www.vinylmeplease.com Open in urlscan Pro
23.227.38.74  Public Scan

Submitted URL: http://www.vinylmeplease.com/
Effective URL: https://www.vinylmeplease.com/
Submission: On February 21 via api from US — Scanned from CA

Form analysis 23 forms found in the DOM

POST /cart/add

<form data-product-form="" data-product-id="6963730448474" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Pre-Order" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Pre-Order</span></button> <input type="text" name="properties[Preorder Message]" class="d-none"> <!----></form>

POST /cart/add

<form data-product-form="" data-product-id="6899105923162" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Pre-Order" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Pre-Order</span></button> <input type="text" name="properties[Preorder Message]" class="d-none"> <!----></form>

POST /cart/add

<form data-product-form="" data-product-id="6861656653914" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Pre-Order" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Pre-Order</span></button> <input type="text" name="properties[Preorder Message]" class="d-none"> <!----></form>

POST /cart/add

<form data-product-form="" data-product-id="6874069794906" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Pre-Order" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Pre-Order</span></button> <input type="text" name="properties[Preorder Message]" class="d-none"> <!----></form>

POST /cart/add

<form data-product-form="" data-product-id="6852714070106" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6872200904794" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6799879438426" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6799879471194" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6864597549146" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6861035176026" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6860449218650" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6860449120346" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6883770368090" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6578919997530" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Pre-Order" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Pre-Order</span></button> <input type="text" name="properties[Preorder Message]" class="d-none"> <!----></form>

POST /cart/add

<form data-product-form="" data-product-id="6859662786650" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Add to Cart" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Add to Cart</span></button> <input type="text" name="properties[Preorder Message]"
    value="IN-STOCK: Ships free for members. Other shipping options available at checkout." class="d-none"></form>

POST /cart/add

<form data-product-form="" data-product-id="6855359266906" action="/cart/add" method="post" enctype="multipart/form-data" class="d-flex justify-content-end"><button type="submit" name="add" aria-label="Pre-Order" data-cart-limit="2"
    class="btn btn-midnight-blue btn-sm ml-auto product-form__cart-submit"><span>Pre-Order</span></button> <input type="text" name="properties[Preorder Message]" class="d-none"> <!----></form>

GET /search

<form id="searchForm" action="/search" method="get" role="search"><label for="searchInput" class="sr-only">Search our store</label> <input id="searchInput" name="q" type="search" autofocus="autofocus" aria-label="Search our store"
    placeholder="Search our store" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" class="form-control shadow-none"></form>

POST /contact#NewsletterPopUp

<form method="post" action="/contact#NewsletterPopUp" id="NewsletterPopUp" accept-charset="UTF-8" class="contact-form"><input type="hidden" name="form_type" value="customer"><input type="hidden" name="utf8" value="✓">
  <div>
    <p>Sign up to receive new vinyl release notifications, curated playlists, Magazine articles, and more.</p>
  </div>
  <div class="row no-gutters my-3">
    <div class="col-12 col-sm-8"><input type="email" name="contact[email]" aria-label="email" id="newsletterPopupEmail" placeholder="email address" value="" autocorrect="off" autocapitalize="off" required="required" class="form-control"></div>
    <div class="col-12 col-sm-4"><button type="submit" name="submit" aria-label="submit" class="btn btn-midnight-blue btn-block ml-0 mt-2 mt-sm-0 ml-sm-2"><span>Sign Up<span></span></span></button></div>
  </div> <input type="hidden" name="contact[tags]" value="newsletter">
  <div class="small">
    <p></p>
  </div>
</form>

POST /account/login

<form method="post" action="/account/login" id="customer_login_modal" accept-charset="UTF-8" data-login-with-shop-sign-in="true" data-form-customer-login=""><input type="hidden" name="form_type" value="customer_login"><input type="hidden" name="utf8"
    value="✓">
  <div class="modal-header border-gray-300">
    <h4 class="modal-title">Sign In</h4> <button type="button" data-dismiss="modal" aria-label="Close" class="btn btn-white m-0 p-0"><span aria-hidden="true" class="vmp-icon vmp-icon-remove"></span></button>
  </div>
  <div class="modal-body">
    <div class="my-4 input-group flex-nowrap"><label for="customerEmailModal" class="has-float-label"><input type="email" id="customerEmailModal" name="customer[email]" aria-label="email" placeholder="Enter your email" autocorrect="off"
          autocapitalize="off" required="required" autocomplete="username" class="form-control"> <span>Email</span></label>
      <div class="input-group-append"><span class="input-group-text"><span class="vmp-icon vmp-icon-required text-coral"></span></span></div>
    </div>
    <div class="input-group mb-1 flex-nowrap"><label for="customerPasswordModal" class="has-float-label"><input type="password" id="customerPasswordModal" name="customer[password]" aria-label="password" placeholder="Enter your password"
          required="required" autocomplete="current-password" class="form-control"> <span>Password</span></label>
      <div class="input-group-append"><span class="input-group-text"><span class="vmp-icon vmp-icon-required text-coral"></span></span></div>
    </div>
    <div class="text-right">
      <p class="m-0 small"><a href="https://www.vinylmeplease.com/account/login#recover">
                                Forgot password?
                            </a></p>
    </div>
  </div>
  <div class="mt-1 mb-3 text-center"> Don't have an account? <a href="https://www.vinylmeplease.com/account/login#register" class="text-decoration-underline">
                        Sign up
                    </a></div>
  <div class="modal-footer border-gray-300"><button type="button" data-dismiss="modal" class="btn btn-secondary btn-sm">Cancel</button> <button type="submit" name="sign-in" disabled="disabled" class="btn btn-midnight-blue btn-sm"> Sign In </button>
  </div> <input type="hidden" name="return_to" value="/">
</form>

POST /account

<form method="post" action="/account" id="customer_register_modal" accept-charset="UTF-8" data-login-with-shop-sign-up="true" data-form-customer-register=""><input type="hidden" name="form_type" value="create_customer"><input type="hidden"
    name="utf8" value="✓">
  <div class="modal-header border-0 d-block">
    <div class="text-right"><button type="button" data-dismiss="modal" aria-label="Close" class="btn btn-white ml-auto p-0"><span aria-hidden="true" class="vmp-icon vmp-icon-remove"></span></button></div>
    <div class="modal-title">
      <div class="w-100">
        <h3 class="fancy-heading text-center">Create An Account</h3> <!---->
      </div>
    </div>
  </div> <!---->
  <div class="modal-body">
    <div class="my-4 input-group flex-nowrap"><label for="registerCustomerFirstName" class="has-float-label"><input type="text" id="registerCustomerFirstName" name="customer[first_name]" aria-label="first name" placeholder="John" autocorrect="off"
          autocapitalize="off" required="required" class="form-control"> <span>First Name</span></label></div>
    <div class="my-4 input-group flex-nowrap"><label for="registerCustomerLastName" class="has-float-label"><input type="text" id="registerCustomerLastName" name="customer[last_name]" aria-label="last name" placeholder="Smith" autocorrect="off"
          autocapitalize="off" required="required" class="form-control"> <span>Last Name</span></label></div>
    <div class="my-4 input-group flex-nowrap"><label for="registerCustomerEmail" class="has-float-label"><input type="email" id="registerCustomerEmail" name="customer[email]" aria-label="email" placeholder="Your email address" autocorrect="off"
          autocapitalize="off" autocomplete="false" required="required" class="form-control"> <span>Email</span></label></div>
    <div class="my-4 input-group flex-nowrap"><label for="registerCustomerPassword" class="has-float-label"><input type="password" data-password-input="" id="registerCustomerPassword" name="customer[password]" aria-label="password"
          placeholder="Create password" autocorrect="off" autocapitalize="off" autocomplete="false" required="required" class="form-control"> <span>Password</span></label></div>
    <div class="form-check custom-control custom-checkbox mt-5"><input type="hidden" name="customer[accepts_marketing]" value=""> <input type="checkbox" name="customer[accepts_marketing]" aria-label="newsletter subscription" checked="checked"
        id="accept_marketing" class="form-check-input custom-control-input d-none"> <label for="accept_marketing" class="form-check-label custom-control-label pl-1"><span class="small">Want to stay in the loop about our exclusive reissues, Records of
          the Month, and other vinyl deals via email?</span></label></div>
  </div>
  <div class="modal-footer border-0"><button type="submit" name="sign-in" disabled="disabled" class="btn btn-midnight-blue w-100"> Sign Up </button>
    <p class="w-100 text-center mt-4 mb-3"> Already have an Account? <a href="#" data-dismiss="modal" class="text-decoration-underline">Sign In</a></p>
  </div> <input type="hidden" name="return_to" value="/">
</form>

<form>
  <div class="modal-header border-0 d-block"><img src="//www.vinylmeplease.com/cdn/shop/files/Gift_Sticker_Green_2x_731e42f4-0738-42f1-b5a7-3ed9c7a2b1d5.png?v=4296106634200054223" alt="Green Gift Sticker" class="position-absolute">
    <div class="text-right"><button type="button" data-dismiss="modal" aria-label="Close" class="btn btn-white ml-auto p-0"><span aria-hidden="true" class="vmp-icon vmp-icon-remove"></span></button></div>
    <div class="modal-title text-center">
      <div class="px-0 px-sm-5">
        <h4 class="modal-title mb-3">Make Your Order a Gift</h4>
        <p class="small"> Want to send this order as a gift? Enter their shipping information, plus an optional note (that will be included in their box) and we’ll take care of the rest. Note: On the next screens, you will be directed to still enter
          your own shipping information for billing and account purposes, but the order will still ship to your recipient. </p>
      </div>
    </div>
  </div>
  <div class="modal-body py-0">
    <div class="px-0 px-sm-5">
      <div class="small font-weight-bold">Who Should We Ship It To?</div>
      <div class="form-group mb-0">
        <div class="row row-small-gutter">
          <div class="col-12 col-sm-6">
            <div class="input-group my-2"><label for="first-name" class="has-float-label"><input type="text" id="first-name" aria-describedby="first-name" placeholder="John" required="required" autocomplete="off" class="form-control"> <span>First
                  Name</span></label></div>
          </div>
          <div class="col-12 col-sm-6">
            <div class="input-group my-2"><label for="last-name" class="has-float-label"><input type="text" id="last-name" aria-describedby="last-name" placeholder="Smith" required="required" autocomplete="off" class="form-control"> <span>Last
                  Name</span></label></div>
          </div>
        </div>
        <div class="input-group mb-2 mt-2 mt-sm-0"><label for="address1Modal" class="has-float-label"><input placeholder="Enter your address" type="text" id="address1Modal" name="address1" autocapitalize="words" required="required"
              autocomplete="false" class="form-control"> <span>Address 1</span></label></div> <!---->
        <div class="input-group my-2"><label for="AddressAddress2Modal" class="has-float-label"><input placeholder="Apartment A" type="text" id="AddressAddress2Modal" name="address2" autocapitalize="words" autocomplete="false" class="form-control">
            <span>Address 2</span></label></div>
        <div class="row row-small-gutter">
          <div class="col-12 col-sm-6">
            <div class="input-group mb-2 mt-2 mt-sm-0"><label for="AddressCityModal" class="has-float-label"><input placeholder="Enter your city" type="text" id="AddressCityModal" name="city" autocapitalize="words" required="required"
                  autocomplete="false" class="form-control"> <span>City</span></label></div>
          </div>
          <div class="col-12 col-sm-6">
            <div class="input-group mb-2 mt-2 mt-sm-0"><label for="AddressZipModal" class="has-float-label"><input placeholder="Enter your postal code" type="text" id="AddressZipModal" name="zip" autocapitalize="characters" required="required"
                  class="form-control"> <span>Zip Code</span></label></div>
          </div>
        </div>
        <div class="input-group float-select-cnt mb-2 mt-2 mt-sm-0 disabled"><label for="AddressCountryModal" class="has-float-label"><select data-select-country="" placeholder="Select your country" id="AddressCountryModal" name="country"
              required="required" disabled="disabled" class="custom-select border-0">
              <option value="United States"
                data-provinces="[[&quot;Alabama&quot;,&quot;Alabama&quot;],[&quot;Alaska&quot;,&quot;Alaska&quot;],[&quot;American Samoa&quot;,&quot;American Samoa&quot;],[&quot;Arizona&quot;,&quot;Arizona&quot;],[&quot;Arkansas&quot;,&quot;Arkansas&quot;],[&quot;Armed Forces Americas&quot;,&quot;Armed Forces Americas&quot;],[&quot;Armed Forces Europe&quot;,&quot;Armed Forces Europe&quot;],[&quot;Armed Forces Pacific&quot;,&quot;Armed Forces Pacific&quot;],[&quot;California&quot;,&quot;California&quot;],[&quot;Colorado&quot;,&quot;Colorado&quot;],[&quot;Connecticut&quot;,&quot;Connecticut&quot;],[&quot;Delaware&quot;,&quot;Delaware&quot;],[&quot;District of Columbia&quot;,&quot;Washington DC&quot;],[&quot;Federated States of Micronesia&quot;,&quot;Micronesia&quot;],[&quot;Florida&quot;,&quot;Florida&quot;],[&quot;Georgia&quot;,&quot;Georgia&quot;],[&quot;Guam&quot;,&quot;Guam&quot;],[&quot;Hawaii&quot;,&quot;Hawaii&quot;],[&quot;Idaho&quot;,&quot;Idaho&quot;],[&quot;Illinois&quot;,&quot;Illinois&quot;],[&quot;Indiana&quot;,&quot;Indiana&quot;],[&quot;Iowa&quot;,&quot;Iowa&quot;],[&quot;Kansas&quot;,&quot;Kansas&quot;],[&quot;Kentucky&quot;,&quot;Kentucky&quot;],[&quot;Louisiana&quot;,&quot;Louisiana&quot;],[&quot;Maine&quot;,&quot;Maine&quot;],[&quot;Marshall Islands&quot;,&quot;Marshall Islands&quot;],[&quot;Maryland&quot;,&quot;Maryland&quot;],[&quot;Massachusetts&quot;,&quot;Massachusetts&quot;],[&quot;Michigan&quot;,&quot;Michigan&quot;],[&quot;Minnesota&quot;,&quot;Minnesota&quot;],[&quot;Mississippi&quot;,&quot;Mississippi&quot;],[&quot;Missouri&quot;,&quot;Missouri&quot;],[&quot;Montana&quot;,&quot;Montana&quot;],[&quot;Nebraska&quot;,&quot;Nebraska&quot;],[&quot;Nevada&quot;,&quot;Nevada&quot;],[&quot;New Hampshire&quot;,&quot;New Hampshire&quot;],[&quot;New Jersey&quot;,&quot;New Jersey&quot;],[&quot;New Mexico&quot;,&quot;New Mexico&quot;],[&quot;New York&quot;,&quot;New York&quot;],[&quot;North Carolina&quot;,&quot;North Carolina&quot;],[&quot;North Dakota&quot;,&quot;North Dakota&quot;],[&quot;Northern Mariana Islands&quot;,&quot;Northern Mariana Islands&quot;],[&quot;Ohio&quot;,&quot;Ohio&quot;],[&quot;Oklahoma&quot;,&quot;Oklahoma&quot;],[&quot;Oregon&quot;,&quot;Oregon&quot;],[&quot;Palau&quot;,&quot;Palau&quot;],[&quot;Pennsylvania&quot;,&quot;Pennsylvania&quot;],[&quot;Puerto Rico&quot;,&quot;Puerto Rico&quot;],[&quot;Rhode Island&quot;,&quot;Rhode Island&quot;],[&quot;South Carolina&quot;,&quot;South Carolina&quot;],[&quot;South Dakota&quot;,&quot;South Dakota&quot;],[&quot;Tennessee&quot;,&quot;Tennessee&quot;],[&quot;Texas&quot;,&quot;Texas&quot;],[&quot;Utah&quot;,&quot;Utah&quot;],[&quot;Vermont&quot;,&quot;Vermont&quot;],[&quot;Virgin Islands&quot;,&quot;U.S. Virgin Islands&quot;],[&quot;Virginia&quot;,&quot;Virginia&quot;],[&quot;Washington&quot;,&quot;Washington&quot;],[&quot;West Virginia&quot;,&quot;West Virginia&quot;],[&quot;Wisconsin&quot;,&quot;Wisconsin&quot;],[&quot;Wyoming&quot;,&quot;Wyoming&quot;]]">
                United States</option>
              <option value="Canada"
                data-provinces="[[&quot;Alberta&quot;,&quot;Alberta&quot;],[&quot;British Columbia&quot;,&quot;British Columbia&quot;],[&quot;Manitoba&quot;,&quot;Manitoba&quot;],[&quot;New Brunswick&quot;,&quot;New Brunswick&quot;],[&quot;Newfoundland and Labrador&quot;,&quot;Newfoundland and Labrador&quot;],[&quot;Northwest Territories&quot;,&quot;Northwest Territories&quot;],[&quot;Nova Scotia&quot;,&quot;Nova Scotia&quot;],[&quot;Nunavut&quot;,&quot;Nunavut&quot;],[&quot;Ontario&quot;,&quot;Ontario&quot;],[&quot;Prince Edward Island&quot;,&quot;Prince Edward Island&quot;],[&quot;Quebec&quot;,&quot;Quebec&quot;],[&quot;Saskatchewan&quot;,&quot;Saskatchewan&quot;],[&quot;Yukon&quot;,&quot;Yukon&quot;]]">
                Canada</option>
              <option value="United Kingdom"
                data-provinces="[[&quot;British Forces&quot;,&quot;British Forces&quot;],[&quot;England&quot;,&quot;England&quot;],[&quot;Northern Ireland&quot;,&quot;Northern Ireland&quot;],[&quot;Scotland&quot;,&quot;Scotland&quot;],[&quot;Wales&quot;,&quot;Wales&quot;]]">
                United Kingdom</option>
              <option value="Australia"
                data-provinces="[[&quot;Australian Capital Territory&quot;,&quot;Australian Capital Territory&quot;],[&quot;New South Wales&quot;,&quot;New South Wales&quot;],[&quot;Northern Territory&quot;,&quot;Northern Territory&quot;],[&quot;Queensland&quot;,&quot;Queensland&quot;],[&quot;South Australia&quot;,&quot;South Australia&quot;],[&quot;Tasmania&quot;,&quot;Tasmania&quot;],[&quot;Victoria&quot;,&quot;Victoria&quot;],[&quot;Western Australia&quot;,&quot;Western Australia&quot;]]">
                Australia</option>
              <option value="---" data-provinces="[]">---</option>
              <option value="Afghanistan" data-provinces="[]">Afghanistan</option>
              <option value="Aland Islands" data-provinces="[]">Åland Islands</option>
              <option value="Albania" data-provinces="[]">Albania</option>
              <option value="Algeria" data-provinces="[]">Algeria</option>
              <option value="Andorra" data-provinces="[]">Andorra</option>
              <option value="Angola" data-provinces="[]">Angola</option>
              <option value="Anguilla" data-provinces="[]">Anguilla</option>
              <option value="Antigua And Barbuda" data-provinces="[]">Antigua &amp; Barbuda</option>
              <option value="Argentina"
                data-provinces="[[&quot;Buenos Aires&quot;,&quot;Buenos Aires Province&quot;],[&quot;Catamarca&quot;,&quot;Catamarca&quot;],[&quot;Chaco&quot;,&quot;Chaco&quot;],[&quot;Chubut&quot;,&quot;Chubut&quot;],[&quot;Ciudad Autónoma de Buenos Aires&quot;,&quot;Buenos Aires (Autonomous City)&quot;],[&quot;Corrientes&quot;,&quot;Corrientes&quot;],[&quot;Córdoba&quot;,&quot;Córdoba&quot;],[&quot;Entre Ríos&quot;,&quot;Entre Ríos&quot;],[&quot;Formosa&quot;,&quot;Formosa&quot;],[&quot;Jujuy&quot;,&quot;Jujuy&quot;],[&quot;La Pampa&quot;,&quot;La Pampa&quot;],[&quot;La Rioja&quot;,&quot;La Rioja&quot;],[&quot;Mendoza&quot;,&quot;Mendoza&quot;],[&quot;Misiones&quot;,&quot;Misiones&quot;],[&quot;Neuquén&quot;,&quot;Neuquén&quot;],[&quot;Río Negro&quot;,&quot;Río Negro&quot;],[&quot;Salta&quot;,&quot;Salta&quot;],[&quot;San Juan&quot;,&quot;San Juan&quot;],[&quot;San Luis&quot;,&quot;San Luis&quot;],[&quot;Santa Cruz&quot;,&quot;Santa Cruz&quot;],[&quot;Santa Fe&quot;,&quot;Santa Fe&quot;],[&quot;Santiago Del Estero&quot;,&quot;Santiago del Estero&quot;],[&quot;Tierra Del Fuego&quot;,&quot;Tierra del Fuego&quot;],[&quot;Tucumán&quot;,&quot;Tucumán&quot;]]">
                Argentina</option>
              <option value="Armenia" data-provinces="[]">Armenia</option>
              <option value="Aruba" data-provinces="[]">Aruba</option>
              <option value="Ascension Island" data-provinces="[]">Ascension Island</option>
              <option value="Australia"
                data-provinces="[[&quot;Australian Capital Territory&quot;,&quot;Australian Capital Territory&quot;],[&quot;New South Wales&quot;,&quot;New South Wales&quot;],[&quot;Northern Territory&quot;,&quot;Northern Territory&quot;],[&quot;Queensland&quot;,&quot;Queensland&quot;],[&quot;South Australia&quot;,&quot;South Australia&quot;],[&quot;Tasmania&quot;,&quot;Tasmania&quot;],[&quot;Victoria&quot;,&quot;Victoria&quot;],[&quot;Western Australia&quot;,&quot;Western Australia&quot;]]">
                Australia</option>
              <option value="Austria" data-provinces="[]">Austria</option>
              <option value="Azerbaijan" data-provinces="[]">Azerbaijan</option>
              <option value="Bahamas" data-provinces="[]">Bahamas</option>
              <option value="Bahrain" data-provinces="[]">Bahrain</option>
              <option value="Bangladesh" data-provinces="[]">Bangladesh</option>
              <option value="Barbados" data-provinces="[]">Barbados</option>
              <option value="Belarus" data-provinces="[]">Belarus</option>
              <option value="Belgium" data-provinces="[]">Belgium</option>
              <option value="Belize" data-provinces="[]">Belize</option>
              <option value="Benin" data-provinces="[]">Benin</option>
              <option value="Bermuda" data-provinces="[]">Bermuda</option>
              <option value="Bhutan" data-provinces="[]">Bhutan</option>
              <option value="Bolivia" data-provinces="[]">Bolivia</option>
              <option value="Bosnia And Herzegovina" data-provinces="[]">Bosnia &amp; Herzegovina</option>
              <option value="Botswana" data-provinces="[]">Botswana</option>
              <option value="Brazil"
                data-provinces="[[&quot;Acre&quot;,&quot;Acre&quot;],[&quot;Alagoas&quot;,&quot;Alagoas&quot;],[&quot;Amapá&quot;,&quot;Amapá&quot;],[&quot;Amazonas&quot;,&quot;Amazonas&quot;],[&quot;Bahia&quot;,&quot;Bahia&quot;],[&quot;Ceará&quot;,&quot;Ceará&quot;],[&quot;Distrito Federal&quot;,&quot;Federal District&quot;],[&quot;Espírito Santo&quot;,&quot;Espírito Santo&quot;],[&quot;Goiás&quot;,&quot;Goiás&quot;],[&quot;Maranhão&quot;,&quot;Maranhão&quot;],[&quot;Mato Grosso&quot;,&quot;Mato Grosso&quot;],[&quot;Mato Grosso do Sul&quot;,&quot;Mato Grosso do Sul&quot;],[&quot;Minas Gerais&quot;,&quot;Minas Gerais&quot;],[&quot;Paraná&quot;,&quot;Paraná&quot;],[&quot;Paraíba&quot;,&quot;Paraíba&quot;],[&quot;Pará&quot;,&quot;Pará&quot;],[&quot;Pernambuco&quot;,&quot;Pernambuco&quot;],[&quot;Piauí&quot;,&quot;Piauí&quot;],[&quot;Rio Grande do Norte&quot;,&quot;Rio Grande do Norte&quot;],[&quot;Rio Grande do Sul&quot;,&quot;Rio Grande do Sul&quot;],[&quot;Rio de Janeiro&quot;,&quot;Rio de Janeiro&quot;],[&quot;Rondônia&quot;,&quot;Rondônia&quot;],[&quot;Roraima&quot;,&quot;Roraima&quot;],[&quot;Santa Catarina&quot;,&quot;Santa Catarina&quot;],[&quot;Sergipe&quot;,&quot;Sergipe&quot;],[&quot;São Paulo&quot;,&quot;São Paulo&quot;],[&quot;Tocantins&quot;,&quot;Tocantins&quot;]]">
                Brazil</option>
              <option value="British Indian Ocean Territory" data-provinces="[]">British Indian Ocean Territory</option>
              <option value="Virgin Islands, British" data-provinces="[]">British Virgin Islands</option>
              <option value="Brunei" data-provinces="[]">Brunei</option>
              <option value="Bulgaria" data-provinces="[]">Bulgaria</option>
              <option value="Burkina Faso" data-provinces="[]">Burkina Faso</option>
              <option value="Burundi" data-provinces="[]">Burundi</option>
              <option value="Cambodia" data-provinces="[]">Cambodia</option>
              <option value="Republic of Cameroon" data-provinces="[]">Cameroon</option>
              <option value="Canada"
                data-provinces="[[&quot;Alberta&quot;,&quot;Alberta&quot;],[&quot;British Columbia&quot;,&quot;British Columbia&quot;],[&quot;Manitoba&quot;,&quot;Manitoba&quot;],[&quot;New Brunswick&quot;,&quot;New Brunswick&quot;],[&quot;Newfoundland and Labrador&quot;,&quot;Newfoundland and Labrador&quot;],[&quot;Northwest Territories&quot;,&quot;Northwest Territories&quot;],[&quot;Nova Scotia&quot;,&quot;Nova Scotia&quot;],[&quot;Nunavut&quot;,&quot;Nunavut&quot;],[&quot;Ontario&quot;,&quot;Ontario&quot;],[&quot;Prince Edward Island&quot;,&quot;Prince Edward Island&quot;],[&quot;Quebec&quot;,&quot;Quebec&quot;],[&quot;Saskatchewan&quot;,&quot;Saskatchewan&quot;],[&quot;Yukon&quot;,&quot;Yukon&quot;]]">
                Canada</option>
              <option value="Cape Verde" data-provinces="[]">Cape Verde</option>
              <option value="Caribbean Netherlands" data-provinces="[]">Caribbean Netherlands</option>
              <option value="Cayman Islands" data-provinces="[]">Cayman Islands</option>
              <option value="Central African Republic" data-provinces="[]">Central African Republic</option>
              <option value="Chad" data-provinces="[]">Chad</option>
              <option value="Chile"
                data-provinces="[[&quot;Antofagasta&quot;,&quot;Antofagasta&quot;],[&quot;Araucanía&quot;,&quot;Araucanía&quot;],[&quot;Arica and Parinacota&quot;,&quot;Arica y Parinacota&quot;],[&quot;Atacama&quot;,&quot;Atacama&quot;],[&quot;Aysén&quot;,&quot;Aysén&quot;],[&quot;Biobío&quot;,&quot;Bío Bío&quot;],[&quot;Coquimbo&quot;,&quot;Coquimbo&quot;],[&quot;Los Lagos&quot;,&quot;Los Lagos&quot;],[&quot;Los Ríos&quot;,&quot;Los Ríos&quot;],[&quot;Magallanes&quot;,&quot;Magallanes Region&quot;],[&quot;Maule&quot;,&quot;Maule&quot;],[&quot;O'Higgins&quot;,&quot;Libertador General Bernardo O’Higgins&quot;],[&quot;Santiago&quot;,&quot;Santiago Metropolitan&quot;],[&quot;Tarapacá&quot;,&quot;Tarapacá&quot;],[&quot;Valparaíso&quot;,&quot;Valparaíso&quot;],[&quot;Ñuble&quot;,&quot;Ñuble&quot;]]">
                Chile</option>
              <option value="China"
                data-provinces="[[&quot;Anhui&quot;,&quot;Anhui&quot;],[&quot;Beijing&quot;,&quot;Beijing&quot;],[&quot;Chongqing&quot;,&quot;Chongqing&quot;],[&quot;Fujian&quot;,&quot;Fujian&quot;],[&quot;Gansu&quot;,&quot;Gansu&quot;],[&quot;Guangdong&quot;,&quot;Guangdong&quot;],[&quot;Guangxi&quot;,&quot;Guangxi&quot;],[&quot;Guizhou&quot;,&quot;Guizhou&quot;],[&quot;Hainan&quot;,&quot;Hainan&quot;],[&quot;Hebei&quot;,&quot;Hebei&quot;],[&quot;Heilongjiang&quot;,&quot;Heilongjiang&quot;],[&quot;Henan&quot;,&quot;Henan&quot;],[&quot;Hubei&quot;,&quot;Hubei&quot;],[&quot;Hunan&quot;,&quot;Hunan&quot;],[&quot;Inner Mongolia&quot;,&quot;Inner Mongolia&quot;],[&quot;Jiangsu&quot;,&quot;Jiangsu&quot;],[&quot;Jiangxi&quot;,&quot;Jiangxi&quot;],[&quot;Jilin&quot;,&quot;Jilin&quot;],[&quot;Liaoning&quot;,&quot;Liaoning&quot;],[&quot;Ningxia&quot;,&quot;Ningxia&quot;],[&quot;Qinghai&quot;,&quot;Qinghai&quot;],[&quot;Shaanxi&quot;,&quot;Shaanxi&quot;],[&quot;Shandong&quot;,&quot;Shandong&quot;],[&quot;Shanghai&quot;,&quot;Shanghai&quot;],[&quot;Shanxi&quot;,&quot;Shanxi&quot;],[&quot;Sichuan&quot;,&quot;Sichuan&quot;],[&quot;Tianjin&quot;,&quot;Tianjin&quot;],[&quot;Xinjiang&quot;,&quot;Xinjiang&quot;],[&quot;Xizang&quot;,&quot;Tibet&quot;],[&quot;Yunnan&quot;,&quot;Yunnan&quot;],[&quot;Zhejiang&quot;,&quot;Zhejiang&quot;]]">
                China</option>
              <option value="Christmas Island" data-provinces="[]">Christmas Island</option>
              <option value="Cocos (Keeling) Islands" data-provinces="[]">Cocos (Keeling) Islands</option>
              <option value="Colombia"
                data-provinces="[[&quot;Amazonas&quot;,&quot;Amazonas&quot;],[&quot;Antioquia&quot;,&quot;Antioquia&quot;],[&quot;Arauca&quot;,&quot;Arauca&quot;],[&quot;Atlántico&quot;,&quot;Atlántico&quot;],[&quot;Bogotá, D.C.&quot;,&quot;Capital District&quot;],[&quot;Bolívar&quot;,&quot;Bolívar&quot;],[&quot;Boyacá&quot;,&quot;Boyacá&quot;],[&quot;Caldas&quot;,&quot;Caldas&quot;],[&quot;Caquetá&quot;,&quot;Caquetá&quot;],[&quot;Casanare&quot;,&quot;Casanare&quot;],[&quot;Cauca&quot;,&quot;Cauca&quot;],[&quot;Cesar&quot;,&quot;Cesar&quot;],[&quot;Chocó&quot;,&quot;Chocó&quot;],[&quot;Cundinamarca&quot;,&quot;Cundinamarca&quot;],[&quot;Córdoba&quot;,&quot;Córdoba&quot;],[&quot;Guainía&quot;,&quot;Guainía&quot;],[&quot;Guaviare&quot;,&quot;Guaviare&quot;],[&quot;Huila&quot;,&quot;Huila&quot;],[&quot;La Guajira&quot;,&quot;La Guajira&quot;],[&quot;Magdalena&quot;,&quot;Magdalena&quot;],[&quot;Meta&quot;,&quot;Meta&quot;],[&quot;Nariño&quot;,&quot;Nariño&quot;],[&quot;Norte de Santander&quot;,&quot;Norte de Santander&quot;],[&quot;Putumayo&quot;,&quot;Putumayo&quot;],[&quot;Quindío&quot;,&quot;Quindío&quot;],[&quot;Risaralda&quot;,&quot;Risaralda&quot;],[&quot;San Andrés, Providencia y Santa Catalina&quot;,&quot;San Andrés \u0026 Providencia&quot;],[&quot;Santander&quot;,&quot;Santander&quot;],[&quot;Sucre&quot;,&quot;Sucre&quot;],[&quot;Tolima&quot;,&quot;Tolima&quot;],[&quot;Valle del Cauca&quot;,&quot;Valle del Cauca&quot;],[&quot;Vaupés&quot;,&quot;Vaupés&quot;],[&quot;Vichada&quot;,&quot;Vichada&quot;]]">
                Colombia</option>
              <option value="Comoros" data-provinces="[]">Comoros</option>
              <option value="Congo" data-provinces="[]">Congo - Brazzaville</option>
              <option value="Congo, The Democratic Republic Of The" data-provinces="[]">Congo - Kinshasa</option>
              <option value="Cook Islands" data-provinces="[]">Cook Islands</option>
              <option value="Costa Rica"
                data-provinces="[[&quot;Alajuela&quot;,&quot;Alajuela&quot;],[&quot;Cartago&quot;,&quot;Cartago&quot;],[&quot;Guanacaste&quot;,&quot;Guanacaste&quot;],[&quot;Heredia&quot;,&quot;Heredia&quot;],[&quot;Limón&quot;,&quot;Limón&quot;],[&quot;Puntarenas&quot;,&quot;Puntarenas&quot;],[&quot;San José&quot;,&quot;San José&quot;]]">
                Costa Rica</option>
              <option value="Croatia" data-provinces="[]">Croatia</option>
              <option value="Curaçao" data-provinces="[]">Curaçao</option>
              <option value="Cyprus" data-provinces="[]">Cyprus</option>
              <option value="Czech Republic" data-provinces="[]">Czechia</option>
              <option value="Côte d'Ivoire" data-provinces="[]">Côte d’Ivoire</option>
              <option value="Denmark" data-provinces="[]">Denmark</option>
              <option value="Djibouti" data-provinces="[]">Djibouti</option>
              <option value="Dominica" data-provinces="[]">Dominica</option>
              <option value="Dominican Republic" data-provinces="[]">Dominican Republic</option>
              <option value="Ecuador" data-provinces="[]">Ecuador</option>
              <option value="Egypt"
                data-provinces="[[&quot;6th of October&quot;,&quot;6th of October&quot;],[&quot;Al Sharqia&quot;,&quot;Al Sharqia&quot;],[&quot;Alexandria&quot;,&quot;Alexandria&quot;],[&quot;Aswan&quot;,&quot;Aswan&quot;],[&quot;Asyut&quot;,&quot;Asyut&quot;],[&quot;Beheira&quot;,&quot;Beheira&quot;],[&quot;Beni Suef&quot;,&quot;Beni Suef&quot;],[&quot;Cairo&quot;,&quot;Cairo&quot;],[&quot;Dakahlia&quot;,&quot;Dakahlia&quot;],[&quot;Damietta&quot;,&quot;Damietta&quot;],[&quot;Faiyum&quot;,&quot;Faiyum&quot;],[&quot;Gharbia&quot;,&quot;Gharbia&quot;],[&quot;Giza&quot;,&quot;Giza&quot;],[&quot;Helwan&quot;,&quot;Helwan&quot;],[&quot;Ismailia&quot;,&quot;Ismailia&quot;],[&quot;Kafr el-Sheikh&quot;,&quot;Kafr el-Sheikh&quot;],[&quot;Luxor&quot;,&quot;Luxor&quot;],[&quot;Matrouh&quot;,&quot;Matrouh&quot;],[&quot;Minya&quot;,&quot;Minya&quot;],[&quot;Monufia&quot;,&quot;Monufia&quot;],[&quot;New Valley&quot;,&quot;New Valley&quot;],[&quot;North Sinai&quot;,&quot;North Sinai&quot;],[&quot;Port Said&quot;,&quot;Port Said&quot;],[&quot;Qalyubia&quot;,&quot;Qalyubia&quot;],[&quot;Qena&quot;,&quot;Qena&quot;],[&quot;Red Sea&quot;,&quot;Red Sea&quot;],[&quot;Sohag&quot;,&quot;Sohag&quot;],[&quot;South Sinai&quot;,&quot;South Sinai&quot;],[&quot;Suez&quot;,&quot;Suez&quot;]]">
                Egypt</option>
              <option value="El Salvador"
                data-provinces="[[&quot;Ahuachapán&quot;,&quot;Ahuachapán&quot;],[&quot;Cabañas&quot;,&quot;Cabañas&quot;],[&quot;Chalatenango&quot;,&quot;Chalatenango&quot;],[&quot;Cuscatlán&quot;,&quot;Cuscatlán&quot;],[&quot;La Libertad&quot;,&quot;La Libertad&quot;],[&quot;La Paz&quot;,&quot;La Paz&quot;],[&quot;La Unión&quot;,&quot;La Unión&quot;],[&quot;Morazán&quot;,&quot;Morazán&quot;],[&quot;San Miguel&quot;,&quot;San Miguel&quot;],[&quot;San Salvador&quot;,&quot;San Salvador&quot;],[&quot;San Vicente&quot;,&quot;San Vicente&quot;],[&quot;Santa Ana&quot;,&quot;Santa Ana&quot;],[&quot;Sonsonate&quot;,&quot;Sonsonate&quot;],[&quot;Usulután&quot;,&quot;Usulután&quot;]]">
                El Salvador</option>
              <option value="Equatorial Guinea" data-provinces="[]">Equatorial Guinea</option>
              <option value="Eritrea" data-provinces="[]">Eritrea</option>
              <option value="Estonia" data-provinces="[]">Estonia</option>
              <option value="Eswatini" data-provinces="[]">Eswatini</option>
              <option value="Ethiopia" data-provinces="[]">Ethiopia</option>
              <option value="Falkland Islands (Malvinas)" data-provinces="[]">Falkland Islands</option>
              <option value="Faroe Islands" data-provinces="[]">Faroe Islands</option>
              <option value="Fiji" data-provinces="[]">Fiji</option>
              <option value="Finland" data-provinces="[]">Finland</option>
              <option value="France" data-provinces="[]">France</option>
              <option value="French Guiana" data-provinces="[]">French Guiana</option>
              <option value="French Polynesia" data-provinces="[]">French Polynesia</option>
              <option value="French Southern Territories" data-provinces="[]">French Southern Territories</option>
              <option value="Gabon" data-provinces="[]">Gabon</option>
              <option value="Gambia" data-provinces="[]">Gambia</option>
              <option value="Georgia" data-provinces="[]">Georgia</option>
              <option value="Germany" data-provinces="[]">Germany</option>
              <option value="Ghana" data-provinces="[]">Ghana</option>
              <option value="Gibraltar" data-provinces="[]">Gibraltar</option>
              <option value="Greece" data-provinces="[]">Greece</option>
              <option value="Greenland" data-provinces="[]">Greenland</option>
              <option value="Grenada" data-provinces="[]">Grenada</option>
              <option value="Guadeloupe" data-provinces="[]">Guadeloupe</option>
              <option value="Guatemala"
                data-provinces="[[&quot;Alta Verapaz&quot;,&quot;Alta Verapaz&quot;],[&quot;Baja Verapaz&quot;,&quot;Baja Verapaz&quot;],[&quot;Chimaltenango&quot;,&quot;Chimaltenango&quot;],[&quot;Chiquimula&quot;,&quot;Chiquimula&quot;],[&quot;El Progreso&quot;,&quot;El Progreso&quot;],[&quot;Escuintla&quot;,&quot;Escuintla&quot;],[&quot;Guatemala&quot;,&quot;Guatemala&quot;],[&quot;Huehuetenango&quot;,&quot;Huehuetenango&quot;],[&quot;Izabal&quot;,&quot;Izabal&quot;],[&quot;Jalapa&quot;,&quot;Jalapa&quot;],[&quot;Jutiapa&quot;,&quot;Jutiapa&quot;],[&quot;Petén&quot;,&quot;Petén&quot;],[&quot;Quetzaltenango&quot;,&quot;Quetzaltenango&quot;],[&quot;Quiché&quot;,&quot;Quiché&quot;],[&quot;Retalhuleu&quot;,&quot;Retalhuleu&quot;],[&quot;Sacatepéquez&quot;,&quot;Sacatepéquez&quot;],[&quot;San Marcos&quot;,&quot;San Marcos&quot;],[&quot;Santa Rosa&quot;,&quot;Santa Rosa&quot;],[&quot;Sololá&quot;,&quot;Sololá&quot;],[&quot;Suchitepéquez&quot;,&quot;Suchitepéquez&quot;],[&quot;Totonicapán&quot;,&quot;Totonicapán&quot;],[&quot;Zacapa&quot;,&quot;Zacapa&quot;]]">
                Guatemala</option>
              <option value="Guernsey" data-provinces="[]">Guernsey</option>
              <option value="Guinea" data-provinces="[]">Guinea</option>
              <option value="Guinea Bissau" data-provinces="[]">Guinea-Bissau</option>
              <option value="Guyana" data-provinces="[]">Guyana</option>
              <option value="Haiti" data-provinces="[]">Haiti</option>
              <option value="Honduras" data-provinces="[]">Honduras</option>
              <option value="Hong Kong" data-provinces="[[&quot;Hong Kong Island&quot;,&quot;Hong Kong Island&quot;],[&quot;Kowloon&quot;,&quot;Kowloon&quot;],[&quot;New Territories&quot;,&quot;New Territories&quot;]]">Hong Kong SAR</option>
              <option value="Hungary" data-provinces="[]">Hungary</option>
              <option value="Iceland" data-provinces="[]">Iceland</option>
              <option value="India"
                data-provinces="[[&quot;Andaman and Nicobar Islands&quot;,&quot;Andaman and Nicobar Islands&quot;],[&quot;Andhra Pradesh&quot;,&quot;Andhra Pradesh&quot;],[&quot;Arunachal Pradesh&quot;,&quot;Arunachal Pradesh&quot;],[&quot;Assam&quot;,&quot;Assam&quot;],[&quot;Bihar&quot;,&quot;Bihar&quot;],[&quot;Chandigarh&quot;,&quot;Chandigarh&quot;],[&quot;Chhattisgarh&quot;,&quot;Chhattisgarh&quot;],[&quot;Dadra and Nagar Haveli&quot;,&quot;Dadra and Nagar Haveli&quot;],[&quot;Daman and Diu&quot;,&quot;Daman and Diu&quot;],[&quot;Delhi&quot;,&quot;Delhi&quot;],[&quot;Goa&quot;,&quot;Goa&quot;],[&quot;Gujarat&quot;,&quot;Gujarat&quot;],[&quot;Haryana&quot;,&quot;Haryana&quot;],[&quot;Himachal Pradesh&quot;,&quot;Himachal Pradesh&quot;],[&quot;Jammu and Kashmir&quot;,&quot;Jammu and Kashmir&quot;],[&quot;Jharkhand&quot;,&quot;Jharkhand&quot;],[&quot;Karnataka&quot;,&quot;Karnataka&quot;],[&quot;Kerala&quot;,&quot;Kerala&quot;],[&quot;Ladakh&quot;,&quot;Ladakh&quot;],[&quot;Lakshadweep&quot;,&quot;Lakshadweep&quot;],[&quot;Madhya Pradesh&quot;,&quot;Madhya Pradesh&quot;],[&quot;Maharashtra&quot;,&quot;Maharashtra&quot;],[&quot;Manipur&quot;,&quot;Manipur&quot;],[&quot;Meghalaya&quot;,&quot;Meghalaya&quot;],[&quot;Mizoram&quot;,&quot;Mizoram&quot;],[&quot;Nagaland&quot;,&quot;Nagaland&quot;],[&quot;Odisha&quot;,&quot;Odisha&quot;],[&quot;Puducherry&quot;,&quot;Puducherry&quot;],[&quot;Punjab&quot;,&quot;Punjab&quot;],[&quot;Rajasthan&quot;,&quot;Rajasthan&quot;],[&quot;Sikkim&quot;,&quot;Sikkim&quot;],[&quot;Tamil Nadu&quot;,&quot;Tamil Nadu&quot;],[&quot;Telangana&quot;,&quot;Telangana&quot;],[&quot;Tripura&quot;,&quot;Tripura&quot;],[&quot;Uttar Pradesh&quot;,&quot;Uttar Pradesh&quot;],[&quot;Uttarakhand&quot;,&quot;Uttarakhand&quot;],[&quot;West Bengal&quot;,&quot;West Bengal&quot;]]">
                India</option>
              <option value="Indonesia"
                data-provinces="[[&quot;Aceh&quot;,&quot;Aceh&quot;],[&quot;Bali&quot;,&quot;Bali&quot;],[&quot;Bangka Belitung&quot;,&quot;Bangka–Belitung Islands&quot;],[&quot;Banten&quot;,&quot;Banten&quot;],[&quot;Bengkulu&quot;,&quot;Bengkulu&quot;],[&quot;Gorontalo&quot;,&quot;Gorontalo&quot;],[&quot;Jakarta&quot;,&quot;Jakarta&quot;],[&quot;Jambi&quot;,&quot;Jambi&quot;],[&quot;Jawa Barat&quot;,&quot;West Java&quot;],[&quot;Jawa Tengah&quot;,&quot;Central Java&quot;],[&quot;Jawa Timur&quot;,&quot;East Java&quot;],[&quot;Kalimantan Barat&quot;,&quot;West Kalimantan&quot;],[&quot;Kalimantan Selatan&quot;,&quot;South Kalimantan&quot;],[&quot;Kalimantan Tengah&quot;,&quot;Central Kalimantan&quot;],[&quot;Kalimantan Timur&quot;,&quot;East Kalimantan&quot;],[&quot;Kalimantan Utara&quot;,&quot;North Kalimantan&quot;],[&quot;Kepulauan Riau&quot;,&quot;Riau Islands&quot;],[&quot;Lampung&quot;,&quot;Lampung&quot;],[&quot;Maluku&quot;,&quot;Maluku&quot;],[&quot;Maluku Utara&quot;,&quot;North Maluku&quot;],[&quot;North Sumatra&quot;,&quot;North Sumatra&quot;],[&quot;Nusa Tenggara Barat&quot;,&quot;West Nusa Tenggara&quot;],[&quot;Nusa Tenggara Timur&quot;,&quot;East Nusa Tenggara&quot;],[&quot;Papua&quot;,&quot;Papua&quot;],[&quot;Papua Barat&quot;,&quot;West Papua&quot;],[&quot;Riau&quot;,&quot;Riau&quot;],[&quot;South Sumatra&quot;,&quot;South Sumatra&quot;],[&quot;Sulawesi Barat&quot;,&quot;West Sulawesi&quot;],[&quot;Sulawesi Selatan&quot;,&quot;South Sulawesi&quot;],[&quot;Sulawesi Tengah&quot;,&quot;Central Sulawesi&quot;],[&quot;Sulawesi Tenggara&quot;,&quot;Southeast Sulawesi&quot;],[&quot;Sulawesi Utara&quot;,&quot;North Sulawesi&quot;],[&quot;West Sumatra&quot;,&quot;West Sumatra&quot;],[&quot;Yogyakarta&quot;,&quot;Yogyakarta&quot;]]">
                Indonesia</option>
              <option value="Iraq" data-provinces="[]">Iraq</option>
              <option value="Ireland"
                data-provinces="[[&quot;Carlow&quot;,&quot;Carlow&quot;],[&quot;Cavan&quot;,&quot;Cavan&quot;],[&quot;Clare&quot;,&quot;Clare&quot;],[&quot;Cork&quot;,&quot;Cork&quot;],[&quot;Donegal&quot;,&quot;Donegal&quot;],[&quot;Dublin&quot;,&quot;Dublin&quot;],[&quot;Galway&quot;,&quot;Galway&quot;],[&quot;Kerry&quot;,&quot;Kerry&quot;],[&quot;Kildare&quot;,&quot;Kildare&quot;],[&quot;Kilkenny&quot;,&quot;Kilkenny&quot;],[&quot;Laois&quot;,&quot;Laois&quot;],[&quot;Leitrim&quot;,&quot;Leitrim&quot;],[&quot;Limerick&quot;,&quot;Limerick&quot;],[&quot;Longford&quot;,&quot;Longford&quot;],[&quot;Louth&quot;,&quot;Louth&quot;],[&quot;Mayo&quot;,&quot;Mayo&quot;],[&quot;Meath&quot;,&quot;Meath&quot;],[&quot;Monaghan&quot;,&quot;Monaghan&quot;],[&quot;Offaly&quot;,&quot;Offaly&quot;],[&quot;Roscommon&quot;,&quot;Roscommon&quot;],[&quot;Sligo&quot;,&quot;Sligo&quot;],[&quot;Tipperary&quot;,&quot;Tipperary&quot;],[&quot;Waterford&quot;,&quot;Waterford&quot;],[&quot;Westmeath&quot;,&quot;Westmeath&quot;],[&quot;Wexford&quot;,&quot;Wexford&quot;],[&quot;Wicklow&quot;,&quot;Wicklow&quot;]]">
                Ireland</option>
              <option value="Isle Of Man" data-provinces="[]">Isle of Man</option>
              <option value="Israel" data-provinces="[]">Israel</option>
              <option value="Italy"
                data-provinces="[[&quot;Agrigento&quot;,&quot;Agrigento&quot;],[&quot;Alessandria&quot;,&quot;Alessandria&quot;],[&quot;Ancona&quot;,&quot;Ancona&quot;],[&quot;Aosta&quot;,&quot;Aosta Valley&quot;],[&quot;Arezzo&quot;,&quot;Arezzo&quot;],[&quot;Ascoli Piceno&quot;,&quot;Ascoli Piceno&quot;],[&quot;Asti&quot;,&quot;Asti&quot;],[&quot;Avellino&quot;,&quot;Avellino&quot;],[&quot;Bari&quot;,&quot;Bari&quot;],[&quot;Barletta-Andria-Trani&quot;,&quot;Barletta-Andria-Trani&quot;],[&quot;Belluno&quot;,&quot;Belluno&quot;],[&quot;Benevento&quot;,&quot;Benevento&quot;],[&quot;Bergamo&quot;,&quot;Bergamo&quot;],[&quot;Biella&quot;,&quot;Biella&quot;],[&quot;Bologna&quot;,&quot;Bologna&quot;],[&quot;Bolzano&quot;,&quot;South Tyrol&quot;],[&quot;Brescia&quot;,&quot;Brescia&quot;],[&quot;Brindisi&quot;,&quot;Brindisi&quot;],[&quot;Cagliari&quot;,&quot;Cagliari&quot;],[&quot;Caltanissetta&quot;,&quot;Caltanissetta&quot;],[&quot;Campobasso&quot;,&quot;Campobasso&quot;],[&quot;Carbonia-Iglesias&quot;,&quot;Carbonia-Iglesias&quot;],[&quot;Caserta&quot;,&quot;Caserta&quot;],[&quot;Catania&quot;,&quot;Catania&quot;],[&quot;Catanzaro&quot;,&quot;Catanzaro&quot;],[&quot;Chieti&quot;,&quot;Chieti&quot;],[&quot;Como&quot;,&quot;Como&quot;],[&quot;Cosenza&quot;,&quot;Cosenza&quot;],[&quot;Cremona&quot;,&quot;Cremona&quot;],[&quot;Crotone&quot;,&quot;Crotone&quot;],[&quot;Cuneo&quot;,&quot;Cuneo&quot;],[&quot;Enna&quot;,&quot;Enna&quot;],[&quot;Fermo&quot;,&quot;Fermo&quot;],[&quot;Ferrara&quot;,&quot;Ferrara&quot;],[&quot;Firenze&quot;,&quot;Florence&quot;],[&quot;Foggia&quot;,&quot;Foggia&quot;],[&quot;Forlì-Cesena&quot;,&quot;Forlì-Cesena&quot;],[&quot;Frosinone&quot;,&quot;Frosinone&quot;],[&quot;Genova&quot;,&quot;Genoa&quot;],[&quot;Gorizia&quot;,&quot;Gorizia&quot;],[&quot;Grosseto&quot;,&quot;Grosseto&quot;],[&quot;Imperia&quot;,&quot;Imperia&quot;],[&quot;Isernia&quot;,&quot;Isernia&quot;],[&quot;L'Aquila&quot;,&quot;L’Aquila&quot;],[&quot;La Spezia&quot;,&quot;La Spezia&quot;],[&quot;Latina&quot;,&quot;Latina&quot;],[&quot;Lecce&quot;,&quot;Lecce&quot;],[&quot;Lecco&quot;,&quot;Lecco&quot;],[&quot;Livorno&quot;,&quot;Livorno&quot;],[&quot;Lodi&quot;,&quot;Lodi&quot;],[&quot;Lucca&quot;,&quot;Lucca&quot;],[&quot;Macerata&quot;,&quot;Macerata&quot;],[&quot;Mantova&quot;,&quot;Mantua&quot;],[&quot;Massa-Carrara&quot;,&quot;Massa and Carrara&quot;],[&quot;Matera&quot;,&quot;Matera&quot;],[&quot;Medio Campidano&quot;,&quot;Medio Campidano&quot;],[&quot;Messina&quot;,&quot;Messina&quot;],[&quot;Milano&quot;,&quot;Milan&quot;],[&quot;Modena&quot;,&quot;Modena&quot;],[&quot;Monza e Brianza&quot;,&quot;Monza and Brianza&quot;],[&quot;Napoli&quot;,&quot;Naples&quot;],[&quot;Novara&quot;,&quot;Novara&quot;],[&quot;Nuoro&quot;,&quot;Nuoro&quot;],[&quot;Ogliastra&quot;,&quot;Ogliastra&quot;],[&quot;Olbia-Tempio&quot;,&quot;Olbia-Tempio&quot;],[&quot;Oristano&quot;,&quot;Oristano&quot;],[&quot;Padova&quot;,&quot;Padua&quot;],[&quot;Palermo&quot;,&quot;Palermo&quot;],[&quot;Parma&quot;,&quot;Parma&quot;],[&quot;Pavia&quot;,&quot;Pavia&quot;],[&quot;Perugia&quot;,&quot;Perugia&quot;],[&quot;Pesaro e Urbino&quot;,&quot;Pesaro and Urbino&quot;],[&quot;Pescara&quot;,&quot;Pescara&quot;],[&quot;Piacenza&quot;,&quot;Piacenza&quot;],[&quot;Pisa&quot;,&quot;Pisa&quot;],[&quot;Pistoia&quot;,&quot;Pistoia&quot;],[&quot;Pordenone&quot;,&quot;Pordenone&quot;],[&quot;Potenza&quot;,&quot;Potenza&quot;],[&quot;Prato&quot;,&quot;Prato&quot;],[&quot;Ragusa&quot;,&quot;Ragusa&quot;],[&quot;Ravenna&quot;,&quot;Ravenna&quot;],[&quot;Reggio Calabria&quot;,&quot;Reggio Calabria&quot;],[&quot;Reggio Emilia&quot;,&quot;Reggio Emilia&quot;],[&quot;Rieti&quot;,&quot;Rieti&quot;],[&quot;Rimini&quot;,&quot;Rimini&quot;],[&quot;Roma&quot;,&quot;Rome&quot;],[&quot;Rovigo&quot;,&quot;Rovigo&quot;],[&quot;Salerno&quot;,&quot;Salerno&quot;],[&quot;Sassari&quot;,&quot;Sassari&quot;],[&quot;Savona&quot;,&quot;Savona&quot;],[&quot;Siena&quot;,&quot;Siena&quot;],[&quot;Siracusa&quot;,&quot;Syracuse&quot;],[&quot;Sondrio&quot;,&quot;Sondrio&quot;],[&quot;Taranto&quot;,&quot;Taranto&quot;],[&quot;Teramo&quot;,&quot;Teramo&quot;],[&quot;Terni&quot;,&quot;Terni&quot;],[&quot;Torino&quot;,&quot;Turin&quot;],[&quot;Trapani&quot;,&quot;Trapani&quot;],[&quot;Trento&quot;,&quot;Trentino&quot;],[&quot;Treviso&quot;,&quot;Treviso&quot;],[&quot;Trieste&quot;,&quot;Trieste&quot;],[&quot;Udine&quot;,&quot;Udine&quot;],[&quot;Varese&quot;,&quot;Varese&quot;],[&quot;Venezia&quot;,&quot;Venice&quot;],[&quot;Verbano-Cusio-Ossola&quot;,&quot;Verbano-Cusio-Ossola&quot;],[&quot;Vercelli&quot;,&quot;Vercelli&quot;],[&quot;Verona&quot;,&quot;Verona&quot;],[&quot;Vibo Valentia&quot;,&quot;Vibo Valentia&quot;],[&quot;Vicenza&quot;,&quot;Vicenza&quot;],[&quot;Viterbo&quot;,&quot;Viterbo&quot;]]">
                Italy</option>
              <option value="Jamaica" data-provinces="[]">Jamaica</option>
              <option value="Japan"
                data-provinces="[[&quot;Aichi&quot;,&quot;Aichi&quot;],[&quot;Akita&quot;,&quot;Akita&quot;],[&quot;Aomori&quot;,&quot;Aomori&quot;],[&quot;Chiba&quot;,&quot;Chiba&quot;],[&quot;Ehime&quot;,&quot;Ehime&quot;],[&quot;Fukui&quot;,&quot;Fukui&quot;],[&quot;Fukuoka&quot;,&quot;Fukuoka&quot;],[&quot;Fukushima&quot;,&quot;Fukushima&quot;],[&quot;Gifu&quot;,&quot;Gifu&quot;],[&quot;Gunma&quot;,&quot;Gunma&quot;],[&quot;Hiroshima&quot;,&quot;Hiroshima&quot;],[&quot;Hokkaidō&quot;,&quot;Hokkaido&quot;],[&quot;Hyōgo&quot;,&quot;Hyogo&quot;],[&quot;Ibaraki&quot;,&quot;Ibaraki&quot;],[&quot;Ishikawa&quot;,&quot;Ishikawa&quot;],[&quot;Iwate&quot;,&quot;Iwate&quot;],[&quot;Kagawa&quot;,&quot;Kagawa&quot;],[&quot;Kagoshima&quot;,&quot;Kagoshima&quot;],[&quot;Kanagawa&quot;,&quot;Kanagawa&quot;],[&quot;Kumamoto&quot;,&quot;Kumamoto&quot;],[&quot;Kyōto&quot;,&quot;Kyoto&quot;],[&quot;Kōchi&quot;,&quot;Kochi&quot;],[&quot;Mie&quot;,&quot;Mie&quot;],[&quot;Miyagi&quot;,&quot;Miyagi&quot;],[&quot;Miyazaki&quot;,&quot;Miyazaki&quot;],[&quot;Nagano&quot;,&quot;Nagano&quot;],[&quot;Nagasaki&quot;,&quot;Nagasaki&quot;],[&quot;Nara&quot;,&quot;Nara&quot;],[&quot;Niigata&quot;,&quot;Niigata&quot;],[&quot;Okayama&quot;,&quot;Okayama&quot;],[&quot;Okinawa&quot;,&quot;Okinawa&quot;],[&quot;Saga&quot;,&quot;Saga&quot;],[&quot;Saitama&quot;,&quot;Saitama&quot;],[&quot;Shiga&quot;,&quot;Shiga&quot;],[&quot;Shimane&quot;,&quot;Shimane&quot;],[&quot;Shizuoka&quot;,&quot;Shizuoka&quot;],[&quot;Tochigi&quot;,&quot;Tochigi&quot;],[&quot;Tokushima&quot;,&quot;Tokushima&quot;],[&quot;Tottori&quot;,&quot;Tottori&quot;],[&quot;Toyama&quot;,&quot;Toyama&quot;],[&quot;Tōkyō&quot;,&quot;Tokyo&quot;],[&quot;Wakayama&quot;,&quot;Wakayama&quot;],[&quot;Yamagata&quot;,&quot;Yamagata&quot;],[&quot;Yamaguchi&quot;,&quot;Yamaguchi&quot;],[&quot;Yamanashi&quot;,&quot;Yamanashi&quot;],[&quot;Ōita&quot;,&quot;Oita&quot;],[&quot;Ōsaka&quot;,&quot;Osaka&quot;]]">
                Japan</option>
              <option value="Jersey" data-provinces="[]">Jersey</option>
              <option value="Jordan" data-provinces="[]">Jordan</option>
              <option value="Kazakhstan" data-provinces="[]">Kazakhstan</option>
              <option value="Kenya" data-provinces="[]">Kenya</option>
              <option value="Kiribati" data-provinces="[]">Kiribati</option>
              <option value="Kosovo" data-provinces="[]">Kosovo</option>
              <option value="Kuwait"
                data-provinces="[[&quot;Al Ahmadi&quot;,&quot;Al Ahmadi&quot;],[&quot;Al Asimah&quot;,&quot;Al Asimah&quot;],[&quot;Al Farwaniyah&quot;,&quot;Al Farwaniyah&quot;],[&quot;Al Jahra&quot;,&quot;Al Jahra&quot;],[&quot;Hawalli&quot;,&quot;Hawalli&quot;],[&quot;Mubarak Al-Kabeer&quot;,&quot;Mubarak Al-Kabeer&quot;]]">
                Kuwait</option>
              <option value="Kyrgyzstan" data-provinces="[]">Kyrgyzstan</option>
              <option value="Lao People's Democratic Republic" data-provinces="[]">Laos</option>
              <option value="Latvia" data-provinces="[]">Latvia</option>
              <option value="Lebanon" data-provinces="[]">Lebanon</option>
              <option value="Lesotho" data-provinces="[]">Lesotho</option>
              <option value="Liberia" data-provinces="[]">Liberia</option>
              <option value="Libyan Arab Jamahiriya" data-provinces="[]">Libya</option>
              <option value="Liechtenstein" data-provinces="[]">Liechtenstein</option>
              <option value="Lithuania" data-provinces="[]">Lithuania</option>
              <option value="Luxembourg" data-provinces="[]">Luxembourg</option>
              <option value="Macao" data-provinces="[]">Macao SAR</option>
              <option value="Madagascar" data-provinces="[]">Madagascar</option>
              <option value="Malawi" data-provinces="[]">Malawi</option>
              <option value="Malaysia"
                data-provinces="[[&quot;Johor&quot;,&quot;Johor&quot;],[&quot;Kedah&quot;,&quot;Kedah&quot;],[&quot;Kelantan&quot;,&quot;Kelantan&quot;],[&quot;Kuala Lumpur&quot;,&quot;Kuala Lumpur&quot;],[&quot;Labuan&quot;,&quot;Labuan&quot;],[&quot;Melaka&quot;,&quot;Malacca&quot;],[&quot;Negeri Sembilan&quot;,&quot;Negeri Sembilan&quot;],[&quot;Pahang&quot;,&quot;Pahang&quot;],[&quot;Penang&quot;,&quot;Penang&quot;],[&quot;Perak&quot;,&quot;Perak&quot;],[&quot;Perlis&quot;,&quot;Perlis&quot;],[&quot;Putrajaya&quot;,&quot;Putrajaya&quot;],[&quot;Sabah&quot;,&quot;Sabah&quot;],[&quot;Sarawak&quot;,&quot;Sarawak&quot;],[&quot;Selangor&quot;,&quot;Selangor&quot;],[&quot;Terengganu&quot;,&quot;Terengganu&quot;]]">
                Malaysia</option>
              <option value="Maldives" data-provinces="[]">Maldives</option>
              <option value="Mali" data-provinces="[]">Mali</option>
              <option value="Malta" data-provinces="[]">Malta</option>
              <option value="Martinique" data-provinces="[]">Martinique</option>
              <option value="Mauritania" data-provinces="[]">Mauritania</option>
              <option value="Mauritius" data-provinces="[]">Mauritius</option>
              <option value="Mayotte" data-provinces="[]">Mayotte</option>
              <option value="Mexico"
                data-provinces="[[&quot;Aguascalientes&quot;,&quot;Aguascalientes&quot;],[&quot;Baja California&quot;,&quot;Baja California&quot;],[&quot;Baja California Sur&quot;,&quot;Baja California Sur&quot;],[&quot;Campeche&quot;,&quot;Campeche&quot;],[&quot;Chiapas&quot;,&quot;Chiapas&quot;],[&quot;Chihuahua&quot;,&quot;Chihuahua&quot;],[&quot;Ciudad de México&quot;,&quot;Ciudad de Mexico&quot;],[&quot;Coahuila&quot;,&quot;Coahuila&quot;],[&quot;Colima&quot;,&quot;Colima&quot;],[&quot;Durango&quot;,&quot;Durango&quot;],[&quot;Guanajuato&quot;,&quot;Guanajuato&quot;],[&quot;Guerrero&quot;,&quot;Guerrero&quot;],[&quot;Hidalgo&quot;,&quot;Hidalgo&quot;],[&quot;Jalisco&quot;,&quot;Jalisco&quot;],[&quot;Michoacán&quot;,&quot;Michoacán&quot;],[&quot;Morelos&quot;,&quot;Morelos&quot;],[&quot;México&quot;,&quot;Mexico State&quot;],[&quot;Nayarit&quot;,&quot;Nayarit&quot;],[&quot;Nuevo León&quot;,&quot;Nuevo León&quot;],[&quot;Oaxaca&quot;,&quot;Oaxaca&quot;],[&quot;Puebla&quot;,&quot;Puebla&quot;],[&quot;Querétaro&quot;,&quot;Querétaro&quot;],[&quot;Quintana Roo&quot;,&quot;Quintana Roo&quot;],[&quot;San Luis Potosí&quot;,&quot;San Luis Potosí&quot;],[&quot;Sinaloa&quot;,&quot;Sinaloa&quot;],[&quot;Sonora&quot;,&quot;Sonora&quot;],[&quot;Tabasco&quot;,&quot;Tabasco&quot;],[&quot;Tamaulipas&quot;,&quot;Tamaulipas&quot;],[&quot;Tlaxcala&quot;,&quot;Tlaxcala&quot;],[&quot;Veracruz&quot;,&quot;Veracruz&quot;],[&quot;Yucatán&quot;,&quot;Yucatán&quot;],[&quot;Zacatecas&quot;,&quot;Zacatecas&quot;]]">
                Mexico</option>
              <option value="Moldova, Republic of" data-provinces="[]">Moldova</option>
              <option value="Monaco" data-provinces="[]">Monaco</option>
              <option value="Mongolia" data-provinces="[]">Mongolia</option>
              <option value="Montenegro" data-provinces="[]">Montenegro</option>
              <option value="Montserrat" data-provinces="[]">Montserrat</option>
              <option value="Morocco" data-provinces="[]">Morocco</option>
              <option value="Mozambique" data-provinces="[]">Mozambique</option>
              <option value="Myanmar" data-provinces="[]">Myanmar (Burma)</option>
              <option value="Namibia" data-provinces="[]">Namibia</option>
              <option value="Nauru" data-provinces="[]">Nauru</option>
              <option value="Nepal" data-provinces="[]">Nepal</option>
              <option value="Netherlands" data-provinces="[]">Netherlands</option>
              <option value="New Caledonia" data-provinces="[]">New Caledonia</option>
              <option value="New Zealand"
                data-provinces="[[&quot;Auckland&quot;,&quot;Auckland&quot;],[&quot;Bay of Plenty&quot;,&quot;Bay of Plenty&quot;],[&quot;Canterbury&quot;,&quot;Canterbury&quot;],[&quot;Chatham Islands&quot;,&quot;Chatham Islands&quot;],[&quot;Gisborne&quot;,&quot;Gisborne&quot;],[&quot;Hawke's Bay&quot;,&quot;Hawke’s Bay&quot;],[&quot;Manawatu-Wanganui&quot;,&quot;Manawatū-Whanganui&quot;],[&quot;Marlborough&quot;,&quot;Marlborough&quot;],[&quot;Nelson&quot;,&quot;Nelson&quot;],[&quot;Northland&quot;,&quot;Northland&quot;],[&quot;Otago&quot;,&quot;Otago&quot;],[&quot;Southland&quot;,&quot;Southland&quot;],[&quot;Taranaki&quot;,&quot;Taranaki&quot;],[&quot;Tasman&quot;,&quot;Tasman&quot;],[&quot;Waikato&quot;,&quot;Waikato&quot;],[&quot;Wellington&quot;,&quot;Wellington&quot;],[&quot;West Coast&quot;,&quot;West Coast&quot;]]">
                New Zealand</option>
              <option value="Nicaragua" data-provinces="[]">Nicaragua</option>
              <option value="Niger" data-provinces="[]">Niger</option>
              <option value="Nigeria"
                data-provinces="[[&quot;Abia&quot;,&quot;Abia&quot;],[&quot;Abuja Federal Capital Territory&quot;,&quot;Federal Capital Territory&quot;],[&quot;Adamawa&quot;,&quot;Adamawa&quot;],[&quot;Akwa Ibom&quot;,&quot;Akwa Ibom&quot;],[&quot;Anambra&quot;,&quot;Anambra&quot;],[&quot;Bauchi&quot;,&quot;Bauchi&quot;],[&quot;Bayelsa&quot;,&quot;Bayelsa&quot;],[&quot;Benue&quot;,&quot;Benue&quot;],[&quot;Borno&quot;,&quot;Borno&quot;],[&quot;Cross River&quot;,&quot;Cross River&quot;],[&quot;Delta&quot;,&quot;Delta&quot;],[&quot;Ebonyi&quot;,&quot;Ebonyi&quot;],[&quot;Edo&quot;,&quot;Edo&quot;],[&quot;Ekiti&quot;,&quot;Ekiti&quot;],[&quot;Enugu&quot;,&quot;Enugu&quot;],[&quot;Gombe&quot;,&quot;Gombe&quot;],[&quot;Imo&quot;,&quot;Imo&quot;],[&quot;Jigawa&quot;,&quot;Jigawa&quot;],[&quot;Kaduna&quot;,&quot;Kaduna&quot;],[&quot;Kano&quot;,&quot;Kano&quot;],[&quot;Katsina&quot;,&quot;Katsina&quot;],[&quot;Kebbi&quot;,&quot;Kebbi&quot;],[&quot;Kogi&quot;,&quot;Kogi&quot;],[&quot;Kwara&quot;,&quot;Kwara&quot;],[&quot;Lagos&quot;,&quot;Lagos&quot;],[&quot;Nasarawa&quot;,&quot;Nasarawa&quot;],[&quot;Niger&quot;,&quot;Niger&quot;],[&quot;Ogun&quot;,&quot;Ogun&quot;],[&quot;Ondo&quot;,&quot;Ondo&quot;],[&quot;Osun&quot;,&quot;Osun&quot;],[&quot;Oyo&quot;,&quot;Oyo&quot;],[&quot;Plateau&quot;,&quot;Plateau&quot;],[&quot;Rivers&quot;,&quot;Rivers&quot;],[&quot;Sokoto&quot;,&quot;Sokoto&quot;],[&quot;Taraba&quot;,&quot;Taraba&quot;],[&quot;Yobe&quot;,&quot;Yobe&quot;],[&quot;Zamfara&quot;,&quot;Zamfara&quot;]]">
                Nigeria</option>
              <option value="Niue" data-provinces="[]">Niue</option>
              <option value="Norfolk Island" data-provinces="[]">Norfolk Island</option>
              <option value="North Macedonia" data-provinces="[]">North Macedonia</option>
              <option value="Norway" data-provinces="[]">Norway</option>
              <option value="Oman" data-provinces="[]">Oman</option>
              <option value="Pakistan" data-provinces="[]">Pakistan</option>
              <option value="Palestinian Territory, Occupied" data-provinces="[]">Palestinian Territories</option>
              <option value="Panama"
                data-provinces="[[&quot;Bocas del Toro&quot;,&quot;Bocas del Toro&quot;],[&quot;Chiriquí&quot;,&quot;Chiriquí&quot;],[&quot;Coclé&quot;,&quot;Coclé&quot;],[&quot;Colón&quot;,&quot;Colón&quot;],[&quot;Darién&quot;,&quot;Darién&quot;],[&quot;Emberá&quot;,&quot;Emberá&quot;],[&quot;Herrera&quot;,&quot;Herrera&quot;],[&quot;Kuna Yala&quot;,&quot;Guna Yala&quot;],[&quot;Los Santos&quot;,&quot;Los Santos&quot;],[&quot;Ngöbe-Buglé&quot;,&quot;Ngöbe-Buglé&quot;],[&quot;Panamá&quot;,&quot;Panamá&quot;],[&quot;Panamá Oeste&quot;,&quot;West Panamá&quot;],[&quot;Veraguas&quot;,&quot;Veraguas&quot;]]">
                Panama</option>
              <option value="Papua New Guinea" data-provinces="[]">Papua New Guinea</option>
              <option value="Paraguay" data-provinces="[]">Paraguay</option>
              <option value="Peru"
                data-provinces="[[&quot;Amazonas&quot;,&quot;Amazonas&quot;],[&quot;Apurímac&quot;,&quot;Apurímac&quot;],[&quot;Arequipa&quot;,&quot;Arequipa&quot;],[&quot;Ayacucho&quot;,&quot;Ayacucho&quot;],[&quot;Cajamarca&quot;,&quot;Cajamarca&quot;],[&quot;Callao&quot;,&quot;El Callao&quot;],[&quot;Cuzco&quot;,&quot;Cusco&quot;],[&quot;Huancavelica&quot;,&quot;Huancavelica&quot;],[&quot;Huánuco&quot;,&quot;Huánuco&quot;],[&quot;Ica&quot;,&quot;Ica&quot;],[&quot;Junín&quot;,&quot;Junín&quot;],[&quot;La Libertad&quot;,&quot;La Libertad&quot;],[&quot;Lambayeque&quot;,&quot;Lambayeque&quot;],[&quot;Lima (departamento)&quot;,&quot;Lima (Department)&quot;],[&quot;Lima (provincia)&quot;,&quot;Lima (Metropolitan)&quot;],[&quot;Loreto&quot;,&quot;Loreto&quot;],[&quot;Madre de Dios&quot;,&quot;Madre de Dios&quot;],[&quot;Moquegua&quot;,&quot;Moquegua&quot;],[&quot;Pasco&quot;,&quot;Pasco&quot;],[&quot;Piura&quot;,&quot;Piura&quot;],[&quot;Puno&quot;,&quot;Puno&quot;],[&quot;San Martín&quot;,&quot;San Martín&quot;],[&quot;Tacna&quot;,&quot;Tacna&quot;],[&quot;Tumbes&quot;,&quot;Tumbes&quot;],[&quot;Ucayali&quot;,&quot;Ucayali&quot;],[&quot;Áncash&quot;,&quot;Ancash&quot;]]">
                Peru</option>
              <option value="Philippines"
                data-provinces="[[&quot;Abra&quot;,&quot;Abra&quot;],[&quot;Agusan del Norte&quot;,&quot;Agusan del Norte&quot;],[&quot;Agusan del Sur&quot;,&quot;Agusan del Sur&quot;],[&quot;Aklan&quot;,&quot;Aklan&quot;],[&quot;Albay&quot;,&quot;Albay&quot;],[&quot;Antique&quot;,&quot;Antique&quot;],[&quot;Apayao&quot;,&quot;Apayao&quot;],[&quot;Aurora&quot;,&quot;Aurora&quot;],[&quot;Basilan&quot;,&quot;Basilan&quot;],[&quot;Bataan&quot;,&quot;Bataan&quot;],[&quot;Batanes&quot;,&quot;Batanes&quot;],[&quot;Batangas&quot;,&quot;Batangas&quot;],[&quot;Benguet&quot;,&quot;Benguet&quot;],[&quot;Biliran&quot;,&quot;Biliran&quot;],[&quot;Bohol&quot;,&quot;Bohol&quot;],[&quot;Bukidnon&quot;,&quot;Bukidnon&quot;],[&quot;Bulacan&quot;,&quot;Bulacan&quot;],[&quot;Cagayan&quot;,&quot;Cagayan&quot;],[&quot;Camarines Norte&quot;,&quot;Camarines Norte&quot;],[&quot;Camarines Sur&quot;,&quot;Camarines Sur&quot;],[&quot;Camiguin&quot;,&quot;Camiguin&quot;],[&quot;Capiz&quot;,&quot;Capiz&quot;],[&quot;Catanduanes&quot;,&quot;Catanduanes&quot;],[&quot;Cavite&quot;,&quot;Cavite&quot;],[&quot;Cebu&quot;,&quot;Cebu&quot;],[&quot;Cotabato&quot;,&quot;Cotabato&quot;],[&quot;Davao Occidental&quot;,&quot;Davao Occidental&quot;],[&quot;Davao Oriental&quot;,&quot;Davao Oriental&quot;],[&quot;Davao de Oro&quot;,&quot;Compostela Valley&quot;],[&quot;Davao del Norte&quot;,&quot;Davao del Norte&quot;],[&quot;Davao del Sur&quot;,&quot;Davao del Sur&quot;],[&quot;Dinagat Islands&quot;,&quot;Dinagat Islands&quot;],[&quot;Eastern Samar&quot;,&quot;Eastern Samar&quot;],[&quot;Guimaras&quot;,&quot;Guimaras&quot;],[&quot;Ifugao&quot;,&quot;Ifugao&quot;],[&quot;Ilocos Norte&quot;,&quot;Ilocos Norte&quot;],[&quot;Ilocos Sur&quot;,&quot;Ilocos Sur&quot;],[&quot;Iloilo&quot;,&quot;Iloilo&quot;],[&quot;Isabela&quot;,&quot;Isabela&quot;],[&quot;Kalinga&quot;,&quot;Kalinga&quot;],[&quot;La Union&quot;,&quot;La Union&quot;],[&quot;Laguna&quot;,&quot;Laguna&quot;],[&quot;Lanao del Norte&quot;,&quot;Lanao del Norte&quot;],[&quot;Lanao del Sur&quot;,&quot;Lanao del Sur&quot;],[&quot;Leyte&quot;,&quot;Leyte&quot;],[&quot;Maguindanao&quot;,&quot;Maguindanao&quot;],[&quot;Marinduque&quot;,&quot;Marinduque&quot;],[&quot;Masbate&quot;,&quot;Masbate&quot;],[&quot;Metro Manila&quot;,&quot;Metro Manila&quot;],[&quot;Misamis Occidental&quot;,&quot;Misamis Occidental&quot;],[&quot;Misamis Oriental&quot;,&quot;Misamis Oriental&quot;],[&quot;Mountain Province&quot;,&quot;Mountain&quot;],[&quot;Negros Occidental&quot;,&quot;Negros Occidental&quot;],[&quot;Negros Oriental&quot;,&quot;Negros Oriental&quot;],[&quot;Northern Samar&quot;,&quot;Northern Samar&quot;],[&quot;Nueva Ecija&quot;,&quot;Nueva Ecija&quot;],[&quot;Nueva Vizcaya&quot;,&quot;Nueva Vizcaya&quot;],[&quot;Occidental Mindoro&quot;,&quot;Occidental Mindoro&quot;],[&quot;Oriental Mindoro&quot;,&quot;Oriental Mindoro&quot;],[&quot;Palawan&quot;,&quot;Palawan&quot;],[&quot;Pampanga&quot;,&quot;Pampanga&quot;],[&quot;Pangasinan&quot;,&quot;Pangasinan&quot;],[&quot;Quezon&quot;,&quot;Quezon&quot;],[&quot;Quirino&quot;,&quot;Quirino&quot;],[&quot;Rizal&quot;,&quot;Rizal&quot;],[&quot;Romblon&quot;,&quot;Romblon&quot;],[&quot;Samar&quot;,&quot;Samar&quot;],[&quot;Sarangani&quot;,&quot;Sarangani&quot;],[&quot;Siquijor&quot;,&quot;Siquijor&quot;],[&quot;Sorsogon&quot;,&quot;Sorsogon&quot;],[&quot;South Cotabato&quot;,&quot;South Cotabato&quot;],[&quot;Southern Leyte&quot;,&quot;Southern Leyte&quot;],[&quot;Sultan Kudarat&quot;,&quot;Sultan Kudarat&quot;],[&quot;Sulu&quot;,&quot;Sulu&quot;],[&quot;Surigao del Norte&quot;,&quot;Surigao del Norte&quot;],[&quot;Surigao del Sur&quot;,&quot;Surigao del Sur&quot;],[&quot;Tarlac&quot;,&quot;Tarlac&quot;],[&quot;Tawi-Tawi&quot;,&quot;Tawi-Tawi&quot;],[&quot;Zambales&quot;,&quot;Zambales&quot;],[&quot;Zamboanga Sibugay&quot;,&quot;Zamboanga Sibugay&quot;],[&quot;Zamboanga del Norte&quot;,&quot;Zamboanga del Norte&quot;],[&quot;Zamboanga del Sur&quot;,&quot;Zamboanga del Sur&quot;]]">
                Philippines</option>
              <option value="Pitcairn" data-provinces="[]">Pitcairn Islands</option>
              <option value="Poland" data-provinces="[]">Poland</option>
              <option value="Portugal"
                data-provinces="[[&quot;Aveiro&quot;,&quot;Aveiro&quot;],[&quot;Açores&quot;,&quot;Azores&quot;],[&quot;Beja&quot;,&quot;Beja&quot;],[&quot;Braga&quot;,&quot;Braga&quot;],[&quot;Bragança&quot;,&quot;Bragança&quot;],[&quot;Castelo Branco&quot;,&quot;Castelo Branco&quot;],[&quot;Coimbra&quot;,&quot;Coimbra&quot;],[&quot;Faro&quot;,&quot;Faro&quot;],[&quot;Guarda&quot;,&quot;Guarda&quot;],[&quot;Leiria&quot;,&quot;Leiria&quot;],[&quot;Lisboa&quot;,&quot;Lisbon&quot;],[&quot;Madeira&quot;,&quot;Madeira&quot;],[&quot;Portalegre&quot;,&quot;Portalegre&quot;],[&quot;Porto&quot;,&quot;Porto&quot;],[&quot;Santarém&quot;,&quot;Santarém&quot;],[&quot;Setúbal&quot;,&quot;Setúbal&quot;],[&quot;Viana do Castelo&quot;,&quot;Viana do Castelo&quot;],[&quot;Vila Real&quot;,&quot;Vila Real&quot;],[&quot;Viseu&quot;,&quot;Viseu&quot;],[&quot;Évora&quot;,&quot;Évora&quot;]]">
                Portugal</option>
              <option value="Qatar" data-provinces="[]">Qatar</option>
              <option value="Reunion" data-provinces="[]">Réunion</option>
              <option value="Romania"
                data-provinces="[[&quot;Alba&quot;,&quot;Alba&quot;],[&quot;Arad&quot;,&quot;Arad&quot;],[&quot;Argeș&quot;,&quot;Argeș&quot;],[&quot;Bacău&quot;,&quot;Bacău&quot;],[&quot;Bihor&quot;,&quot;Bihor&quot;],[&quot;Bistrița-Năsăud&quot;,&quot;Bistriţa-Năsăud&quot;],[&quot;Botoșani&quot;,&quot;Botoşani&quot;],[&quot;Brașov&quot;,&quot;Braşov&quot;],[&quot;Brăila&quot;,&quot;Brăila&quot;],[&quot;București&quot;,&quot;Bucharest&quot;],[&quot;Buzău&quot;,&quot;Buzău&quot;],[&quot;Caraș-Severin&quot;,&quot;Caraș-Severin&quot;],[&quot;Cluj&quot;,&quot;Cluj&quot;],[&quot;Constanța&quot;,&quot;Constanța&quot;],[&quot;Covasna&quot;,&quot;Covasna&quot;],[&quot;Călărași&quot;,&quot;Călărași&quot;],[&quot;Dolj&quot;,&quot;Dolj&quot;],[&quot;Dâmbovița&quot;,&quot;Dâmbovița&quot;],[&quot;Galați&quot;,&quot;Galați&quot;],[&quot;Giurgiu&quot;,&quot;Giurgiu&quot;],[&quot;Gorj&quot;,&quot;Gorj&quot;],[&quot;Harghita&quot;,&quot;Harghita&quot;],[&quot;Hunedoara&quot;,&quot;Hunedoara&quot;],[&quot;Ialomița&quot;,&quot;Ialomița&quot;],[&quot;Iași&quot;,&quot;Iași&quot;],[&quot;Ilfov&quot;,&quot;Ilfov&quot;],[&quot;Maramureș&quot;,&quot;Maramureş&quot;],[&quot;Mehedinți&quot;,&quot;Mehedinți&quot;],[&quot;Mureș&quot;,&quot;Mureş&quot;],[&quot;Neamț&quot;,&quot;Neamţ&quot;],[&quot;Olt&quot;,&quot;Olt&quot;],[&quot;Prahova&quot;,&quot;Prahova&quot;],[&quot;Satu Mare&quot;,&quot;Satu Mare&quot;],[&quot;Sibiu&quot;,&quot;Sibiu&quot;],[&quot;Suceava&quot;,&quot;Suceava&quot;],[&quot;Sălaj&quot;,&quot;Sălaj&quot;],[&quot;Teleorman&quot;,&quot;Teleorman&quot;],[&quot;Timiș&quot;,&quot;Timiș&quot;],[&quot;Tulcea&quot;,&quot;Tulcea&quot;],[&quot;Vaslui&quot;,&quot;Vaslui&quot;],[&quot;Vrancea&quot;,&quot;Vrancea&quot;],[&quot;Vâlcea&quot;,&quot;Vâlcea&quot;]]">
                Romania</option>
              <option value="Russia"
                data-provinces="[[&quot;Altai Krai&quot;,&quot;Altai Krai&quot;],[&quot;Altai Republic&quot;,&quot;Altai&quot;],[&quot;Amur Oblast&quot;,&quot;Amur&quot;],[&quot;Arkhangelsk Oblast&quot;,&quot;Arkhangelsk&quot;],[&quot;Astrakhan Oblast&quot;,&quot;Astrakhan&quot;],[&quot;Belgorod Oblast&quot;,&quot;Belgorod&quot;],[&quot;Bryansk Oblast&quot;,&quot;Bryansk&quot;],[&quot;Chechen Republic&quot;,&quot;Chechen&quot;],[&quot;Chelyabinsk Oblast&quot;,&quot;Chelyabinsk&quot;],[&quot;Chukotka Autonomous Okrug&quot;,&quot;Chukotka Okrug&quot;],[&quot;Chuvash Republic&quot;,&quot;Chuvash&quot;],[&quot;Irkutsk Oblast&quot;,&quot;Irkutsk&quot;],[&quot;Ivanovo Oblast&quot;,&quot;Ivanovo&quot;],[&quot;Jewish Autonomous Oblast&quot;,&quot;Jewish&quot;],[&quot;Kabardino-Balkarian Republic&quot;,&quot;Kabardino-Balkar&quot;],[&quot;Kaliningrad Oblast&quot;,&quot;Kaliningrad&quot;],[&quot;Kaluga Oblast&quot;,&quot;Kaluga&quot;],[&quot;Kamchatka Krai&quot;,&quot;Kamchatka Krai&quot;],[&quot;Karachay–Cherkess Republic&quot;,&quot;Karachay-Cherkess&quot;],[&quot;Kemerovo Oblast&quot;,&quot;Kemerovo&quot;],[&quot;Khabarovsk Krai&quot;,&quot;Khabarovsk Krai&quot;],[&quot;Khanty-Mansi Autonomous Okrug&quot;,&quot;Khanty-Mansi&quot;],[&quot;Kirov Oblast&quot;,&quot;Kirov&quot;],[&quot;Komi Republic&quot;,&quot;Komi&quot;],[&quot;Kostroma Oblast&quot;,&quot;Kostroma&quot;],[&quot;Krasnodar Krai&quot;,&quot;Krasnodar Krai&quot;],[&quot;Krasnoyarsk Krai&quot;,&quot;Krasnoyarsk Krai&quot;],[&quot;Kurgan Oblast&quot;,&quot;Kurgan&quot;],[&quot;Kursk Oblast&quot;,&quot;Kursk&quot;],[&quot;Leningrad Oblast&quot;,&quot;Leningrad&quot;],[&quot;Lipetsk Oblast&quot;,&quot;Lipetsk&quot;],[&quot;Magadan Oblast&quot;,&quot;Magadan&quot;],[&quot;Mari El Republic&quot;,&quot;Mari El&quot;],[&quot;Moscow&quot;,&quot;Moscow&quot;],[&quot;Moscow Oblast&quot;,&quot;Moscow Province&quot;],[&quot;Murmansk Oblast&quot;,&quot;Murmansk&quot;],[&quot;Nizhny Novgorod Oblast&quot;,&quot;Nizhny Novgorod&quot;],[&quot;Novgorod Oblast&quot;,&quot;Novgorod&quot;],[&quot;Novosibirsk Oblast&quot;,&quot;Novosibirsk&quot;],[&quot;Omsk Oblast&quot;,&quot;Omsk&quot;],[&quot;Orenburg Oblast&quot;,&quot;Orenburg&quot;],[&quot;Oryol Oblast&quot;,&quot;Oryol&quot;],[&quot;Penza Oblast&quot;,&quot;Penza&quot;],[&quot;Perm Krai&quot;,&quot;Perm Krai&quot;],[&quot;Primorsky Krai&quot;,&quot;Primorsky Krai&quot;],[&quot;Pskov Oblast&quot;,&quot;Pskov&quot;],[&quot;Republic of Adygeya&quot;,&quot;Adygea&quot;],[&quot;Republic of Bashkortostan&quot;,&quot;Bashkortostan&quot;],[&quot;Republic of Buryatia&quot;,&quot;Buryat&quot;],[&quot;Republic of Dagestan&quot;,&quot;Dagestan&quot;],[&quot;Republic of Ingushetia&quot;,&quot;Ingushetia&quot;],[&quot;Republic of Kalmykia&quot;,&quot;Kalmykia&quot;],[&quot;Republic of Karelia&quot;,&quot;Karelia&quot;],[&quot;Republic of Khakassia&quot;,&quot;Khakassia&quot;],[&quot;Republic of Mordovia&quot;,&quot;Mordovia&quot;],[&quot;Republic of North Ossetia–Alania&quot;,&quot;North Ossetia-Alania&quot;],[&quot;Republic of Tatarstan&quot;,&quot;Tatarstan&quot;],[&quot;Rostov Oblast&quot;,&quot;Rostov&quot;],[&quot;Ryazan Oblast&quot;,&quot;Ryazan&quot;],[&quot;Saint Petersburg&quot;,&quot;Saint Petersburg&quot;],[&quot;Sakha Republic (Yakutia)&quot;,&quot;Sakha&quot;],[&quot;Sakhalin Oblast&quot;,&quot;Sakhalin&quot;],[&quot;Samara Oblast&quot;,&quot;Samara&quot;],[&quot;Saratov Oblast&quot;,&quot;Saratov&quot;],[&quot;Smolensk Oblast&quot;,&quot;Smolensk&quot;],[&quot;Stavropol Krai&quot;,&quot;Stavropol Krai&quot;],[&quot;Sverdlovsk Oblast&quot;,&quot;Sverdlovsk&quot;],[&quot;Tambov Oblast&quot;,&quot;Tambov&quot;],[&quot;Tomsk Oblast&quot;,&quot;Tomsk&quot;],[&quot;Tula Oblast&quot;,&quot;Tula&quot;],[&quot;Tver Oblast&quot;,&quot;Tver&quot;],[&quot;Tyumen Oblast&quot;,&quot;Tyumen&quot;],[&quot;Tyva Republic&quot;,&quot;Tuva&quot;],[&quot;Udmurtia&quot;,&quot;Udmurt&quot;],[&quot;Ulyanovsk Oblast&quot;,&quot;Ulyanovsk&quot;],[&quot;Vladimir Oblast&quot;,&quot;Vladimir&quot;],[&quot;Volgograd Oblast&quot;,&quot;Volgograd&quot;],[&quot;Vologda Oblast&quot;,&quot;Vologda&quot;],[&quot;Voronezh Oblast&quot;,&quot;Voronezh&quot;],[&quot;Yamalo-Nenets Autonomous Okrug&quot;,&quot;Yamalo-Nenets Okrug&quot;],[&quot;Yaroslavl Oblast&quot;,&quot;Yaroslavl&quot;],[&quot;Zabaykalsky Krai&quot;,&quot;Zabaykalsky Krai&quot;]]">
                Russia</option>
              <option value="Rwanda" data-provinces="[]">Rwanda</option>
              <option value="Samoa" data-provinces="[]">Samoa</option>
              <option value="San Marino" data-provinces="[]">San Marino</option>
              <option value="Sao Tome And Principe" data-provinces="[]">São Tomé &amp; Príncipe</option>
              <option value="Saudi Arabia" data-provinces="[]">Saudi Arabia</option>
              <option value="Senegal" data-provinces="[]">Senegal</option>
              <option value="Serbia" data-provinces="[]">Serbia</option>
              <option value="Seychelles" data-provinces="[]">Seychelles</option>
              <option value="Sierra Leone" data-provinces="[]">Sierra Leone</option>
              <option value="Singapore" data-provinces="[]">Singapore</option>
              <option value="Sint Maarten" data-provinces="[]">Sint Maarten</option>
              <option value="Slovakia" data-provinces="[]">Slovakia</option>
              <option value="Slovenia" data-provinces="[]">Slovenia</option>
              <option value="Solomon Islands" data-provinces="[]">Solomon Islands</option>
              <option value="Somalia" data-provinces="[]">Somalia</option>
              <option value="South Africa"
                data-provinces="[[&quot;Eastern Cape&quot;,&quot;Eastern Cape&quot;],[&quot;Free State&quot;,&quot;Free State&quot;],[&quot;Gauteng&quot;,&quot;Gauteng&quot;],[&quot;KwaZulu-Natal&quot;,&quot;KwaZulu-Natal&quot;],[&quot;Limpopo&quot;,&quot;Limpopo&quot;],[&quot;Mpumalanga&quot;,&quot;Mpumalanga&quot;],[&quot;North West&quot;,&quot;North West&quot;],[&quot;Northern Cape&quot;,&quot;Northern Cape&quot;],[&quot;Western Cape&quot;,&quot;Western Cape&quot;]]">
                South Africa</option>
              <option value="South Georgia And The South Sandwich Islands" data-provinces="[]">South Georgia &amp; South Sandwich Islands</option>
              <option value="South Korea"
                data-provinces="[[&quot;Busan&quot;,&quot;Busan&quot;],[&quot;Chungbuk&quot;,&quot;North Chungcheong&quot;],[&quot;Chungnam&quot;,&quot;South Chungcheong&quot;],[&quot;Daegu&quot;,&quot;Daegu&quot;],[&quot;Daejeon&quot;,&quot;Daejeon&quot;],[&quot;Gangwon&quot;,&quot;Gangwon&quot;],[&quot;Gwangju&quot;,&quot;Gwangju City&quot;],[&quot;Gyeongbuk&quot;,&quot;North Gyeongsang&quot;],[&quot;Gyeonggi&quot;,&quot;Gyeonggi&quot;],[&quot;Gyeongnam&quot;,&quot;South Gyeongsang&quot;],[&quot;Incheon&quot;,&quot;Incheon&quot;],[&quot;Jeju&quot;,&quot;Jeju&quot;],[&quot;Jeonbuk&quot;,&quot;North Jeolla&quot;],[&quot;Jeonnam&quot;,&quot;South Jeolla&quot;],[&quot;Sejong&quot;,&quot;Sejong&quot;],[&quot;Seoul&quot;,&quot;Seoul&quot;],[&quot;Ulsan&quot;,&quot;Ulsan&quot;]]">
                South Korea</option>
              <option value="South Sudan" data-provinces="[]">South Sudan</option>
              <option value="Spain"
                data-provinces="[[&quot;A Coruña&quot;,&quot;A Coruña&quot;],[&quot;Albacete&quot;,&quot;Albacete&quot;],[&quot;Alicante&quot;,&quot;Alicante&quot;],[&quot;Almería&quot;,&quot;Almería&quot;],[&quot;Asturias&quot;,&quot;Asturias Province&quot;],[&quot;Badajoz&quot;,&quot;Badajoz&quot;],[&quot;Balears&quot;,&quot;Balears Province&quot;],[&quot;Barcelona&quot;,&quot;Barcelona&quot;],[&quot;Burgos&quot;,&quot;Burgos&quot;],[&quot;Cantabria&quot;,&quot;Cantabria Province&quot;],[&quot;Castellón&quot;,&quot;Castellón&quot;],[&quot;Ceuta&quot;,&quot;Ceuta&quot;],[&quot;Ciudad Real&quot;,&quot;Ciudad Real&quot;],[&quot;Cuenca&quot;,&quot;Cuenca&quot;],[&quot;Cáceres&quot;,&quot;Cáceres&quot;],[&quot;Cádiz&quot;,&quot;Cádiz&quot;],[&quot;Córdoba&quot;,&quot;Córdoba&quot;],[&quot;Girona&quot;,&quot;Girona&quot;],[&quot;Granada&quot;,&quot;Granada&quot;],[&quot;Guadalajara&quot;,&quot;Guadalajara&quot;],[&quot;Guipúzcoa&quot;,&quot;Gipuzkoa&quot;],[&quot;Huelva&quot;,&quot;Huelva&quot;],[&quot;Huesca&quot;,&quot;Huesca&quot;],[&quot;Jaén&quot;,&quot;Jaén&quot;],[&quot;La Rioja&quot;,&quot;La Rioja Province&quot;],[&quot;Las Palmas&quot;,&quot;Las Palmas&quot;],[&quot;León&quot;,&quot;León&quot;],[&quot;Lleida&quot;,&quot;Lleida&quot;],[&quot;Lugo&quot;,&quot;Lugo&quot;],[&quot;Madrid&quot;,&quot;Madrid Province&quot;],[&quot;Melilla&quot;,&quot;Melilla&quot;],[&quot;Murcia&quot;,&quot;Murcia&quot;],[&quot;Málaga&quot;,&quot;Málaga&quot;],[&quot;Navarra&quot;,&quot;Navarra&quot;],[&quot;Ourense&quot;,&quot;Ourense&quot;],[&quot;Palencia&quot;,&quot;Palencia&quot;],[&quot;Pontevedra&quot;,&quot;Pontevedra&quot;],[&quot;Salamanca&quot;,&quot;Salamanca&quot;],[&quot;Santa Cruz de Tenerife&quot;,&quot;Santa Cruz de Tenerife&quot;],[&quot;Segovia&quot;,&quot;Segovia&quot;],[&quot;Sevilla&quot;,&quot;Seville&quot;],[&quot;Soria&quot;,&quot;Soria&quot;],[&quot;Tarragona&quot;,&quot;Tarragona&quot;],[&quot;Teruel&quot;,&quot;Teruel&quot;],[&quot;Toledo&quot;,&quot;Toledo&quot;],[&quot;Valencia&quot;,&quot;Valencia&quot;],[&quot;Valladolid&quot;,&quot;Valladolid&quot;],[&quot;Vizcaya&quot;,&quot;Biscay&quot;],[&quot;Zamora&quot;,&quot;Zamora&quot;],[&quot;Zaragoza&quot;,&quot;Zaragoza&quot;],[&quot;Álava&quot;,&quot;Álava&quot;],[&quot;Ávila&quot;,&quot;Ávila&quot;]]">
                Spain</option>
              <option value="Sri Lanka" data-provinces="[]">Sri Lanka</option>
              <option value="Saint Barthélemy" data-provinces="[]">St. Barthélemy</option>
              <option value="Saint Helena" data-provinces="[]">St. Helena</option>
              <option value="Saint Kitts And Nevis" data-provinces="[]">St. Kitts &amp; Nevis</option>
              <option value="Saint Lucia" data-provinces="[]">St. Lucia</option>
              <option value="Saint Martin" data-provinces="[]">St. Martin</option>
              <option value="Saint Pierre And Miquelon" data-provinces="[]">St. Pierre &amp; Miquelon</option>
              <option value="St. Vincent" data-provinces="[]">St. Vincent &amp; Grenadines</option>
              <option value="Sudan" data-provinces="[]">Sudan</option>
              <option value="Suriname" data-provinces="[]">Suriname</option>
              <option value="Svalbard And Jan Mayen" data-provinces="[]">Svalbard &amp; Jan Mayen</option>
              <option value="Sweden" data-provinces="[]">Sweden</option>
              <option value="Switzerland" data-provinces="[]">Switzerland</option>
              <option value="Taiwan" data-provinces="[]">Taiwan</option>
              <option value="Tajikistan" data-provinces="[]">Tajikistan</option>
              <option value="Tanzania, United Republic Of" data-provinces="[]">Tanzania</option>
              <option value="Thailand"
                data-provinces="[[&quot;Amnat Charoen&quot;,&quot;Amnat Charoen&quot;],[&quot;Ang Thong&quot;,&quot;Ang Thong&quot;],[&quot;Bangkok&quot;,&quot;Bangkok&quot;],[&quot;Bueng Kan&quot;,&quot;Bueng Kan&quot;],[&quot;Buriram&quot;,&quot;Buri Ram&quot;],[&quot;Chachoengsao&quot;,&quot;Chachoengsao&quot;],[&quot;Chai Nat&quot;,&quot;Chai Nat&quot;],[&quot;Chaiyaphum&quot;,&quot;Chaiyaphum&quot;],[&quot;Chanthaburi&quot;,&quot;Chanthaburi&quot;],[&quot;Chiang Mai&quot;,&quot;Chiang Mai&quot;],[&quot;Chiang Rai&quot;,&quot;Chiang Rai&quot;],[&quot;Chon Buri&quot;,&quot;Chon Buri&quot;],[&quot;Chumphon&quot;,&quot;Chumphon&quot;],[&quot;Kalasin&quot;,&quot;Kalasin&quot;],[&quot;Kamphaeng Phet&quot;,&quot;Kamphaeng Phet&quot;],[&quot;Kanchanaburi&quot;,&quot;Kanchanaburi&quot;],[&quot;Khon Kaen&quot;,&quot;Khon Kaen&quot;],[&quot;Krabi&quot;,&quot;Krabi&quot;],[&quot;Lampang&quot;,&quot;Lampang&quot;],[&quot;Lamphun&quot;,&quot;Lamphun&quot;],[&quot;Loei&quot;,&quot;Loei&quot;],[&quot;Lopburi&quot;,&quot;Lopburi&quot;],[&quot;Mae Hong Son&quot;,&quot;Mae Hong Son&quot;],[&quot;Maha Sarakham&quot;,&quot;Maha Sarakham&quot;],[&quot;Mukdahan&quot;,&quot;Mukdahan&quot;],[&quot;Nakhon Nayok&quot;,&quot;Nakhon Nayok&quot;],[&quot;Nakhon Pathom&quot;,&quot;Nakhon Pathom&quot;],[&quot;Nakhon Phanom&quot;,&quot;Nakhon Phanom&quot;],[&quot;Nakhon Ratchasima&quot;,&quot;Nakhon Ratchasima&quot;],[&quot;Nakhon Sawan&quot;,&quot;Nakhon Sawan&quot;],[&quot;Nakhon Si Thammarat&quot;,&quot;Nakhon Si Thammarat&quot;],[&quot;Nan&quot;,&quot;Nan&quot;],[&quot;Narathiwat&quot;,&quot;Narathiwat&quot;],[&quot;Nong Bua Lam Phu&quot;,&quot;Nong Bua Lam Phu&quot;],[&quot;Nong Khai&quot;,&quot;Nong Khai&quot;],[&quot;Nonthaburi&quot;,&quot;Nonthaburi&quot;],[&quot;Pathum Thani&quot;,&quot;Pathum Thani&quot;],[&quot;Pattani&quot;,&quot;Pattani&quot;],[&quot;Pattaya&quot;,&quot;Pattaya&quot;],[&quot;Phangnga&quot;,&quot;Phang Nga&quot;],[&quot;Phatthalung&quot;,&quot;Phatthalung&quot;],[&quot;Phayao&quot;,&quot;Phayao&quot;],[&quot;Phetchabun&quot;,&quot;Phetchabun&quot;],[&quot;Phetchaburi&quot;,&quot;Phetchaburi&quot;],[&quot;Phichit&quot;,&quot;Phichit&quot;],[&quot;Phitsanulok&quot;,&quot;Phitsanulok&quot;],[&quot;Phra Nakhon Si Ayutthaya&quot;,&quot;Phra Nakhon Si Ayutthaya&quot;],[&quot;Phrae&quot;,&quot;Phrae&quot;],[&quot;Phuket&quot;,&quot;Phuket&quot;],[&quot;Prachin Buri&quot;,&quot;Prachin Buri&quot;],[&quot;Prachuap Khiri Khan&quot;,&quot;Prachuap Khiri Khan&quot;],[&quot;Ranong&quot;,&quot;Ranong&quot;],[&quot;Ratchaburi&quot;,&quot;Ratchaburi&quot;],[&quot;Rayong&quot;,&quot;Rayong&quot;],[&quot;Roi Et&quot;,&quot;Roi Et&quot;],[&quot;Sa Kaeo&quot;,&quot;Sa Kaeo&quot;],[&quot;Sakon Nakhon&quot;,&quot;Sakon Nakhon&quot;],[&quot;Samut Prakan&quot;,&quot;Samut Prakan&quot;],[&quot;Samut Sakhon&quot;,&quot;Samut Sakhon&quot;],[&quot;Samut Songkhram&quot;,&quot;Samut Songkhram&quot;],[&quot;Saraburi&quot;,&quot;Saraburi&quot;],[&quot;Satun&quot;,&quot;Satun&quot;],[&quot;Sing Buri&quot;,&quot;Sing Buri&quot;],[&quot;Sisaket&quot;,&quot;Si Sa Ket&quot;],[&quot;Songkhla&quot;,&quot;Songkhla&quot;],[&quot;Sukhothai&quot;,&quot;Sukhothai&quot;],[&quot;Suphan Buri&quot;,&quot;Suphanburi&quot;],[&quot;Surat Thani&quot;,&quot;Surat Thani&quot;],[&quot;Surin&quot;,&quot;Surin&quot;],[&quot;Tak&quot;,&quot;Tak&quot;],[&quot;Trang&quot;,&quot;Trang&quot;],[&quot;Trat&quot;,&quot;Trat&quot;],[&quot;Ubon Ratchathani&quot;,&quot;Ubon Ratchathani&quot;],[&quot;Udon Thani&quot;,&quot;Udon Thani&quot;],[&quot;Uthai Thani&quot;,&quot;Uthai Thani&quot;],[&quot;Uttaradit&quot;,&quot;Uttaradit&quot;],[&quot;Yala&quot;,&quot;Yala&quot;],[&quot;Yasothon&quot;,&quot;Yasothon&quot;]]">
                Thailand</option>
              <option value="Timor Leste" data-provinces="[]">Timor-Leste</option>
              <option value="Togo" data-provinces="[]">Togo</option>
              <option value="Tokelau" data-provinces="[]">Tokelau</option>
              <option value="Tonga" data-provinces="[]">Tonga</option>
              <option value="Trinidad and Tobago" data-provinces="[]">Trinidad &amp; Tobago</option>
              <option value="Tristan da Cunha" data-provinces="[]">Tristan da Cunha</option>
              <option value="Tunisia" data-provinces="[]">Tunisia</option>
              <option value="Turkey" data-provinces="[]">Türkiye</option>
              <option value="Turkmenistan" data-provinces="[]">Turkmenistan</option>
              <option value="Turks and Caicos Islands" data-provinces="[]">Turks &amp; Caicos Islands</option>
              <option value="Tuvalu" data-provinces="[]">Tuvalu</option>
              <option value="United States Minor Outlying Islands" data-provinces="[]">U.S. Outlying Islands</option>
              <option value="Uganda" data-provinces="[]">Uganda</option>
              <option value="Ukraine" data-provinces="[]">Ukraine</option>
              <option value="United Arab Emirates"
                data-provinces="[[&quot;Abu Dhabi&quot;,&quot;Abu Dhabi&quot;],[&quot;Ajman&quot;,&quot;Ajman&quot;],[&quot;Dubai&quot;,&quot;Dubai&quot;],[&quot;Fujairah&quot;,&quot;Fujairah&quot;],[&quot;Ras al-Khaimah&quot;,&quot;Ras al-Khaimah&quot;],[&quot;Sharjah&quot;,&quot;Sharjah&quot;],[&quot;Umm al-Quwain&quot;,&quot;Umm al-Quwain&quot;]]">
                United Arab Emirates</option>
              <option value="United Kingdom"
                data-provinces="[[&quot;British Forces&quot;,&quot;British Forces&quot;],[&quot;England&quot;,&quot;England&quot;],[&quot;Northern Ireland&quot;,&quot;Northern Ireland&quot;],[&quot;Scotland&quot;,&quot;Scotland&quot;],[&quot;Wales&quot;,&quot;Wales&quot;]]">
                United Kingdom</option>
              <option value="United States"
                data-provinces="[[&quot;Alabama&quot;,&quot;Alabama&quot;],[&quot;Alaska&quot;,&quot;Alaska&quot;],[&quot;American Samoa&quot;,&quot;American Samoa&quot;],[&quot;Arizona&quot;,&quot;Arizona&quot;],[&quot;Arkansas&quot;,&quot;Arkansas&quot;],[&quot;Armed Forces Americas&quot;,&quot;Armed Forces Americas&quot;],[&quot;Armed Forces Europe&quot;,&quot;Armed Forces Europe&quot;],[&quot;Armed Forces Pacific&quot;,&quot;Armed Forces Pacific&quot;],[&quot;California&quot;,&quot;California&quot;],[&quot;Colorado&quot;,&quot;Colorado&quot;],[&quot;Connecticut&quot;,&quot;Connecticut&quot;],[&quot;Delaware&quot;,&quot;Delaware&quot;],[&quot;District of Columbia&quot;,&quot;Washington DC&quot;],[&quot;Federated States of Micronesia&quot;,&quot;Micronesia&quot;],[&quot;Florida&quot;,&quot;Florida&quot;],[&quot;Georgia&quot;,&quot;Georgia&quot;],[&quot;Guam&quot;,&quot;Guam&quot;],[&quot;Hawaii&quot;,&quot;Hawaii&quot;],[&quot;Idaho&quot;,&quot;Idaho&quot;],[&quot;Illinois&quot;,&quot;Illinois&quot;],[&quot;Indiana&quot;,&quot;Indiana&quot;],[&quot;Iowa&quot;,&quot;Iowa&quot;],[&quot;Kansas&quot;,&quot;Kansas&quot;],[&quot;Kentucky&quot;,&quot;Kentucky&quot;],[&quot;Louisiana&quot;,&quot;Louisiana&quot;],[&quot;Maine&quot;,&quot;Maine&quot;],[&quot;Marshall Islands&quot;,&quot;Marshall Islands&quot;],[&quot;Maryland&quot;,&quot;Maryland&quot;],[&quot;Massachusetts&quot;,&quot;Massachusetts&quot;],[&quot;Michigan&quot;,&quot;Michigan&quot;],[&quot;Minnesota&quot;,&quot;Minnesota&quot;],[&quot;Mississippi&quot;,&quot;Mississippi&quot;],[&quot;Missouri&quot;,&quot;Missouri&quot;],[&quot;Montana&quot;,&quot;Montana&quot;],[&quot;Nebraska&quot;,&quot;Nebraska&quot;],[&quot;Nevada&quot;,&quot;Nevada&quot;],[&quot;New Hampshire&quot;,&quot;New Hampshire&quot;],[&quot;New Jersey&quot;,&quot;New Jersey&quot;],[&quot;New Mexico&quot;,&quot;New Mexico&quot;],[&quot;New York&quot;,&quot;New York&quot;],[&quot;North Carolina&quot;,&quot;North Carolina&quot;],[&quot;North Dakota&quot;,&quot;North Dakota&quot;],[&quot;Northern Mariana Islands&quot;,&quot;Northern Mariana Islands&quot;],[&quot;Ohio&quot;,&quot;Ohio&quot;],[&quot;Oklahoma&quot;,&quot;Oklahoma&quot;],[&quot;Oregon&quot;,&quot;Oregon&quot;],[&quot;Palau&quot;,&quot;Palau&quot;],[&quot;Pennsylvania&quot;,&quot;Pennsylvania&quot;],[&quot;Puerto Rico&quot;,&quot;Puerto Rico&quot;],[&quot;Rhode Island&quot;,&quot;Rhode Island&quot;],[&quot;South Carolina&quot;,&quot;South Carolina&quot;],[&quot;South Dakota&quot;,&quot;South Dakota&quot;],[&quot;Tennessee&quot;,&quot;Tennessee&quot;],[&quot;Texas&quot;,&quot;Texas&quot;],[&quot;Utah&quot;,&quot;Utah&quot;],[&quot;Vermont&quot;,&quot;Vermont&quot;],[&quot;Virgin Islands&quot;,&quot;U.S. Virgin Islands&quot;],[&quot;Virginia&quot;,&quot;Virginia&quot;],[&quot;Washington&quot;,&quot;Washington&quot;],[&quot;West Virginia&quot;,&quot;West Virginia&quot;],[&quot;Wisconsin&quot;,&quot;Wisconsin&quot;],[&quot;Wyoming&quot;,&quot;Wyoming&quot;]]">
                United States</option>
              <option value="Uruguay"
                data-provinces="[[&quot;Artigas&quot;,&quot;Artigas&quot;],[&quot;Canelones&quot;,&quot;Canelones&quot;],[&quot;Cerro Largo&quot;,&quot;Cerro Largo&quot;],[&quot;Colonia&quot;,&quot;Colonia&quot;],[&quot;Durazno&quot;,&quot;Durazno&quot;],[&quot;Flores&quot;,&quot;Flores&quot;],[&quot;Florida&quot;,&quot;Florida&quot;],[&quot;Lavalleja&quot;,&quot;Lavalleja&quot;],[&quot;Maldonado&quot;,&quot;Maldonado&quot;],[&quot;Montevideo&quot;,&quot;Montevideo&quot;],[&quot;Paysandú&quot;,&quot;Paysandú&quot;],[&quot;Rivera&quot;,&quot;Rivera&quot;],[&quot;Rocha&quot;,&quot;Rocha&quot;],[&quot;Río Negro&quot;,&quot;Río Negro&quot;],[&quot;Salto&quot;,&quot;Salto&quot;],[&quot;San José&quot;,&quot;San José&quot;],[&quot;Soriano&quot;,&quot;Soriano&quot;],[&quot;Tacuarembó&quot;,&quot;Tacuarembó&quot;],[&quot;Treinta y Tres&quot;,&quot;Treinta y Tres&quot;]]">
                Uruguay</option>
              <option value="Uzbekistan" data-provinces="[]">Uzbekistan</option>
              <option value="Vanuatu" data-provinces="[]">Vanuatu</option>
              <option value="Holy See (Vatican City State)" data-provinces="[]">Vatican City</option>
              <option value="Venezuela"
                data-provinces="[[&quot;Amazonas&quot;,&quot;Amazonas&quot;],[&quot;Anzoátegui&quot;,&quot;Anzoátegui&quot;],[&quot;Apure&quot;,&quot;Apure&quot;],[&quot;Aragua&quot;,&quot;Aragua&quot;],[&quot;Barinas&quot;,&quot;Barinas&quot;],[&quot;Bolívar&quot;,&quot;Bolívar&quot;],[&quot;Carabobo&quot;,&quot;Carabobo&quot;],[&quot;Cojedes&quot;,&quot;Cojedes&quot;],[&quot;Delta Amacuro&quot;,&quot;Delta Amacuro&quot;],[&quot;Dependencias Federales&quot;,&quot;Federal Dependencies&quot;],[&quot;Distrito Capital&quot;,&quot;Capital&quot;],[&quot;Falcón&quot;,&quot;Falcón&quot;],[&quot;Guárico&quot;,&quot;Guárico&quot;],[&quot;La Guaira&quot;,&quot;Vargas&quot;],[&quot;Lara&quot;,&quot;Lara&quot;],[&quot;Miranda&quot;,&quot;Miranda&quot;],[&quot;Monagas&quot;,&quot;Monagas&quot;],[&quot;Mérida&quot;,&quot;Mérida&quot;],[&quot;Nueva Esparta&quot;,&quot;Nueva Esparta&quot;],[&quot;Portuguesa&quot;,&quot;Portuguesa&quot;],[&quot;Sucre&quot;,&quot;Sucre&quot;],[&quot;Trujillo&quot;,&quot;Trujillo&quot;],[&quot;Táchira&quot;,&quot;Táchira&quot;],[&quot;Yaracuy&quot;,&quot;Yaracuy&quot;],[&quot;Zulia&quot;,&quot;Zulia&quot;]]">
                Venezuela</option>
              <option value="Vietnam" data-provinces="[]">Vietnam</option>
              <option value="Wallis And Futuna" data-provinces="[]">Wallis &amp; Futuna</option>
              <option value="Western Sahara" data-provinces="[]">Western Sahara</option>
              <option value="Yemen" data-provinces="[]">Yemen</option>
              <option value="Zambia" data-provinces="[]">Zambia</option>
              <option value="Zimbabwe" data-provinces="[]">Zimbabwe</option>
            </select> <span>Country</span></label></div>
        <div id="AddressStateContainerModal" class="my-2" style="display: none;">
          <div class="input-group disabled"><label for="AddressStateModal" class="has-float-label"><select data-select-state="" id="AddressStateModal" name="state" disabled="disabled" class="custom-select border-0"></select>
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        </div>
        <div class="form-group my-2">
          <div class="input-group bg-white"><label for="phone-number" class="has-float-label"><input data-tel-input="" type="tel" id="phone-number" aria-describedby="phone-number" required="required" mode="international"
                placeholder="Enter a Phone Number" enabledflags="true" onlycountries="" autocomplete="off" name="phone" maxlen="25" dropdownoptions="[object Object]" inputoptions="[object Object]" class="form-control"><span class="phone-label">Phone
                Number</span></label></div>
        </div>
        <div class="form-group mt-2"><label for="note" class="fixed-label position-relative w-100"><textarea type="note" id="note" rows="2" aria-describedby="note" placeholder="Write your note" class="form-control"></textarea> <span>Note For
              Recipient</span></label> <span class="char-counter small mt-0 valid">0/50</span> <span class="clearfix"></span></div>
      </div>
    </div>
  </div>
  <div class="modal-footer border-0 pt-0 pb-3">
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</form>

POST /contact#NewsletterFooter

<form method="post" action="/contact#NewsletterFooter" id="NewsletterFooter" accept-charset="UTF-8" class="contact-form"><input type="hidden" name="form_type" value="customer"><input type="hidden" name="utf8" value="✓">
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BOB MARLEY: ONE LOVE (MUSIC INSPIRED BY THE FILM)

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BOB MARLEY: ONE LOVE (MUSIC INSPIRED BY THE FILM)

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Kacey Musgraves, Leon Bridges, and more. Also available as a bundle that
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"A LOVE SUPREME" LIKE NEVER BEFORE

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