xombra

 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>