[text* senderName placeholder "Your Full Name" autocomplete:name] [email* senderEmail placeholder "Your Email" autocomplete:email] [tel* senderPhone placeholder "Your Phone" autocomplete:tel] [text* destinationCountry placeholder "Destination Country" autocomplete:country] Select Pay-In MethodCashCheckMoney OrderOther Select Payout TypeCash CollectionMobile MoneyBank Deposit I acknowledge receipt of all required fee and rate disclosures.