<?php
// define variables and set to empty values
$user = "apkdown1_wealth-trust";
$pass = "wealth-trust"; 
$dbname = "apkdown1_wealth-trust";
$conn = mysqli_connect("localhost", $user, $pass, $dbname);
$sql = "SELECT * FROM site_details";
$result = mysqli_query($conn, $sql);

if (mysqli_num_rows($result) > 0) {
        while($row = mysqli_fetch_assoc($result)) {
            $email = $row["email"];
            $sitename = $row["site_name"];
            $location = $row["location"];
            $phone = $row["phone"];
        }
}
if (isset($_POST["submit"])) {
  $conn = mysqli_connect("localhost", $user, $pass, $dbname);
  if (!$conn) {
    die("Connection failed: " . mysqli_connect_error());
  }
  
  function test_input($data) {
  $data = trim($data);
  $data = stripslashes($data);
  $data = htmlspecialchars($data);
  return $data;
  }
    
  if (empty($_POST["reg_firstname"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_firstname = test_input($_POST["reg_firstname"]);
    
  }
  
  if (empty($_POST["reg_middlename"])) {
      $reg_middlename = "";
  } else {
    $reg_middlename = test_input($_POST["reg_middlename"]);
    
  }
  if (empty($_POST["reg_lastname"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_lastname = test_input($_POST["reg_lastname"]);
    
  }
  if (empty($_POST["reg_suffix"])) {
    $reg_suffix = "";
  } else {
    $reg_suffix = test_input($_POST["reg_suffix"]);
    
  }
  if (empty($_POST["reg_dob"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_dob = test_input($_POST["reg_dob"]);
    
  }
  if (empty($_POST["reg_src_income"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_src_income = test_input($_POST["reg_src_income"]);
    
  }
  if (empty($_POST["reg_address1"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_address1 = test_input($_POST["reg_address1"]);
    
  }
  if (empty($_POST["reg_address2"])) {
    $reg_address2 = "";
  } else {
    $reg_address2 = test_input($_POST["reg_address2"]);
    
  }
  if (empty($_POST["reg_city"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_city = test_input($_POST["reg_city"]);
    
  }
  if (empty($_POST["reg_state"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_state = test_input($_POST["reg_state"]);
    
  }
  if (empty($_POST["reg_zip"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_zip = test_input($_POST["reg_zip"]);
    
  }
  if (empty($_POST["reg_country"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_country = test_input($_POST["reg_country"]);
    
  }
  if (empty($_POST["reg_phone1"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_phone1 = test_input($_POST["reg_phone1"]);
    
  }
  if (empty($_POST["reg_phone2"])) {
    $reg_phone2 = "";
  } else {
    $reg_phone2 = test_input($_POST["reg_phone2"]);
    
  }
  if (empty($_POST["reg_acc_type"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_acc_type = test_input($_POST["reg_acc_type"]);
    
  }
  if (empty($_POST["reg_phone1_type"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_phone1_type = test_input($_POST["reg_phone1_type"]);
    
  }
  if (empty($_POST["reg_phone2_type"])) {
    $reg_phone2_type = "";
  } else {
    $reg_phone2_type = test_input($_POST["reg_phone2_type"]);
    
  }
  if (empty($_POST["reg_email_rpt"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_email_rpt = test_input($_POST["reg_email_rpt"]);
    
  }
  if (empty(basename($_FILES["passport"]["name"]))) {
    $error = "Upload your passport";
  } else {
     
    $target_dir = "/acc-images/";
    $target_file = $target_dir . basename($_FILES["passport"]["name"]);
    $uploadOk = 1;
    $imageFileType = strtolower(pathinfo($target_file,PATHINFO_EXTENSION));
    $passport = basename($_FILES["passport"]["name"]);
    if (file_exists($target_file)) {
    $target_file = $target_dir . $reg_firstname.".".$imageFileType;
    
    }
    $check = getimagesize($_FILES["passport"]["tmp_name"]);
    if($check !== false) {
        $uploadOk = 1;
    } else {
        $error = "Passport File is not an image.";
        $uploadOk = 0;
    }
    
  }
  if (empty($_POST["reg_nos_firstname"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_nos_firstname = test_input($_POST["reg_nos_firstname"]);
    
  }
  if (empty($_POST["reg_nos_middlename"])) {
    $reg_nos_middlename = "";
  } else {
    $reg_nos_middlename = test_input($_POST["reg_nos_middlename"]);
    
  }
  if (empty($_POST["reg_nos_lastname"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_nos_lastname = test_input($_POST["reg_nos_lastname"]);
    
  }
  if (empty($_POST["reg_nos_address"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_nos_address = test_input($_POST["reg_nos_address"]);
    
  }
  
  if (empty($_POST["reg_nos_phone"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_nos_phone = test_input($_POST["reg_nos_phone"]);
    
  }
  if (empty($_POST["reg_nos_rel"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_nos_rel = test_input($_POST["reg_nos_rel"]);
    
  }
  
  if (empty($_POST["reg_email"])) {
    $error = "Fill out all the required fields";
  } else {
    $reg_email = test_input($_POST["reg_email"]);
    $sql = "SELECT * FROM accounts WHERE reg_email='$reg_email'";
    $result = mysqli_query($conn, $sql); 
    
    if (mysqli_num_rows($result) > 0) {
      $error = "Email already used";
    }
    
  }
  if ($reg_email != $reg_email_rpt ){
      $error = "Emails doest not match";
  }
  
  if (!isset($error) && $uploadOk == 1){
    move_uploaded_file($_FILES["passport"]["tmp_name"], $target_file);
    //create online Id
    $chkiid = 1;
    while($chkiid == 1){
        $idsuff = mt_rand(1000,10000);
        $online_id = "$reg_firstname.$reg_lastname.$idsuff";
        $sql = "SELECT * FROM accounts WHERE online_id='$online_id'";
        $result = mysqli_query($conn, $sql);
        
        if (mysqli_num_rows($result) > 0) {
            $chkiid = 1; 
        }
        else{
            $chkiid = 0; 
        }
    }
    //create account number
    $chkacc = 1;
    while($chkacc == 1){
        $account_no = mt_rand(1000000000,9999999999);
        $sql = "SELECT * FROM accounts WHERE account_no=$account_no";
        $result = mysqli_query($conn, $sql);
        
        if (mysqli_num_rows($result) > 0) {
            $chkacc = 1; 
        }
        else{
            $chkacc = 0;
        }
    }
    
    $passcode = mt_rand(10000,100000);
    $sql = "INSERT INTO accounts "."(online_id,passcode,reg_firstname,reg_middlename,reg_lastname,reg_suffix,reg_dob,reg_src_income,reg_address1,reg_address2,reg_city,reg_state,reg_zip,reg_country,reg_phone1,reg_phone2,reg_email,reg_phone1_type,reg_phone2_type,reg_acc_type,passport,reg_nos_firstname,reg_nos_middlename,reg_nos_lastname,reg_nos_address,reg_nos_phone,reg_nos_rel,status,balance,account_no) "."VALUES ('$online_id','$passcode','$reg_firstname','$reg_middlename','$reg_lastname','$reg_suffix','$reg_dob','$reg_src_income','$reg_address1','$reg_address2','$reg_city','$reg_state','$reg_zip','$reg_country','$reg_phone1','$reg_phone2','$reg_email','$reg_phone1_type','$reg_phone2_type','$reg_acc_type','$passport','$reg_nos_firstname','$reg_nos_middlename','$reg_nos_lastname','$reg_nos_address','$reg_nos_phone','$reg_nos_rel','Pending','0','$account_no')";
    if (mysqli_query($conn, $sql)) {
        $success = "Application submitted successfully, Our admins will review your application for Approval .<br> It takes only a few munites <br>Check your email for your login details";
        $message_body = "<p style='padding:8px;background-color:#172531'><img src='https://wealthseabnk.com/images/logo.png' style='width:30%;height:30%'></p><br><p>Dear $reg_firstname</p><br><br><h3 style='color:blue;text-align:center'>PLEASE READ THIS EMAIL IN FULL AND PRINT IT FOR YOUR RECORDS</h3><br><br>";
        $message_body .= "<p>Your registeration was successful.</p><br><br>
        
        <table width='550px'cellpadding='4px'>
				
						<tr style='color:blue;font-size:30px;border-bottom:solid 1px gray;'>
							<th colspan='2' style='color:white;background-color:darkblue'><h2>Account Details</h2></th>
						</tr>

			<tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Online Id</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$online_id</td>
            </tr>
            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Passcode</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$passcode</td>
            </tr>
            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Account Number</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$account_no</td>
            </tr>
            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>First Name</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_firstname</td>
            </tr>
            

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Middle Name</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_middlename</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Last Name</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_lastname</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Suffix</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_suffix</td>
            </tr>

        
            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Date of Birth</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_dob</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Source of Income</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_src_income</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Address</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_address1</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>City</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_city</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>State</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_state</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>ZIP</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_zip</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Country</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_country</td>
            </tr>
  

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Email</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_email</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Phone Number</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_phone1</td>
            </tr>           

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Next of Kin First Name</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_nos_firstname</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Next of Kin Middle Name</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_nos_middlename</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Next of Kin Last Name</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_nos_lastname</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Next of Kin Address</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_nos_address</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Next of Kin Relationship</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_nos_rel</td>
            </tr>

            <tr>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #e7dede;padding:10px' valign='top' bgcolor='#e7dede'>Next of Kin Phone</td>
              <td style='font-family: sans-serif; font-size: 14px; vertical-align: top; background-color: #3498db; color:#ffffff;padding:10px' fgcolor='#ffffff' valign='top' bgcolor='#3498db' colspan='2' >$reg_nos_phone</td>
            </tr>


						

					</table>
					
			<br>
 <br>
 <p> You can chat with our live support via $phone; $email</p>
 
 <br>
 <br>
 <p>Your account information is private. Please do not disclose your login credentials to anyone</p>";
        $headers = "From: $email\r\n";
        $headers  .= "Reply-To: $email"."\r\n";
        $headers  .= 'MIME-Version: 1.0' . "\r\n";
        $headers .= 'Content-type: text/html; charset=UTF-8' . "\r\n";
        
        // Additional headers
        
        mail($reg_email,"YOUR ACCOUNT DETAIILLS",$message_body,$headers);
        
    } else {
        echo "Error: " . $sql . "<br>" . mysqli_error($conn);
    }
  }
    


}
?>

<!DOCTYPE html>
<html lang="en">

<!-- Mirrored from westamericafinance.com/signup/verify-registration.php by HTTrack Website Copier/3.x [XR&CO'2014], Wed, 10 Apr 2024 07:46:18 GMT -->
<!-- Added by HTTrack --><meta http-equiv="content-type" content="text/html;charset=UTF-8" /><!-- /Added by HTTrack -->
<head>
    <meta charset="utf-8">
    <meta http-equiv="X-UA-Compatible" content="IE=edge">
    <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, shrink-to-fit=no">
    <title>Registration - Wealth Trust </title>
    <link rel="icon" type="image/x-icon" href="../assets/img/favicon.ico"/>
    <!-- BEGIN GLOBAL MANDATORY STYLES -->
    <link href="https://fonts.googleapis.com/css?family=Quicksand:400,500,600,700&amp;display=swap" rel="stylesheet">
    <link href="../bootstrap/css/bootstrap.min.css" rel="stylesheet" type="text/css" />
    <link href="../assets/css/plugins.css" rel="stylesheet" type="text/css" />
    <link href="formcss.css" rel="stylesheet" type="text/css"/>

    <!-- END GLOBAL MANDATORY STYLES -->
    <link rel="stylesheet" type="text/css" href="../assets/css/forms/theme-checkbox-radio.css">
    <link rel="stylesheet" type="text/css" href="../assets/css/forms/switches.css">


    <!-- BEGIN THEME GLOBAL STYLES -->
    <link href="../assets/css/scrollspyNav.css" rel="stylesheet" type="text/css" />
    <link href="../plugins/animate/animate.css" rel="stylesheet" type="text/css" />
    <link href="../plugins/notification/snackbar/snackbar.min.css" rel="stylesheet" type="text/css" />
    <link rel="stylesheet" type="text/css" href="../assets/css/elements/alert.css">
    <script src="../plugins/sweetalerts/promise-polyfill.js"></script>
    <link href="../plugins/sweetalerts/sweetalert2.min.css" rel="stylesheet" type="text/css" />
    <link href="../plugins/sweetalerts/sweetalert.css" rel="stylesheet" type="text/css" />
    <link href="../assets/css/components/custom-sweetalert.css" rel="stylesheet" type="text/css" />
    <script src="../../www.dukelearntoprogram.com/course1/common/js/image/SimpleImage.js">
    </script>
    <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css">
    <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
<!--    <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>-->
    <style>
        #Div2{
            display: none;
        }
        #nextShow{
            display: none;
        }

        #Div4{
            display: none;
        }

        #Button11{
            display: none;
        }

        .container-div{
            height: 100%;
        }

        canvas {
            height: 100px;
            border-style: solid;
            border-width: 1px;
            border-color: black;
        }


    </style>
    
    
</head>

<body>


<section class="wizard-section">
    <div class="row no-gutters">
        <div class="col-lg-6 col-md-6 container-div">
            <div class="wizard-content-left d-flex justify-content-center align-items-center">
                <h1>Create Your Bank Account</h1>
            </div>
        </div>
        <div class="col-lg-6 col-md-6 container-div">
            <div class="container mt-5">
                <h4 style="color:red"><?php if(isset($error)){echo $error;}?></h4>
    			<h4 style="color:green"><?php if(isset($success)){echo $success;}?></h4>
                <h4 class="text-success1">Welcome to Wealth Trust Registration </h4>
                <p class="text-dark">Just take a few minutes to register for Wealth Trust and you'll have online and mobile access to all your personal accounts with one Login ID and Password.
                </p>
                <p class="text-dark">If you are currently registered for eastBroker or eastInsurance, EasyWeb will be added to your existing profile, giving you convenient single login access to all your accounts. 
                </p>
                <form method="post" action="<?php echo htmlspecialchars($_SERVER["PHP_SELF"]);?>" enctype="multipart/form-data">
                    <div class="" id="step1">
                        <h4 class="mt-5">Personal Information</h4>
    				
    					<input class="form-control form-control-lg mt-3" name="reg_firstname" id="" type="text" placeholder="First name *" value="" >
    					
    				
    
    				
    					<input class="form-control form-control-lg mt-3" name="reg_middlename" id="" type="text" placeholder="Middle name" value="" >
    				
    
    				
    					<input class="form-control form-control-lg mt-3" name="reg_lastname" id="" type="text" placeholder="Last name *" value="" >
    					
    					<select class="form-control form-control-lg mt-3" name="reg_suffix" id="">
    						<option value=""  >Suffix</option>
    						<option value="Jr"  >Jr</option>
    						<option value="Sr"  >Sr</option>
    						<option value="II"  >II</option>
    						<option value="III"  >III</option>
    						<option value="IV"  >IV</option>
    						<option value="V"  >V</option>
    						<option value="None"  >None</option>
    					</select>
    					
    				    <label class="w3-small mt-3">DD/MM/YYY</label>
    					<input class="form-control form-control-lg " name="reg_dob" id="" type="date" placeholder="Date of birth *" value="" >
    					
    				
    					<select class="form-control form-control-lg mt-3" name="reg_src_income" id="">
    						<option value=""  >Source of income *</option>
    						<option value="Employement income"  >Employement income</option>
    						<option value="Inheritance or"  >Inheritance or</option>
    						<option value="Investment Income"  >Investment Income</option>
    						<option value="Retirement Income"  >Retirement Income</option>
    						<option value="Social Security"  >Social Security</option>
    						<option value="Self Employed"  >Self Employed</option>
    						<option value="Unemployed"  >Unemployed</option>
    						<option value="Other"  >Other</option>
    					</select>
    					<div class="form-group mt-5 clearfix mb-5">
                
                            <a class="btn btn-primary btn-lg float-right" id="step2button" href="javascript:;">Next <i class="fa fa-arrow-right"></i></a>
                        </div>
    					
        			</div>
        			<div class="" id="step2" style="display:none">
        				<h4 class="mt-5">Address</h4>
    				
    					<input class="form-control form-control-lg mt-3" name="reg_address1" id="" type="text" placeholder="Address 1 *" value="" >
    					
    				
    
    				
    				    
    					<input class="form-control form-control-lg mt-3" name="reg_address2" id="" type="text" placeholder="Address 2" value="" >
    					
    				
    					<input class="form-control form-control-lg mt-3" name="reg_city" id="" type="text" placeholder="City *" value="" >
    					<span></span>
    				
    					<input class="form-control form-control-lg mt-3" name="reg_state" id="" type="text" placeholder="State *" value="" >
    					<label class="w3-small">First 5 digits required</label>
    					<input class="form-control form-control-lg mt-3" name="reg_zip" id="" type="text" placeholder="ZIP Code *" value="" >
    					
    				
    					<select class="form-control form-control-lg mt-3" name="reg_country" id="">
    												
    
    
    					<option value="" selected="selected">Select Country</option>
    					<option value="Afghanistan [93]"  >Afghanistan [93]</option>
    					<option value="Albania [355]"  >Albania [355]</option>
    					<option value="Algeria [213]"  >Algeria [213]</option>
    					<option value="American Samoa [1684]"  >American Samoa [1684]</option>
    					<option value="Andorra [376]"  >Andorra [376]</option>
    					<option value="Angola [244]"  >Angola [244]</option>
    					<option value="Anguilla [1264]"  >Anguilla [1264]</option>
    					<option value="Antarctica [672]"  >Antarctica [672]</option>
    					<option value="Antigua [1268]"  >Antigua [1268]</option>
    					<option value="Argentina [54]"  >Argentina [54]</option>
    					<option value="Armenia [374]"  >Armenia [374]</option>
    					<option value="Aruba [297]"  >Aruba [297]</option>
    					<option value="Ascension [247]"  >Ascension [247]</option>
    					<option value="Australia [61]"  >Australia [61]</option>
    					<option value="Australian External Territories [672]"  >Australian External Territories [672]</option>
    					<option value="Austria [43]"  >Austria [43]</option>
    					<option value="Azerbaijan [994]"  >Azerbaijan [994]</option>
    					<option value="Bahamas [1242]"  >Bahamas [1242]</option>
    					<option value="Bahrain [973]"  >Bahrain [973]</option>
    					<option value="Bangladesh [880]"  >Bangladesh [880]</option>
    					<option value="Barbados [1246]"  >Barbados [1246]</option>
    					<option value="Barbuda [1268]"  >Barbuda [1268]</option>
    					<option value="Belarus [375]"  >Belarus [375]</option>
    					<option value="Belgium [32]"  >Belgium [32]</option>
    					<option value="Belize [501]"  >Belize [501]</option>
    					<option value="Benin [229]"  >Benin [229]</option>
    					<option value="Bermuda [1441]"  >Bermuda [1441]</option>
    					<option value="Bhutan [975]"  >Bhutan [975]</option>
    					<option value="Bolivia [591]"  >Bolivia [591]</option>
    					<option value="Bosnia and Herzegovina [387]"  >Bosnia &amp; Herzegovina [387]</option>
    					<option value="Botswana [267]"  >Botswana [267]</option>
    					<option value="Brazil [55]"  >Brazil [55]</option>
    					<option value="British Virgin Islands [1284]"  >British Virgin Islands [1284]</option>
    					<option value="Brunei Darussalam [673]"  >Brunei Darussalam [673]</option>
    					<option value="Bulgaria [359]"  >Bulgaria [359]</option>
    					<option value="Burkina Faso [226]"  >Burkina Faso [226]</option>
    					<option value="Burundi [257]"  >Burundi [257]</option>
    					<option value="Cambodia [855]"  >Cambodia [855]</option>
    					<option value="Cameroon [237]"  >Cameroon [237]</option>
    					<option value="Canada [1]"  >Canada [1]</option>
    					<option value="Cape Verde Islands [238]"  >Cape Verde Islands [238]</option>
    					<option value="Cayman Islands [1345]"  >Cayman Islands [1345]</option>
    					<option value="Central African Republic [236]"  >Central African Republic [236]</option>
    					<option value="Chad [235]"  >Chad [235]</option>
    					<option value="Chatham Island (New Zealand) [64]"  >Chatham Island (New Zealand) [64]</option>
    					<option value="Chile [56]"  >Chile [56]</option>
    					<option value="China (PRC) [86]"  >China (PRC) [86]</option>
    					<option value="Christmas Island [61]"  >Christmas Island [61]</option>
    					<option value="CocosKeeling Islands [61]"  >CocosKeeling Islands [61]</option>
    					<option value="Colombia [57]"  >Colombia [57]</option>
    					<option value="Comoros [269]"  >Comoros [269]</option>
    					<option value="Congo [242]"  >Congo [242]</option>
    					<option value="Congo, Dem. Rep. of (Zaire) [243]"  >Congo, Dem. Rep. of (Zaire) [243]</option>
    					<option value="Cook Islands [682]"  >Cook Islands [682]</option>
    					<option value="Costa Rica [506]"  >Costa Rica [506]</option>
    					<option value="Cote d'Ivoire (Ivory Coast) [225]"  >Cote d&#039;Ivoire (Ivory Coast) [225]</option>
    					<option value="Croatia [385]"  >Croatia [385]</option>
    					<option value="Cuba [53]"  >Cuba [53]</option>
    					<option value="Cuba (Guantanamo Bay) [5399]"  >Cuba (Guantanamo Bay) [5399]</option>
    					<option value="Curacao [599]"  >Curacao [599]</option>
    					<option value="Cyprus [357]"  >Cyprus [357]</option>
    					<option value="Czech Republic [420]"  >Czech Republic [420]</option>
    					<option value="Denmark [45]"  >Denmark [45]</option>
    					<option value="Diego Garcia [246]"  >Diego Garcia [246]</option>
    					<option value="Djibouti [253]"  >Djibouti [253]</option>
    					<option value="Dominica [1767]"  >Dominica [1767]</option>
    					<option value="Dominican Republic [1809]"  >Dominican Republic [1809]</option>
    					<option value="Mega Timor [670]"  >Mega Timor [670]</option>
    					<option value="Megaer Island [56]"  >Megaer Island [56]</option>
    					<option value="Ecuador [593]"  >Ecuador [593]</option>
    					<option value="Egypt [20]"  >Egypt [20]</option>
    					<option value="El Salvador [503]"  >El Salvador [503]</option>
    					<option value="Ellipso (Mobile Satellite service) [17625]"  >Ellipso (Mobile Satellite service) [17625]</option>
    					<option value="Equatorial Guinea [240]"  >Equatorial Guinea [240]</option>
    					<option value="Eritrea [291]"  >Eritrea [291]</option>
    					<option value="Estonia [372]"  >Estonia [372]</option>
    					<option value="Ethiopia [251]"  >Ethiopia [251]</option>
    					<option value="Falkland Islands (Malvinas) [500]"  >Falkland Islands (Malvinas) [500]</option>
    					<option value="Faroe Islands [298]"  >Faroe Islands [298]</option>
    					<option value="Fiji Islands [679]"  >Fiji Islands [679]</option>
    					<option value="Finland [358]"  >Finland [358]</option>
    					<option value="France [33]"  >France [33]</option>
    					<option value="French Antilles [596]"  >French Antilles [596]</option>
    					<option value="French Guiana [594]"  >French Guiana [594]</option>
    					<option value="French Polynesia [689]"  >French Polynesia [689]</option>
    					<option value="Gabonese Republic [241]"  >Gabonese Republic [241]</option>
    					<option value="Gambia [220]"  >Gambia [220]</option>
    					<option value="Georgia [995]"  >Georgia [995]</option>
    					<option value="Germany [49]"  >Germany [49]</option>
    					<option value="Ghana [233]"  >Ghana [233]</option>
    					<option value="Gibraltar [350]"  >Gibraltar [350]</option>
    					<option value="Greece [30]"  >Greece [30]</option>
    					<option value="Greenland [299]"  >Greenland [299]</option>
    					<option value="Grenada [1473]"  >Grenada [1473]</option>
    					<option value="Guadeloupe [590]"  >Guadeloupe [590]</option>
    					<option value="Guam [1671]"  >Guam [1671]</option>
    					<option value="Guantanamo Bay [5399]"  >Guantanamo Bay [5399]</option>
    					<option value="Guatemala [502]"  >Guatemala [502]</option>
    					<option value="Guinea Bissau [245]"  >GuineaBissau [245]</option>
    					<option value="Guinea [224]"  >Guinea [224]</option>
    					<option value="Guyana [592]"  >Guyana [592]</option>
    					<option value="Haiti [509]"  >Haiti [509]</option>
    					<option value="Honduras [504]"  >Honduras [504]</option>
    					<option value="Hong Kong [852]"  >Hong Kong [852]</option>
    					<option value="Hungary [36]"  >Hungary [36]</option>
    					<option value="Iceland [354]"  >Iceland [354]</option>
    					<option value="India [91]"  >India [91]</option>
    					<option value="Indonesia [62]"  >Indonesia [62]</option>
    					<option value="Iran [98]"  >Iran [98]</option>
    					<option value="Iraq [964]"  >Iraq [964]</option>
    					<option value="Ireland [353]"  >Ireland [353]</option>
    					<option value="Israel [972]"  >Israel [972]</option>
    					<option value="Italy [39]"  >Italy [39]</option>
    					<option value="Jamaica [1876]"  >Jamaica [1876]</option>
    					<option value="Japan [81]"  >Japan [81]</option>
    					<option value="Jordan [962]"  >Jordan [962]</option>
    					<option value="Kazakhstan [7]"  >Kazakhstan [7]</option>
    					<option value="Kenya [254]"  >Kenya [254]</option>
    					<option value="Kiribati [686]"  >Kiribati [686]</option>
    					<option value="Korea (Mega) [850]"  >Korea (Mega) [850]</option>
    					<option value="Korea (South) [82]"  >Korea (South) [82]</option>
    					<option value="Kosovo [381]"  >Kosovo [381]</option>
    					<option value="Kuwait [965]"  >Kuwait [965]</option>
    					<option value="Kyrgyz Republic [996]"  >Kyrgyz Republic [996]</option>
    					<option value="Laos [856]"  >Laos [856]</option>
    					<option value="Latvia [371]"  >Latvia [371]</option>
    					<option value="Lebanon [961]"  >Lebanon [961]</option>
    					<option value="Lesotho [266]"  >Lesotho [266]</option>
    					<option value="Liberia [231]"  >Liberia [231]</option>
    					<option value="Libya [218]"  >Libya [218]</option>
    					<option value="Liechtenstein [423]"  >Liechtenstein [423]</option>
    					<option value="Lithuania [370]"  >Lithuania [370]</option>
    					<option value="Luxembourg [352]"  >Luxembourg [352]</option>
    					<option value="Macao [853]"  >Macao [853]</option>
    					<option value="Macedonia (Former Yugoslav Rep of.) [389]"  >Macedonia (Former Yugoslav Rep of.) [389]</option>
    					<option value="Madagascar [261]"  >Madagascar [261]</option>
    					<option value="Malawi [265]"  >Malawi [265]</option>
    					<option value="Malaysia [60]"  >Malaysia [60]</option>
    					<option value="Maldives [960]"  >Maldives [960]</option>
    					<option value="Mali Republic [223]"  >Mali Republic [223]</option>
    					<option value="Malta [356]"  >Malta [356]</option>
    					<option value="Marshall Islands [692]"  >Marshall Islands [692]</option>
    					<option value="Martinique [596]"  >Martinique [596]</option>
    					<option value="Mauritania [222]"  >Mauritania [222]</option>
    					<option value="Mauritius [230]"  >Mauritius [230]</option>
    					<option value="Mayotte Island [269]"  >Mayotte Island [269]</option>
    					<option value="Mexico [52]"  >Mexico [52]</option>
    					<option value="Micronesia [691]"  >Micronesia [691]</option>
    					<option value="Midway Island [1808]"  >Midway Island [1808]</option>
    					<option value="Moldova [373]"  >Moldova [373]</option>
    					<option value="Monaco [377]"  >Monaco [377]</option>
    					<option value="Mongolia [976]"  >Mongolia [976]</option>
    					<option value="Montenegro [382]"  >Montenegro [382]</option>
    					<option value="Montserrat [1664]"  >Montserrat [1664]</option>
    					<option value="Morocco [212]"  >Morocco [212]</option>
    					<option value="Mozambique [258]"  >Mozambique [258]</option>
    					<option value="Myanmar [95]"  >Myanmar [95]</option>
    					<option value="Namibia [264]"  >Namibia [264]</option>
    					<option value="Nauru [674]"  >Nauru [674]</option>
    					<option value="Nepal [977]"  >Nepal [977]</option>
    					<option value="Netherlands [31]"  >Netherlands [31]</option>
    					<option value="Netherlands Antilles [599]"  >Netherlands Antilles [599]</option>
    					<option value="Nevis [1869]"  >Nevis [1869]</option>
    					<option value="New Caledonia [687]"  >New Caledonia [687]</option>
    					<option value="New Zealand [64]"  >New Zealand [64]</option>
    					<option value="Nicaragua [505]"  >Nicaragua [505]</option>
    					<option value="Niger [227]"  >Niger [227]</option>
    					<option value="Nigeria [234]"  >Nigeria [234]</option>
    					<option value="Niue [683]"  >Niue [683]</option>
    					<option value="Norfolk Island [672]"  >Norfolk Island [672]</option>
    					<option value="Megaern Marianas Islands [1670]"  >Megaern Marianas Islands [1670]</option>
    					<option value="Norway [47]"  >Norway [47]</option>
    					<option value="Oman [968]"  >Oman [968]</option>
    					<option value="Pakistan [92]"  >Pakistan [92]</option>
    					<option value="Palau [680]"  >Palau [680]</option>
    					<option value="Palestinian Settlements [970]"  >Palestinian Settlements [970]</option>
    					<option value="Panama [507]"  >Panama [507]</option>
    					<option value="Papua New Guinea [675]"  >Papua New Guinea [675]</option>
    					<option value="Paraguay [595]"  >Paraguay [595]</option>
    					<option value="Peru [51]"  >Peru [51]</option>
    					<option value="Philippines [63]"  >Philippines [63]</option>
    					<option value="Poland [48]"  >Poland [48]</option>
    					<option value="Portugal [351]"  >Portugal [351]</option>
    					<option value="Puerto Rico [1787]"  >Puerto Rico [1787]</option>
    					<option value="Qatar [974]"  >Qatar [974]</option>
    					<option value="Reunion Island [262]"  >Reunion Island [262]</option>
    					<option value="Romania [40]"  >Romania [40]</option>
    					<option value="Russia [7]"  >Russia [7]</option>
    					<option value="Rwandese Republic [250]"  >Rwandese Republic [250]</option>
    					<option value="St. Helena [290]"  >St. Helena [290]</option>
    					<option value="St. Kitts/Nevis [1869]"  >St. Kitts/Nevis [1869]</option>
    					<option value="St. Lucia [1758]"  >St. Lucia [1758]</option>
    					<option value="St. Pierre and Miquelon [508]"  >St. Pierre &amp; Miquelon [508]</option>
    					<option value="St. Vincent and Grenadines [1784]"  >St. Vincent &amp; Grenadines [1784]</option>
    					<option value="Samoa [685]"  >Samoa [685]</option>
    					<option value="San Marino [378]"  >San Marino [378]</option>
    					<option value="Sao Tome and Principe [239]"  >Sao Tome and Principe [239]</option>
    					<option value="Saudi Arabia [966]"  >Saudi Arabia [966]</option>
    					<option value="Senegal [221]"  >Senegal [221]</option>
    					<option value="Serbia [381]"  >Serbia [381]</option>
    					<option value="Seychelles Republic [248]"  >Seychelles Republic [248]</option>
    					<option value="Sierra Leone [232]"  >Sierra Leone [232]</option>
    					<option value="Singapore [65]"  >Singapore [65]</option>
    					<option value="Slovak Republic [421]"  >Slovak Republic [421]</option>
    					<option value="Slovenia [386]"  >Slovenia [386]</option>
    					<option value="Solomon Islands [677]"  >Solomon Islands [677]</option>
    					<option value="Somali Democratic Republic [252]"  >Somali Democratic Republic [252]</option>
    					<option value="South Africa [27]"  >South Africa [27]</option>
    					<option value="Spain [34]"  >Spain [34]</option>
    					<option value="Sri Lanka [94]"  >Sri Lanka [94]</option>
    					<option value="Sudan [249]"  >Sudan [249]</option>
    					<option value="Suriname [597]"  >Suriname [597]</option>
    					<option value="Swaziland [268]"  >Swaziland [268]</option>
    					<option value="Sweden [46]"  >Sweden [46]</option>
    					<option value="Switzerland [41]"  >Switzerland [41]</option>
    					<option value="Syria [963]"  >Syria [963]</option>
    					<option value="Taiwan [886]"  >Taiwan [886]</option>
    					<option value="Tajikistan [992]"  >Tajikistan [992]</option>
    					<option value="Tanzania [255]"  >Tanzania [255]</option>
    					<option value="Thailand [66]"  >Thailand [66]</option>
    					<option value="Timor Leste [670]"  >Timor Leste [670]</option>
    					<option value="Togolese Republic [228]"  >Togolese Republic [228]</option>
    					<option value="Tokelau [690]"  >Tokelau [690]</option>
    					<option value="Tonga Islands [676]"  >Tonga Islands [676]</option>
    					<option value="Trinidad and Tobago [1868]"  >Trinidad &amp; Tobago [1868]</option>
    					<option value="Tunisia [216]"  >Tunisia [216]</option>
    					<option value="Turkey [90]"  >Turkey [90]</option>
    					<option value="Turkmenistan [993]"  >Turkmenistan [993]</option>
    					<option value="Turks and Caicos Islands [1649]"  >Turks and Caicos Islands [1649]</option>
    					<option value="Tuvalu [688]"  >Tuvalu [688]</option>
    					<option value="Uganda [256]"  >Uganda [256]</option>
    					<option value="Ukraine [380]"  >Ukraine [380]</option>
    					<option value="United Arab Emirates [971]"  >United Arab Emirates [971]</option>
    					<option value="United Kingdom [44]"  >United Kingdom [44]</option>
    					<option value="United States of America [1]"  >United States of America [1]</option>
    					<option value="US Virgin Islands [1340]"  >US Virgin Islands [1340]</option>
    					<option value="Uruguay [598]"  >Uruguay [598]</option>
    					<option value="Uzbekistan [998]"  >Uzbekistan [998]</option>
    					<option value="Vanuatu [678]"  >Vanuatu [678]</option>
    					<option value="Vatican City [39]"  >Vatican City [39]</option>
    					<option value="Venezuela [58]"  >Venezuela [58]</option>
    					<option value="Vietnam [84]"  >Vietnam [84]</option>
    					<option value="Wake Island [808]"  >Wake Island [808]</option>
    					<option value="Wallis and Futuna Islands [681]"  >Wallis and Futuna Islands [681]</option>
    					<option value="Yemen [967]"  >Yemen [967]</option>
    					<option value="Zambia [260]"  >Zambia [260]</option>
    					<option value="Zanzibar [255]"  >Zanzibar [255]</option>
    					<option value="Zimbabwe [263]"  >Zimbabwe [263]</option>
    				</select>						</select>
    					
    				<h4 class="mt-5">Contact</h4>
				
					<input class="form-control form-control-lg mt-3" name="reg_phone1" id="" type="text" placeholder="Phone number * " value="" >
					<span class="w3-small">In international format eg +123456789</span>
					<select class="form-control form-control-lg mt-3" name="reg_phone1_type" id="">
						<option value=""  >Phone number type *</option>
						<option value="Home"  >Home</option>
						<option value="Work"  >Work</option>
						<option value="Mobile"  >Mobile</option>
					</select>
				
					<input class="form-control form-control-lg mt-3" name="reg_phone2" id="" type="text" placeholder="Phone number 2 If any" value="" >
					<select class="form-control form-control-lg mt-3" name="reg_phone2_type" id="">
						<option value=""  >Phone number 2 type</option>
						<option value="Home"  >Home</option>
						<option value="Work"  >Work</option>
						<option value="Mobile"  >Mobile</option>
					</select>
				
					<input class="form-control form-control-lg mt-3" name="reg_email" id="" type="text" placeholder="Email address *" value="" >
					<span class="w3-small">Verification link and other mails will be sent to this email</span>
				
					
					<input class="form-control form-control-lg mt-3" name="reg_email_rpt" id="" type="text" placeholder="Re-enter email address *" value="" >
					
					<div class="form-group mt-5 clearfix mb-5">
                        <a class="btn btn-secondary btn-lg float-left" id="step1button" href="javascript:;">Back <i class="fa fa-arrow-left"></i></a>
                        <a class="btn btn-primary btn-lg float-right" id="step3button" href="javascript:;">Next <i class="fa fa-arrow-right"></i></a>
                    </div>
				</div>
				<div class="" id="step3" style="display:none">
    				<h4 class="mt-5">Account</h4> 
				
					<select class="form-control form-control-lg mt-3" name="reg_acc_type" id="">
						<option value=""  >Account type *</option>
						<option value="Savings"  >Savings</option>
						<option value="Current"  >Current</option>
					</select>
					<span class="w3-small">Select type of account you wish to open</span>
				
    				<h4 class="mt-5">Verification</h4> 
				
					<input class="form-control form-control-lg mt-3" name="passport" id="" type="file" class="apply_input" multiple>
					<span class="w3-small">Attach your scanned passport photograph (200px X 200px)</span>

    				<p style="margin-left:0px; margin-top:10px;" class="w3-small"><strong>Note: </strong>File formats accepted are png, jpg, jpeg and gif.</p>
    				
    				<div class="form-group mt-5 clearfix mb-5">
                        <a class="btn btn-secondary btn-lg float-left" id="step22button" href="javascript:;">Back <i class="fa fa-arrow-left"></i></a>
                        <a class="btn btn-primary btn-lg float-right" id="step4button" href="javascript:;">Next <i class="fa fa-arrow-right"></i></a>
                    </div>
    				
                </div>
			    <div class="" id="step4" style="display:none">
    				<h4 class="mt-5">Next of Kin</h4>
				
					<input class="form-control form-control-lg mt-3" name="reg_nos_firstname" id="" type="text" placeholder="First name *" value="" >
					
				

				
					<input class="form-control form-control-lg mt-3" name="reg_nos_middlename" id="" type="text" placeholder="Middle name" value="" >
					
					<input class="form-control form-control-lg mt-3" name="reg_nos_lastname" id="" type="text" placeholder="Last name *" value="" >
					
					<input class="form-control form-control-lg mt-3" name="reg_nos_address" id="" type="text" placeholder="Address *" value="" >
					
					<input class="form-control form-control-lg mt-3" name="reg_nos_phone" id="" type="text" placeholder="Phone Number *" value="" >
					
				
					<select class="form-control form-control-lg mt-3" name="reg_nos_rel" id="">
						<option value=""  >Relationship *</option>
						<option value="Brother"  >Brother</option>
						<option value="Sister"  >Sister</option>
						<option value="Father"  >Father</option>
						<option value="Mother"  >Mother</option>
						<option value="Aunt"  >Aunt</option>
						<option value="Uncle"  >Uncle</option>
						<option value="Brother-Inlaw"  >Brother-Inlaw</option>
						<option value="Sister-Inlaw"  >Sister-Inlaw</option>
						<option value="Father-Inlaw"  >Father-Inlaw</option>
						<option value="Mother-Inlaw"  >Mother-Inlaw</option>
						<option value="Husband"  >Husband</option>
						<option value="Wife"  >Wife</option>
						<option value="Cousin"  >Cousin</option>
						<option value="Other"  >Other</option>
					</select>
					
				
			
        			<!--<input class="btn btn-lg bg-success text-light " type="submit" value="Submit" id="sign_in_submit" name="submit" >-->
        			<div class="form-group mt-5 clearfix mb-5">
                        <a class="btn btn-secondary btn-lg float-left" id="step33button" href="javascript:;">Back <i class="fa fa-arrow-left"></i></a>
                        <button class="btn btn-success btn-lg float-right" type="submit" name="submit">Submit <i class="fa fa-check-square-o"></i></button>
                    </div>
        		</div>
                
                </form>
            </div>
            
        
        </div>
    </div>
</section>






<!-- BEGIN GLOBAL MANDATORY SCRIPTS -->
<script src="../bootstrap/js/popper.min.js"></script>
<script src="../bootstrap/js/bootstrap.min.js"></script>
<script src="../plugins/perfect-scrollbar/perfect-scrollbar.min.js"></script>
<script src="../assets/js/app.js"></script>

<!-- END GLOBAL MANDATORY SCRIPTS -->
<script src="../assets/js/authentication/form-2.js"></script>
<script src="../plugins/highlight/highlight.pack.js"></script>
<script src="../assets/js/custom.js"></script>
<!-- END GLOBAL MANDATORY STYLES -->
<script src="../plugins/notification/snackbar/snackbar.min.js"></script>
<!-- END PAGE LEVEL PLUGINS -->

<!--  BEGIN CUSTOM SCRIPTS FILE  -->
<script src="../assets/js/components/notification/custom-snackbar.js"></script>
<!--  END CUSTOM SCRIPTS FILE  -->

<!-- BEGIN THEME GLOBAL STYLE -->
<script src="../assets/js/scrollspyNav.js"></script>
<script src="../plugins/sweetalerts/sweetalert2.min.js"></script>
<script src="../plugins/sweetalerts/custom-sweetalert.js"></script>

<!-- END THEME GLOBAL STYLE -->
<script>
  $(document).ready(function(){
  $("#step2button").click(function(){
    $("#step1").hide();
    $("#step2").show();
    $("#step3").hide();
    $("#step4").hide();
  });
  $("#step22button").click(function(){
    $("#step1").hide();
    $("#step2").show();
    $("#step3").hide();
    $("#step4").hide();
  });
  $("#step1button").click(function(){
    $("#step1").show();
    $("#step2").hide();
    $("#step3").hide();
    $("#step4").hide();
  });
  $("#step3button").click(function(){
    $("#step3").show();
    $("#step2").hide();
    $("#step1").hide();
    $("#step4").hide();
  });
  $("#step33button").click(function(){
    $("#step3").show();
    $("#step2").hide();
    $("#step1").hide();
    $("#step4").hide();
  });
  $("#step4button").click(function(){
    $("#step4").show();
    $("#step1").hide();
    $("#step2").hide();
    $("#step3").hide();
    
  });
});
</script>
</body>

<!-- Mirrored from westamericafinance.com/signup/verify-registration.php by HTTrack Website Copier/3.x [XR&CO'2014], Wed, 10 Apr 2024 07:46:22 GMT -->
</html>