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distributor-form.html
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distributor-form.html
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<!DOCTYPE html>
<html lang="en-US">
<head>
<script>
var require = {
"baseUrl": "http://8pandas.net/pub/static/version1506329978/frontend/Magento/luma/en_US"
};
</script>
<title>8 Pandas | Distriutors Form</title>
<meta http-equiv="content-type" content="text/html; charset=UTF-8">
<meta charset="utf-8">
<meta name="description" content="8 Pandas">
<meta name="keywords" content="Magento, 8 Pandas, E-commerce">
<meta name="robots" content="INDEX,FOLLOW">
<meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1.0, user-scalable=no">
<!-- Styles -->
<link rel="stylesheet" type="text/css" media="all" href="css/calendar.css">
<link rel="stylesheet" type="text/css" media="all" href="css/styles-m.css">
<link rel="stylesheet" type="text/css" media="screen and (min-width: 768px)" href="css/styles-l.css">
<link rel="stylesheet" type="text/css" media="print" href="css/print.css">
<link rel="stylesheet" type="text/css" media="all" href="css/bootstrap.css">
<link rel="stylesheet" type="text/css" media="all" href="css/font-awesome.min.css">
<!-- Custom Styles -->
<link rel="stylesheet" type="text/css" media="all" href="css/custom-styles-dist.css">
<!-- Scripts -->
<script type="text/javascript" src="js/require.js"></script>
<script type="text/javascript" src="js/mixins.js"></script>
<script type="text/javascript" src="js/requirejs-config.js"></script>
<link rel="icon" type="image/x-icon" href="http://8pandas.net/pub/media/favicon/stores/1/favicon-16x16_1.png">
<link rel="shortcut icon" type="image/x-icon" href="http://8pandas.net/pub/media/favicon/stores/1/favicon-16x16_1.png">
<link rel="stylesheet" type="text/css" media="all" href="js/styles.css"> <script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="jquery" src="js/jquery.js"></script>
<script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="jquery/jquery.mobile.custom" src="js/jquery_004.js"></script>
<script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="js/responsive" src="js/responsive.js"></script>
<script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="mage/dataPost" src="js/dataPost.js"></script>
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<script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="mage/bootstrap" src="js/bootstrap_002.js"></script>
<script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="mage/translate-inline" src="js/translate-inline.js"></script>
<script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="mage/translate" src="js/translate.js"></script>
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<script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="Magento_Ui/js/modal/modal" src="js/modal.js"></script>
<script type="text/javascript" charset="utf-8" async="" data-requirecontext="_" data-requiremodule="Magento_Captcha/js/model/captcha" src="js/captcha.js"></script>
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<script type="text/javascript" src="custom-js/distributors-form.js"></script>
</head>
<body data-container="body" class="cms-home cms-index-index page-layout-1column">
<script>
require.config({
deps: [
'jquery',
'mage/translate',
'jquery/jquery-storageapi'
],
callback: function ($) {
'use strict';
var dependencies = [],
versionObj;
$.initNamespaceStorage('mage-translation-storage');
$.initNamespaceStorage('mage-translation-file-version');
versionObj = $.localStorage.get('mage-translation-file-version');
if (versionObj.version !== '848b665716e8b72b8680952da779960ba49e0b46') {
dependencies.push(
'text!js-translation.json'
);
}
require.config({
deps: dependencies,
callback: function (string) {
if (typeof string === 'string') {
$.mage.translate.add(JSON.parse(string));
$.localStorage.set('mage-translation-storage', string);
$.localStorage.set(
'mage-translation-file-version',
{
version: '848b665716e8b72b8680952da779960ba49e0b46'
}
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} else {
$.mage.translate.add($.localStorage.get('mage-translation-storage'));
}
}
});
}
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<div class="page-wrapper">
<!-- Start of Header -->
<header class="page-header">
<div class="panel wrapper">
<!-- Top bar -->
<div class="c1"></div>
<div class="c2"></div>
<div class="c3"></div>
<!-- Top bar -->
<!-- Navbar -->
<div class="nav-bar">
<ul>
<li><a href="#">Home</a></li>
<li><a href="#">Products</a></li>
<li><a href="#">Resources</a></li>
<li><a href="#">Support</a></li>
<li><a href="#">Contact Us</a></li>
</ul>
</div>
<!-- <div class="panel header">
<a class="action skip contentarea" href="#contentarea"><span>Skip to Content</span></a>
<ul class="header links">
<li class="greet welcome" data-bind="scope: 'customer'"> -->
<!-- ko if: customer().fullname --><!-- /ko -->
<!-- ko ifnot: customer().fullname -->
<!-- <span data-bind="html:'Default welcome msg!'">Default welcome msg!</span> -->
<!-- /ko -->
<!-- </li>
<li class="authorization-link" data-label="or">
<a href="http://8pandas.net/customer/account/login/">Sign In</a>
</li>
<li>
<a href="http://8pandas.net/customer/account/create/">Create an Account</a>
</li>
</ul>
</div> -->
</div>
<div class="header content home-page">
<span data-action="toggle-nav" class="action nav-toggle">
<i class="fa fa-navicon"></i>
<span>Toggle Nav</span>
</span>
<strong class="logo">
<a href="https://8pandas.000webhostapp.com/magento/homepage/">
<img src="js/8_Pandas_Logo.png" alt="8 Pandas" width="399">
</a>
</strong>
<!-- CART -->
<div class="cart-wrapper">
<div class="diamond"></div>
<div class="diamond2"></div>
<div class="top-wrapper">
<div class="title-wrapper">
<a href="" id="" class="action showcart"><p><i class="fa fa-shopping-cart" data-bind="scope: 'minicart_content'"></i> <span>Shopping Cart</span></p></a>
</div>
<div class="flag-wrapper">
<a href="#">
<img src="https://8pandas.000webhostapp.com/magento/homepage/img/australian-flag-graphic.png">
</a>
<a href="#">
<img src="https://8pandas.000webhostapp.com/magento/homepage/img/french-flag-large.png">
</a>
<a href="#">
<img src="https://8pandas.000webhostapp.com/magento/homepage/img/german-flag-large.png">
</a>
</div>
</div>
<div class="labels">
<span>Items</span>
<span id="price">Price</span>
</div>
<div class="items-wrapper">
<div class="item">
<label><span>Item 1</span><span id="item-price">$ 10.00</span></label>
<a href=""><i class="fa fa-times-circle"></i></a>
</div>
<div class="item">
<label id="item2"><span>Item 2</span><span id="item-price">$ 09.59</span></label>
<a href=""><i class="fa fa-times-circle"></i></a>
</div>
<div class="item">
<label id="item2" class="view-all-cart"><span><i class="fa fa-shopping-basket"></i> Click here to view all items</span></label>
</div>
</div>
<hr>
<div class="total-wrapper">
<span id="total">Total</span>
<span id="total-item">3</span>
<span id="total-price">$ 19.59</span>
</div>
<a class="checkout-btn" href="http://8pandas.net/checkout/cart/">CHECKOUT</a>
</div>
<!-- ### CART ### -->
<!-- minicart -->
<div data-block="minicart" class="minicart-wrapper">
<!-- <label for="">Cart Button</label> -->
<a class="action showcart" href="http://8pandas.net/checkout/cart/" data-bind="scope: 'minicart_content'">
<i class="fa fa-shopping-cart"></i>
<span class="text">My Cart</span>
<span class="counter qty empty" data-bind="css: { empty: !!getCartParam('summary_count') == false }, blockLoader: isLoading">
<span class="counter-number"><!-- ko text: getCartParam('summary_count') -->0<!-- /ko --></span>
<span class="counter-label">
<!-- ko if: getCartParam('summary_count') --><!-- /ko -->
</span>
</span>
</a>
<script>
window.checkout = {"shoppingCartUrl":"http:\/\/8pandas.net\/checkout\/cart\/","checkoutUrl":"http:\/\/8pandas.net\/checkout\/","updateItemQtyUrl":"http:\/\/8pandas.net\/checkout\/sidebar\/updateItemQty\/","removeItemUrl":"http:\/\/8pandas.net\/checkout\/sidebar\/removeItem\/","imageTemplate":"Magento_Catalog\/product\/image_with_borders","baseUrl":"http:\/\/8pandas.net\/","minicartMaxItemsVisible":5,"websiteId":"1","maxItemsToDisplay":10,"customerLoginUrl":"http:\/\/8pandas.net\/customer\/account\/login\/","isRedirectRequired":false,"autocomplete":"off","captcha":{"user_login":{"isCaseSensitive":false,"imageHeight":50,"imageSrc":"","refreshUrl":"http:\/\/8pandas.net\/captcha\/refresh\/","isRequired":false},"guest_checkout":{"isCaseSensitive":false,"imageHeight":50,"imageSrc":"","refreshUrl":"http:\/\/8pandas.net\/captcha\/refresh\/","isRequired":false}}};
</script>
<!-- popup cart -->
<div class="ui-dialog ui-widget ui-widget-content ui-corner-all ui-front mage-dropdown-dialog" style="display: none;" tabindex="-1" role="dialog" aria-describedby="ui-id-1">
<div class="block block-minicart empty ui-dialog-content ui-widget-content" data-role="dropdownDialog" id="ui-id-1" style="display: block;">
<div id="minicart-content-wrapper" data-bind="scope: 'minicart_content'">
<!-- ko template: getTemplate() -->
<div class="block-title">
<strong>
<span class="text"><!-- ko i18n: 'My Cart' --><span>My Cart</span><!-- /ko --></span>
<span class="qty empty" data-bind="css: { empty: !!getCartParam('summary_count') == false },
attr: { title: $t('Items in Cart') }" title="Items in Cart">
<!-- ko text: getCartParam('summary_count') -->0<!-- /ko -->
</span>
</strong>
</div>
<div class="block-content">
<button type="button" id="btn-minicart-close" class="action close" data-action="close" data-bind="attr: { title: $t('Close') }" title="Close">
<span><!-- ko i18n: 'Close' --><span>Close</span><!-- /ko --></span>
</button>
<!-- ko if: getCartParam('summary_count') --><!-- /ko -->
<!-- ko if: getCartParam('summary_count') --><!-- /ko -->
<!-- ko ifnot: getCartParam('summary_count') -->
<strong class="subtitle empty" data-bind="visible: closeSidebar()">
<!-- ko i18n: 'You have no items in your shopping cart.' --><span>You have no items in your shopping cart.</span><!-- /ko -->
</strong>
<!-- ko if: getCartParam('cart_empty_message') --><!-- /ko -->
<!-- /ko -->
<!-- ko if: getCartParam('summary_count') --><!-- /ko -->
<div id="minicart-widgets" class="minicart-widgets">
<!-- ko foreach: getRegion('promotion') -->
<!-- ko template: getTemplate() -->
<!-- ko foreach: {data: elems, as: 'element'} --><!-- /ko -->
<!-- /ko -->
<!-- /ko -->
</div>
</div>
<!-- ko foreach: getRegion('sign-in-popup') --><!-- /ko -->
<!-- /ko -->
</div>
</div>
</div>
<!-- popup cart -->
</div>
<!-- minicart -->
<div class="block block-search">
<div class="block block-title"><strong>Search</strong></div>
<div class="block block-content">
<form class="form minisearch" id="search_mini_form" action="http://8pandas.net/catalogsearch/result/" method="get">
<div class="field search">
<label class="label" for="search" data-role="minisearch-label">
<i class="fa fa-search"></i>
<span>Search</span>
</label>
<div class="control">
<input id="search" name="q" placeholder="Search entire store here..." class="input-text" maxlength="128" role="combobox" aria-haspopup="false" aria-autocomplete="both" autocomplete="off" type="text">
<div id="search_autocomplete" class="search-autocomplete" style="display: none;"></div>
<div class="nested">
<a class="action advanced" href="http://8pandas.net/catalogsearch/advanced/" data-action="advanced-search">Advanced Search</a>
</div>
</div>
</div>
<div class="actions">
<button type="submit" title="Search" class="action search" disabled="disabled">
<span>Search</span>
</button>
</div>
</form>
</div>
</div>
<ul class="compare wrapper">
<li class="item link compare" data-bind="scope: 'compareProducts'" data-role="compare-products-link">
<a class="action compare no-display" title="Compare Products" data-bind="attr: {'href': compareProducts().listUrl}, css: {'no-display': !compareProducts().count}" href="http://8pandas.net/catalog/product_compare/index/uenc/aHR0cDovLzhwYW5kYXMubmV0L2N1c3RvbWVyL3NlY3Rpb24vbG9hZC8_c2VjdGlvbnM9JnVwZGF0ZV9zZWN0aW9uX2lkPWZhbHNlJl89MTUwNjU1ODk3NjIwNg%2C%2C/">Compare Products
<span class="counter qty" data-bind="text: compareProducts().countCaption">0 items</span>
</a>
</li>
</ul>
</div>
</header>
<!-- End of Header -->
<div class="dist-banner bg-globe" id="banner">
<div class="container">
<div class="row">
<h1>Ready to become a 8 Pandas Distributor?</h1>
<div class="col-lg-8 col-md-8 col-sm-12 col-sx-12 col-lg-push-2 col-md-push-2">
<p>We're looking for distributors to offer our customers more local purchase options. If you are interested in becoming a 8 Pandas partner, please fill out the form below.</p>
</div>
</div>
</div>
</div>
<!-- Main Content -->
<main id="maincontent" class="page-main">
<a id="contentarea" tabindex="-1"></a>
<!-- <div class="page-title-wrapper">
<h1 class="page-title">
<span class="base" data-ui-id="page-title-wrapper">Create Shipping Address</span> </h1>
</div> -->
<div class="page messages">
<div data-placeholder="messages"></div>
<div data-bind="scope: 'messages'">
<div data-bind="foreach: { data: cookieMessages, as: 'message' }" class="messages"></div>
<div data-bind="foreach: { data: messages().messages, as: 'message' }" class="messages"></div>
</div>
</div>
<div class="columns">
<div class="column main main-form">
<input name="form_key" value="FXFQLm176yp6mA2Y" type="hidden">
<div id="authenticationPopup" data-bind="scope:'authenticationPopup'" style="display: none;">
<script>
window.authenticationPopup = {
"autocomplete": "off",
"customerRegisterUrl": "http:\/\/localhost\/8Pandas\/customer\/account\/create\/",
"customerForgotPasswordUrl": "http:\/\/localhost\/8Pandas\/customer\/account\/forgotpassword\/",
"baseUrl": "http:\/\/localhost\/8Pandas\/"
};
</script>
<!-- ko template: getTemplate() -->
<!-- /ko -->
</div>
<form class="form-address-edit" action="http://localhost/8Pandas/customer/address/formPost/" method="post" id="form-validate" enctype="multipart/form-data" data-hasrequired="* Required Fields" novalidate="novalidate">
<!-- Contact Info -->
<fieldset class="fieldset">
<legend class="legend"><span>Contact Information</span></legend>
<br>
<input name="form_key" value="FXFQLm176yp6mA2Y" type="hidden">
<input name="success_url" value="http://localhost/8Pandas/multishipping/checkout_address/shippingSaved/" type="hidden">
<input name="error_url" value="http://localhost/8Pandas/multishipping/checkout_address/newShipping/" type="hidden">
<div class="field field-name-firstname required">
<span class="icons"><i class="fa fa-user-circle"></i></span>
<div class="control fname">
<input id="firstname" name="firstname" value="" title="First Name" class="input-text required-entry" data-validate="{required:true}" aria-required="true" type="text">
</div>
</div>
<div class="field field-name-lastname required">
<span class="icons"><i class="fa fa-user-circle-o"></i></span>
<div class="control lname">
<input id="lastname" name="lastname" value="" title="Last Name" class="input-text required-entry" data-validate="{required:true}" aria-required="true" type="text">
</div>
</div>
<div class="field company">
<span class="icons"><i class="fa fa-building"></i></span>
<div class="control company">
<input name="company" id="company" title="Company" class="input-text " type="text">
</div>
</div>
<div class="field telephone required">
<span class="icons"><i class="fa fa-phone"></i></span>
<div class="control phone">
<input name="telephone" title="Phone Number" class="input-text required-entry" id="telephone" aria-required="true" type="text">
</div>
</div>
<div class="field fax">
<span class="icons"><i class="fa fa-fax"></i></span>
<div class="control fax">
<input name="fax" id="fax" title="Fax" class="input-text " type="text">
</div>
</div>
</fieldset>
<!-- Address -->
<fieldset class="fieldset">
<legend class="legend"><span>Address</span></legend>
<br>
<div class="field street required">
<span class="icons icons-1"><i class="fa fa-street-view"></i></span>
<span class="icons"><i class="fa fa-street-view"></i></span>
<div class="control address address-f">
<input name="street[]" title="Street Address" id="street_1" class="input-text required-entry add-f" aria-required="true" type="text">
<div class="nested">
<div class="field additional">
<div class="control address address-s">
<input name="street[]" title="Street Address 2" id="street_2" class="input-text " aria-required="true" type="text">
</div>
</div>
</div>
</div>
<!-- Address -->
</div>
<div class="field city required">
<!-- <label class="label" for="city"><span>City</span></label> -->
<span class="icons"><i class="fa fa-map"></i></span>
<div class="control city">
<input name="city" title="City" class="input-text required-entry" id="city" aria-required="true" type="text">
</div>
</div>
<div class="field region required">
<!-- <label class="label" for="region_id" id="state"><span>State/Province</span></label> -->
<span class="icons"><i class="fa fa-map-marker"></i></span>
<div class="control">
<select id="region_id" name="region_id" title="State/Province" class="validate-select required-entry" aria-required="true" style="display: inline-block;" defaultvalue="0">
<option value="" selected="selected">Please select a region, state or province.</option>
<option value="1">Alabama</option>
<option value="2">Alaska</option>
<option value="3">American Samoa</option>
<option value="4">Arizona</option>
<option value="5">Arkansas</option>
<option value="6">Armed Forces Africa</option>
<option value="7">Armed Forces Americas</option>
<option value="8">Armed Forces Canada</option>
<option value="9">Armed Forces Europe</option>
<option value="10">Armed Forces Middle East</option>
<option value="11">Armed Forces Pacific</option>
<option value="12">California</option>
<option value="13">Colorado</option>
<option value="14">Connecticut</option>
<option value="15">Delaware</option>
<option value="16">District of Columbia</option>
<option value="17">Federated States Of Micronesia</option>
<option value="18">Florida</option>
<option value="19">Georgia</option>
<option value="20">Guam</option>
<option value="21">Hawaii</option>
<option value="22">Idaho</option>
<option value="23">Illinois</option>
<option value="24">Indiana</option>
<option value="25">Iowa</option>
<option value="26">Kansas</option>
<option value="27">Kentucky</option>
<option value="28">Louisiana</option>
<option value="29">Maine</option>
<option value="30">Marshall Islands</option>
<option value="31">Maryland</option>
<option value="32">Massachusetts</option>
<option value="33">Michigan</option>
<option value="34">Minnesota</option>
<option value="35">Mississippi</option>
<option value="36">Missouri</option>
<option value="37">Montana</option>
<option value="38">Nebraska</option>
<option value="39">Nevada</option>
<option value="40">New Hampshire</option>
<option value="41">New Jersey</option>
<option value="42">New Mexico</option>
<option value="43">New York</option>
<option value="44">North Carolina</option>
<option value="45">North Dakota</option>
<option value="46">Northern Mariana Islands</option>
<option value="47">Ohio</option>
<option value="48">Oklahoma</option>
<option value="49">Oregon</option>
<option value="50">Palau</option>
<option value="51">Pennsylvania</option>
<option value="52">Puerto Rico</option>
<option value="53">Rhode Island</option>
<option value="54">South Carolina</option>
<option value="55">South Dakota</option>
<option value="56">Tennessee</option>
<option value="57">Texas</option>
<option value="58">Utah</option>
<option value="59">Vermont</option>
<option value="60">Virgin Islands</option>
<option value="61">Virginia</option>
<option value="62">Washington</option>
<option value="63">West Virginia</option>
<option value="64">Wisconsin</option>
<option value="65">Wyoming</option>
</select>
<input id="region" name="region" title="State/Province" class="input-text" aria-required="true" style="display: none;" type="text">
</div>
</div>
<div class="field zip required">
<!-- <label class="label" for="zip"><span>Zip/Postal Code</span></label> -->
<span class="icons"><i class="fa fa-envelope-o"></i></span>
<div class="control zip">
<input name="postcode" title="Zip/Postal Code" id="zip" class="input-text validate-zip-international required-entry" aria-required="true" type="text">
</div>
</div>
<div class="field country required">
<!-- <label class="label" for="country"><span>Country</span></label> -->
<span class="icons"><i class="fa fa-globe"></i></span>
<div class="control">
<select name="country_id" id="country" class="required-entry" title="Country" data-validate="{'validate-select':true}" aria-required="true">
<option value=""> </option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua & Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia & Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo - Brazzaville</option>
<option value="CD">Congo - Kinshasa</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="CI">Côte d’Ivoire</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard & McDonald Islands</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong SAR China</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Laos</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macau SAR China</option>
<option value="MK">Macedonia</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia</option>
<option value="MD">Moldova</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar (Burma)</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="KP">North Korea</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territories</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn Islands</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="QA">Qatar</option>
<option value="RO">Romania</option>
<option value="RU">Russia</option>
<option value="RW">Rwanda</option>
<option value="RE">Réunion</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia & South Sandwich Islands</option>
<option value="KR">South Korea</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="BL">St. Barthélemy</option>
<option value="SH">St. Helena</option>
<option value="KN">St. Kitts & Nevis</option>
<option value="LC">St. Lucia</option>
<option value="MF">St. Martin</option>
<option value="PM">St. Pierre & Miquelon</option>
<option value="VC">St. Vincent & Grenadines</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard & Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syria</option>
<option value="ST">São Tomé & Príncipe</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad & Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks & Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UM">U.S. Outlying Islands</option>
<option value="VI">U.S. Virgin Islands</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US" selected="selected">United States</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vatican City</option>
<option value="VE">Venezuela</option>
<option value="VN">Vietnam</option>
<option value="WF">Wallis & Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
<option value="AX">Åland Islands</option>
</select>
</div>
</div>
<input name="default_billing" value="1" type="hidden">
<input name="default_shipping" value="1" type="hidden">
</fieldset>
<!-- Corporate Information -->
<fieldset class="fieldset corp-info">
<legend class="legend"><span>Corporate Information</span></legend>
<br>
<input name="form_key" value="FXFQLm176yp6mA2Y" type="hidden">
<input name="success_url" value="http://localhost/8Pandas/multishipping/checkout_address/shippingSaved/" type="hidden">
<input name="error_url" value="http://localhost/8Pandas/multishipping/checkout_address/newShipping/" type="hidden">
<div class="field field-name-establish required field-establish">
<span class="icons"><i class="fa fa-user-circle"></i></span>
<div class="control establish">
<input id="establish" name="establish" value="" title="Establish" class="input-text required-entry" data-validate="{required:true}" aria-required="true" type="text">
</div>
</div>
<div class="field field-name-lastname required field-employee">
<span class="icons"><i class="fa fa-user-circle-o"></i></span>
<div class="control employee">
<input id="employee" name="employee" value="" title="Employees Count" class="input-text required-entry" data-validate="{required:true}" aria-required="true" type="text">
</div>
</div>
</fieldset>
<!-- Company Structure -->
<fieldset class="fieldset com-struct">
<legend class="legend"><span>Company Structure</span></legend>
<br>
<div class="rad-container">
<div class="rad-wrapper">
<div class="rad-btn"></div>
<input type="radio" class="rad-input" id="">
<label for="">Sole Trader</label>
</div>
<div class="rad-wrapper">
<div class="rad-btn"></div>
<input type="radio" class="rad-input" id="">
<label for="">LLC</label>
</div>
<div class="rad-wrapper">
<div class="rad-btn"></div>
<input type="radio" class="rad-input" id="">
<label for="">Partnership</label>
</div>
<div class="rad-wrapper">
<div class="rad-btn"></div>
<input type="radio" class="rad-input" id="">
<label for="">Private Entity</label>
</div>
</div>
</fieldset>
<!-- Distribution Information -->
<fieldset class="fieldset dist-info">
<legend class="legend"><span>Distribution Information</span></legend>
<p>Please specify the nature of your sales</p>
<br>
<div class="rad-container">
<div class="rad-wrapper">
<div class="rad-btn"></div>
<input type="radio" class="rad-input" id="">
<label for="">Direct Consumer</label>
</div>
<div class="rad-wrapper">
<div class="rad-btn"></div>
<input type="radio" class="rad-input" id="">
<label for="">Distributor</label>