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1 forms found in the DOM

Name: formulario — POST

<form method="POST" enctype="multipart/form-data" name="formulario" id="formulario">
  <fieldset class="form-horizontal">
    <div class="col-lg-6">
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Identidad:</label>
        <div class="col-sm-6">
          <input type="text" pattern="[0-9]+" value="" placeholder="0000000000000" minlength="13" maxlength="13" name="t1" id="t1" class="form-control" title="Campo de Identidad debe de contener 13 dígitos y solo números" required=""
            onkeypress="return (event.charCode >= 48 &amp;&amp; event.charCode <= 57)">
        </div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Nombre:</label>
        <div class="col-sm-6"><input type="text" value="" name="t2" class="form-control" required="" onkeypress="return (event.charCode != 39 &amp;&amp; event.charCode != 34)"></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Apellido:</label>
        <div class="col-sm-6"><input type="text" name="t16" value="" class="form-control" required="" onkeypress="return (event.charCode != 39 &amp;&amp; event.charCode != 34)"></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Fecha Nacimiento:</label>
        <div class="col-sm-6"><input type="date" name="t17" value="" class="form-control" required=""></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Estado Civil:</label>
        <div class="col-sm-6"><select class="form-control select" value="" name="t18" required="">
            <option></option>
            <option value="Soltera">Soltero (a)</option>
            <option value="Casada">Casado (a)</option>
            <option value="Casada">Viudo (a)</option>
            <option value="Union Libre"> Union Libre</option>
          </select></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Teléfono 1:</label>
        <div class="col-sm-6"><input type="text" placeholder="00000000" minlength="8" maxlength="8" data-mask="99999999" class="form-control" title="Campo de Teléfono debe de contener 8 dígitos y solo números" value="" required="" pattern="[0-9]+"
            name="t3" id="t3"></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label">Teléfono 2:</label>
        <div class="col-sm-6"><input type="text" placeholder="00000000" class="form-control" minlength="8" data-mask="99999999" title="Campo de Teléfono debe de contener 8 dígitos y solo números" pattern="[0-9]+" value="" maxlength="8" name="t4"
            id="t4"> </div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label">Teléfono 3:</label>
        <div class="col-sm-6"><input type="text" placeholder="00000000" class="form-control" minlength="8" data-mask="99999999" title="Campo de Teléfono debe de contener 8 dígitos y solo números" pattern="[0-9]+" value="" maxlength="8" name="t5"
            id="t5"></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label">Correo:</label>
        <div class="col-sm-6"><input type="email" placeholder="correo@gmail.com" value="" class="form-control" name="t6"></div>
      </div>
    </div>
    <div class="col-lg-6">
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Barrio y/o Colonia:</label>
        <div class="col-sm-6"><input type="text" class="form-control" name="t14" value="" required=""></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Interés de Crédito:</label>
        <div class="col-sm-6"><select class="form-control select" name="t9" required="">
            <option></option>
            <option value="Credito de Consumo">Crédito Elektra </option>
            <option value="Credito Italika">Crédito Italika </option>
            <option value="Prestamo Personal"> Préstamo Personal</option>
          </select></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Ingresos Mensuales:</label>
        <div class="col-sm-6"><input type="number" class="form-control" name="t19" value="" required=""></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label">Comentarios:</label>
        <div class="col-sm-6"><textarea class="form-control" name="t10" value=""></textarea></div>
      </div>
      <div class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Departamentos:</label>
        <div class="col-sm-10">
          <select id="lista1" name="lista1" class="form-control select" required="">  <option value="Atlantida">Atlantida</option>
            <option value="Choluteca">Choluteca</option>
            <option value="Colon">Colon</option>
            <option value="Comayagua">Comayagua</option>
            <option value="Copan">Copan</option>
            <option value="Cortés">Cortés</option>
            <option value="El Paraiso">El Paraiso</option>
            <option value="Francisco Morazan">Francisco Morazan</option>
            <option value="Intibuca">Intibuca</option>
            <option value="Islas de la Bahia">Islas de la Bahia</option>
            <option value="Lempira">Lempira</option>
            <option value="Ocotepeque">Ocotepeque</option>
            <option value="Olancho">Olancho</option>
            <option value="Santa Barbara">Santa Barbara</option>
            <option value="Valle">Valle</option>
            <option value="Yoro">Yoro</option>
          </select>
          <br>
          <div id="select2lista" name="select2lista" class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Ciudad:</label>
            <div class="col-sm-12">
              <select id="lista2" name="lista2" class="form-control select" required="">
                <option></option>
              </select>
            </div>
          </div>
          <div id="select3lista" name="select3lista" class="form-group"><label class="col-sm-4 control-label"><small style="color: red;">*</small> Agencias:</label>
            <div class="col-sm-12">
              <select id="select3lista" name="select3lista" class="form-control select" required="">
                <option></option>
              </select>
            </div>
          </div>
          <div class="form-group"><label for="acceptTerms" class="col-sm-9 control-label"> ¿Autoriza a Banco Azteca de Honduras consultar su historial en el buró de crédito? </label>
            <div class="col-sm-1"><input id="acceptTerms" name="Autorizacion" type="checkbox" title="Marca esta casilla para poder continuar." required=""></div>
          </div>
          <div class="form-group">
            <br>
          </div>
        </div>
      </div>
    </div>
  </fieldset>
  <br> <br> <br>
  <div class="col-sm-4" align="text-center">
    <div class="col-sm-12"></div>
  </div>
  <div class="col-sm-4" align="text-center">
    <div class="col-sm-12"><button style=" font-size: 20px;  background-color: #006739; color: #ffffff;" type="submit" name="Guardar" id="Guardar" class="btn btn-primary btn-block"><i class="fa fa-send"></i> Enviar Formulario</button></div>
  </div>
  <div class="col-sm-4" align="text-center">
    <div class="col-sm-12"></div>
  </div>
</form>

Text Content

PRE-SOLICITUD DE CRÉDITO

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

* Identidad:

* Nombre:

* Apellido:

* Fecha Nacimiento:

* Estado Civil:
Soltero (a) Casado (a) Viudo (a) Union Libre
* Teléfono 1:

Teléfono 2:

Teléfono 3:

Correo:

* Barrio y/o Colonia:

* Interés de Crédito:
Crédito Elektra Crédito Italika Préstamo Personal
* Ingresos Mensuales:

Comentarios:

* Departamentos:
 Atlantida Choluteca Colon Comayagua Copan Cortés El Paraiso Francisco Morazan
Intibuca Islas de la Bahia Lempira Ocotepeque Olancho Santa Barbara Valle Yoro

* Ciudad:

* Agencias:

¿Autoriza a Banco Azteca de Honduras consultar su historial en el buró de
crédito?







Enviar Formulario

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