elitemate.com
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URL:
https://elitemate.com/
Submission Tags: falconsandbox
Submission: On October 14 via api from US — Scanned from DE
Submission Tags: falconsandbox
Submission: On October 14 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
Name: frmLogin — POST myJsp/loginValid.jsp
<form action="myJsp/loginValid.jsp" method="post" name="frmLogin">
<table width="100%" border="0" cellspacing="0" cellpadding="0" height="226">
<tbody>
<tr>
<td width="28" height="15"></td>
<td height="15" align="left" valign="top">
<font face="Arial"> <img src="images2/line_simplify.jpg" width="375" height="1"></font>
</td>
<td width="33" height="15"></td>
</tr>
<tr>
<td width="28" height="48"> </td>
<td align="left" valign="middle" class="simplify_text" height="48">
<div align="center">
<font color="#FFCC00" face="Arial" size="1">Meet Millions of ELITE singles in your area of interest: <a target="_blank" style="text-decoration: none" href="http://www.eliteindiansingles.com"> <font color="#FFCC00">Indian</font></a>,
</font>
<font face="Arial" size="1">
<a target="_blank" class="simplify_text" style="text-decoration: none" href="https://www.elitemate.com/myJsp/promo/memberjoin_58574.jsp"> <font color="#FFCC00">Black</font></a>
<font color="#FFCC00">, <a style="text-decoration: none" target="_blank" href="http://www.eliterelationships.com"><font color="#FFCC00">Caucasian</font></a>, </font>
<a href="https://www.elitemate.com/myJsp/promo/memberjoin_hen45.jsp" target="_blank" class="simplify_text" style="text-decoration: none"><font color="#FFCC00">Asian</font></a>
<font color="#FFCC00">, </font>
<a href="https://www.elitemate.com/myJsp/promo/memberjoin_76594.jsp" target="_blank" class="simplify_text" style="text-decoration: none"><font color="#FFCC00"> Hispanic</font></a>
<font color="#FFCC00">, </font><a href="http://www.EliteWealthyMatch.com/" target="_blank" class="simplify_text" style="text-decoration: none"><font color="#FFCC00"> Wealthy</font></a>
<font color="#FFCC00">, </font><a href="http://www.EliteEducatedSingles.com/" class="simplify_text" style="text-decoration: none" target="_blank"><font color="#FFCC00">Educated</font></a>
<font color="#FFCC00">, </font><a href="http://www.EliteAstrologyMatch.com/" class="simplify_text" style="text-decoration: none" target="_blank"><font color="#FFCC00">Astrology</font></a>
<font color="#FFCC00">, </font><a target="_blank" class="simplify_text" style="text-decoration: none" href="http://www.mindbodysoulsocial.com"> <font color="#FFCC00">Spiritual</font></a>
<font color="#FFCC00">, </font>
<a href="https://www.elitemate.com/myJsp/promo/memberjoin_goths.jsp" target="_blank" class="simplify_text" style="text-decoration: none"><font color="#FFCC00">Gothic</font></a>
<font color="#FFCC00">, </font><a target="_blank" class="simplify_text" style="text-decoration: none" href="http://www.elitesingleswithkids.com"><font color="#FFCC00">Single Parents</font></a>
<font color="#FFCC00">, </font><a href="http://www.elitegaymen.com" style="text-decoration: none" target="_blank"> <font color="#FFCC00">Gay</font></a>
<font color="#FFCC00">, </font>
<a href="https://www.elitemate.com/myJsp/promo/memberjoin_40190.jsp" style="text-decoration: none" target="_blank"> <font color="#FFCC00">Lesbians</font></a>
<font color="#FFCC00">, </font><a style="text-decoration: none" target="_blank" href="http://www.elitesexlife.com"><font color="#FFCC00">Adult Swinger</font></a>
<font color="#FFCC00">s, <a href="https://www.elitemate.com/myJsp/promo/memberjoin_hotmd.jsp" style="text-decoration: none" target="_blank"><font color="#FFCC00">Models</font></a>,
<a href="https://www.elitemate.com/myJsp/promo/memberjoin_couga.jsp" style="text-decoration: none" target="_blank"><font color="#FFCC00">Cougars,</font></a>
<a style="text-decoration: none" href="http://www.elitefitnesssingles.com" target="_blank"><font color="#FFCC00">Physically Fit,</font></a>
<a style="text-decoration: none" target="_blank" href="http://www.hubforlove.com/"><font color="#FFCC00">Cartoon Styled</font></a>,
<a target="_blank" href="http://www.elitesmokers.com/" style="text-decoration: none"> <font color="#FFCC00">Smokers</font></a>,
<a target="_blank" style="text-decoration: none" href="http://www.elitesocial.com"><font color="#FFCC00">Social Friends</font></a>,
<a target="_blank" style="text-decoration: none" href="http://www.stimulationserotica.com"> <font color="#FFCC00">Fetish</font>es</a>,
<a style="text-decoration: none" href="http://www.elitemateseniors.com" target="_blank"> <font color="#FFCC00">Mature Over 40</font></a>,
<a target="_blank" style="text-decoration: none" href="http://www.datewithstyle.com"><font color="#FFCC00">Fashionable</font></a>,
<a target="_blank" style="text-decoration: none" href="http://www.elitebigbeautifulsingles.com"> <font color="#FFCC00">Big And Beautiful</font></a>,
<a target="_blank" href="http://www.onenightstandsingles.com" style="text-decoration: none"><font color="#FFCC00">One Night Stands</font></a>,
<a target="_blank" style="text-decoration: none" href="http://www.elitecelebrities.com/"> <font color="#FFCC00">Celebrities</font></a>,
<a target="_blank" href="http://www.youcanswingit.com/" style="text-decoration: none"><font color="#FFCC00">Threesomes</font></a>,
<a href="http://www.elitesociallife.com/" style="text-decoration: none" target="_blank"><font color="#FFCC00"> Pen Pals</font></a>,
</font>
</font>
<font color="#FFCC00" size="1" face="Arial"><a style="text-decoration: none" href="http://www.elitediabetics.com" target="_blank"> Diabetics</a>,
<a style="text-decoration: none" href="http://www.getmillionaires.com" target="_blank">Millionaires,</a> <a style="text-decoration: none" href="http://www.elitelove.com" target="_blank">Casual Encounters</a><a style="text-decoration: none" href="http://www.sportsdaters.com" target="_blank">,
Sporty</a>, <a style="text-decoration: none" href="http://www.drinkersociety.com" target="_blank">Social
Drinkers</a>, <a style="text-decoration: none" href="http://www.elitegamble.com" target="_blank">Gamblers</a> and Those People
<a style="text-decoration: none" target="_blank" href="http://www.elitespouse.com"><font color="#FFCC00">Seeking Marriage</font></a>.</font>
</div>
</td>
<td width="33" height="48"> </td>
</tr>
<tr>
<td width="28" height="13"></td>
<td height="13" align="left" valign="bottom">
<font face="Arial"> <img src="images2/line_simplify.jpg" width="375" height="1"></font>
</td>
<td width="33" height="13"></td>
</tr>
<tr>
<td height="15"></td>
<td height="15"></td>
<td height="15"></td>
</tr>
<tr>
<td height="90"> </td>
<td align="left" valign="top" height="90">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr>
<td width="54" align="left" valign="middle" class="simplifymenutext2">
<font face="Arial"> I am :</font>
</td>
<td width="9" align="left" valign="top"> </td>
<td width="124" align="left" valign="top">
<font face="Arial">
<select class="simplifymenutext" name="iAm">
<option selected="" value="M">Male</option>
<option value="F">Female</option>
</select>
</font>
</td>
<td width="48" align="left" valign="middle" class="simplifymenutext2">
<font face="Arial">State :</font>
</td>
<td width="10"> </td>
<td width="136">
<font face="Arial">
<select class="simplifymenutext" name="state">
<option value="tri">TriState</option>
<option value="AL">Alabama </option>
<option value="AK">Alaska </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">District of Columbia </option>
<option value="FL">Florida </option>
<option value="GA">Georgia </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="MD">Maryland </option>
<option value="MA">Massachusetts </option>
<option value="MI">Michigan </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="OH">Ohio </option>
<option value="OK">Oklahoma </option>
<option value="OR">Oregon </option>
<option value="PA">Pennsylvania </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="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>
</font>
</td>
</tr>
<tr>
<td height="7" align="left" valign="middle" class="simplifymenutext2"></td>
<td width="9" height="7" align="left" valign="top"></td>
<td width="124" height="7" align="left" valign="top"></td>
<td height="7" align="left" valign="middle" class="simplifymenutext2"></td>
<td width="10" height="7"></td>
<td width="136" height="7"></td>
</tr>
<tr>
<td align="left" valign="middle" class="simplifymenutext2">
<font face="Arial"> Looking :</font>
</td>
<td width="9" align="left" valign="top"> </td>
<td width="124" align="left" valign="top">
<font face="Arial">
<select class="simplifymenutext" name="lookingFor">
<option value="M">Male</option>
<option selected="" value="F">Female</option>
</select>
</font>
</td>
<td align="left" valign="middle" class="simplifymenutext2">
<font face="Arial">Photos :</font>
</td>
<td width="10"> </td>
<td width="136">
<font face="Arial">
<input type="checkbox" value="ON" name="withPhoto">
</font>
</td>
</tr>
<tr>
<td height="7" align="left" valign="middle" class="simplifymenutext2"></td>
<td height="7" align="left" valign="top"></td>
<td width="124" height="7" align="left" valign="top"></td>
<td height="7" align="left" valign="middle"></td>
<td width="10" height="7"></td>
<td width="136" height="7"></td>
</tr>
<tr>
<td align="left" valign="middle" class="simplifymenutext2">
<font face="Arial"> Age :</font>
</td>
<td align="left" valign="top"> </td>
<td width="124" align="left" valign="top">
<div align="left">
<script language="javascript">
getHTMLComboWithClass("fromAge", 18, 18, 90, 'textfeild');
</script><select name="fromAge" class="textfeild">
<option value="18" selected="">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
<option value="60">60</option>
<option value="61">61</option>
<option value="62">62</option>
<option value="63">63</option>
<option value="64">64</option>
<option value="65">65</option>
<option value="66">66</option>
<option value="67">67</option>
<option value="68">68</option>
<option value="69">69</option>
<option value="70">70</option>
<option value="71">71</option>
<option value="72">72</option>
<option value="73">73</option>
<option value="74">74</option>
<option value="75">75</option>
<option value="76">76</option>
<option value="77">77</option>
<option value="78">78</option>
<option value="79">79</option>
<option value="80">80</option>
<option value="81">81</option>
<option value="82">82</option>
<option value="83">83</option>
<option value="84">84</option>
<option value="85">85</option>
<option value="86">86</option>
<option value="87">87</option>
<option value="88">88</option>
<option value="89">89</option>
<option value="90">90</option>
</select>
<span style="color: white">-</span>
<script language="javascript">
getHTMLComboWithClass("toAge", 35, 18, 90, 'textfeild');
</script><select name="toAge" class="textfeild">
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35" selected="">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
<option value="60">60</option>
<option value="61">61</option>
<option value="62">62</option>
<option value="63">63</option>
<option value="64">64</option>
<option value="65">65</option>
<option value="66">66</option>
<option value="67">67</option>
<option value="68">68</option>
<option value="69">69</option>
<option value="70">70</option>
<option value="71">71</option>
<option value="72">72</option>
<option value="73">73</option>
<option value="74">74</option>
<option value="75">75</option>
<option value="76">76</option>
<option value="77">77</option>
<option value="78">78</option>
<option value="79">79</option>
<option value="80">80</option>
<option value="81">81</option>
<option value="82">82</option>
<option value="83">83</option>
<option value="84">84</option>
<option value="85">85</option>
<option value="86">86</option>
<option value="87">87</option>
<option value="88">88</option>
<option value="89">89</option>
<option value="90">90</option>
</select>
</div>
</td>
<td align="left" valign="middle"> </td>
<td width="10"> </td>
<td width="136"> </td>
</tr>
</tbody>
</table>
</td>
<td height="90"> </td>
</tr>
<tr>
<td height="30"> </td>
<td height="30">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr>
<td width="60" height="29"> </td>
<td width="113" align="left" valign="top"><input src="images2/search.jpg" onclick="quickSearch()" name="Submit" width="99" border="0" height="28" type="image"></td>
<td>
<a href="https://www.elitemate.com/index.jsp?intl=Y"> <img src="images2/international.jpg" alt="International" width="129" height="28" border="0"></a>
</td>
</tr>
</tbody>
</table>
</td>
<td height="30"> </td>
</tr>
<tr>
<td height="6"></td>
<td height="6"></td>
<td height="6"></td>
</tr>
</tbody>
</table>
<input type="hidden" name="indexUserAction" value="">
</form>Name: frmReg — POST myJsp/reg.jsp
<form onsubmit="return regValidate();" target="_parent" action="myJsp/reg.jsp" method="post" name="frmReg">
<table style="border: 4px #DDDACB solid" width="100%" border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr>
<td width="30" align="left" valign="top"></td>
<td width="400" align="left" valign="top">
<table width="100%" border="0" cellpadding="0" cellspacing="0">
<tbody>
<tr>
<td align="left" valign="top">
<table width="100%" border="0" cellspacing="0" cellpadding="0" height="560">
<tbody>
<tr>
<td colspan="3" align="left" valign="middle" class="formtext" height="19"> </td>
</tr>
<tr>
<td colspan="3" align="left" valign="middle" class="formtext" height="19"> </td>
</tr>
<tr>
<td colspan="3" align="left" valign="middle" class="formtext" height="24"><img src="images2/community.jpg" alt="Join the Elitemate Singles Community" width="314" height="22"></td>
</tr>
<tr>
<td align="left" valign="middle" class="formtext" height="19" colspan="3"> Note: All fields with asterisk(*) are required . </td>
</tr>
<tr>
<td align="left" valign="middle" class="formtext" height="19"> </td>
<td height="19"></td>
<td align="left" valign="top" height="19"> </td>
</tr>
<tr>
<td align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Referral Code :</font>
</td>
<td height="22"></td>
<td height="22">
<font face="Arial">
<input type="text" maxlength="1" size="1" id="textfield5" class="textfeild" name="ref_1" onkeyup="if (this.value.length >= 1) document.frmReg.ref_2.focus();">
<input type="text" maxlength="1" size="1" value="" class="textfeild" name="ref_2" onkeyup="if (this.value.length >= 1) document.frmReg.ref_3.focus();">
<input type="text" maxlength="1" size="1" class="textfeild" name="ref_3" onkeyup="if (this.value.length >= 1) document.frmReg.ref_4.focus();">
<input type="text" maxlength="1" size="1" class="textfeild" name="ref_4" onkeyup="if (this.value.length >= 1) document.frmReg.ref_5.focus();">
<input type="text" maxlength="1" size="1" class="textfeild" name="ref_5">
</font>
</td>
</tr>
<tr>
<td align="left" valign="middle" class="formtext" height="38"> </td>
<td height="38"></td>
<td align="left" valign="top" height="38">
<font face="Arial"><span class="warningtext">if you had not received a referral code, please leave this area blank. </span></font>
</td>
</tr>
<tr>
<td align="left" valign="middle" class="formtext" height="19"> </td>
<td height="19"></td>
<td align="left" valign="top" height="19"> </td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Username : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<input size="20" class="textlitle" name="uname" maxlength="20">
</font>
</label></td>
</tr>
<tr>
<td width="114" height="3" align="left" valign="middle" class="formtext"></td>
<td width="10" height="3"></td>
<td height="3" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="38"> </td>
<td width="10" height="38"></td>
<td align="left" valign="top" class="warningtext" height="38">
<font face="Arial">alpha numeric and underscore are valid<br> characters. </font>
</td>
</tr>
<tr>
<td width="114" height="3" align="left" valign="middle" class="formtext"></td>
<td width="10" height="3"></td>
<td height="3" align="left" valign="top" class="warningtext"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Password : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<input maxlength="15" value="" name="pwd" class="textlitle" size="20" type="password">
</font>
</label></td>
</tr>
<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="38">
<font face="Arial">Confirm Password : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="38"></td>
<td align="left" valign="top" height="38"><label>
<font face="Arial">
<input maxlength="15" value="" name="pwd2" class="textlitle" size="20" type="password">
</font>
</label></td>
</tr>
<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">First name : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<input maxlength="50" name="fname" class="textlitle" size="20">
</font>
</label></td>
</tr>
<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Last Name : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
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</label></td>
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<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Email Address : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<input maxlength="100" name="email" class="textlitle" size="20">
</font>
</label></td>
</tr>
<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Address : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<input maxlength="50" name="add" class="textlitle" size="20">
</font>
</label></td>
</tr>
<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">City : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<input maxlength="25" name="city" class="textlitle" size="20">
</font>
</label></td>
</tr>
<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Country : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<select onchange="javascript: refreshOnCountryChange();" name="country" class="textfeild" style="width:145px;">
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Azores (Portugal)">Azores (Portugal)</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Barbuda (Antigua)">Barbuda (Antigua)</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bophuthatswana">Bophuthatswana</option>
<option value="Borneo">Borneo</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Honduras">British Honduras</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burma (Myanmar)">Burma (Myanmar)</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia (Kampuchea)">Cambodia (Kampuchea)</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Canal Zone">Canal Zone</option>
<option value="Cape Verde Islands">Cape Verde Islands</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Ceylon (Sri Lanka)">Ceylon (Sri Lanka)</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Ciskei">Ciskei</option>
<option value="Colombia">Colombia</option>
<option value="Comoros Islands">Comoros Islands</option>
<option value="Congo Dem. Republic">Congo Dem. Republic</option>
<option value="Congo">Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Dahomey">Dahomey</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Germany">East Germany</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="England">England</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea (Ethiopia)">Eritrea (Ethiopia)</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Faeroe Islands">Faeroe Islands</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Great Britain">Great Britain</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland Northern">Ireland Northern</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Java">Java</option>
<option value="Jersey">Jersey</option>
<option value="Jibuti">Jibuti</option>
<option value="Jordan">Jordan</option>
<option value="Kampuchea (Cambodia)">Kampuchea (Cambodia)</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldive Islands">Maldive Islands</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Midway Island">Midway Island</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Muscat and Oman">Muscat and Oman</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands Antilles">Netherlands Antilles</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="North Korea">North Korea</option>
<option value="Northern Ireland">Northern Ireland</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pacific Islands TT">Pacific Islands TT</option>
<option value="Pakistan">Pakistan</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Portuguese Guinea">Portuguese Guinea</option>
<option value="Portuguese Timor">Portuguese Timor</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Reunion">Reunion</option>
<option value="Rhodesia (Zimbabwe)">Rhodesia (Zimbabwe)</option>
<option value="Romania">Romania</option>
<option value="Russia">Russia</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Christopher (Kitts)-Nevis">Saint Christopher (Kitts)-Nevis</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Scotland">Scotland</option>
<option value="Senegal">Senegal</option>
<option value="Serbia and Montenegro">Serbia and Montenegro</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and South Sandwich">South Georgia and South Sandwich</option>
<option value="South Korea">South Korea</option>
<option value="South West Africa (Namibia)">South West Africa (Namibia)</option>
<option value="Southern Yemen">Southern Yemen</option>
<option value="Spain">Spain</option>
<option value="Spanish North Africa">Spanish North Africa</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Surinam">Surinam</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Togo">Togo</option>
<option value="Tokelau Island">Tokelau Island</option>
<option value="Tonga">Tonga</option>
<option value="Transkei">Transkei</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu Islands">Tuvalu Islands</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="Upper Volta (Burkina Faso)">Upper Volta (Burkina Faso)</option>
<option value="Uruguay">Uruguay</option>
<option value="USA" selected="selected">USA</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venda">Venda</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Virgin Islands">Virgin Islands</option>
<option value="Wake Island">Wake Island</option>
<option value="Wales">Wales</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="West Germany">West Germany</option>
<option value="Western Sahara (Morocco)">Western Sahara (Morocco)</option>
<option value="Western Samoa">Western Samoa</option>
<option value="Yemen (N and S)">Yemen (N and S)</option>
<option value="Zaire">Zaire</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</font>
</label></td>
</tr>
<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">State : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<select style="visibility: visible; width: 120px; display: block;" id="statecombo" name="state" class="textfeild">
<option value="AL" selected="selected">Alabama</option>
<option value="AK">Alaska</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">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</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="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</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="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</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="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
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<input type="text" name="statetextbox" id="statetext" class="textlitle" size="1" style="display: none; width: 0px;">
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<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Zip : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22"><label>
<font face="Arial">
<input maxlength="5" name="zip" class="textlitle" size="20">
</font>
</label></td>
</tr>
<tr>
<td width="114" height="5" align="left" valign="middle" class="formtext"></td>
<td width="10" height="5"></td>
<td height="5" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Phone : <strong style="color: red">*</strong></font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22">
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<td width="114" height="4" align="left" valign="middle" class="formtext"></td>
<td width="10" height="4"></td>
<td height="4" align="left" valign="top"></td>
</tr>
<tr>
<td width="114" align="left" valign="middle" class="formtext" height="22">
<font face="Arial">Cell Phone : </font>
</td>
<td width="10" height="22"></td>
<td align="left" valign="top" height="22">
<div align="left"> <span class="black_text_form">
<font face="Arial">
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<input maxlength="4" style="visibility: visible;" name="phSecdry3" class="textlitle" size="5" type="text">
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<table width="100%" border="0" cellspacing="0" cellpadding="0" height="279">
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