app.elitefinancebank.com Open in urlscan Pro
79.133.41.61  Public Scan

Form analysis
1 forms found in the DOM

POST

<form method="post" class="signin_validate row g-3" enctype="multipart/form-data" action="">
  <h4 class="text-success" id="register-error"></h4>
  <div class="col-md-6">
    <label class="form-label">First Name</label>
    <input type="text" class="form-control" required="" placeholder="First Name" name="firstname">
  </div>
  <div class="col-md-6">
    <label class="form-label">Last Name</label>
    <input type="text" class="form-control" required="" placeholder="Last Name" name="lastname">
  </div>
  <div class="col-md-6">
    <label class="form-label">Email</label>
    <input type="email" class="form-control" required="" placeholder="hello@example.com" name="acct_email">
  </div>
  <div class="col-md-6">
    <label class="form-label">Phone Number</label>
    <div class="input-group">
      <div class="input-group-prepend">
        <span class="input-group-text"> + </span>
      </div>
      <input type="text" required="" minlength="8" autocomplete="off" placeholder="+1 440 941 4254" class="form-control wizard-required" name="phoneNumber">
    </div>
    <small><b>Please Note: </b> With country code (e.g +1, +44, +90) </small>
  </div>
  <div class="col-md-6">
    <label class="form-label">Home Address</label>
    <input type="text" class="form-control" required="" placeholder="Home Address" name="address">
  </div>
  <div class="col-md-6">
    <label class="form-label">State</label>
    <input type="text" class="form-control" required="" placeholder="State" name="state">
  </div>
  <div class="col-md-6">
    <label class="form-label">City</label>
    <input type="text" class="form-control wizard-required" placeholder="City" id="city" name="city">
  </div>
  <div class="col-md-6">
    <label class="form-label">Zipcode/postal code</label>
    <input type="text" inputmode="numeric" required="" pattern="[0-9]+" minlength="4" maxlength="6" autocomplete="off" class="form-control wizard-required" placeholder="100001" id="zipcode" name="zipcode">
  </div>
  <div class="col-md-6">
    <label class="form-label">Gender</label>
    <select name="acct_gender" required="" class="form-control" data-width="100%">
      <option value="">Select Gender Type</option>
      <option value="Male">Male</option>
      <option value="Female">Female</option>
    </select>
  </div>
  <div class="col-md-6">
    <label class="form-label">Account Type</label>
    <select name="acct_type" required="" class="form-control" data-width="100%">
      <option value="">Select Account Type</option>
      <option value="Savings">Savings Account</option>
      <option value="Current">Current Account</option>
      <option value="Checking">Checking Account</option>
      <option value="Fixed Deposit">Fixed Deposit</option>
      <option value="Non Resident">Non Resident Account</option>
      <option value="Joint Account">Joint Account</option>
    </select>
  </div>
  <div class="col-md-6">
    <label class="form-label">Date of Birth</label>
    <input type="date" class="form-control" required="" placeholder="Date of Birth" name="acct_dob">
  </div>
  <!--<div class="col-md-6">
                                    <label class="form-label">SSN</label>

                                    <input type="text" inputmode="numeric" required pattern="[0-9]+" minlength="4" maxlength="15" autocomplete="off" class="form-control wizard-required" placeholder="8765XXXXXXX" id="acct_ssn" name="acct_ssn">
                                </div>-->
  <div class="col-md-6">
    <label class="form-label">Upload Picture</label>
    <input type="file" id="input-file-max-fs" required="" class="form-control" data-max-file-size="2M" name="image">
    <input type="hidden" name="MAX_FILE_SIZE" value="10485760">
  </div>
  <div class="col-md-6">
    <label class="form-label">4 Digit Transaction Pin</label>
    <input type="text" class="form-control" inputmode="numeric" required="" pattern="[0-9]+" maxlength="4" autocomplete="off" style="margin-bottom: 5px" placeholder="****" name="acct_pin">
  </div>
  <div class="col-md-6">
    <label class="form-label">Password</label>
    <input type="password" class="form-control" maxlength="20" required="" placeholder="Password" name="acct_password">
  </div>
  <div class="col-md-6">
    <label class="form-label">Confirm Password</label>
    <input type="password" class="form-control" maxlength="20" required="" placeholder="Confirm Password" name="confirmPassword">
  </div>
  <br>
  <div class="d-grid gap-2">
    <button type="submit" class="btn btn-primary" name="regSubmit">Create account</button>
  </div>
</form>

Text Content

ONLINE ACCOUNT OPENING

Want to open a bank account, but have no time to visit the branch and fill in
the form? Knowing that your time is precious, we are happy to introduce the new
service Online Account Opening. Ready to start banking with Elite Finance Bank?
Complete the form below and apply for your account now!


First Name
Last Name
Email
Phone Number
+
Please Note: With country code (e.g +1, +44, +90)
Home Address
State
City
Zipcode/postal code
Gender Select Gender Type Male Female
Account Type Select Account Type Savings Account Current Account Checking
Account Fixed Deposit Non Resident Account Joint Account
Date of Birth
Upload Picture
4 Digit Transaction Pin
Password
Confirm Password

Create account

Sign in to your account


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