jeffnet.org
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34.215.110.115
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URL:
https://jeffnet.org/
Submission: On December 18 via api from US — Scanned from DE
Submission: On December 18 via api from US — Scanned from DE
Form analysis 5 forms found in the DOM
GET https://jeffnet.org/
<form role="search" method="get" class="et-search-form" action="https://jeffnet.org/"> <input type="search" class="et-search-field" placeholder="Search …" value="" name="s" title="Search for:"></form><form class="form-horizontal fv-form fv-form-bootstrap" role="form" id="subscriber_login" novalidate="novalidate"><button type="submit" class="fv-hidden-submit" style="display: none; width: 0px; height: 0px;"></button>
<p class="form-group" style="margin-left: 0px; margin-right:0px;"> <input type="text" name="username" id="username" placeholder="Username" data-fv-field="username"><small class="help-block" data-fv-validator="notEmpty" data-fv-for="username"
data-fv-result="NOT_VALIDATED" style="display: none;">The Username is required</small></p>
<p class="form-group has-feedback" style="margin-left: 0px; margin-right:0px;"> <input type="password" name="password" id="password" placeholder="Password"
data-fv-field="password"><i class="form-control-feedback fv-icon-no-label" data-fv-icon-for="password" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="password" data-fv-result="NOT_VALIDATED"
style="display: none;">The password is required.</small><small class="help-block" data-fv-validator="regexp" data-fv-for="password" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a stronger password.<br>It should be at least
8 characters long and must match at least 3 of the following:<br>1. upper case letter <br>2. lower case letter <br>3. a number <br>4. and a symbol ["[].{}()()&#?!@%^*-~]</small></p>
<p style="display:none;"> <label for="remember"><input type="checkbox" name="remember_me">Remember Me</label></p>
<p style=""> <a id="lnk_password_reset" data-toggle="modal" data-target="#password-reset-request-modal" style="cursor: pointer; margin-bottom:0px">Forgot your password?</a></p>
<p> <button type="submit" class="et_pb_newsletter_button et_pb_button">Login</button></p>
<div class="err_msg" style="color:red;display:none;"></div> <input type="hidden" name="action" value="check_subscriber_login">
<div class="reset_pass_msg"></div>
</form><form class="gsc-search-box gsc-search-box-tools" accept-charset="utf-8">
<table cellspacing="0" cellpadding="0" role="presentation" class="gsc-search-box">
<tbody>
<tr>
<td class="gsc-input">
<div class="gsc-input-box" id="gsc-iw-id1">
<table cellspacing="0" cellpadding="0" role="presentation" id="gs_id50" class="gstl_50 gsc-input" style="width: 100%; padding: 0px;">
<tbody>
<tr>
<td id="gs_tti50" class="gsib_a"><input autocomplete="off" type="text" size="10" class="gsc-input" name="search" title="search" aria-label="search" id="gsc-i-id1" dir="ltr" spellcheck="false"
style="width: 100%; padding: 0px; border: none; margin: 0px; height: auto; background: url("https://www.google.com/cse/static/images/1x/en/branding.png") left center no-repeat rgb(255, 255, 255); outline: none;"></td>
<td class="gsib_b">
<div class="gsst_b" id="gs_st50" dir="ltr"><a class="gsst_a" href="javascript:void(0)" title="Clear search box" role="button" style="display: none;"><span class="gscb_a" id="gs_cb50" aria-hidden="true">×</span></a></div>
</td>
</tr>
</tbody>
</table>
</div>
</td>
<td class="gsc-search-button"><button class="gsc-search-button gsc-search-button-v2"><svg width="13" height="13" viewBox="0 0 13 13">
<title>search</title>
<path
d="m4.8495 7.8226c0.82666 0 1.5262-0.29146 2.0985-0.87438 0.57232-0.58292 0.86378-1.2877 0.87438-2.1144 0.010599-0.82666-0.28086-1.5262-0.87438-2.0985-0.59352-0.57232-1.293-0.86378-2.0985-0.87438-0.8055-0.010599-1.5103 0.28086-2.1144 0.87438-0.60414 0.59352-0.8956 1.293-0.87438 2.0985 0.021197 0.8055 0.31266 1.5103 0.87438 2.1144 0.56172 0.60414 1.2665 0.8956 2.1144 0.87438zm4.4695 0.2115 3.681 3.6819-1.259 1.284-3.6817-3.7 0.0019784-0.69479-0.090043-0.098846c-0.87973 0.76087-1.92 1.1413-3.1207 1.1413-1.3553 0-2.5025-0.46363-3.4417-1.3909s-1.4088-2.0686-1.4088-3.4239c0-1.3553 0.4696-2.4966 1.4088-3.4239 0.9392-0.92727 2.0864-1.3969 3.4417-1.4088 1.3553-0.011889 2.4906 0.45771 3.406 1.4088 0.9154 0.95107 1.379 2.0924 1.3909 3.4239 0 1.2126-0.38043 2.2588-1.1413 3.1385l0.098834 0.090049z">
</path>
</svg></button></td>
<td class="gsc-clear-button">
<div class="gsc-clear-button" title="clear results"> </div>
</td>
</tr>
</tbody>
</table>
</form>POST #
<form method="post" action="#" onsubmit="javascript:return false;"><input type="text" id="aw-search-input" class="aw-input" value="Amsterdam, NL" autocomplete="off"><button class="bt aw-submit-button" type="submit"><i>Search</i></button></form>Name: subscriberForm —
<form class="subscriberForm fv-form fv-form-bootstrap" id="subscriberForm" role="form" data-toggle="validator" name="subscriberForm" novalidate="novalidate"><button type="submit" class="fv-hidden-submit"
style="display: none; width: 0px; height: 0px;"></button> <input type="hidden" name="location_id" id="loc_id" value="" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off">
<div class="panel-group" id="accordion">
<div class="panel panel-default panel-package-information">
<div class="panel-heading">
<h4 class="panel-title">
<div class="panel-title-text" id="select_package_header">Selected Package</div>
</h4>
</div>
<div id="collapseOne" class="panel-collapse collapse in" data-step="1" data-title="Subscribe">
<div class="panel-body">
<h1 id="package_name"></h1>
<div class="package_pricing_div"><span style="font-weight:bold;">Package Pricing:</span> <span id="exclude_bill_text">This is a non-billed package</span> <span id="package_price_solo"></span>
<p><select data-pack-id="0" id="package_price" name="package_price"></select></p> <input type="hidden" id="pack_id" name="package_id" value="0" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <input
type="hidden" id="pack_term" name="term" value="" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <input type="hidden" id="is_additional_shown" name="additional_info_shown" spellcheck="false"
autocapitalize="off" autocomplete="off" autocorrect="off"> <input type="hidden" id="paydup_merchant" value="N" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <input type="hidden"
id="paydup_collect_checkout_key" value="" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off">
</div>
<div class="signup_setupFee_div"> <span style="font-weight:bold;">Setup Fee:</span> <span id="signup_setupFee_value"></span></div>
<div class="descri"><span style="font-weight:bold;">Description:</span>
<p id="desc" style="word-wrap:break-word;"></p>
</div>
<div class="visp-choose-button"> <a data-toggle="collapse" class="next" data-parent="#accordion" data-target="#collapseTwo" id="nextone">Next</a></div>
</div>
</div>
</div>
<div class="panel panel-default panel-login-information check_for_service" style="display: none">
<div class="panel-heading">
<h4 class="panel-title">
<div>Check for Service</div>
</h4>
</div>
<div id="collapseCheckService" class="panel-collapse collapse">
<div class="panel-body">
<div class="row">
<div class="col-sm-9">
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-map-marker" aria-hidden="true"></i></span> <input type="text" class="form-control" name="location" id="cust_location" required=""
placeholder="Enter your address here..." data-fv-field="location" spellcheck="false" autocapitalize="off" autocomplete="off"
autocorrect="off"><i class="form-control-feedback fv-icon-no-label" data-fv-icon-for="location" style="display: none;"></i></div><small class="help-block" data-fv-validator="notEmpty" data-fv-for="location"
data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a value</small>
</div>
<div class="col-sm-3"> <span lass="input-group-append"> <a id="search_location" class="btn btn-primary" href="#">Search</a> </span></div>
</div> <input type="hidden" id="map_view" name="term" value="street" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off">
<div id="no_pinned_address" style="color:red; font-size: 16px; font-family: 'Helvetica Neue',Helvetica,Arial,sans-serif"></div>
<div class="alert alert-danger" style="text-align: center; margin: 15px 0px; display: none;" id="location_not_found" role="alert"></div> <span style="font-weight: bold; display: none;" class="address_label">Address: </span><span
id="service_location_name"></span> <br>
<div id="wait_map_load" style="display:block; width:100px; height:100px; margin-left:40%"><img src="https://jeffnet.org/wp-content/uploads/2017/06/loading1.gif"></div>
<div id="map" style="height: 250px; border: 1px solid silver; margin-bottom: 10px; margin-top: 10px; position: relative; display: none;"
class="leaflet-container leaflet-touch leaflet-fade-anim leaflet-grab leaflet-touch-drag leaflet-touch-zoom" tabindex="0">
<div style=" position: absolute; top: 10px; right: 10px; z-index: 1001;">
<div class="btn-toolbar justify-content-between" role="toolbar" aria-label="Toolbar with button groups">
<div class="btn-group" role="group" style=""> <input type="button" id="change_to_street" class="btn btn-secondary map-view-icon-selected" value="" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <input
type="button" id="change_to_satellite" class="btn btn-secondary map-view-icon" value="" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
</div>
</div>
<div class="leaflet-pane leaflet-map-pane" style="transform: translate3d(0px, 0px, 0px);">
<div class="leaflet-pane leaflet-tile-pane">
<div class="leaflet-layer " style="z-index: 1; opacity: 1;">
<div class="leaflet-tile-container leaflet-zoom-animated" style="z-index: 18; transform: translate3d(0px, 0px, 0px) scale(1);"><img alt="" role="presentation" src="https://c.tile.openstreetmap.org/15/5214/12140.png"
class="leaflet-tile leaflet-tile-loaded" style="width: 256px; height: 256px; transform: translate3d(-196px, -43px, 0px); opacity: 1;"></div>
</div>
</div>
<div class="leaflet-pane leaflet-shadow-pane"></div>
<div class="leaflet-pane leaflet-overlay-pane"></div>
<div class="leaflet-pane leaflet-marker-pane"></div>
<div class="leaflet-pane leaflet-tooltip-pane"></div>
<div class="leaflet-pane leaflet-popup-pane"></div>
<div class="leaflet-proxy leaflet-zoom-animated" style="transform: translate3d(1.33498e+06px, 3.10788e+06px, 0px) scale(16384);"></div>
</div>
<div class="leaflet-control-container">
<div class="leaflet-top leaflet-left"></div>
<div class="leaflet-top leaflet-right"></div>
<div class="leaflet-bottom leaflet-left"></div>
<div class="leaflet-bottom leaflet-right"></div>
</div>
</div>
<div id="wait_qualify_result" style="display: none; width: 50px; height: 50px; margin-left: 45%;"><img src="https://jeffnet.org/wp-content/uploads/2017/06/loading1.gif"></div>
<div class="alert alert-danger" id="out_of_service" role="alert" style="display: none;"></div>
<div class="alert alert-success" id="qualified" role="alert" style="display: none;"></div>
<div class="visp-choose-button"> <a data-toggle="collapse" data-parent="#accordion" data-target="#collapseOne">Previous</a>
<a data-toggle="collapse" class="btn btn-primary service_but collapsed next" data-parent="#accordion" data-target="#collapseTwo">Next</a></div>
</div>
</div>
</div>
<div id="online_account" class="panel panel-default">
<div class="panel-heading">
<h4 class="panel-title">
<div class="panel-title-text">Create an Account</div>
</h4>
</div>
<div id="collapseTwo" class="panel-collapse collapse">
<div class="panel-body">
<div>
<div class="form-group has-feedback"> <label for="username" class="cols-sm-2 control-label">Username</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-user-circle fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="username" id="username" required="" placeholder="Enter Username*"
value="" data-fv-field="username" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <input type="hidden" name="mac" id="mac_val" value="" spellcheck="false" autocapitalize="off" autocomplete="off"
autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="username" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="username"
data-fv-result="NOT_VALIDATED" style="display: none;">The username is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="username" data-fv-result="NOT_VALIDATED" style="display: none;">The username is
invalid.</small><small class="help-block" data-fv-validator="remote" data-fv-for="username" data-fv-result="NOT_VALIDATED" style="display: none;">The username has already been taken.</small>
</div>
<div class="form-group has-feedback"> <label for="password" class="cols-sm-2 control-label">Password</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-lock fa-lg" aria-hidden="true"></i></span> <input type="password" class="form-control" name="password" id="password" required=""
placeholder="Enter your Password*" value="" data-fv-field="password" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off">
<div class="progress password-progress">
<div id="strengthBar" class="progress-bar" role="progressbar" style="width: 0;"></div>
</div>
</div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="password" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="password" data-fv-result="NOT_VALIDATED"
style="display: none;">The password is required.</small><small class="help-block" data-fv-validator="regexp" data-fv-for="password" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a stronger password.<br>It should
be at least 8 characters long and must match at least 3 of the following:<br>1. upper case letter <br>2. lower case letter <br>3. a number <br>4. and a symbol ["[].{}()()&#?!@%^*-~]</small>
</div>
</div>
<div style="width: 100%; float: left;">
<div class="form-group has-feedback"> <label for="confirm" class="cols-sm-2 control-label">Confirm Password</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-lock fa-lg" aria-hidden="true"></i></span> <input type="password" class="form-control" name="confirm" id="confirm" required=""
placeholder="Confirm your Password*" value="" data-fv-field="confirm" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="confirm" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="confirm" data-fv-result="NOT_VALIDATED"
style="display: none;">The confirm password is required</small><small class="help-block" data-fv-validator="identical" data-fv-for="confirm" data-fv-result="NOT_VALIDATED" style="display: none;">The password and confirm password is
not matching</small>
</div>
</div>
<div class="form-group div-nick has-feedback"> <label>Nick Name</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-user-circle fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="nickname" id="nickname" placeholder="Enter Nickname" value=""
autocomplete="off" data-fv-field="nickname" spellcheck="false" autocapitalize="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="nickname" style="display: none;"></i><small
class="help-block" data-fv-validator="callback" data-fv-for="nickname" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a valid value</small>
</div>
<div class="visp-choose-button"> <a data-toggle="collapse" data-parent="#accordion" data-target="#collapseOne">Previous</a>
<a data-toggle="collapse" id="next_sub" class="next_sub_info collapsed" data-parent="#accordion" data-target="#collapseThree">Next</a></div>
</div>
</div>
</div>
<div class="panel panel-default panel-account-information">
<div class="panel-heading">
<h4 class="panel-title">
<div class="panel-title-text">Subscriber Information</div>
</h4>
</div>
<div id="collapseThree" class="panel-collapse collapse">
<div class="panel-body"> <input type="hidden" name="main_country" id="main_country" value="US" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <input type="hidden" name="latitude" id="latitude" spellcheck="false"
autocapitalize="off" autocomplete="off" autocorrect="off"> <input type="hidden" name="longitude" id="longitude" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off">
<div id="main_info_form_div">
<div class="pull-left" style="width:100%">
<div class="form-group has-feedback"> <label for="first_name" class="cols-sm-2 control-label">First Name</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-user fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="first_name" id="first_name" required=""
placeholder="Enter your First Name*" value="" data-fv-field="first_name" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="first_name" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="first_name" data-fv-result="NOT_VALIDATED"
style="display: none;">The first name is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="first_name" data-fv-result="NOT_VALIDATED" style="display: none;">The first name is invalid.</small>
</div>
<div class="form-group has-feedback"> <label for="mi" class="cols-sm-2 control-label">M.I.</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-user fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="mi" id="mi" placeholder="M.I." maxlength="1" value="" data-fv-field="mi"
spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="mi" style="display: none;"></i><small class="help-block"
data-fv-validator="regexp" data-fv-for="mi" data-fv-result="NOT_VALIDATED" style="display: none;">The middle initial is invalid.</small><small class="help-block" data-fv-validator="stringLength" data-fv-for="mi"
data-fv-result="NOT_VALIDATED" style="display: none;">Please enter a value with valid length</small>
</div>
</div>
<div class="pull-left" style="width:100%">
<div class="form-group has-feedback"> <label for="last_name" class="cols-sm-2 control-label">Last Name</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-user fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="last_name" id="last_name" required="" placeholder="Enter your Last Name*"
value="" data-fv-field="last_name" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="last_name" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="last_name" data-fv-result="NOT_VALIDATED"
style="display: none;">The last name is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="last_name" data-fv-result="NOT_VALIDATED" style="display: none;">The last name is invalid.</small>
</div>
<div class="form-group has-feedback"> <label for="company" class="cols-sm-2 control-label">Company</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-building-o" aria-hidden="true"></i></span> <input type="text" class="form-control" name="company" id="company" placeholder="Enter your Company" value=""
data-fv-field="company" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="company" style="display: none;"></i><small
class="help-block" data-fv-validator="regexp" data-fv-for="company" data-fv-result="NOT_VALIDATED" style="display: none;">The company is invalid.</small>
</div>
</div>
<div class="pull-left" style="width:100%">
<div class="form-group has-feedback"> <label for="address1" class="cols-sm-2 control-label">Address 1</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-map-marker" aria-hidden="true"></i></span> <input type="text" class="form-control" name="address1" id="address1" required="" placeholder="Enter your Address 1*"
value="" data-fv-field="address1" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="address1" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="address1" data-fv-result="NOT_VALIDATED"
style="display: none;">The address1 is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="address1" data-fv-result="NOT_VALIDATED" style="display: none;">The address1 is invalid.</small><small
class="help-block" data-fv-validator="stringLength" data-fv-for="address1" data-fv-result="NOT_VALIDATED" style="display: none;">The address must be at least 5 characters</small>
</div>
<div class="form-group has-feedback" id="main_address2_div"> <label for="address2" class="cols-sm-2 control-label">Address 2</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-map-marker" aria-hidden="true"></i></span> <input type="text" class="form-control" name="address2" id="main_address2" placeholder="Enter your Address 2"
value="" data-fv-field="address2" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="address2" style="display: none;"></i><small class="help-block" data-fv-validator="regexp" data-fv-for="address2" data-fv-result="NOT_VALIDATED"
style="display: none;">The address2 is invalid.</small>
</div>
</div>
<div class="form-group main_state_zip_group has-feedback" id="main_city_div"> <label for="city" class="cols-sm-2 control-label">City </label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-globe" aria-hidden="true"></i></span> <input type="text" class="form-control" name="city" id="main_city" placeholder="Enter your City*" value=""
data-fv-field="city" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="city" style="display: none;"></i><small
class="help-block" data-fv-validator="notEmpty" data-fv-for="city" data-fv-result="NOT_VALIDATED" style="display: none;">The City is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="city"
data-fv-result="NOT_VALIDATED" style="display: none;">The City is invalid</small>
</div>
<div class="form-group main_state_zip_group has-feedback" id="main_state_div"> <label for="state" class="cols-sm-2 control-label">State</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-globe" aria-hidden="true"></i></span> <select class="form-control" name="state" id="main_state" data-fv-field="state">
<option value="" disabled="">Select the State*</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">Dist. of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MH">Marshall Islands</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="FM">Micronesia</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Marianas</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PW">Palau</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="state" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="state"
data-fv-result="NOT_VALIDATED" style="display: none;">The state is required</small>
</div>
<div class="form-group main_state_zip_group has-feedback" id="main_zip_div"> <label for="zip" class="cols-sm-2 control-label">Zip</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-globe" aria-hidden="true"></i></span> <input type="text" class="form-control" name="zip" id="zip" placeholder="Enter your Zip*" value="" data-fv-field="zip"
spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="zip" style="display: none;"></i><small class="help-block"
data-fv-validator="notEmpty" data-fv-for="zip" data-fv-result="NOT_VALIDATED" style="display: none;">The zip is required</small><small class="help-block" data-fv-validator="callback" data-fv-for="zip" data-fv-result="NOT_VALIDATED"
style="display: none;">The value is not valid Zip</small>
</div>
<div class="form-group has-feedback"> <label for="phone" class="cols-sm-2 control-label">Phone</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-phone fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="phone" id="phone" required="" placeholder="Enter your Phone*" value=""
data-fv-field="phone" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="phone" style="display: none;"></i><small
class="help-block" data-fv-validator="notEmpty" data-fv-for="phone" data-fv-result="NOT_VALIDATED" style="display: none;">The phone is required</small><small class="help-block" data-fv-validator="phone" data-fv-for="phone"
data-fv-result="NOT_VALIDATED" style="display: none;">The value is not valid phone number for your country</small>
</div>
<div class="form-group email_div has-feedback" style="width:97%"> <label for="email" class="cols-sm-2 control-label">Email</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-envelope fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="main_email" id="main_email" required="" placeholder="Enter your Email*"
value="" data-fv-field="main_email" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="main_email" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="main_email" data-fv-result="NOT_VALIDATED"
style="display: none;">Please enter a value</small><small class="help-block" data-fv-validator="regexp" data-fv-for="main_email" data-fv-result="NOT_VALIDATED" style="display: none;">The value is not a valid email address</small>
</div>
</div>
<div class="form-group col-sm-12 bill-contact" style="width: 100% !important;padding-left: 0 !important">
<lable> <input checked="checked" id="bill" name="billingtoo" type="checkbox" value="1" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <i style="font-size:12px;"> <b> This is also my billing contact</b></i>
</lable>
</div>
<div class="visp-choose-button"> <a data-toggle="collapse" id="sub_info_prev_button" data-parent="#accordion" data-target="#collapseTwo">Previous</a>
<a data-toggle="collapse" class="btn btn-primary next_billing_info" id="change_next" data-parent="#accordion" data-target="#collapseFive">Next</a></div>
</div>
</div>
</div>
<div id="show" class="panel panel-default panel-billing-information" style="display:none;">
<div class="panel-heading">
<h4 class="panel-title">
<div class="panel-title-text">Billing</div>
</h4>
</div>
<div id="collapseFour" class="panel-collapse collapse">
<div class="panel-body">
<div class="form-group" style="width:100%"> <label for="bill_country" class="cols-sm-2 control-label">Country</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-address-card fa" aria-hidden="true"></i></span> <select class="form-control" name="bill_country" id="bill_country" style="width:97%">
<option value="AF">Afghanistan</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</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="BR">Brazil</option>
<option value="BN">Brunei</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="MM">Burma (Myanmar)</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="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo Dem </option>
<option value="CG">Congo Rep </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="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="TP">East Timor</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="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</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="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GT">Guatemala</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HN">Honduras</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="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea north</option>
<option value="KR">Korea south</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="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="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</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="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="AN">Netherlands Antilles</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</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="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="KN">Saint Kitts And Nevis</option>
<option value="SM">San Marino</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="YU">Serbia/Montenegro Yugoslavia </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="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syria</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania</option>
<option value="TH">Thailand</option>
<option value="TG">Togo</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</option>
<option value="TV">Tuvalu</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 selected="" value="US">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="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select></div>
</div>
<div id="bill_info_form_div">
<div class="pull-left" style="width:100%">
<div class="form-group has-feedback"> <label for="first_name" class="cols-sm-2 control-label">First Name</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-user fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_first_name" id="bill_first_name" required=""
placeholder="Enter your First Name*" value="" data-fv-field="bill_first_name" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_first_name" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="bill_first_name"
data-fv-result="NOT_VALIDATED" style="display: none;">The first name is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="bill_first_name" data-fv-result="NOT_VALIDATED" style="display: none;">The
first name is invalid.</small>
</div>
<div class="form-group has-feedback"> <label for="mi" class="cols-sm-2 control-label">M.I.</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-user fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_mi" id="bill_mi" placeholder="M.I." value="" data-fv-field="bill_mi"
spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_mi" style="display: none;"></i><small class="help-block"
data-fv-validator="regexp" data-fv-for="bill_mi" data-fv-result="NOT_VALIDATED" style="display: none;">The middle name is invalid.</small>
</div>
</div>
<div class="pull-left" style="width:100%">
<div class="form-group has-feedback"> <label for="last_name" class="cols-sm-2 control-label">Last Name</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-user fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_last_name" id="bill_last_name" required=""
placeholder="Enter your Last Name*" value="" data-fv-field="bill_last_name" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_last_name" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="bill_last_name"
data-fv-result="NOT_VALIDATED" style="display: none;">The last name is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="bill_last_name" data-fv-result="NOT_VALIDATED" style="display: none;">The last
name is invalid.</small>
</div>
<div class="form-group has-feedback"> <label for="company" class="cols-sm-2 control-label">Company</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-building-o fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_company" id="bill_company" placeholder="Enter your Company"
value="" data-fv-field="bill_company" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_company" style="display: none;"></i><small class="help-block" data-fv-validator="regexp" data-fv-for="bill_company" data-fv-result="NOT_VALIDATED"
style="display: none;">The company is invalid.</small>
</div>
</div>
<div class="pull-left" style="width:100%">
<div class="form-group has-feedback"> <label for="address1" class="cols-sm-2 control-label">Address 1</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-map-marker" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_address1" id="bill_address" required=""
placeholder="Enter your Address 1*" value="" data-fv-field="bill_address1" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_address1" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="bill_address1"
data-fv-result="NOT_VALIDATED" style="display: none;">The address1 is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="bill_address1" data-fv-result="NOT_VALIDATED" style="display: none;">The bill
address1 is invalid.</small><small class="help-block" data-fv-validator="stringLength" data-fv-for="bill_address1" data-fv-result="NOT_VALIDATED" style="display: none;">The address must be at least 5 characters</small>
</div>
<div class="form-group has-feedback" id="bill_address2_div"> <label for="address2" class="cols-sm-2 control-label">Address 2</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-map-marker" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_address2" id="bill_address2" placeholder="Enter your Address 2"
value="" data-fv-field="bill_address2" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_address2" style="display: none;"></i><small class="help-block" data-fv-validator="regexp" data-fv-for="bill_address2" data-fv-result="NOT_VALIDATED"
style="display: none;">The bill address2 is invalid.</small>
</div>
</div>
<div class="form-group has-feedback" id="bill_city_div"> <label for="city" class="cols-sm-2 control-label">City </label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-globe" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_city" id="bill_city" placeholder="Enter your City*" value=""
data-fv-field="bill_city" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_city" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="bill_city" data-fv-result="NOT_VALIDATED"
style="display: none;">The City is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="bill_city" data-fv-result="NOT_VALIDATED" style="display: none;">The City is invalid</small>
</div>
<div class="form-group bill_state_zip_group has-feedback" id="bill_state_div"> <label for="state" class="cols-sm-2 control-label">State</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-globe" aria-hidden="true"></i></span> <select class="form-control" name="bill_state" id="bill_state" data-fv-field="bill_state">
<option value="" disabled="">Select the State*</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">Dist. of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MH">Marshall Islands</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="FM">Micronesia</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="MP">Northern Marianas</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PW">Palau</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VI">Virgin Islands</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_state" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="bill_state"
data-fv-result="NOT_VALIDATED" style="display: none;">The state is required</small>
</div>
<div class="form-group bill_state_zip_group has-feedback" id="bill_zip_div"> <label for="zip" class="cols-sm-2 control-label">Zip</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-globe fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_zip" id="bill_zip" placeholder="Enter your Zip*" value=""
data-fv-field="bill_zip" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_zip" style="display: none;"></i><small
class="help-block" data-fv-validator="notEmpty" data-fv-for="bill_zip" data-fv-result="NOT_VALIDATED" style="display: none;">The zip is required</small><small class="help-block" data-fv-validator="regexp" data-fv-for="bill_zip"
data-fv-result="NOT_VALIDATED" style="display: none;">The value is not valid Zip</small>
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<div class="form-group bill_phone_div has-feedback"> <label for="phone" class="cols-sm-2 control-label">Phone</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-phone fa" aria-hidden="true"></i></span> <input type="text" class="form-control" name="bill_phone" id="bill_phone" required="" placeholder="Enter your Phone*"
value="" data-fv-field="bill_phone" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="bill_phone" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="bill_phone" data-fv-result="NOT_VALIDATED"
style="display: none;">The phone is required</small><small class="help-block" data-fv-validator="phone" data-fv-for="bill_phone" data-fv-result="NOT_VALIDATED" style="display: none;">The value is not valid phone number for your
country</small>
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<div class="col-md-6" style="padding:0;"> <input type="checkbox" name="new_sim_card" value="Y" id="f_new_sim_card" accept=".jpg,.jpeg,.png,.gif" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <span
class="new_sim_label">I have my own <strong>NEW</strong> sim card</span></div>
<div class="col-md-6"> <input type="file" name="sim_card_img" disabled="" id="f_sim_card_img" data-fv-field="sim_card_img" spellcheck="false" autocapitalize="off" autocomplete="off"
autocorrect="off"><i class="form-control-feedback" data-fv-icon-for="sim_card_img" style="display: none;"></i><small class="help-block" data-fv-validator="callback" data-fv-for="sim_card_img" data-fv-result="NOT_VALIDATED"
style="display: none;">Invalid image file. Upload only image-type files (.jpg, .jpeg, .png, .gif)</small></div>
</div>
</div>
<div class="form-group has-feedback" style="width:100%" id="f_modem_div"> <label>Modem Sticker w/ IMEI number and MAC address</label> <input type="file" name="modem_sticker" id="f_modem_sticker" accept=".jpg,.jpeg,.png,.gif"
data-fv-field="modem_sticker" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"><i class="form-control-feedback" data-fv-icon-for="modem_sticker" style="display: none;"></i><small class="help-block"
data-fv-validator="callback" data-fv-for="modem_sticker" data-fv-result="NOT_VALIDATED" style="display: none;">Invalid image file. Upload only image-type files (.jpg, .jpeg, .png, .gif)</small></div>
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<div class="input-group my-no-tick"> <input type="text" class="form-control" name="registration_code" id="registration_code" value="" placeholder="Registration Code" spellcheck="false" autocapitalize="off" autocomplete="off"
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<div class="my-card-payment cc-payment">
<div class="form-group has-feedback"> <label for="card_number" class="cols-sm-2 control-label card-num-card">Card Number</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-credit-card-alt" aria-hidden="true"></i></span> <input type="text" class="form-control" name="card_number" id="card_number" required=""
placeholder="Enter your card number*" maxlength="19" value="" data-fv-field="card_number" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="card_number" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="card_number" data-fv-result="NOT_VALIDATED"
style="display: none;">The card number is required</small><small class="help-block" data-fv-validator="creditCard" data-fv-for="card_number" data-fv-result="NOT_VALIDATED" style="display: none;">The credit card number is not
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</div>
<div class="form-group" style="display:none;"> <input type="hidden" class="form-control set-card-name" name="card_name" id="card_name" value="" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
<div class="form-group has-feedback"> <label for="cvv" class="cols-sm-2 control-label">CVV</label>
<div class="input-group"> <span class="input-group-addon"><i class="fa fa-credit-card" aria-hidden="true"></i></span> <input type="text" class="form-control" name="cvv" id="cvv" required="" placeholder="Enter your CVV*" maxlength="4"
data-fv-field="cvv" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="cvv" style="display: none;"></i><small
class="help-block" data-fv-validator="notEmpty" data-fv-for="cvv" data-fv-result="NOT_VALIDATED" style="display: none;">The CVV is required</small><small class="help-block" data-fv-validator="cvv" data-fv-for="cvv"
data-fv-result="NOT_VALIDATED" style="display: none;">The CVV number is not valid</small><small class="help-block" data-fv-validator="stringLength" data-fv-for="cvv" data-fv-result="NOT_VALIDATED" style="display: none;">Please enter
a value with valid length</small>
</div>
</div>
<div class="my-card-payment cc-payment">
<div class="form-group has-feedback"> <label for="Month" class="cols-sm-2 control-label">Month</label>
<div class="input-group"> <select class="form-control" id="month" name="month" value="" data-fv-field="month">
<option disabled="" value="" selected="">Month*</option>
<option value="01">01 - January</option>
<option value="02">02 - February</option>
<option value="03">03 - March</option>
<option value="04">04 - April</option>
<option value="05">05 - May</option>
<option value="06">06 - June</option>
<option value="07">07 - July</option>
<option value="08">08 - August</option>
<option value="09">09 - September</option>
<option value="10">10 - October</option>
<option value="11">11 - November</option>
<option value="12">12 - December</option>
</select></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="month" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="month"
data-fv-result="NOT_VALIDATED" style="display: none;">The expiration month is required</small><small class="help-block" data-fv-validator="digits" data-fv-for="month" data-fv-result="NOT_VALIDATED" style="display: none;">The
expiration month can contain digits only</small><small class="help-block" data-fv-validator="callback" data-fv-for="month" data-fv-result="NOT_VALIDATED" style="display: none;">Expired</small>
</div>
<div class="form-group has-feedback"> <label for="year" class="cols-sm-2 control-label">Year</label>
<div class="input-group"> <select class="form-control" id="year" name="year" value="" data-fv-field="year">
<option disabled="" value="" selected="">Year*</option>
<option value="2023" style="padding: 5px;">2023</option>
<option value="2024" style="padding: 5px;">2024</option>
<option value="2025" style="padding: 5px;">2025</option>
<option value="2026" style="padding: 5px;">2026</option>
<option value="2027" style="padding: 5px;">2027</option>
<option value="2028" style="padding: 5px;">2028</option>
<option value="2029" style="padding: 5px;">2029</option>
<option value="2030" style="padding: 5px;">2030</option>
<option value="2031" style="padding: 5px;">2031</option>
<option value="2032" style="padding: 5px;">2032</option>
<option value="2033" style="padding: 5px;">2033</option>
<option value="2034" style="padding: 5px;">2034</option>
<option value="2035" style="padding: 5px;">2035</option>
<option value="2036" style="padding: 5px;">2036</option>
<option value="2037" style="padding: 5px;">2037</option>
<option value="2038" style="padding: 5px;">2038</option>
<option value="2039" style="padding: 5px;">2039</option>
<option value="2040" style="padding: 5px;">2040</option>
<option value="2041" style="padding: 5px;">2041</option>
<option value="2042" style="padding: 5px;">2042</option>
<option value="2043" style="padding: 5px;">2043</option>
<option value="2044" style="padding: 5px;">2044</option>
<option value="2045" style="padding: 5px;">2045</option>
<option value="2046" style="padding: 5px;">2046</option>
<option value="2047" style="padding: 5px;">2047</option>
<option value="2048" style="padding: 5px;">2048</option>
<option value="2049" style="padding: 5px;">2049</option>
<option value="2050" style="padding: 5px;">2050</option>
<option value="2051" style="padding: 5px;">2051</option>
<option value="2052" style="padding: 5px;">2052</option>
<option value="2053" style="padding: 5px;">2053</option>
</select></div><i class="form-control-feedback fv-bootstrap-icon-input-group" data-fv-icon-for="year" style="display: none;"></i><small class="help-block" data-fv-validator="notEmpty" data-fv-for="year"
data-fv-result="NOT_VALIDATED" style="display: none;">The expiration year is required</small><small class="help-block" data-fv-validator="digits" data-fv-for="year" data-fv-result="NOT_VALIDATED" style="display: none;">The
expiration year can contain digits only</small><small class="help-block" data-fv-validator="callback" data-fv-for="year" data-fv-result="NOT_VALIDATED" style="display: none;">Expired</small>
</div>
</div>
<div class="my-card-payment cc-payment deposit_amount_div">
<div class="form-group"> <label for="deposit_amount" class="cols-sm-2 control-label">Deposit Amount</label>
<div class="input-group"> <span class="input-group-addon">$</span> <input type="text" class="form-control" name="deposit_amoun" id="deposit_amount" placeholder="Enter your Deposit Amount*" val="0" spellcheck="false"
autocapitalize="off" autocomplete="off" autocorrect="off"> <input type="hidden" id="currency_code" name="currency_code" value="USD" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"></div>
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<div class="signup_autopay_option"> <input type="hidden" name="enable_autopay" value="Y" spellcheck="false" autocapitalize="off" autocomplete="off" autocorrect="off"> <span>Auto-pay will be enabled for your entered credit card
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CAR PLOWS INTO PARKED VEHICLE IN BIDEN'S MOTORCADE OUTSIDE DELAWARE CAMPAIGN HQ
Sun, 17 Dec 2023 22:34:20 -0500
A car plowed into a parked SUV that was guarding President Joe Biden’s motorcade
Sunday night while the president was leaving a visit to his campaign
headquarters
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Sun, 17 Dec 2023 17:32:26 -0500
Authorities say five people including three young children have died in a house
fire in northwestern Arizona near the Colorado River
16 KILLED IN CHRISTMAS-SEASON SHOOTINGS IN CENTRAL MEXICO STATE OF GUANAJUATO
Sun, 17 Dec 2023 21:38:05 -0500
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in the town of Salvatierra in Mexico's north-central state of Guanajuato
COLOMBIA'S LEFTIST ELN REBELS AGREE TO STOP KIDNAPPING FOR RANSOM
Sun, 17 Dec 2023 17:34:12 -0500
Rebels from Colombia’s leftist National Liberation Army have agreed to stop
using kidnapping as a fund-raising tactic, if the current cease-fire with the
government is extended
GREEK PARLIAMENT PASSES GOVERNMENT'S 2024 BUDGET
Sun, 17 Dec 2023 17:37:59 -0500
The Greek parliament has approved the government’s 2024 budget, the first in 14
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TEXAS CITY LIFTS SHELTER-IN-PLACE AFTER CHEMICAL RELEASE EARLIER SUNDAY
Sun, 17 Dec 2023 14:00:30 -0500
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sulfur dioxide emissions" earlier Sunday at the Marathon Galveston Bay Refinery.
NBA LEGEND KAREEM ABDUL-JABBAR BREAKS HIP IN FALL AT CONCERT: REP
Sat, 16 Dec 2023 16:41:01 -0500
NBA legend Kareem Abdul-Jabbar broke his hip in a fall at a concert and will
need surgery, his representative said.
SOUTH KOREA'S MILITARY: NORTH KOREA FIRED A BALLISTIC MISSILE TOWARD EASTERN
WATERS
Sun, 17 Dec 2023 11:38:27 -0500
South Korea’s military says North Korea has fired a short-range ballistic
missile in the sea in a possible display of defiance against the steps by
Washington and Seoul to tighten nuclear deterrence against North Korean threats
FIRE DESTROYS A LOS ANGELES-AREA CHURCH JUST BEFORE CHRISTMAS
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A Los Angeles-area church was destroyed in a massive fire just hours before a
Christmas play and a toy giveaway
SMALL PLANE CRASHES INTO POWER LINES IN OREGON AND KILLS 3, POLICE SAY
Sun, 17 Dec 2023 06:33:53 -0500
Police in Oregon say a small plane has crashed into power lines and killed all
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SHERROCK SUFFERS FIRST-ROUND DEFEAT AS HUMPHRIES MAKES COOL START
Sun, 17 Dec 2023 23:16:00 GMT
Fallon Sherrock suffered a gut-wrenching opening round defeat at the World Darts
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FIFA ANNOUNCES 32-TEAM CLUB WORLD CUP | LIVERPOOL AND MAN UTD MISS OUT
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RANGERS RETURN TO IBROX TO CELEBRATE LEAGUE CUP WIN
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NEVILLE: ARSENAL ARE CITY'S ONLY CHALLENGERS FOR PL TITLE
Sun, 17 Dec 2023 21:11:00 GMT
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WEST BROM HELD BY MANAGERLESS STOKE
Sun, 17 Dec 2023 16:16:00 GMT
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WOODS TO WIN AGAIN IN 2024? TIGER: 'I KNOW I CAN DO IT'
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Tiger Woods has set his sights on challenging for a record-breaking 83rd PGA
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Sun, 17 Dec 2023 16:00:00 GMT
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Looking for Quordle clues? We can help. Plus get the answers to Quordle today
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PAST WORDLE ANSWERS - EVERY SOLUTION SO FAR, BY DATE
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'The Gilded Age' season 2 has come to an end, so what does this mean for season
3? Here's what we know about a potential third season of the HBO series.
KOURTNEY KARDASHIAN SHARES MOMENTS FROM SON REIGN’S FUN-FILLED 9TH BIRTHDAY
PARTY & REVEALS HE ‘PLANNED’ IT
Sun, 17 Dec 2023 23:03:29 +0000
The Poosh founder celebrated her third child's special day with bouncy castles
and a doughnut cake.
KENDALL JENNER & BAD BUNNY REPORTEDLY SPLIT AFTER LESS THAN A YEAR TOGETHER
Sun, 17 Dec 2023 22:06:59 +0000
The model and the rapper first went public with their romance in February.
KENDALL JENNER & BAD BUNNY’S RELATIONSHIP TIMELINE: FROM THEIR DATES TO REPORTED
SPLIT
Sun, 17 Dec 2023 20:39:04 +0000
Learn about Kendall Jenner and Bad Bunny's relationship from the very beginning
to now amidst their reported breakup.
JENNIFER ANISTON REPORTEDLY PLANNING A ‘SPECIAL’ GET-TOGETHER TO CELEBRATE
MATTHEW PERRY’S LIFE WITH ‘FRIENDS’ CAST
Sun, 17 Dec 2023 20:36:51 +0000
The late actor died from 'acute effects of ketamine' in October at the age of
54.
TRAVIS KELCE ADMIRES PHOTO OF GF TAYLOR SWIFT AT GILLETTE STADIUM AHEAD OF
CHIEFS GAME: WATCH
Sun, 17 Dec 2023 19:22:04 +0000
The NFL player walked by hanging photos of New England Patriots players and
other influential people and made sure to glance over when he noticed a photo of
the singer was among them.
TAYLOR SWIFT & HER DAD SCOTT CHEER ON TRAVIS KELCE AT CHIEFS VS. PATRIOTS GAME:
PHOTOS
Sun, 17 Dec 2023 18:50:36 +0000
The singer waved to fans as she excitingly settled in Gillette Stadium to watch
her beau on the field after spending a few days away from him.
KENDALL JENNER SPARKS BAD BUNNY SPLIT SPECULATION WITH SOLO OUTING IN ASPEN:
PHOTOS
Sun, 17 Dec 2023 17:55:40 +0000
The model appeared to have a great time with a group of friends but didn't seem
to be with the rapper during the trip.
ANNA ‘CHICKADEE’ CARDWELL: WHY SHE WANTED TO FILM HER LAST DAYS
Sun, 17 Dec 2023 17:05:09 +0000
The late reality star's husband, Eldrige Toney, revealed his wife's feelings on
filming for her family's television show and what she wanted in her last
moments, in a new interview.
JUTE$: 5 THINGS TO KNOW ABOUT DEMI LOVATO’S NEW FIANCE
Sun, 17 Dec 2023 16:28:46 +0000
Jute$ and Demi have been happily dating since 2022, and they reportedly got
engaged over the weekend.
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