


<form action="/Register/RegisterSubmit" data-ajax="true" data-ajax-begin="onAjaxRequestBegin" data-ajax-complete="onAjaxRequestComplete" data-ajax-method="POST" data-ajax-success="onRegisterAjaxRequestSuccess" data-copied-text="Disalin" enctype="multipart/form-data" id="register_form" method="post"><input name="__RequestVerificationToken" type="hidden" value="i2FFa8R9XXFJBZkABFsBOt7j6g9LmMzZTgjnQIP5SudAqKN_bkGjQKVTd-0u3JTyIg1MGlsA4_Z7IVn0ouMk7QQsHtM1" />    <div class="standard-sub-section">
        <div class="standard-form-title">
            Informasi Pribadi
        </div>
        <div class="standard-form-content form_subcategory">
            <div class="form-group required-form-group">
                <label for="UserName">Nama Pengguna</label>
                <input MaxLength="12" autocomplete="off" class="form-control lowercase" data-val="true" data-val-regex="Harap masukkan antara 3 - 12 karakter dalam alfanumerik.&lt;br>Nama pengguna tidak boleh memiliki spasi." data-val-regex-pattern="^[0-9a-zA-Z]{3,12}$" data-val-remote="&#39;UserName&#39; is invalid." data-val-remote-additionalfields="*.UserName" data-val-remote-url="/validate/username" data-val-required="Harap masukkan antara 3 - 12 karakter dalam alfanumerik.&lt;br>Nama pengguna tidak boleh memiliki spasi." id="username_field" name="UserName" placeholder="Nama Pengguna Anda" type="text" value="" />
                <span class="field-validation-valid standard-required-message" data-valmsg-for="UserName" data-valmsg-replace="true"></span>
            </div>
            <div class="form-group required-form-group standard-password-field">
                <label for="Password">Kata Sandi</label>
                <input MaxLength="20" class="form-control" data-val="true" data-val-regex="The field Password must match the regular expression &#39;^(?=.*[A-Za-z])(?=.*\d)[A-Za-z\d!@#$%^*()_+=\[\]{}|;&#39;&quot;&#39;&#39;,.?/~`\\-]{8,20}$&#39;." data-val-regex-pattern="^(?=.*[A-Za-z])(?=.*\d)[A-Za-z\d!@#$%^*()_+=\[\]{}|;&#39;&quot;&#39;&#39;,.?/~`\\-]{8,20}$" data-val-required="The Password field is required." id="password_field" name="Password" placeholder="Kata Sandi Anda" type="password" />
                <span class="standard-required-message">Kata Sandi harus terdiri dari 8-20 karakter, harus mengandung huruf dan angka, dan tidak boleh mengandung simbol &amp;, &lt;, atau &gt;.</span>
                <div class="password-validations" id="password_validations" style="display: none;">
    <div id="password_username_validation">
        <i class="glyphicon"></i>
        Kata sandi tidak boleh mengandung nama pengguna.
    </div>
    <div id="password_symbol_validation">
        <i class="glyphicon"></i>
        Kata sandi tidak boleh mengandung simbol &amp;, &lt;, atau &gt;
    </div>
    <div id="password_length_validation">
        <i class="glyphicon"></i>
        Terdiri dari 8-20 karakter.
    </div>
    <div id="password_alphanumeric_validation">
        <i class="glyphicon"></i>
        Mengandung 1 angka dan 1 huruf.
    </div>
</div>

                <i class="glyphicon glyphicon-eye-close password_input_trigger"></i>
            </div>
            <div class="form-group required-form-group standard-password-field">
                <label for="ConfirmedPassword">Ulangi Kata Sandi</label>
                <input MaxLength="20" class="form-control" data-val="true" data-val-equalto="&#39;ConfirmedPassword&#39; and &#39;Password&#39; do not match." data-val-equalto-other="*.Password" data-val-required="The ConfirmedPassword field is required." id="ConfirmedPassword" name="ConfirmedPassword" placeholder="Ulangi Kata Sandi Anda" type="password" />
                <span class="standard-required-message">Konfirmasi kata sandi tidak cocok!</span>
                <i class="glyphicon glyphicon-eye-close password_input_trigger"></i>
            </div>
                <div class="form-group ">
                    <label for="FullName">Nama Lengkap</label>
<input MaxLength="100" autocomplete="off" class="form-control" data-val="true" data-val-regex="The field FullName must match the regular expression &#39;^[\u4e00-\u9fa5\u0E00-\u0E7F\u0400-\u04FF\u00C0-\u00FF\u0100-\u017F\u0180-\u024Fa-zA-Z0-9\uFF10-\uFF19\uFF21-\uFF3A\uFF41-\uFF5A\u0905-\u097F\u3000 ]+$&#39;." data-val-regex-pattern="^[\u4e00-\u9fa5\u0E00-\u0E7F\u0400-\u04FF\u00C0-\u00FF\u0100-\u017F\u0180-\u024Fa-zA-Z0-9\uFF10-\uFF19\uFF21-\uFF3A\uFF41-\uFF5A\u0905-\u097F\u3000 ]+$" id="FullName" name="FullName" placeholder="Nama Lengkap Anda" type="text" value="" />                    <span class="standard-required-message">Nama lengkap hanya boleh berisi karakter alfanumerik.</span>
                </div>
                                                                                                                                                    <div class="form-group referral-glyphicon-container">
                    <div class="referral-code-header" id="referral_code_header">
                        <label>Kode Referral</label>
                        <span class="toggler" id="referral_code_detail_toggler">
                            <i class="glyphicon glyphicon-chevron-right"></i>
                        </span>
                    </div>
                    <div class="referral-code-content" id="referral_code_content">
<input autocomplete="off" class="form-control referral-code-input" id="ReferrerCode" name="ReferrerCode" placeholder="Kode Referral" type="text" value="" />                    </div>
                </div>
        </div>
    </div>
        <div class="standard-sub-section" id="bank_account_section">
            <div class="standard-form-title">
                Informasi Pembayaran
            </div>
            <div class="standard-form-content form_subcategory">
                <div class="form-group">
                    <label for="SelectedBank">Metode Pembayaran</label>
                    <div data-section="input" class="payment-method-container">
                        <label>
                            <input type="radio" name="bank_section_radio_group" value="bank" checked>
                            BANK
                        </label>
                    </div>
                </div>
                <div class="form-group ">
                    <label for="SelectedBank">Bank</label>
<select class="form-control" id="selected_bank_select" name="SelectedBank"><option value="">-- Pilih Bank --</option>
<option value="42c740e1-0541-4e57-b764-108652beee25">ALLO BANK</option>
<option value="cb107033-fa0f-4edd-a7f7-bf1eadc3daa4">BANK APATUH</option>
<option value="148bafef-3aa1-4bb2-86cb-4211ab8044a3">BANK BY U</option>
<option value="ab829c0d-87f8-44fd-849d-d980a1066c46">BANK INI</option>
<option value="0141fcbf-00d3-4129-9d97-911d9c315b10">BANK TEST 6679</option>
<option value="c44f5d3e-5323-4ac2-84f9-83edc72e922f">BANKOFCHINA</option>
<option value="974890a6-0fee-4f15-9292-1cf557b524e5">BARU NIH</option>
<option value="e1bab23f-dda6-4835-b3ce-d5039f28546c">BCA</option>
<option value="9658498c-812d-406d-bbe4-fb22423e3396">BLU RANGER</option>
<option value="30d60eec-3d57-4e08-9b3e-69f2cada912d">BNI</option>
<option value="a458ab91-91a3-49ac-98b3-1bfc5d1966bd">BRI</option>
<option value="d096a4c8-0232-45fc-a81b-b94fbeb25e6b">BSI</option>
<option value="f610a02f-3b74-464f-a32d-13cef703115e">DANA BANK</option>
<option value="8b9da291-abff-4e2e-a2c3-e89d38694857">DANAMON</option>
<option value="11875183-1780-4dca-ac70-e8db8b1ab792">DY BCA PAYMENT NAME EDIT NEXPAY</option>
<option value="f5e3e775-6c25-49ea-92ed-03171aacf0b6">DY GODZILLA</option>
<option value="d9dee9f1-e63f-4011-9a70-389fe1cb9b52">DY PULSA UNDER NEW PAYMENT 11</option>
<option value="2fa63f08-791b-429d-9245-e24ce4f6cfa8">EEE</option>
<option value="edf9deda-bf37-4bd6-9262-cd225a5325a4">ERWRWERW</option>
<option value="7612e51b-9005-4db0-9b8b-360e1f383f5a">FAKE ADMIN FEE</option>
<option value="112aa5f5-a5d7-4d86-ab11-bef1bb924d39">FAKE ADMIN FEE123</option>
<option value="bd398443-0d39-468a-ae04-d164837c3e29">HEHE</option>
<option value="5f2e1727-c123-49e9-99d0-5900b3160306">JAGO</option>
<option value="ec4427ff-2e6e-4657-a2fe-b3702bc15e7c">MANDIRI</option>
<option value="3b95dbc0-4061-410b-b248-b4db1ed85fab">MAYBANK</option>
<option value="3d1fad73-1dd2-4ec2-b80a-4e695314e539">NEW BANK</option>
<option value="0ca52715-1266-4622-aaa0-42b0fd496a05">NEW BANK 2024</option>
<option value="a3813c74-c0d8-4299-82bb-ebdc9cfc4c44">NEW PAYMENT ACC NAME</option>
<option value="06de5b44-429c-43e9-b646-f80c7017c49f">PAY123</option>
<option value="f0003bdb-d960-488c-b222-928016c0273b">PERMATA</option>
<option value="5b1565bd-e32b-4def-b625-8dc11dfd2aab">PULSA ADD FROM ACCOUNT</option>
<option value="9e105d86-cb6c-41cc-9a45-66ca1dffffc5">PULSA ONE</option>
<option value="8f066c68-5255-459d-8512-e6a93d175c2b">PULSA TWO</option>
<option value="a8c5b8dc-9511-45ae-a2ad-52fbe7c11130">QPAY QR BANK</option>
<option value="7fe60bf9-4e20-448c-91b2-ed1501e6e1f8">QPAY WITHDRAWAL BANK</option>
<option value="291a8687-053d-457c-a7e8-4668c01f62c9">RANDOM EMONEY</option>
<option value="d49d3d62-45a3-4f69-a59a-c153f11b4da2">SAKUKU</option>
<option value="48963c89-1071-449f-852a-6d74df203e23">TEST</option>
<option value="cea95c3f-4f61-42a6-9967-1b8ddaf6454a">TEST DEFAULT BANK</option>
<option value="8f68c9e6-9f73-4b41-83f0-63b5f9ef6a28">TEST NEW METHOD</option>
<option value="15370e5a-90b2-4557-ab16-9ff2f740f039">TESTHAHA</option>
<option value="dcd06e52-7cc4-4442-a288-614803d829dd">TESTTEST</option>
<option value="60325b0f-ab56-40f1-b0da-b3ba1a1dadea">UM TEST1</option>
<option value="a3314515-f9b5-447c-ae78-bbf691e25c0b">URSABABYPRO</option>
</select>                    <span class="field-validation-valid standard-required-message" data-valmsg-for="SelectedBank" data-valmsg-replace="true"></span>
                </div>
                <div class="form-group ">
                    <label for="BankAccountNumber">Nomor Rekening</label>
<input MaxLength="20" autocomplete="off" class="form-control format_account_number" data-val="true" data-val-regex="The field BankAccountNumber must match the regular expression &#39;^[0-9\-]+$&#39;." data-val-regex-pattern="^[0-9\-]+$" id="bank_account_number_input" name="BankAccountNumber" placeholder="Nomor rekening anda" type="text" value="" />                    <span class="field-validation-valid standard-required-message" data-valmsg-for="BankAccountNumber" data-valmsg-replace="true"></span>
                </div>
                <div class="form-group ">
                    <label for="BankAccountName">Nama Lengkap</label>
<input MaxLength="100" autocomplete="off" class="form-control" data-val="true" data-val-equal-to="Nama rekening harus sama dengan nama lengkap Anda." data-val-regex="The field BankAccountName must match the regular expression &#39;^[\u4e00-\u9fa5\u0E00-\u0E7F\u0400-\u04FF\u00C0-\u00FF\u0100-\u017F\u0180-\u024Fa-zA-Z0-9\uFF10-\uFF19\uFF21-\uFF3A\uFF41-\uFF5A\u0905-\u097F\u3000 ]+$&#39;." data-val-regex-pattern="^[\u4e00-\u9fa5\u0E00-\u0E7F\u0400-\u04FF\u00C0-\u00FF\u0100-\u017F\u0180-\u024Fa-zA-Z0-9\uFF10-\uFF19\uFF21-\uFF3A\uFF41-\uFF5A\u0905-\u097F\u3000 ]+$" id="bank_account_name_input" name="BankAccountName" placeholder="Nama Lengkap Anda" type="text" value="" />                    <span class="standard-required-message">Nama lengkap hanya boleh berisi karakter alfanumerik.</span>
                </div>
            </div>
        </div>
    <div class="standard-sub-section">
        <div class="standard-form-title">
            Lainnya
        </div>
        <div class="standard-form-content form_subcategory">
                    </div>
    </div>
<input class="visitor_id_input" id="VisitorId" name="VisitorId" type="hidden" value="" />    <div class="standard-button-group">
        <input type="submit" class="standard-secondary-button btn btn-primary" id="register_submit_button" value="DAFTAR!" />
    </div>
</form>