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if(embedStyleJSON&&(embedStyleJSON[this.embedURLHash])){if(embedStyleJSON[this.embedURLHash]['inlineStyle']&&embedStyleJSON[this.embedURLHash]['inlineStyle']['embedHeight']){this.defaultHeight='data-frameHeight="'+embedStyleJSON[this.embedURLHash]['inlineStyle']['embedHeight']+'"';}}
this.createFrame();this.addFrameContent(this.iframeCode);};this.createFrame=function(){var tmp_is_ie=!!window.ActiveXObject;this.iframeDomId=document.getElementById(this.formId)?this.formId+'_'+new Date().getTime():this.formId;var htmlCode="<"+"iframe title=\""+title.replace(/[\\"']/g,'\\$&').replace(/&amp;/g,'&')+"\" src=\"\" allowtransparency=\"true\" allowfullscreen=\"true\" name=\""+this.formId+"\" id=\""+this.iframeDomId+"\" style=\"width: 10px; min-width:"+this.frameMinWidth+"; display: block; overflow: hidden; height:"+this.initialHeight+"px; border: none;\" scrolling=\"no\""+this.defaultHeight+"></if"+"rame>";if(this.appendTo===false){document.write(htmlCode);}else{var tmp=document.createElement('div');tmp.innerHTML=htmlCode;var a=this.appendTo;document.getElementById(a).appendChild(tmp.firstChild);}
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this.setTimer();};this.bindMethod=function(method,scope){return function(){method.apply(scope,arguments);};};this.frameHeight=0;this.getBodyHeight=function(){if(this.formSubmitted===1){return;}
var height;var scrollHeight;var offsetHeight;try{if(this.frame.contentWindow.document.height){height=this.frame.contentWindow.document.height;if(this.frame.contentWindow.document.body.scrollHeight){height=scrollHeight=this.frame.contentWindow.document.body.scrollHeight;}
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if(isChrome){height=scrollHeight=this.frame.contentWindow.document.height;}
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var height=0;try{if(this.frame.contentWindow.window.innerHeight)
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FrameBuilder.get=qsProxy||[];var i50022403453843=new FrameBuilder("50022403453843",false,"","<!DOCTYPE HTML PUBLIC \"-\/\/W3C\/\/DTD HTML 4.01\/\/EN\" \"http:\/\/www.w3.org\/TR\/html4\/strict.dtd\">\n<html class=\"supernova\"><head>\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<link rel=\"alternate\" type=\"application\/json+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=json&amp;url=http%3A%2F%2Fwww.jotform.com%2Fform%2F50022403453843\" title=\"oEmbed Form\"><link rel=\"alternate\" type=\"text\/xml+oembed\" href=\"https:\/\/www.jotform.com\/oembed\/?format=xml&amp;url=http%3A%2F%2Fwww.jotform.com%2Fform%2F50022403453843\" title=\"oEmbed Form\">\n<meta property=\"og:title\" content=\"Stripe Book Order Form\" >\n<meta property=\"og:url\" content=\"http:\/\/www.jotform.co\/form\/50022403453843\" >\n<meta property=\"og:description\" content=\"Please click the link to complete this form.\">\n<link rel=\"shortcut icon\" href=\"https:\/\/cdn.jotfor.ms\/favicon.ico\">\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=0\" \/>\n<meta name=\"HandheldFriendly\" content=\"true\" \/>\n<title>Stripe Book Order Form<\/title>\n<link href=\"https:\/\/cdn.jotfor.ms\/static\/formCss.css?3.3.4715\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/styles\/nova.css?3.3.4715\" \/>\n<link type=\"text\/css\" media=\"print\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/printForm.css?3.3.4715\" \/>\n<style type=\"text\/css\">\n    .form-label-left{\n        width:150px;\n    }\n    .form-line{\n        padding-top:12px;\n        padding-bottom:12px;\n    }\n    .form-label-right{\n        width:150px;\n    }\n    body, html{\n        margin:0;\n        padding:0;\n        background:#FFFFFF;\n    }\n\n    .form-all{\n        margin:0px auto;\n        padding-top:0px;\n        width:590px;\n        color:#555 !important;\n        font-family:\"Lucida Grande\", \"Lucida Sans Unicode\", \"Lucida Sans\", Verdana, sans-serif;\n        font-size:14px;\n    }\n    .form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{\n        color: #555;\n    }\n\n<\/style>\n\n<style type=\"text\/css\" id=\"form-designer-style\">\n    \/* Injected CSS Code *\/\n.form-all {\n  font-family: \"Lucida Grande\", sans-serif;\n}\n.form-all {\n  width: 590px;\n}\n.form-label-left,\n.form-label-right {\n  width: 150px;\n}\n.form-label {\n  white-space: normal;\n}\n.form-label.form-label-auto {\n  display: inline-block;\n  float: left;\n  text-align: left;\n  width: 150px;\n}\n.form-label-left {\n  display: inline-block;\n  white-space: normal;\n  float: left;\n  text-align: left;\n}\n.form-label-right {\n  display: inline-block;\n  white-space: normal;\n  float: left;\n  text-align: right;\n}\n.form-label-top {\n  white-space: normal;\n  display: block;\n  float: none;\n  text-align: left;\n}\n.form-all {\n  font-size: 14px;\n}\n.form-label {\n  font-weight: bold;\n}\n.form-checkbox-item label,\n.form-radio-item label {\n  font-weight: normal;\n}\n.supernova {\n  background-color: #ffffff;\n  background-color: #fafafa;\n}\n.supernova body {\n  background-color: transparent;\n}\n\/*\n@width30: (unit(@formWidth, px) + 60px);\n@width60: (unit(@formWidth, px)+ 120px);\n@width90: (unit(@formWidth, px)+ 180px);\n*\/\n\/* | *\/\n@media screen and (min-width: 480px) {\n  .supernova .form-all {\n    border: 1px solid #e1e1e1;\n    -webkit-box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);\n    -moz-box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);\n    box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (max-width: 480px) {\n  .jotform-form {\n    padding: 10px 0;\n  }\n}\n\/* | *\/\n\/* | *\/\n@media screen and (min-width: 480px) and (max-width: 768px) {\n  .jotform-form {\n    padding: 30px 0;\n  }\n}\n\/* | *\/\n\/* | 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-o-transition-property: all;\n  transition-property: all;\n  -webkit-transition-duration: 0.3s;\n  -moz-transition-duration: 0.3s;\n  -ms-transition-duration: 0.3s;\n  -o-transition-duration: 0.3s;\n  transition-duration: 0.3s;\n  -webkit-transition-timing-function: ease;\n  -moz-transition-timing-function: ease;\n  -ms-transition-timing-function: ease;\n  -o-transition-timing-function: ease;\n  transition-timing-function: ease;\n  background-color: #ffffe0;\n}\n\/* \u00f6mer *\/\n.form-radio-item,\n.form-checkbox-item {\n  padding-bottom: 0px !important;\n}\n.form-radio-item:last-child,\n.form-checkbox-item:last-child {\n  padding-bottom: 0;\n}\n\/* \u00f6mer *\/\n.form-single-column .form-checkbox-item,\n.form-single-column .form-radio-item {\n  width: 100%;\n}\n.supernova {\n  height: 100%;\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n  background-repeat: repeat;\n}\n.supernova {\n  background-image: none;\n}\n#stage {\n  background-image: none;\n}\n\/* | *\/\n.form-all {\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n  background-repeat: repeat;\n}\n.form-header-group {\n  background-repeat: no-repeat;\n  background-attachment: scroll;\n  background-position: center top;\n}\n.form-line {\n  margin-top: 12px;\n  margin-bottom: 12px;\n}\n.form-line {\n  padding: 12px 36px;\n}\n.form-all .qq-upload-button,\n.form-all .form-submit-button,\n.form-all .form-submit-reset,\n.form-all .form-submit-print {\n  font-size: 1em;\n  padding: 9px 15px;\n  font-family: \"Lucida Grande\", sans-serif;\n  font-size: 14px;\n  font-weight: normal;\n}\n.form-all .form-pagebreak-back,\n.form-all .form-pagebreak-next {\n  font-size: 1em;\n  padding: 9px 15px;\n  font-family: \"Lucida Grande\", sans-serif;\n  font-size: 14px;\n  font-weight: normal;\n}\n\/*\n&amp; when ( @buttonFontType = google ) {\n\t@import (css) \"@{buttonFontLink}\";\n}\n*\/\nh2.form-header {\n  line-height: 1.618em;\n  font-size: 1.714em;\n}\nh2 ~ .form-subHeader {\n  line-height: 1.5em;\n  font-size: 1.071em;\n}\n.form-header-group {\n  text-align: left;\n}\n\/*.form-dropdown,\n.form-radio-item,\n.form-checkbox-item,\n.form-radio-other-input,\n.form-checkbox-other-input,*\/\n.form-captcha input,\n.form-spinner input,\n.form-error-message {\n  padding: 4px 3px 2px 3px;\n}\n.form-header-group {\n  font-family: \"Lucida Grande\", sans-serif;\n}\n.form-section {\n  padding: 0px 0px 0px 0px;\n}\n.form-header-group {\n  margin: 12px 36px 12px 36px;\n}\n.form-header-group {\n  padding: 24px 0px 24px 0px;\n}\n.form-textbox,\n.form-textarea {\n  padding: 4px 3px 2px 3px;\n}\n.form-textbox,\n.form-textarea,\n.form-radio-other-input,\n.form-checkbox-other-input,\n.form-captcha input,\n.form-spinner input {\n  background-color: #ffffff;\n}\n[data-type=\"control_dropdown\"] .form-input,\n[data-type=\"control_dropdown\"] .form-input-wide {\n  width: 150px;\n}\n.form-label {\n  font-family: \"Lucida Grande\", sans-serif;\n}\nli[data-type=\"control_image\"] div {\n  text-align: left;\n}\nli[data-type=\"control_image\"] img {\n  border: none;\n  border-width: 0px !important;\n  border-style: solid !important;\n  border-color: false !important;\n}\n.form-line-column {\n  width: auto;\n}\n.form-line-error {\n  overflow: hidden;\n  -webkit-transition-property: none;\n  -moz-transition-property: none;\n  -ms-transition-property: none;\n  -o-transition-property: none;\n  transition-property: none;\n  -webkit-transition-duration: 0.3s;\n  -moz-transition-duration: 0.3s;\n  -ms-transition-duration: 0.3s;\n  -o-transition-duration: 0.3s;\n  transition-duration: 0.3s;\n  -webkit-transition-timing-function: ease;\n  -moz-transition-timing-function: ease;\n  -ms-transition-timing-function: ease;\n  -o-transition-timing-function: ease;\n  transition-timing-function: ease;\n  background-color: #fff4f4;\n}\n.form-line-error .form-error-message {\n  background-color: #ff3200;\n  clear: both;\n  float: none;\n}\n.form-line-error .form-error-message .form-error-arrow {\n  border-bottom-color: #ff3200;\n}\n.form-line-error input:not(#coupon-input),\n.form-line-error textarea,\n.form-line-error .form-validation-error {\n  border: 1px solid #ff3200;\n  -webkit-box-shadow: 0 0 3px #ff3200;\n  -moz-box-shadow: 0 0 3px #ff3200;\n  box-shadow: 0 0 3px #ff3200;\n}\n.ie-8 .form-all {\n  margin-top: auto;\n  margin-top: initial;\n}\n.ie-8 .form-all:before {\n  display: none;\n}\n\/* | *\/\n@media screen and (max-width: 480px), screen and (max-device-width: 768px) and (orientation: portrait), screen and (max-device-width: 415px) and (orientation: landscape) {\n  .jotform-form {\n    padding: 0;\n  }\n  .form-all {\n    border: 0;\n    width: 100%;\n    max-width: initial;\n  }\n  .form-sub-label-container {\n    width: 100%;\n    margin: 0;\n  }\n  .form-input {\n    width: 100%;\n  }\n  .form-label {\n    width: 100%!important;\n  }\n  .form-line {\n    padding: 2% 5%;\n    -moz-box-sizing: border-box;\n    -webkit-box-sizing: border-box;\n    box-sizing: border-box;\n  }\n  input[type=text],\n  input[type=email],\n  input[type=tel],\n  textarea {\n    width: 100%;\n    -moz-box-sizing: border-box;\n    -webkit-box-sizing: border-box;\n    box-sizing: border-box;\n    max-width: initial !important;\n  }\n  .form-input,\n  .form-input-wide,\n  .form-textarea,\n  .form-textbox,\n  .form-dropdown {\n    max-width: initial !important;\n  }\n  div.form-header-group {\n    padding: 24px 0px !important;\n    margin: 0 12px 2% !important;\n    margin-left: 5% !important;\n    margin-right: 5% !important;\n    -moz-box-sizing: border-box;\n    -webkit-box-sizing: border-box;\n    box-sizing: border-box;\n  }\n  [data-type=\"control_button\"] {\n    margin-bottom: 0 !important;\n  }\n  .form-buttons-wrapper {\n    margin: 0!important;\n  }\n  .form-buttons-wrapper button {\n    width: 100%;\n  }\n  table {\n    width: 100%!important;\n    max-width: initial !important;\n  }\n  table td + td {\n    padding-left: 3%;\n  }\n  .form-checkbox-item input,\n  .form-radio-item input {\n    width: auto;\n  }\n  .form-collapse-table {\n    margin: 0 5%;\n  }\n}\n\/* | *\/\n\n\/*__INSPECT_SEPERATOR__*\/\n\n    \/* Injected CSS Code *\/\n<\/style>\n\n<link type=\"text\/css\" rel=\"stylesheet\" href=\"https:\/\/cdn.jotfor.ms\/css\/responsive.css?3.3.4715\" \/>\n<script src=\"https:\/\/js.stripe.com\/v1\/\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/static\/prototype.forms.js\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/static\/jotform.forms.js?3.3.4715\" type=\"text\/javascript\"><\/script>\n<script src=\"https:\/\/cdn.jotfor.ms\/js\/stripe.js?v=3.3.4715\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n   JotForm.jsForm = true;\n\n   JotForm.init(function(){\n      productID = {\"0\":\"input_7_1001\"};\n      paymentType = \"product\";\n      JotForm.setCurrencyFormat('AUD',true, 'point');\n      JotForm.totalCounter({\"input_7_1001\":{\"price\":\"14.95\",\"shipping\":{\"firstItem\":\"6\",\"addItem\":\"3\"},\"tax\":{\"rate\":\"10\",\"surcharge\":{}}}});\n      $$('.form-product-custom_quantity').each(function(el, i){el.observe('blur', function(){isNaN(this.value) || this.value < 1 ? this.value = '0' : this.value})});\n      $$('.form-product-custom_quantity').each(function(el, i){el.observe('focus', function(){this.value == 0 ? this.value = '' : this.value})});\n      JotForm.setStripeSettings('pk_test_wLbLEkPRioLs6pjvfj0VZFaJ', '6');\n      setTimeout(function() {\n          $('input_5').hint('ex: myname@example.com');\n       }, 20);\n      JotForm.alterTexts({\"shippingShipping\":\"Shipping\",\"taxTax\":\"GST\"}, true);\n    \/*INIT-END*\/\n});\n\n   clearInterval(jsTime);\n }catch(e){}}, 1000);\n\n   JotForm.prepareCalculationsOnTheFly([null,{\"name\":\"clickTo\",\"qid\":\"1\",\"type\":\"control_head\"},{\"name\":\"submit\",\"qid\":\"2\",\"text\":\"Send me the book\",\"type\":\"control_button\"},null,{\"name\":\"yourName\",\"qid\":\"4\",\"text\":\"Your Name\",\"type\":\"control_fullname\"},{\"name\":\"yourEmail5\",\"qid\":\"5\",\"text\":\"Your E-mail\",\"type\":\"control_email\"},{\"name\":\"shippingAddress\",\"qid\":\"6\",\"text\":\"Shipping Address\",\"type\":\"control_address\"},{\"name\":\"getMy\",\"qid\":\"7\",\"text\":\"Get My Book\",\"type\":\"control_stripe\"}]);\n   setTimeout(function() {\nJotForm.paymentExtrasOnTheFly([null,{\"name\":\"clickTo\",\"qid\":\"1\",\"type\":\"control_head\"},{\"name\":\"submit\",\"qid\":\"2\",\"text\":\"Send me the book\",\"type\":\"control_button\"},null,{\"name\":\"yourName\",\"qid\":\"4\",\"text\":\"Your Name\",\"type\":\"control_fullname\"},{\"name\":\"yourEmail5\",\"qid\":\"5\",\"text\":\"Your E-mail\",\"type\":\"control_email\"},{\"name\":\"shippingAddress\",\"qid\":\"6\",\"text\":\"Shipping Address\",\"type\":\"control_address\"},{\"name\":\"getMy\",\"qid\":\"7\",\"text\":\"Get My Book\",\"type\":\"control_stripe\"}]);}, 20); \n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"https:\/\/submit.jotform.co\/submit\/50022403453843\/\" method=\"post\" name=\"form_50022403453843\" id=\"50022403453843\" accept-charset=\"utf-8\">\n  <input type=\"hidden\" name=\"formID\" value=\"50022403453843\" \/>\n  <div class=\"form-all\">\n    <ul class=\"form-section page-section\">\n      <li id=\"cid_1\" class=\"form-input-wide\" data-type=\"control_head\">\n        <div class=\"form-header-group \">\n          <div class=\"header-text httal htvam\">\n            <h1 id=\"header_1\" class=\"form-header\" data-component=\"header\">\n            <\/h1>\n            <div id=\"subHeader_1\" class=\"form-subHeader\">\n              Order the book by completing the form below\n            <\/div>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_stripe\" id=\"id_7\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_7\" for=\"input_7\"> Get My Book <\/label>\n        <div id=\"cid_7\" class=\"form-input\">\n          <div data-wrapper-react=\"true\">\n            <div data-wrapper-react=\"true\">\n              <input type=\"hidden\" name=\"simple_fpc\" data-payment_type=\"stripe\" data-component=\"payment1\" value=\"7\" \/>\n              <input type=\"hidden\" name=\"payment_total_checksum\" id=\"payment_total_checksum\" data-component=\"payment2\" \/>\n              <div data-wrapper-react=\"true\">\n                <input type=\"hidden\" id=\"payment_enable_lightbox\" \/>\n                <span class=\"form-product-item hover-product-item\">\n                  <div data-wrapper-react=\"true\" class=\"form-product-item-detail\">\n                    <input class=\"form-radio \" type=\"radio\" id=\"input_7_1001\" name=\"q7_getMy[][id]\" value=\"1001\" checked=\"\" \/>\n                    <label for=\"input_7_1001\" class=\"form-product-container\">\n                      <span data-wrapper-react=\"true\">\n                        <span class=\"form-product-name\" id=\"product-name-input_7_1001\">\n                          10 Secrets to Small Business Marketing Success\n                        <\/span>\n                        <span class=\"form-product-details\">\n                          <b>\n                            <span data-wrapper-react=\"true\">\n                              $\n                              <span id=\"input_7_1001_price\">\n                                14.95\n                              <\/span>\n                              AUD\n                            <\/span>\n                          <\/b>\n                        <\/span>\n                      <\/span>\n                    <\/label>\n                  <\/div>\n                <\/span>\n                <br\/>\n                <span class=\"form-payment-divider\" style=\"margin:0 0 8px;\">\n                <\/span>\n                <span class=\"form-payment-subtotal form-payment-label\">\n                  <span id=\"subtotal-text\">\n                    Subtotal:\n                  <\/span>\n                  \u00a0\n                  <span class=\"form-payment-price\">\n                    <span data-wrapper-react=\"true\">\n                      $\n                      <span id=\"payment_subtotal\">\n                        0.00\n                      <\/span>\n                      AUD\n                    <\/span>\n                  <\/span>\n                <\/span>\n                <span class=\"form-payment-tax form-payment-label\">\n                  <span id=\"tax-text\">\n                    Tax:\n                  <\/span>\n                  \u00a0\n                  <span class=\"form-payment-price\">\n                    <span data-wrapper-react=\"true\">\n                      $\n                      <span id=\"payment_tax\">\n                        0.00\n                      <\/span>\n                      AUD\n                    <\/span>\n                  <\/span>\n                <\/span>\n                <span class=\"form-payment-shipping form-payment-label\">\n                  <span id=\"shipping-text\">\n                    Shipping:\n                  <\/span>\n                  \u00a0\n                  <span class=\"form-payment-price\">\n                    <span data-wrapper-react=\"true\">\n                      $\n                      <span id=\"payment_shipping\">\n                        0.00\n                      <\/span>\n                      AUD\n                    <\/span>\n                  <\/span>\n                <\/span>\n                <span class=\"form-payment-divider\" style=\"margin:8px 0;\">\n                <\/span>\n                <span class=\"form-payment-total\">\n                  <b>\n                    <span id=\"total-text\">\n                      Total:\n                    <\/span>\n                    \u00a0\n                    <span class=\"form-payment-price\">\n                      <span data-wrapper-react=\"true\">\n                        $\n                        <span id=\"payment_total\">\n                          0.00\n                        <\/span>\n                        AUD\n                      <\/span>\n                    <\/span>\n                  <\/b>\n                <\/span>\n              <\/div>\n              <hr\/>\n            <\/div>\n            <table class=\"form-address-table payment-form-table\" cellpadding=\"0\" cellspacing=\"0\">\n              <tbody>\n                <tr>\n                  <th colspan=\"2\" style=\"text-align:left;margin-top:20px;display:table;\" id=\"ccTitle7\">\n                    Credit Card Details\n                  <\/th>\n                <\/tr>\n                <tr>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_7_cc_firstName\" id=\"sublabel_cc_firstName\" style=\"min-height:13px;margin:0 0 3px 0;\"> First Name <\/label>\n                      <input type=\"text\" id=\"input_7_cc_firstName\" name=\"q7_getMy[cc_firstName]\" class=\"form-textbox cc_firstName\" size=\"20\" value=\"\" data-component=\"cc_firstName\" \/>\n                    <\/span>\n                  <\/td>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_7_cc_lastName\" id=\"sublabel_cc_lastName\" style=\"min-height:13px;margin:0 0 3px 0;\"> Last Name <\/label>\n                      <input type=\"text\" id=\"input_7_cc_lastName\" name=\"q7_getMy[cc_lastName]\" class=\"form-textbox cc_lastName\" size=\"20\" value=\"\" data-component=\"cc_lastName\" \/>\n                    <\/span>\n                  <\/td>\n                <\/tr>\n                <tr>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_7_cc_number\" id=\"sublabel_cc_number\" style=\"min-height:13px;margin:0 0 3px 0;\"> Credit Card Number <\/label>\n                      <input type=\"number\" id=\"input_7_cc_number\" name=\"q7_getMy[cc_number]\" class=\"form-textbox cc_number\" autocomplete=\"off\" size=\"20\" value=\"\" data-component=\"cc_number\" \/>\n                    <\/span>\n                  <\/td>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_7_cc_ccv\" id=\"sublabel_cc_ccv\" style=\"min-height:13px;margin:0 0 3px 0;\"> Security Code <\/label>\n                      <input type=\"number\" id=\"input_7_cc_ccv\" name=\"q7_getMy[cc_ccv]\" class=\"form-textbox cc_ccv\" autocomplete=\"off\" style=\"width:52px;\" value=\"\" data-component=\"cc_ccv\" \/>\n                    <\/span>\n                  <\/td>\n                <\/tr>\n                <tr>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_7_cc_exp_month\" id=\"sublabel_cc_exp_month\" style=\"min-height:13px;margin:0 0 3px 0;\"> Expiration Month <\/label>\n                      <select class=\"form-dropdown cc_exp_month\" name=\"q7_getMy[cc_exp_month]\" id=\"input_7_cc_exp_month\" data-component=\"cc_exp_month\">\n                        <option>  <\/option>\n                        <option value=\"1\"> January <\/option>\n                        <option value=\"2\"> February <\/option>\n                        <option value=\"3\"> March <\/option>\n                        <option value=\"4\"> April <\/option>\n                        <option value=\"5\"> May <\/option>\n                        <option value=\"6\"> June <\/option>\n                        <option value=\"7\"> July <\/option>\n                        <option value=\"8\"> August <\/option>\n                        <option value=\"9\"> September <\/option>\n                        <option value=\"10\"> October <\/option>\n                        <option value=\"11\"> November <\/option>\n                        <option value=\"12\"> December <\/option>\n                      <\/select>\n                    <\/span>\n                  <\/td>\n                  <td width=\"50%\">\n                    <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                      <label class=\"form-sub-label\" for=\"input_7_cc_exp_year\" id=\"sublabel_cc_exp_year\" style=\"min-height:13px;margin:0 0 3px 0;\"> Expiration Year <\/label>\n                      <select class=\"form-dropdown cc_exp_year\" name=\"q7_getMy[cc_exp_year]\" id=\"input_7_cc_exp_year\" data-component=\"cc_exp_year\">\n                        <option>  <\/option>\n                        <option value=\"2018\"> 2018 <\/option>\n                        <option value=\"2019\"> 2019 <\/option>\n                        <option value=\"2020\"> 2020 <\/option>\n                        <option value=\"2021\"> 2021 <\/option>\n                        <option value=\"2022\"> 2022 <\/option>\n                        <option value=\"2023\"> 2023 <\/option>\n                        <option value=\"2024\"> 2024 <\/option>\n                        <option value=\"2025\"> 2025 <\/option>\n                        <option value=\"2026\"> 2026 <\/option>\n                        <option value=\"2027\"> 2027 <\/option>\n                        <option value=\"2028\"> 2028 <\/option>\n                        <option value=\"2029\"> 2029 <\/option>\n                        <option value=\"2030\"> 2030 <\/option>\n                        <option value=\"2031\"> 2031 <\/option>\n                        <option value=\"2032\"> 2032 <\/option>\n                        <option value=\"2033\"> 2033 <\/option>\n                        <option value=\"2034\"> 2034 <\/option>\n                        <option value=\"2035\"> 2035 <\/option>\n                        <option value=\"2036\"> 2036 <\/option>\n                        <option value=\"2037\"> 2037 <\/option>\n                      <\/select>\n                    <\/span>\n                  <\/td>\n                <\/tr>\n              <\/tbody>\n            <\/table>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_fullname\" id=\"id_4\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_4\" for=\"first_4\"> Your Name <\/label>\n        <div id=\"cid_4\" class=\"form-input\">\n          <div data-wrapper-react=\"true\">\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"first_4\" name=\"q4_yourName[first]\" class=\"form-textbox\" size=\"10\" value=\"\" data-component=\"first\" \/>\n              <label class=\"form-sub-label\" for=\"first_4\" id=\"sublabel_first\" style=\"min-height:13px;\"> First Name <\/label>\n            <\/span>\n            <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n              <input type=\"text\" id=\"last_4\" name=\"q4_yourName[last]\" class=\"form-textbox\" size=\"15\" value=\"\" data-component=\"last\" \/>\n              <label class=\"form-sub-label\" for=\"last_4\" id=\"sublabel_last\" style=\"min-height:13px;\"> Last Name <\/label>\n            <\/span>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_email\" id=\"id_5\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_5\" for=\"input_5\"> Your E-mail <\/label>\n        <div id=\"cid_5\" class=\"form-input\">\n          <input type=\"email\" id=\"input_5\" name=\"q5_yourEmail5\" class=\"form-textbox validate[Email]\" size=\"32\" value=\"\" placeholder=\"ex: myname@example.com\" data-component=\"email\" \/>\n        <\/div>\n      <\/li>\n      <li class=\"form-line\" data-type=\"control_button\" id=\"id_2\">\n        <div id=\"cid_2\" class=\"form-input-wide\">\n          <div style=\"margin-left:156px;\" class=\"form-buttons-wrapper\">\n            <button id=\"input_2\" type=\"submit\" class=\"form-submit-button\" data-component=\"button\">\n              Send me the book\n            <\/button>\n            <span>\n              \u00a0\n            <\/span>\n            <button id=\"input_print_2\" style=\"margin-left:25px;\" type=\"button\" class=\"form-submit-print\" data-component=\"button\">\n              <img src=\"https:\/\/cdn.jotfor.ms\/images\/printer.png\" style=\"vertical-align:middle;\" \/>\n              <span id=\"span_print_2\" class=\"span_print\">\n                Print Form\n              <\/span>\n            <\/button>\n          <\/div>\n        <\/div>\n      <\/li>\n      <li class=\"form-line always-hidden\" data-type=\"control_address\" id=\"id_6\">\n        <label class=\"form-label form-label-left form-label-auto\" id=\"label_6\" for=\"input_6_addr_line1\"> Shipping Address <\/label>\n        <div id=\"cid_6\" class=\"form-input always-hidden\">\n          <table summary=\"\" class=\"form-address-table\" cellpadding=\"0\" cellspacing=\"0\">\n            <tbody>\n              <tr>\n                <td colspan=\"2\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_6_addr_line1\" name=\"q6_shippingAddress[addr_line1]\" class=\"form-textbox form-address-line\" value=\"\" data-component=\"address_line_1\" \/>\n                    <label class=\"form-sub-label\" for=\"input_6_addr_line1\" id=\"sublabel_6_addr_line1\" style=\"min-height:13px;\"> Street Address <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td colspan=\"2\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_6_addr_line2\" name=\"q6_shippingAddress[addr_line2]\" class=\"form-textbox form-address-line\" size=\"46\" value=\"\" data-component=\"address_line_2\" \/>\n                    <label class=\"form-sub-label\" for=\"input_6_addr_line2\" id=\"sublabel_6_addr_line2\" style=\"min-height:13px;\"> Street Address Line 2 <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td width=\"50%\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_6_city\" name=\"q6_shippingAddress[city]\" class=\"form-textbox form-address-city\" size=\"21\" value=\"\" data-component=\"city\" \/>\n                    <label class=\"form-sub-label\" for=\"input_6_city\" id=\"sublabel_6_city\" style=\"min-height:13px;\"> City <\/label>\n                  <\/span>\n                <\/td>\n                <td>\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_6_state\" name=\"q6_shippingAddress[state]\" class=\"form-textbox form-address-state\" size=\"22\" value=\"\" data-component=\"state\" \/>\n                    <label class=\"form-sub-label\" for=\"input_6_state\" id=\"sublabel_6_state\" style=\"min-height:13px;\"> State \/ Province <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n              <tr>\n                <td width=\"50%\">\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <input type=\"text\" id=\"input_6_postal\" name=\"q6_shippingAddress[postal]\" class=\"form-textbox form-address-postal\" size=\"10\" value=\"\" data-component=\"zip\" \/>\n                    <label class=\"form-sub-label\" for=\"input_6_postal\" id=\"sublabel_6_postal\" style=\"min-height:13px;\"> Postal \/ Zip Code <\/label>\n                  <\/span>\n                <\/td>\n                <td>\n                  <span class=\"form-sub-label-container\" style=\"vertical-align:top;\">\n                    <select class=\"form-dropdown form-address-country\" name=\"q6_shippingAddress[country]\" id=\"input_6_country\" data-component=\"country\">\n                      <option value=\"\"> Please Select <\/option>\n                      <option value=\"United States\"> United States <\/option>\n                      <option value=\"Afghanistan\"> Afghanistan <\/option>\n                      <option value=\"Albania\"> Albania <\/option>\n                      <option value=\"Algeria\"> Algeria <\/option>\n                      <option value=\"American Samoa\"> American Samoa <\/option>\n                      <option value=\"Andorra\"> Andorra <\/option>\n                      <option value=\"Angola\"> Angola <\/option>\n                      <option value=\"Anguilla\"> Anguilla <\/option>\n                      <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n                      <option value=\"Argentina\"> Argentina <\/option>\n                      <option value=\"Armenia\"> Armenia <\/option>\n                      <option value=\"Aruba\"> Aruba <\/option>\n                      <option selected=\"\" value=\"Australia\"> Australia <\/option>\n                      <option value=\"Austria\"> Austria <\/option>\n                      <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n                      <option value=\"The Bahamas\"> The Bahamas <\/option>\n                      <option value=\"Bahrain\"> Bahrain <\/option>\n                      <option value=\"Bangladesh\"> Bangladesh <\/option>\n                      <option value=\"Barbados\"> Barbados <\/option>\n                      <option value=\"Belarus\"> Belarus <\/option>\n                      <option value=\"Belgium\"> Belgium <\/option>\n                      <option value=\"Belize\"> Belize <\/option>\n                      <option value=\"Benin\"> Benin <\/option>\n                      <option value=\"Bermuda\"> Bermuda <\/option>\n                      <option value=\"Bhutan\"> Bhutan <\/option>\n                      <option value=\"Bolivia\"> Bolivia <\/option>\n                      <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n                      <option value=\"Botswana\"> Botswana <\/option>\n                      <option value=\"Brazil\"> Brazil <\/option>\n                      <option value=\"Brunei\"> Brunei <\/option>\n                      <option value=\"Bulgaria\"> Bulgaria <\/option>\n                      <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n                      <option value=\"Burundi\"> Burundi <\/option>\n                      <option value=\"Cambodia\"> Cambodia <\/option>\n                      <option value=\"Cameroon\"> Cameroon <\/option>\n                      <option value=\"Canada\"> Canada <\/option>\n                      <option value=\"Cape Verde\"> Cape Verde <\/option>\n                      <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n                      <option value=\"Central African Republic\"> Central African Republic <\/option>\n                      <option value=\"Chad\"> Chad <\/option>\n                      <option value=\"Chile\"> Chile <\/option>\n                      <option value=\"China\"> China <\/option>\n                      <option value=\"Christmas Island\"> Christmas Island <\/option>\n                      <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n                      <option value=\"Colombia\"> Colombia <\/option>\n                      <option value=\"Comoros\"> Comoros <\/option>\n                      <option value=\"Congo\"> Congo <\/option>\n                      <option value=\"Cook Islands\"> Cook Islands <\/option>\n                      <option value=\"Costa Rica\"> Costa Rica <\/option>\n                      <option value=\"Cote d&#x27;Ivoire\"> Cote d&#x27;Ivoire <\/option>\n                      <option value=\"Croatia\"> Croatia <\/option>\n                      <option value=\"Cuba\"> Cuba <\/option>\n                      <option value=\"Cyprus\"> Cyprus <\/option>\n                      <option value=\"Czech Republic\"> Czech Republic <\/option>\n                      <option value=\"Democratic Republic of the Congo\"> Democratic Republic of the Congo <\/option>\n                      <option value=\"Denmark\"> Denmark <\/option>\n                      <option value=\"Djibouti\"> Djibouti <\/option>\n                      <option value=\"Dominica\"> Dominica <\/option>\n                      <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n                      <option value=\"Ecuador\"> Ecuador <\/option>\n                      <option value=\"Egypt\"> Egypt <\/option>\n                      <option value=\"El Salvador\"> El Salvador <\/option>\n                      <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n                      <option value=\"Eritrea\"> Eritrea <\/option>\n                      <option value=\"Estonia\"> Estonia <\/option>\n                      <option value=\"Ethiopia\"> Ethiopia <\/option>\n                      <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n                      <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n                      <option value=\"Fiji\"> Fiji <\/option>\n                      <option value=\"Finland\"> Finland <\/option>\n                      <option value=\"France\"> France <\/option>\n                      <option value=\"French Polynesia\"> French Polynesia <\/option>\n                      <option value=\"Gabon\"> Gabon <\/option>\n                      <option value=\"The Gambia\"> The Gambia <\/option>\n                      <option value=\"Georgia\"> Georgia <\/option>\n                      <option value=\"Germany\"> Germany <\/option>\n                      <option value=\"Ghana\"> Ghana <\/option>\n                      <option value=\"Gibraltar\"> Gibraltar <\/option>\n                      <option value=\"Greece\"> Greece <\/option>\n                      <option value=\"Greenland\"> Greenland <\/option>\n                      <option value=\"Grenada\"> Grenada <\/option>\n                      <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n                      <option value=\"Guam\"> Guam <\/option>\n                      <option value=\"Guatemala\"> Guatemala <\/option>\n                      <option value=\"Guernsey\"> Guernsey <\/option>\n                      <option value=\"Guinea\"> Guinea <\/option>\n                      <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n                      <option value=\"Guyana\"> Guyana <\/option>\n                      <option value=\"Haiti\"> Haiti <\/option>\n                      <option value=\"Honduras\"> Honduras <\/option>\n                      <option value=\"Hong Kong\"> Hong Kong <\/option>\n                      <option value=\"Hungary\"> Hungary <\/option>\n                      <option value=\"Iceland\"> Iceland <\/option>\n                      <option value=\"India\"> India <\/option>\n                      <option value=\"Indonesia\"> Indonesia <\/option>\n                      <option value=\"Iran\"> Iran <\/option>\n                      <option value=\"Iraq\"> Iraq <\/option>\n                      <option value=\"Ireland\"> Ireland <\/option>\n                      <option value=\"Israel\"> Israel <\/option>\n                      <option value=\"Italy\"> Italy <\/option>\n                      <option value=\"Jamaica\"> Jamaica <\/option>\n                      <option value=\"Japan\"> Japan <\/option>\n                      <option value=\"Jersey\"> Jersey <\/option>\n                      <option value=\"Jordan\"> Jordan <\/option>\n                      <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n                      <option value=\"Kenya\"> Kenya <\/option>\n                      <option value=\"Kiribati\"> Kiribati <\/option>\n                      <option value=\"North Korea\"> North Korea <\/option>\n                      <option value=\"South Korea\"> South Korea <\/option>\n                      <option value=\"Kosovo\"> Kosovo <\/option>\n                      <option value=\"Kuwait\"> Kuwait <\/option>\n                      <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n                      <option value=\"Laos\"> Laos <\/option>\n                      <option value=\"Latvia\"> Latvia <\/option>\n                      <option value=\"Lebanon\"> Lebanon <\/option>\n                      <option value=\"Lesotho\"> Lesotho <\/option>\n                      <option value=\"Liberia\"> Liberia <\/option>\n                      <option value=\"Libya\"> Libya <\/option>\n                      <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n                      <option value=\"Lithuania\"> Lithuania <\/option>\n                      <option value=\"Luxembourg\"> Luxembourg <\/option>\n                      <option value=\"Macau\"> Macau <\/option>\n                      <option value=\"Macedonia\"> Macedonia <\/option>\n                      <option value=\"Madagascar\"> Madagascar <\/option>\n                      <option value=\"Malawi\"> Malawi <\/option>\n                      <option value=\"Malaysia\"> Malaysia <\/option>\n                      <option value=\"Maldives\"> Maldives <\/option>\n                      <option value=\"Mali\"> Mali <\/option>\n                      <option value=\"Malta\"> Malta <\/option>\n                      <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n                      <option value=\"Martinique\"> Martinique <\/option>\n                      <option value=\"Mauritania\"> Mauritania <\/option>\n                      <option value=\"Mauritius\"> Mauritius <\/option>\n                      <option value=\"Mayotte\"> Mayotte <\/option>\n                      <option value=\"Mexico\"> Mexico <\/option>\n                      <option value=\"Micronesia\"> Micronesia <\/option>\n                      <option value=\"Moldova\"> Moldova <\/option>\n                      <option value=\"Monaco\"> Monaco <\/option>\n                      <option value=\"Mongolia\"> Mongolia <\/option>\n                      <option value=\"Montenegro\"> Montenegro <\/option>\n                      <option value=\"Montserrat\"> Montserrat <\/option>\n                      <option value=\"Morocco\"> Morocco <\/option>\n                      <option value=\"Mozambique\"> Mozambique <\/option>\n                      <option value=\"Myanmar\"> Myanmar <\/option>\n                      <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n                      <option value=\"Namibia\"> Namibia <\/option>\n                      <option value=\"Nauru\"> Nauru <\/option>\n                      <option value=\"Nepal\"> Nepal <\/option>\n                      <option value=\"Netherlands\"> Netherlands <\/option>\n                      <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n                      <option value=\"New Caledonia\"> New Caledonia <\/option>\n                      <option value=\"New Zealand\"> New Zealand <\/option>\n                      <option value=\"Nicaragua\"> Nicaragua <\/option>\n                      <option value=\"Niger\"> Niger <\/option>\n                      <option value=\"Nigeria\"> Nigeria <\/option>\n                      <option value=\"Niue\"> Niue <\/option>\n                      <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n                      <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n                      <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n                      <option value=\"Norway\"> Norway <\/option>\n                      <option value=\"Oman\"> Oman <\/option>\n                      <option value=\"Pakistan\"> Pakistan <\/option>\n                      <option value=\"Palau\"> Palau <\/option>\n                      <option value=\"Palestine\"> Palestine <\/option>\n                      <option value=\"Panama\"> Panama <\/option>\n                      <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n                      <option value=\"Paraguay\"> Paraguay <\/option>\n                      <option value=\"Peru\"> Peru <\/option>\n                      <option value=\"Philippines\"> Philippines <\/option>\n                      <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n                      <option value=\"Poland\"> Poland <\/option>\n                      <option value=\"Portugal\"> Portugal <\/option>\n                      <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n                      <option value=\"Qatar\"> Qatar <\/option>\n                      <option value=\"Republic of the Congo\"> Republic of the Congo <\/option>\n                      <option value=\"Romania\"> Romania <\/option>\n                      <option value=\"Russia\"> Russia <\/option>\n                      <option value=\"Rwanda\"> Rwanda <\/option>\n                      <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n                      <option value=\"Saint Helena\"> Saint Helena <\/option>\n                      <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n                      <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n                      <option value=\"Saint Martin\"> Saint Martin <\/option>\n                      <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n                      <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n                      <option value=\"Samoa\"> Samoa <\/option>\n                      <option value=\"San Marino\"> San Marino <\/option>\n                      <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n                      <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n                      <option value=\"Senegal\"> Senegal <\/option>\n                      <option value=\"Serbia\"> Serbia <\/option>\n                      <option value=\"Seychelles\"> Seychelles <\/option>\n                      <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n                      <option value=\"Singapore\"> Singapore <\/option>\n                      <option value=\"Slovakia\"> Slovakia <\/option>\n                      <option value=\"Slovenia\"> Slovenia <\/option>\n                      <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n                      <option value=\"Somalia\"> Somalia <\/option>\n                      <option value=\"Somaliland\"> Somaliland <\/option>\n                      <option value=\"South Africa\"> South Africa <\/option>\n                      <option value=\"South Ossetia\"> South Ossetia <\/option>\n                      <option value=\"South Sudan\"> South Sudan <\/option>\n                      <option value=\"Spain\"> Spain <\/option>\n                      <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n                      <option value=\"Sudan\"> Sudan <\/option>\n                      <option value=\"Suriname\"> Suriname <\/option>\n                      <option value=\"Svalbard\"> Svalbard <\/option>\n                      <option value=\"Swaziland\"> Swaziland <\/option>\n                      <option value=\"Sweden\"> Sweden <\/option>\n                      <option value=\"Switzerland\"> Switzerland <\/option>\n                      <option value=\"Syria\"> Syria <\/option>\n                      <option value=\"Taiwan\"> Taiwan <\/option>\n                      <option value=\"Tajikistan\"> Tajikistan <\/option>\n                      <option value=\"Tanzania\"> Tanzania <\/option>\n                      <option value=\"Thailand\"> Thailand <\/option>\n                      <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n                      <option value=\"Togo\"> Togo <\/option>\n                      <option value=\"Tokelau\"> Tokelau <\/option>\n                      <option value=\"Tonga\"> Tonga <\/option>\n                      <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n                      <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n                      <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n                      <option value=\"Tunisia\"> Tunisia <\/option>\n                      <option value=\"Turkey\"> Turkey <\/option>\n                      <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n                      <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n                      <option value=\"Tuvalu\"> Tuvalu <\/option>\n                      <option value=\"Uganda\"> Uganda <\/option>\n                      <option value=\"Ukraine\"> Ukraine <\/option>\n                      <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n                      <option value=\"United Kingdom\"> United Kingdom <\/option>\n                      <option value=\"Uruguay\"> Uruguay <\/option>\n                      <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n                      <option value=\"Vanuatu\"> Vanuatu <\/option>\n                      <option value=\"Vatican City\"> Vatican City <\/option>\n                      <option value=\"Venezuela\"> Venezuela <\/option>\n                      <option value=\"Vietnam\"> Vietnam <\/option>\n                      <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n                      <option value=\"Isle of Man\"> Isle of Man <\/option>\n                      <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n                      <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n                      <option value=\"Western Sahara\"> Western Sahara <\/option>\n                      <option value=\"Yemen\"> Yemen <\/option>\n                      <option value=\"Zambia\"> Zambia <\/option>\n                      <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n                      <option value=\"other\"> Other <\/option>\n                    <\/select>\n                    <label class=\"form-sub-label\" for=\"input_6_country\" id=\"sublabel_6_country\" style=\"min-height:13px;\"> Country <\/label>\n                  <\/span>\n                <\/td>\n              <\/tr>\n            <\/tbody>\n          <\/table>\n        <\/div>\n      <\/li>\n      <li style=\"display:none\">\n        Should be Empty:\n        <input type=\"text\" name=\"website\" value=\"\" \/>\n      <\/li>\n    <\/ul>\n  <\/div>\n  <script>\n  JotForm.showJotFormPowered = \"0\";\n  <\/script>\n  <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"50022403453843\" \/>\n  <script type=\"text\/javascript\">\n  document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"50022403453843-50022403453843\";\n  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