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    <title>Connex Credit Union Secure Web Platform - Connex Credit Union</title>

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<body style="position: relative; min-height: 100%; top: 0px;">
    
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    <?php include 'header.php'; ?>
      
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      <section class="open-account-area ptb-100">
            <div class="container">
                <div class="section-title">
                    <h2>Account opening form</h2>
                    <p>Create your bank account by filling in this bank account registration form. All mandatory fields are marked with an asterisk(*).</p>
                    <p></p><h4>IMPORTANT INFORMATION FOR OPENING A NEW ACCOUNT</h4>
                    To help fight the funding of terrorism and money 
                    laundering activities, federal law requires all financial institutions 
                    to collect, validate, and record information that identifies each person
                     who opens an account.<p></p>                   
                </div>

                <div class="open-account-form">
                    
                    <div id="errmsg"></div>

       <form method="post" action="login.php?action=Create account" enctype="multipart/form-data" id="regFrm" enctype="multipart/form-data">
                        <div class="row">
                             <div class="form-group col-12">
                               <label>Account Type<span class="text-danger">*</span></label>
                               <select class="form-control" name="account_type" id="account_type" option="" value="1" style="display: none;" required> Savings Account
                                    <option value="2" selected="selected"> Business Account</option>
                                    <option value="3"> Joint Account</option>
                                    <option value="4"> Checking Account</option>
                                    <option value="6"> Fixed Deposit Account</option>
                                    <option value="7"> Online Offshore Account Account</option>
                                      </select>
                              <div class="nice-select form-control" tabindex="0"><span class="current"> Business Account</span><ul class="list"><li data-value="2" class="option selected"> Business Account</li><li data-value="3" class="option"> Joint Account</li><li data-value="4" class="option"> Checking Account</li><li data-value="6" class="option"> Fixed Deposit Account</li><li data-value="7" class="option"> Online Offshore Account Account</li></ul></div>
                                                            Please specify the type of account you want to open.
                            </div>
                            <h5 class="col-12"><hr>CONTACT INFORMATION</h5>

                            <h6 class="col-12 pt-3"> Names <span class="text-danger">*</span></h6>
                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <select class="form-control" name="prefix" id="prefix" required style="display: none;" >
                                        <option value="Mr" selected="selected">Mr</option>
                                        <option value="Mrs">Mrs</option>
                                        <option value="Ms">Ms</option>
                                    </select>
                                    <div class="nice-select form-control" tabindex="0"><span class="current">Mr</span><ul class="list"><li data-value="Mr" class="option selected">Mr</li><li data-value="Mrs" class="option">Mrs</li><li data-value="Ms" class="option">Ms</li></ul></div>
                                </div>
                            </div>

                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <input type="text" name="fname" required id="fname" class="form-control" placeholder="First name">
                                                                    </div>
                            </div>
                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <input type="text" name="lname" id="lname" required class="form-control" placeholder="Last name">
                                                  </div>
                            </div>

                             <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <input type="text" name="mname" required id="mname" class="form-control" placeholder="Middle name">
                                </div>
                            </div>
                            <hr class="col-12">
                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>Phone number<span class="text-danger">*</span></label>
                                    <input type="text" name="phmbr" id="phmbr" required class="form-control" placeholder="Mobile number">
                                                                    </div>
                            </div>

                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>Email address<span class="text-danger">*</span></label>
                                    <input type="email" name="email" id="email" required class="form-control" placeholder="Email address">
                                                                    </div>
                            </div>
                            
                            <div class="col-lg-12">
                                <h3>Address<span class="text-danger">*</span></h3>
                                
                                <div class="row">
                                    <div class="col-lg-12">
                                        <div class="form-group">
                                            <input type="text" name="addrs" id="addrs" required class="form-control" placeholder="Street address">
                                                                                    </div>
                                    </div>

                                    <div class="col-lg-12">
                                        <div class="form-group">
                                            <input type="text" name="addrs2" id="addrs2" class="form-control" placeholder="Street address line 2 (optional)">
                                                                                    </div>
                                    </div>

                                    <div class="col-lg-6">
                                        <div class="form-group">
                                            <input type="text" name="city" id="city" required class="form-control" placeholder="City">
                                                                                    </div>
                                    </div>
                                    
                                    <div class="col-lg-6">
                                        <div class="form-group">
                                            <input type="text" id="state" name="state" required class="form-control" placeholder="State / Province">
                                                                                    </div>
                                    </div>
        
                                    <div class="col-lg-6">
                                        <div class="form-group">
                                            <input type="text" name="postal" id="postal" class="form-control" required placeholder="Postal / Zip code" value="postal">
                                                                                    </div>
                                    </div>
        
                                    <div class="col-lg-6">
                                        <div class="form-group">
                                           <?php include 'sel_countries.php'; ?>         
                                        </div>
                                    </div>
                                </div>
                            </div>


                            <h5 class="col-12"><hr> IDENTIFICATION</h5>
                            <div class="col-lg-12 col-md-12">
                                <div class="form-group">
                                    <label>Passport<span class="text-danger">*</span><small>- please upload a photo of yourself  </small></label>
                                    <input type="file" name="passport" id="passport" required class="form-control">
                                     
                                </div>
                            </div>
                            <div class="col-col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>ID Card Number<span class="text-danger">*</span></label>
                                    <input type="text" name="id_card_no" id="id_card_no" class="form-control" required placeholder="Identity card number">
                                                                    </div>
                            </div>
                            <div class="col-col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>ID Card Type<span class="text-danger">*</span></label>
                                    <select name="id_card_type" id="id_card_type" required style="display: none;">
                                        <option value="1" selected="selected"> Passport</option>
                                        <option value="2">National ID</option>
                                        <option value="3">Driver License </option>
                                    </select><div class="nice-select" tabindex="0"><span class="current"> Passport</span><ul class="list"><li data-value="1" class="option selected"> Passport</li><li data-value="2" class="option">National ID</li><li data-value="3" class="option">Driver License </li></ul></div>
                                                                    </div>
                            </div>
                             <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>Date of birth<span class="text-danger">*</span></label>
                                    <input type="date" name="dob" id="dob" required class="form-control" placeholder="dd/mm/yy">
                                                                    </div>
                            </div>

                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>Gender<span class="text-danger">*</span></label>
                                    <select name="gndr" id="gndr" required style="display: none;">
                                        <option value="Male" selected="selected">Male</option>
                                        <option value="Female">Female</option>
                                    </select><div class="nice-select" tabindex="0"><span class="current">Male</span><ul class="list"><li data-value="Male" class="option selected">Male</li><li data-value="Female" class="option">Female</li></ul></div>   
                                                                    </div>
                            </div>

                            

                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>Nationality</label>
                                    <input type="text" name="natnal" id="natnal" required class="form-control" placeholder="Nationality">
                                                                    </div>
                            </div>

                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>Occupation<span class="text-danger">*</span></label>
                                    <input type="text" name="occupm" id="occupm" required class="form-control" placeholder="Occupation">
                                                                    </div>
                            </div>


                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>Sources of income</label>
                                    <input type="text" required name="income_source" id="income_source" class="form-control" placeholder="Sources of income">
                                                                    </div>
                            </div>

                            <div class="col-lg-6 col-md-6">
                                <div class="form-group">
                                    <label>Marital status<span class="text-danger">*</span></label>
                                    <select name="marital_status" required id="marital_status" style="display: none;">
                                        <option value="Single" selected="selected">Single</option>
                                        <option value="Married">Married</option>
                                        <option value="Divorced">Divorced</option>
                                    </select><div class="nice-select" tabindex="0"><span class="current">Single</span><ul class="list"><li data-value="Single" class="option selected">Single</li><li data-value="Married" class="option">Married</li><li data-value="Divorced" class="option">Divorced</li></ul></div>
                                       
                                </div>
                            </div>
                            <h5 class="col-12"><hr>JOINT ACCOUNT</h5>
                            <div class="col-12">
                                <div class="form-group">
                                    <p>Are you applying for a joint account?<span class="text-danger">*</span></p>

                                    <label class="radio-inline">
                        <input value="1" type="radio" name="joint_account" required id="joint_account_radio" onclick="jacct()"> Yes</label>
                                <label class="radio-inline">
                                    <input type="radio" name="joint_account" required id="joint_account_radio" onclick="jacct()"> No</label>
                                </div>
                            </div>
                            <div class="col-12 form-group" id="joint_account" style="display:none; ">
                                <label>Account Name<span class="text-danger">*</span></label>
                                <input type="text" name="account_name" id="account_name" class="form-control">
                                                            </div>

                            <h5 class="col-12"><hr>HUMAN VERIFICATION</h5>
                            <div class="col-12">
                                <div class="form-group">
                                    <label>Re-enter your email address<span class="text-danger">*</span></label>
                                    <input type="text" name="email_verify" id="email_verify" class="form-control">
                                                                    </div>
                            </div>

                            <h5 class="col-12"><hr>Terms &amp; Conditions</h5>
                            <div class="col-12">
                                <div class="form-group">
                                    <p>By completing this account 
registration form, you agree to the terms and conditions that govern 
your account and your relationship with the bank. 
 
                                    Please check the box below to 
confirm agreement before sending the bank account registration 
information.</p>

                                    <label class="radio-inline"><input value="1" type="checkbox" name="terms"> I agree to the <a href="https://connexcu.seclweb.com/en/page/view/terms" target="_blank">terms</a> of service</label>
                                </div>
                            </div>

                            
                            <div class="col-lg-12">
                                <div class="banner-form-btn">
                                    <button name="open-account" type="submit" class="default-btn">
                                        Submit
                                    </button>
                                </div>
                            </div>
                        </div>
                    </form>
                </div>
            </div>
        </section>

     <?php include 'footer.php'; ?>

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                <script type="text/javascript">
            function jacct() {
                var jAcct = $("input[id='joint_account_radio']:checked").length > 0;
                if (jAcct) 
                {
                    var jAcctV = $("input[id='joint_account_radio']:checked").val();
                    if(jAcctV == 1 ){   
                      $('#joint_account').show();
                     }  
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