<?php
require_once './library/config.php';
require_once './library/functions.php';

$errorMessage = '&nbsp;';

if (isset($_POST['firstname']) && isset($_POST['lastname'])) {
	$result = doRegister();
	if ($result != '') {
		$errorMessage = $result;
	}
}

?>

<!DOCTYPE html><html>

<head><title>Enroll Customer | <?php echo $site_title; ?></title><meta charset="utf-8"><meta content="ie=edge" http-equiv="x-ua-compatible">

<meta content="template language" name="keywords"><meta content="Tamerlan Soziev" name="author">
<meta content="Admin dashboard html template" name="description"><meta content="width=device-width,initial-scale=1" name="viewport">
<link href="assets/icon.png" rel="shortcut icon"><link href="apple-touch-icon.png" rel="apple-touch-icon">
<link href="../fast.fonts.net/cssapi/487b73f1-c2d1-43db-8526-db577e4c822b.css" rel="stylesheet">
<link href="assets/bower_components/select2/dist/css/select2.min.css" rel="stylesheet">
<link href="assets/bower_components/bootstrap-daterangepicker/daterangepicker.css" rel="stylesheet">
<link href="assets/bower_components/dropzone/dist/dropzone.css" rel="stylesheet">
<link href="assets/bower_components/datatables.net-bs/css/dataTables.bootstrap.min.css" rel="stylesheet">
<link href="assets/bower_components/fullcalendar/dist/fullcalendar.min.css" rel="stylesheet">
<link href="assets/bower_components/perfect-scrollbar/css/perfect-scrollbar.min.css" rel="stylesheet">
<link href="assets/bower_components/slick-carousel/slick/slick.css" rel="stylesheet">
<link href="assets/css/main5739.css?version=4.5.0" rel="stylesheet">

<link href="library/spry/textfieldvalidation/SpryValidationTextField.css" rel="stylesheet" type="text/css" />
<script src="library/spry/textfieldvalidation/SpryValidationTextField.js" type="text/javascript"></script>

<link href="library/spry/passwordvalidation/SpryValidationPassword.css" rel="stylesheet" type="text/css" />
<script src="library/spry/passwordvalidation/SpryValidationPassword.js" type="text/javascript"></script>

<link href="library/spry/selectvalidation/SpryValidationSelect.css" rel="stylesheet" type="text/css" />
<script src="library/spry/selectvalidation/SpryValidationSelect.js" type="text/javascript"></script>

<link href="library/spry/textareavalidation/SpryValidationTextarea.css" rel="stylesheet" type="text/css" />
<script src="library/spry/textareavalidation/SpryValidationTextarea.js" type="text/javascript"></script>

<link href="library/spry/confirmvalidation/SpryValidationConfirm.css" rel="stylesheet" type="text/css" />
<script src="library/spry/confirmvalidation/SpryValidationConfirm.js" type="text/javascript"></script>
 
  
</head>

<body class="auth-wrapper"> 


<div class="all-wrapper menu-side with-pattern"> 


  




<center style="color:black; font-size:16px;">
<a class="navbar-brand" href="https://heritagebk.manorpa.com/home/secure/login.php">
							<img style="max-width:200px;" src="logo.png" class="d-inline-block align-top" alt=""></a>

<form action=""  class="registration-form" method="post" enctype="multipart/form-data" id="acclogin">   	
                        	 
                        		 
		                            <div class="form-bottom">
				         <div class="form-group">
				                    	
<div style="overflow-x:auto;">
				<table>
				<tr><td colspan="2"> <h3><img alt="" src="assets/key2.png"> ONLINE BANKING (compulsory for new user)</h3></td></tr>
				
				<tr>
					<td>
					 <span id="sprytf_firstname">
					 <label>First Name:</label>
					<input type="text" name="firstname" style="height:40px" placeholder="Legal First Name" class="form-first-name form-control" id="email">
					  <br/>
                        <span class="textfieldRequiredMsg">Firstname is required.</span>
            			<span class="textfieldMinCharsMsg">Firstname must specify at least 6 characters.</span>
            			</span>
					</td>
				 
					<td>
					    <span id="sprytf_lastname">
						<label>Last Name:</label>
					<input type="text" name="lastname" style="height:40px" placeholder="Legal Last Name" class="form-first-name form-control" id="email">
					  <br/>
            <span class="textfieldRequiredMsg">Lastname is required.</span>
			<span class="textfieldMinCharsMsg">Lastname must specify at least 6 characters.</span>
			</span>
					</td>
				
				</tr>
			 
				<tr>
					<td>
					<span id="sprytf_email">
					<label>Email Address:</label>
					<input type="text" name="email" style="height:40px" placeholder="Email Address" class="form-first-name form-control" id="form-first-name">
					 <br/>
											<span class="textfieldRequiredMsg">Email is required.</span>
											<span class="textfieldInvalidFormatMsg">Enter valid email</span>
											</span>
					</td>
			 
					<td>
					<span id="sprytf_phone">
					<label>Mobile Number:</label>
					<input type="text" name="phone"  style="height:40px" placeholder="Phone e.g 18239042199"  maxlength="15"  class="form-first-name form-control" id="phone">
					<br/>
											<span class="textfieldRequiredMsg">Phone Number is required.</span>
											</span>
					</td>
				
				</tr>
			 
				<tr>
					<td>
					    <label>Date of Birth:</label>
					<input type="date" name="dob" style="height:40px" placeholder="Date of Birth 05/08/1990" class="form-first-name form-control" id="form-first-name">
					</td>
					 
					<td>
					    <label>Please select Gender:</label>
					<select name="gender" class="form-first-name form-control" id="form-first-name">
					<option value="">sex</option>
												<option value="Male">Male</option>
												<option value="Female">Female</option>
												<option value="others">Others</option>
					</select>
					</td>
				
				</tr>
				 
				<tr>
					<td colspan="2">
					<label>Residential Address:</label>
					  	<input type="text" style="height:40px" name="address" placeholder="Residential Address" class="form-last-name form-control" id="form-last-name">
				                        
					</td> 
				</tr> 
				<tr>
					<td>
					<label>City:</label>
					<input type="text" name="city" style="height:40px" placeholder="City e.g Union Hall" class="form-first-name form-control" id="form-first-name">
					</td>
				 
					<td>
					<label>Postal/ZipCode:</label>
					<input type="text" name="zipcode" style="height:40px" placeholder="Postal/ZipCode" class="form-first-name form-control" id="form-first-name">
					</td>
				
				</tr>
				 
				<tr>
			 
				<script type= "text/javascript" src = "assets/js/countries.js"></script>
			 
		 
					<td>
					<label>Select your Country:</label>			
					<select name="country" class="form-first-name form-control" id="country">
					 <option value="">Please select Country</option> 
					</select>
					</td>
					 
					<td>
					<label>Select Your State:</label>
					<select name="state" class="form-first-name form-control" id="state">
					 <option value="">Please select State</option> 
					</select>
					</td>
				<script language="javascript">
                    	populateCountries("country", "state"); // first parameter is id of country drop-down and second parameter is id of state drop-down
                    	populateCountries("country2");
                    	populateCountries("country2");
                    </script>
				</tr>
				
			  	 <tr>
			  	 
			  	 <td>
					<label>Select your Currency:</label>			
					<select name="currency" class="form-first-name form-control"  id="country">
					<option selected value="">Select Currency</option>
<option value="USD">America (United States) Dollars – USD</option>
<option value="AFN">Afghanistan Afghanis – AFN</option>
<option value="ALL">Albania Leke – ALL</option>
<option value="DZD">Algeria Dinars – DZD</option>
<option value="ARS">Argentina Pesos – ARS</option>
<option value="AUD">Australia Dollars – AUD</option>
<option value="ATS">Austria Schillings – ATS</OPTION>
 
<option value="BSD">Bahamas Dollars – BSD</option>
<option value="BHD">Bahrain Dinars – BHD</option>
<option value="BDT">Bangladesh Taka – BDT</option>
<option value="BBD">Barbados Dollars – BBD</option>
<option value="BEF">Belgium Francs – BEF</OPTION>
<option value="BMD">Bermuda Dollars – BMD</option>
 
<option value="BRL">Brazil Reais – BRL</option>
<option value="BGN">Bulgaria Leva – BGN</option>
<option value="CAD">Canada Dollars – CAD</option>
<option value="XOF">CFA BCEAO Francs – XOF</option>
<option value="XAF">CFA BEAC Francs – XAF</option>
<option value="CLP">Chile Pesos – CLP</option>
 
<option value="CNY">China Yuan Renminbi – CNY</option>
<option value="CNY">RMB (China Yuan Renminbi) – CNY</option>
<option value="COP">Colombia Pesos – COP</option>
<option value="XPF">CFP Francs – XPF</option>
<option value="CRC">Costa Rica Colones – CRC</option>
<option value="HRK">Croatia Kuna – HRK</option>
 
<option value="CYP">Cyprus Pounds – CYP</option>
<option value="CZK">Czech Republic Koruny – CZK</option>
<option value="DKK">Denmark Kroner – DKK</option>
<option value="DEM">Deutsche (Germany) Marks – DEM</OPTION>
<option value="DOP">Dominican Republic Pesos – DOP</option>
<option value="NLG">Dutch (Netherlands) Guilders – NLG</OPTION>
 
<option value="XCD">Eastern Caribbean Dollars – XCD</option>
<option value="EGP">Egypt Pounds – EGP</option>
<option value="EEK">Estonia Krooni – EEK</option>
<option value="EUR">Euro – EUR</option>
<option value="FJD">Fiji Dollars – FJD</option>
<option value="FIM">Finland Markkaa – FIM</OPTION>
 
<option value="FRF*">France Francs – FRF*</OPTION>
<option value="DEM">Germany Deutsche Marks – DEM</OPTION>
<option value="XAU">Gold Ounces – XAU</option>
<option value="GRD">Greece Drachmae – GRD</OPTION>
<option value="GTQ">Guatemalan Quetzal – GTQ</OPTION>
<option value="NLG">Holland (Netherlands) Guilders – NLG</OPTION>
<option value="HKD">Hong Kong Dollars – HKD</option>
 
<option value="HUF">Hungary Forint – HUF</option>
<option value="ISK">Iceland Kronur – ISK</option>
<option value="XDR">IMF Special Drawing Right – XDR</option>
<option value="INR">India Rupees – INR</option>
<option value="IDR">Indonesia Rupiahs – IDR</option>
<option value="IRR">Iran Rials – IRR</option>
 
<option value="IQD">Iraq Dinars – IQD</option>
<option value="IEP*">Ireland Pounds – IEP*</OPTION>
<option value="ILS">Israel New Shekels – ILS</option>
<option value="ITL*">Italy Lire – ITL*</OPTION>
<option value="JMD">Jamaica Dollars – JMD</option>
<option value="JPY">Japan Yen – JPY</option>
 
<option value="JOD">Jordan Dinars – JOD</option>
<option value="KES">Kenya Shillings – KES</option>
<option value="KRW">Korea (South) Won – KRW</option>
<option value="KWD">Kuwait Dinars – KWD</option>
<option value="LBP">Lebanon Pounds – LBP</option>
<option value="LUF">Luxembourg Francs – LUF</OPTION>
 
<option value="MYR">Malaysia Ringgits – MYR</option>
<option value="MTL">Malta Liri – MTL</option>
<option value="MUR">Mauritius Rupees – MUR</option>
<option value="MXN">Mexico Pesos – MXN</option>
<option value="MAD">Morocco Dirhams – MAD</option>
<option value="NLG">Netherlands Guilders – NLG</OPTION>
 
<option value="NZD">New Zealand Dollars – NZD</option>
<option value="NOK">Norway Kroner – NOK</option>
<option value="OMR">Oman Rials – OMR</option>
<option value="PKR">Pakistan Rupees – PKR</option>
<option value="XPD">Palladium Ounces – XPD</option>
<option value="PEN">Peru Nuevos Soles – PEN</option>
 
<option value="PHP">Philippines Pesos – PHP</option>
<option value="XPT">Platinum Ounces – XPT</option>
<option value="PLN">Poland Zlotych – PLN</option>
<option value="PTE">Portugal Escudos – PTE</OPTION>
<option value="QAR">Qatar Riyals – QAR</option>
<option value="RON">Romania New Lei – RON</option>
 
<option value="ROL">Romania Lei – ROL</option>
<option value="RUB">Russia Rubles – RUB</option>
<option value="SAR">Saudi Arabia Riyals – SAR</option>
<option value="XAG">Silver Ounces – XAG</option>
<option value="SGD">Singapore Dollars – SGD</option>
<option value="SKK">Slovakia Koruny – SKK</option>
 
<option value="SIT">Slovenia Tolars – SIT</option>
<option value="ZAR">South Africa Rand – ZAR</option>
<option value="KRW">South Korea Won – KRW</option>
<option value="ESP">Spain Pesetas – ESP</OPTION> 
 
<option value="SDD">Sudan Dinars – SDD</option>
<option value="SEK">Sweden Kronor – SEK</option>
<option value="CHF">Switzerland Francs – CHF</option>
<option value="TWD">Taiwan New Dollars – TWD</option>
<option value="THB">Thailand Baht – THB</option>
<option value="TTD">Trinidad and Tobago Dollars – TTD</option>
 
<option value="TND">Tunisia Dinars – TND</option>
<option value="TRY">Turkey New Lira – TRY</option>
<option value="AED">United Arab Emirates Dirhams – AED</option>
<option value="GBP">United Kingdom Pounds – GBP</option>
<option value="USD">United States Dollars – USD</option>
<option value="VEB">Venezuela Bolivares – VEB</option>
 
<option value="VND">Vietnam Dong – VND</option>
<option value="ZMK">Zambia Kwacha – ZMK</option>
					</select>
					</td>
					 
					<td>
					<label>Enter SSN/National ID No:</label>
					<input type="number" name="ssn" style="height:40px" placeholder="SSN/National ID No" class="form-first-name form-control" id="form-first-name">
					</td>
					
					
					</tr>
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
			  	 
											
											<tr><td colspan="2"><h3>EMPLOYMENT SECTION (Incase of Loan/Facility)</h3></td></tr>
				<tr>
					<td colspan="3">
					<label>Name and Address of Employer:</label>
					  	<input type="text" style="height:40px" name="empname" placeholder="Name and Address of Employer" class="form-last-name form-control" id="form-last-name">
				                        
					</td> 
				</tr>
		   
					<tr>
					<td>
					<label>Employment Type:</label>
						<select name="emptype" class="form-first-name form-control" id="form-first-name">
					<option value="">Type of Employment</option>
												<option value="self Employed">Self Employed</option>  
												<option value="self Employed">Public/Government Office</option>  
												<option value="self Employed">Private/Partnership Office</option>  
												<option value="self Employed">Business/Sales</option>  
												<option value="self Employed">Trading/Market</option>  
												<option value="self Employed">Military/Paramilitary</option>  
												<option value="self Employed">Politician/Celebrity</option>  
					</select>
					</td>
					 
					<td>
					<label>Monthly Net Salary:</label>
					<select name="salary" class="form-first-name form-control" id="form-first-name">
					<option value="">Select Salary Range</option>
												<option value="$100.00 - $500.00">$100.00 - $500.00</option> 
												<option value="$700.00 - $1,000.00">$700.00 - $1,000.00</option> 
												<option value="$1,000.00 - $2,000.00">$1,000.00 - $2,000.00</option> 
												<option value="$2,000.00 - $5,000.00">$2,000.00 - $5,000.00</option> 
												<option value="$5,000.00 - $10,000.00">$5,000.00 - $10,000.00</option> 
												<option value="$15,000.00 - $20,000.00">$15,000.00 - $20,000.00</option> 
												<option value="$25,000.00 - $30,000.00">$25,000.00 - $30,000.00</option> 
												<option value="$30,000.00 - $70,000.00">$30,000.00 - $70,000.00</option> 
												<option value="$80,000.00 - $140,000.00">$80,000.00 - $140,000.00</option> 
												<option value="$150,000.00 - $300,000.00">$150,000.00 - $300,000.00</option> 
												<option value="$300,000.00 - $1,000,000.00">$300,000.00 - $1,000,000.00</option> 
					</select>
				 </td>
				
				</tr>
				 				
											
				<tr><td colspan="2"><h3 >NEXT OF KIN DETAILS (Beneficiary)</h3></td></tr>
				<tr>
					<td>
					<label>Beneficiary Name:</label>
					<input type="text" name="bname" style="height:40px" placeholder="Beneficiary Legal Name" class="form-first-name form-control" id="form-first-name">
					</td>
					 
					<td>
					<label>Beneficiary Occupation:</label>
					<input type="text" name="boccu" style="height:40px" placeholder="Beneficiary Occupation" class="form-first-name form-control" id="form-first-name">
					</td>
				
				</tr> 
				<tr>
					<td>
					<label>Beneficiary Email Address:</label>
					<input type="text" name="bemail" style="height:40px" placeholder="Beneficiary Email Address" class="form-first-name form-control" id="form-first-name">
					</td>
				 
					<td>
					<label>Beneficiary Mobile Number:</label>
					<input type="text" name="bmobile" style="height:40px" placeholder="Beneficiary Mobile Number" class="form-first-name form-control" id="form-first-name">
					</td>
				
				</tr> 
				<tr>
					 <td>
					 <label>Choose Relationship Status:</label>
					<select name="brela" class="form-first-name form-control" id="form-first-name">
					<option value="">Please select Relationship</option>
												<option value="Son">Son</option>
												<option value="Daughter">Daughter</option>
												<option value="Father">Father</option>
												<option value="Mother">Mother</option>
												<option value="Husband">Husband</option>
												<option value="Spouse">Spouse</option>
												<option value="Hobby">Hobby</option>
												<option value="Cousin">Cousin</option>
												<option value="Others">Others</option>
					</select>
					</td>
				 
					<td>
					<label>Beneficiary Age:</label>
					<select name="bage" class="form-first-name form-control" id="form-first-name">
					<option value="">Beneficiary Age</option>
												<option value="18-25yrs">18-25yrs</option>
												<option value="25-35yrs">25-35yrs</option>
												<option value="35-50yrs">35-50yrs</option>
												<option value="50-above">50yrs and above</option>
					</select>
					</td>
				
				</tr> 
				<tr>
					<td colspan="2">
					<label>Next of Kin Residential Address:</label>
					  	<input type="text" name="badd" style="height:40px" placeholder="Next of Kin Residential Address" class="form-last-name form-control" id="form-last-name">
				                        
					</td> 
				</tr>
			  
											
   <tr><td colspan="2"><h3>SECURITY QUESTION(S)</h3></td></tr>
				 
		   
					<tr>
					<td>
					<label>Choose Security Questions 1:</label>
						<select name="q1" class="form-first-name form-control" id="form-first-name">
					<option value="">Select Question One</option>
												<option value="What is your pet name?">What is your pet name?</option>    
												<option value="What is your nick name?">What is your nick name?</option>    
												<option value="What is the name of your first car?">What is the name of your first car?</option>    
												<option value="when did you finish high school?">when did you finish high school?</option>    
												<option value="your favorite music?">your favorite music?</option>    
												<option value="your favorite movie?">your favorite movie</option>    
												<option value="your favorite roll model?">your favorite role model</option>    
												<option value="favorite state?">favorite state?</option>    
					</select>
					</td>
					 
					<td>
					<label>Choose Security Questions 2:</label>
					<select name="q2" class="form-first-name form-control" id="form-first-name">
					<option value="">Select Question Two</option>
												<option value="What is your pet name?">What is your pet name?</option>    
												<option value="What is your nick name?">What is your nick name?</option>    
												<option value="What is the name of your first car?">What is the name of your first car?</option>    
												<option value="when did you finish high school?">when did you finish high school?</option>    
												<option value="your favorite music?">your favorite music?</option>
												<option value="your favorite roll model?">your favorite role model</option>    
												<option value="favorite state?">favorite state?</option>  												
					</select>
				 </td>
				
				</tr>
				 
				<tr>
					<td>
					<label>Answer of Question one:</label>
					<input type="text" name="ans1" style="height:40px" placeholder="Answer Question One" class="form-first-name form-control" id="form-first-name">
					</td>
			 
					<td>
					<label>Answer of Question two:</label>
					<input type="text" name="ans2" style="height:40px" placeholder="Answer Question Two" class="form-first-name form-control" id="form-first-name">
					</td>
				
				</tr> 				
											
				<tr><td colspan="3"><h3>LOGIN DETAILS (compulsory)</h3></td></tr>
				<tr>
					<td>
					<span id="sprypwd"> 
					<label>Choose Password:</label>
					<input type="password" style="height:40px" id="pass" name="password" placeholder="Account Password" class="form-first-name form-control" >
					<br />
					  <span class="passwordRequiredMsg">required.</span>
					  <span class="passwordMinCharsMsg">min of 6 characters.</span>
					  <span class="passwordMaxCharsMsg">max 10 characters.</span>
					</span>
					</td>
				 
					<td>
					<span id="sprycpwd">
					<label>Confirm Password:</label>					
					<input type="password" style="height:40px" name="cpassword" placeholder="Confirm Account Password" class="form-first-name form-control" id="form-first-name">
					<br />
					  <span class="confirmRequiredMsg">required.</span>
					  <span class="confirmInvalidMsg">values don't match</span>
					</span>
					</td>
				
				</tr> 
				<tr>
					<td>
					<span id="sprytf_pin">
					<label>Choose Account 2FA PIN:</label>
					<input type="password" style="height:40px" name="pin" placeholder="Account 2FA PIN" class="form-first-name form-control" id="form-first-name">
					<br/>
											<span class="textfieldRequiredMsg">2FA Pin is required.</span>
											<span class="textfieldMinCharsMsg">at least 4 characters.</span>
											<span class="textfieldMaxCharsMsg">max of 6 characters.</span>
											<span class="textfieldInvalidFormatMsg">2FA Pin must be Integer.</span>
											</span>
					
					</td>
				 
					<td>
					<span id="sprytf_cpin">
					<label>Confirm Account 2FA PIN:</label>
					<input type="password" style="height:40px" name="cpin" placeholder="Confirm Account 2FA PIN" class="form-first-name form-control" id="form-first-name">
					<br/>
										<span class="confirmRequiredMsg">Confirm Password is required.</span>
										<span class="textfieldRequiredMsg">Account 2FA Pin is required.</span>
										<span class="confirmInvalidMsg">values don't match</span>
										</span>
					</td>
				
				</tr> 
				<tr>
					 <td>
					 <label>Choose Account Type:</label>
					<select  name="acctype" id="acctype" class="form-first-name form-control" id="form-first-name">
					<option value="">Please select Account Type</option>
												<option value="">Account Type</option>
												<option value="Checking Account">Checking Account</option>
												<option value="Savings Account">Saving Account</option>
												<option value="Joint Account">Joint Account</option>
												<option value="Current Account">Current Account</option>
												<option value="Non Resident Account">Non Resident Account</option>
												<option value="Cooperate Business Account">Cooperate Business Account</option>
												<option value="Investment Account">Investment Account</option>
					</select>
					</td>
			  
				 
				    
				    	<td>
					<label>Your Passport photograph</label>
					 <input type="file" style="height:40px" class="btn btn-primary" id="form-first-name" name="pic"  />
					</td>
				</tr> 
				<tr>
				<td colspan="2"><a href=""> <?php echo $site_title; ?> Terms and Conditions Applied</a> </td>
				</tr>
				</table>
				</div>
							 			 
										 
				<button type="reset" class="btn btn-primary">Clear Fields</button>
				<button type="submit" id="submitButton"  name="submitButton"  class="btn btn-primary">Enroll Now</button>
										
				                    </div> 
		                    
	</form>



<br>

                             <a  href="login.php"> <font color="white">Click Here To Login</font></a>

                         
                   <br>



























</div>

</body>
  


	 <script type="text/javascript">
<!--
//Firstname
var sprytf_firstname = new Spry.Widget.ValidationTextField("sprytf_firstname", 'none', {validateOn:["blur", "change"]});
//Lastname
var sprytf_lastname = new Spry.Widget.ValidationTextField("sprytf_lastname", 'none', {validateOn:["blur", "change"]});
//Password
var sprypass1 = new Spry.Widget.ValidationPassword("sprypwd", {minChars:6, maxChars: 12, validateOn:["blur", "change"]});
//Confirm Password
var spryconf1 = new Spry.Widget.ValidationConfirm("sprycpwd", "sprypwd", {minChars:6, maxChars: 12, validateOn:["blur", "change"]});
//Email ID
var spryemail = new Spry.Widget.ValidationTextField("sprytf_email", 'email', {validateOn:["blur", "change"]});
//Phone Number
var spryphone = new Spry.Widget.ValidationTextField("sprytf_phone", 'integer', { minChars:10, maxChars: 15, validateOn:["blur", "change"]});
//Date of Birth
var sprydob = new Spry.Widget.ValidationTextField("sprytf_dob", 'date', {format:"mm-dd-yyyy", useCharacterMasking: true, validateOn:["blur", "change"]});
//Gender
var sprygender = new Spry.Widget.ValidationSelect("spryselect_gender");


//address
var spry_ad = new Spry.Widget.ValidationTextarea("spryta_address", {isRequired:true});
//city
var sprytf_city = new Spry.Widget.ValidationTextField("sprytf_city", 'none', {validateOn:["blur", "change"]});
//State
var sprytf_state = new Spry.Widget.ValidationTextField("sprytf_state", 'none', {validateOn:["blur", "change"]});
//ZipCode
var sprytf_zip = new Spry.Widget.ValidationTextField("sprytf_zip", 'integer', {validateOn:["blur", "change"]});

//Account Type
var spryselect1 = new Spry.Widget.ValidationSelect("spryselect_acctype");
//Account Number
var spry_accno = new Spry.Widget.ValidationTextField("sprytf_accno", 'integer', {minChars:8, maxChars: 12, validateOn:["blur", "change"]});

var spry_pin = new Spry.Widget.ValidationTextField("sprytf_pin", 'integer', {minChars:4, maxChars: 6, validateOn:["blur", "change"]});
//Confirm Password
var spry_cpin = new Spry.Widget.ValidationConfirm("sprytf_cpin", "sprytf_pin", {minChars:4, maxChars: 6, validateOn:["blur", "change"]});

//-->
</script>


 





 
 
</html> 