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| Banco: | |
| <select name="banco"> | |
| <option value=""></option> | |
| <option value="0156">100%BANCO</option> | |
| <option value="0196">ABN AMRO BANK</option> | |
| <option value="0172">BANCAMIGA BANCO MICROFINANCIERO, C.A.</option> | |
| <option value="0171">BANCO ACTIVO BANCO COMERCIAL, C.A.</option> | |
| <option value="0166">BANCO AGRICOLA</option> | |
| <option value="0175">BANCO BICENTENARIO</option> | |
| <option value="0128">BANCO CARONI, C.A. BANCO UNIVERSAL</option> |