemala
 * Guernsey
 * Guinea
 * Guinea Bissau
 * Guyana
 * Haiti
 * Heard Island And Mcdonald Islands
 * Honduras
 * Hong Kong
 * Hungary
 * Iceland
 * India
 * Indonesia
 * Iran
 * Iraq
 * Ireland
 * Isle Of Man
 * Israel
 * Jamaica
 * Japan
 * Jersey
 * Jordan
 * Kazakhstan
 * Kenya
 * Kiribati
 * Kosovo
 * Kuwait
 * Kyrgyzstan
 * Laos
 * Latvia
 * Lebanon
 * Lesotho
 * Liberia
 * Libya
 * Liechtenstein
 * Lithuania
 * Luxembourg
 * Macau
 * Macedonia
 * Madagascar
 * Malawi
 * Malaysia
 * Maldives
 * Mali
 * Malta
 * Marshall Islands
 * Martinique
 * Mauritania
 * Mauritius
 * Mayotte
 * Mexico
 * Micronesia
 * Moldova
 * Monaco
 * Mongolia
 * Montenegro
 * Montserrat
 * Morocco
 * Mozambique
 * Myanmar
 * Nagorno-Karabakh
 * Namibia
 * Nauru
 * Nepal
 * Netherlands
 * Netherlands Antilles
 * New Caledonia
 * New Zealand
 * Nicaragua
 * Niger
 * Nigeria
 * Niue
 * Norfolk Island
 * North Korea
 * Northern Cyprus
 * Northern Mariana Islands
 * Norway
 * Oman
 * Pakistan
 * Palau
 * Palestine
 * Panama
 * Papua New Guinea
 * Paraguay
 * Peru
 * Philippines
 * Pitcairn
 * Poland
 * Portugal
 * Puerto Rico
 * Qatar
 * Republic Of The Congo
 * Reunion
 * Romania
 * Russia
 * Rwanda
 * Saint Barthelemy
 * Saint Helena
 * Saint Kitts And Nevis
 * Saint Lucia
 * Saint Vincent And The Grenadines
 * Saint-Martin
 * Saint-Pierre And Miquelon
 * Samoa
 * San Marino
 * Sao Tome And Principe
 * Saudi Arabia
 * Senegal
 * Serbia
 * Seychelles
 * Sierra Leone
 * Singapore
 * Slovakia
 * Slovenia
 * Solomon Islands
 * Somalia
 * Somaliland
 * South Africa
 * South Georgia And The South Sandwich Islands
 * South Korea
 * South Ossetia
 * Sri Lanka
 * Sudan
 * Suriname
 * Svalbard And Jan Mayen
 * Swaziland
 * Sweden
 * Switzerland
 * Syria
 * Taiwan
 * Tajikistan
 * Tanzania
 * Thailand
 * Togo
 * Tokelau
 * Tonga
 * Transnistria
 * Trinidad And Tobago
 * Tristan Da Cunha
 * Tunisia
 * Turkey
 * Turkmenistan
 * Turks And Caicos Islands
 * Tuvalu
 * Uganda
 * Ukraine
 * United Arab Emirates
 * United States Minor Outlying Islands
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Financial Information

§Alimony, child support and separate maintenance income need not be revealed if
you do not wish to have them considered as a basis for repaying this obligation.
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Other Monthly Income
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Employment Status --Please Select--EmployedActive MilitaryHomemakerRetiredSelf
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PREVIOUS EMPLOYMENT INFORMATION

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MONTHLY EXPENSES

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Co/Joint Declarations
1. Do you currently have any outstanding judgments or have you ever filed for
bankruptcy, had a debt adjustment plan confirmed under Chapter 13, Had Property
Foreclosed Upon or Repossessed in the Last 7 yrs, or been a party in a lawsuit?
No Yes

2. Have you ever been declared bankrupt or filed a petition for chapter 7 or 13?
No Yes

3. Have you ever filed for bankruptcy or had a debt adjustment plan confirmed
under chapter 13 in the past 10 years?
No Yes

4. Have you any outstanding judgments?
No Yes

5. Are you a party to a lawsuit?
No Yes

6. Have you had property foreclosed upon or given a deed in lieu of foreclosure
in the last 7 years?
No Yes

7. Have you any obligations not listed?
No Yes

8. Are you a Co-maker, Co-signer or Guarantor on any loan?
No Yes

Primary Name
Creditor Name
Amount
9. Have you any suits pending, judgments filed, alimony or support awards
against you?
No Yes

10. Are you obligated to make Alimony, Support or Maintenance Payments?
No Yes

Recipient Name
Recipient Address
Alimony
Separate Maintenance
Child Support
Additional Information
Is any of your income generated from a cannabis-related business? (Marijuana,
Hemp, or CBD)*
NoneA Portion100%
Are you an employee or do you have ownership interest in the cannabis-related
business?*
EmployeeOwnership Interest
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REVIEW AND SUBMIT

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Personal Loan Information

Additional Loan Information

Applicant Information

Reference Information

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Address

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Financial Information

Previous Employment Information

Declaration

Additional Applicant Information

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Additional Applicant Declaration

Additional Information


Additional Applicant Additional Information


Please answer the following question(s)
How did you hear about our organization?*
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All applicants authorize the credit union to review their credit report obtained
for this application to determine if more favorable or additional credit
products are available.
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NOYES
We are unable to offer Cannabis-related business services at this time. Please
discontinue the application.*
I have read and acknowledged.
Already Working with a Loan Officer?
NOYES
What is the Loan Officers Name?
Protection that Matters

Credit Life and Credit Disability Insurance, underwritten by CMFG Life Insurance
Company, is available for most loan products

Would you like more information about protecting your loan payment or balance
with Credit Life and Credit Disability Insurance from your lender?
Interested
Not Now

Debt Protection is available with most loans by the credit union. It is designed
to cancel your loan payment or balance, up to the contract maximums, if a
protected life event occurs. Available package options will include one or more
of the following life events: Life, Disability or involuntary unemployment.

Would you like more information about protecting your loan payment or balance
with Debt Protection from your lender?
Interested
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MEMBER’S CHOICE™ Guaranteed Asset Protection (GAP) is an optional protection
product made available by the credit union. In the event of a total loss, GAP is
designed to cancel the difference between your primary insurance settlement and
the outstanding loan balance, up to the contract maximums. For more information,
call or visit the credit union.

Would you like more information about protecting your loan with GAP from your
lender?
Interested
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Mechanical Repair Coverage can help you limit the cost of covered vehicle
breakdowns.

Would you like more information about Mechanical Repair Coverage from your
lender?
Interested
Not Now
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report. Upon your request, we will tell you if a credit report was obtained and
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information contained in your application, as well as the status of your
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