orders.manwardpress.com Open in urlscan Pro
192.135.136.193  Public Scan

Submitted URL: https://events-b.mb.manwardpress.com/track?uid=5ebec341-8e79-4078-ad86-82f483c1ad30&txnid=ce184aa9-82c9-4599-ad53-df60e0e504fb&bsft_a...
Effective URL: https://orders.manwardpress.com/LASTCHANCE39MWLLT/EMWLX6CD/index.htm?pageNumber=2&customerNumber=000037052743&campaignId=d5c744f...
Submission: On April 11 via api from CH — Scanned from DE

Form analysis 2 forms found in the DOM

POST

<form method="post" class="form-horizontal constrained-width center-block">
  <fieldset class="step">
    <legend class="step__header">Step No. 1: Review Your Subscription</legend>
    <script language="javascript">
      Namespace('AGORA', {
        pricingOptionMap: {},
        shippingOptionMap: {},
        setPricingOptionIdIfHidden: function(choiceId) {
          if (choiceId in AGORA.pricingOptionMap) {
            AGORA.setPricingOptionIdSelection(AGORA.pricingOptionMap[choiceId]);
            if ($('#__billingEmailAddress__').val() != null && $('#__billingEmailAddress__').val().length != 0) {
              AGORA.checkIfPasswordInputRequired();
            }
          } else {
            AGORA.setPricingOptionIdSelection("");
          }
          AGORA.viewModel.displayAutoRenewPaymentSection();
        },
        setPricingOptionIdSelection: function(pricingOptionId) {
          document.getElementById("__selectedOfferPricingOptionId__").value = pricingOptionId;
          if (pricingOptionId != "") {
            AGORA.viewModel.selectedOfferPricingOptionId(pricingOptionId);
            if (pricingOptionId in AGORA.shippingOptionMap) {
              AGORA.viewModel.selectedOfferShippingOptionId(AGORA.shippingOptionMap[pricingOptionId]);
            }
          }
        },
        registerPricingOptionId: function(choiceId, pricingOptionId) {
          AGORA.pricingOptionMap[choiceId] = pricingOptionId;
        },
        registerShippingOptionId: function(pricingOptionId, shippingOptionId) {
          AGORA.shippingOptionMap[pricingOptionId] = shippingOptionId;
        }
      });
    </script>
    <input name="formComponentsMap['offer'].choiceId" type="hidden" value="7849121">
    <input id="__selectedOfferPricingOptionId__" name="formComponentsMap['offer'].pricingOptionId" type="hidden" value="7848165">
    <div class="choice choice-single">
      <label>
        <div class="choice__box">
          <header class="choice__title">
            <h2 class="choice__name"> One-Year Subscription to&nbsp;<cite>Manward Letter</cite>&nbsp;for Just $39 ($79/year after)! </h2>
          </header>
          <div class="choice__copy">
            <!--<p class="text-suppressed"><b>Billing Terms:</b> I agree to pay the price mentioned above for a one-year subscription to this service. I understand that each year, my card on file will be billed automatically at the low rate of just $79 for another year of service, to ensure that I never lose service. If I want to&nbsp;<a href="https://manwardpress.com/contact-us/" target="_blank">cancel my subscription</a>&nbsp;or remove the automatic renewal feature, I can contact the Support Team at any time by&nbsp;<a href="https://manwardpress.com/contact-us/" target="_blank">clicking here</a>&nbsp;or calling 800.682.5210 or 443.353.4263, Monday through Friday from 8 a.m. to 8 p.m. ET. I have read and accepted the&nbsp;<a href="https://manwardpress.com/terms-and-conditions/" target="_blank">Terms &amp; Conditions</a>&nbsp;and&nbsp;<a href="https://manwardpress.com/privacy-policy/" target="_blank">Privacy Policy</a>, which explain how my charge will appear on my credit card statement.</p>-->
            <p class="text-suppressed"><b>Refund Policy:</b> Your subscription to&nbsp;<cite>Manward Letter</cite>&nbsp;is completely risk-free for 90 days. If for any reason you decide over the next 90 days that&nbsp;<cite>Manward
                Letter</cite>&nbsp;is not right for you, simply call us up. You’ll receive a full, prompt refund of your subscription fee. You can reach our Support Team at 800.682.5210 or 443.353.4263.</p>
            <p class="text-suppressed">*Applicable sales tax applies. For more information, please visit <a href="https://manwardpress.com/sales-tax/" target="_blank">https://manwardpress.com/sales-tax/</a>.</p>
          </div>
          <p class="autorenewMessage">
            <strong>The Term</strong> is <strong><span> 12 </span> <span>months</span></strong>.
          </p>
          <div class="premiumMessage">
            <h3 class="premiumMessageTitle">You will also receive:</h3>
            <p class="premiumMessageContent"> MWL No Kit/eLetters only </p>
          </div>
          <table class="priceOption">
            <tbody>
              <tr>
                <td width="18" class="radioCell">
                  <script language="javascript">
                    $(function() {
                      AGORA.setPricingOptionIdSelection(7848165);
                    });
                  </script>
                </td>
                <td width="180">
                  <span class="label">Price:</span>
                  <span class="data"> USD $ 39.00 </span>
                </td>
              </tr>
            </tbody>
          </table>
          <!-- Quantity box -->
          <!-- End Quantity box -->
          <!-- Shipping Options ----------------------------------------------------------------- -->
          <!-- End Shipping Options ----------------------------------------------------------------- -->
        </div>
      </label>
    </div>
  </fieldset>
  <input name="urlQueryString" id="urlQueryString" type="hidden"
    value="pageNumber=2&amp;customerNumber=000037052743&amp;campaignId=d5c744f2-0fee-4214-b48c-1dd55017b0ae&amp;r=eml&amp;experimentId=eb9c777a-85dd-4c7b-8d53-c35c9b9f608f&amp;vid=j_t8lZ&amp;customerId=000037052743-000032200185&amp;utm_campaign=mdded_day-26-last-chance&amp;utm_source=blueshift&amp;utm_medium=email&amp;utm_content=mdded_day-26_mwl-last-chance&amp;bsft_clkid=fe501e55-0aa4-44dd-afbd-3c38fe6d59d2&amp;bsft_uid=5ebec341-8e79-4078-ad86-82f483c1ad30&amp;bsft_mid=c5a96282-df8d-4e47-b898-d8d54c53b35f&amp;bsft_eid=eb9c777a-85dd-4c7b-8d53-c35c9b9f608f&amp;bsft_txnid=ce184aa9-82c9-4599-ad53-df60e0e504fb&amp;bsft_utid=5ebec341-8e79-4078-ad86-82f483c1ad30-MDDED&amp;bsft_mime_type=html&amp;bsft_ek=2022-04-09T18%3A01%3A35Z&amp;bsft_aaid=54c3d0e6-ad11-4074-88a7-e425e3059094&amp;bsft_lx=2&amp;bsft_tv=80">
  <fieldset class="step">
    <legend class="step__header">Step No. 2: Enter Your Name &amp; Email</legend>
    <div class="form-notes">
      <p class="text-suppressed ta-center">Fields with (*) are mandatory.</p>
    </div>
    <div class="form-group">
      <label class="control-label"> *First Name: </label>
      <input name="formComponentsMap['order'].firstName" type="text" value="ALAN" maxlength="20" class="form-control">
    </div>
    <div class="form-group">
      <label class="control-label"> *Last Name: </label>
      <input name="formComponentsMap['order'].lastName" type="text" value="KATZ" maxlength="30" class="form-control">
    </div>
    <div class="form-group">
      <label class="control-label"> *Email: </label>
      <script type="text/javascript">
        $(document).ready(function() {
          $('#__billingEmailAddress__').blur(function() {
            AGORA.checkIfPasswordInputRequired();
            AGORA.checkIfLinkIsEnabled(false);
          });
          if ($('#__billingEmailAddress__').val()) {
            AGORA.checkIfLinkIsEnabled(true);
          }
        });
        Namespace('AGORA', {
          getPricingOptionIds: function() {
            var selectedOfferPricingOptionId = $('#__selectedOfferPricingOptionId__');
            if (selectedOfferPricingOptionId) {
              return [selectedOfferPricingOptionId.val()];
            }
          }
        });
        Namespace('AGORA', {
          checkIfPasswordInputRequired: function() {
            if ($('#__billingEmailAddress__').val().length == 0) {
              AGORA.onAccountCheckResult(true);
            } else {
              var pricingOptionIds = AGORA.getPricingOptionIds();
              if (pricingOptionIds && pricingOptionIds.length != 0) {
                $.getJSON("/__ajax__/accountServices/hasAccountsForAllPricingOptions", {
                  emailAddress: $('#__billingEmailAddress__').val(),
                  pricingOptionIds: pricingOptionIds
                }, AGORA.onAccountCheckResult);
              }
            }
          },
          onAccountCheckResult: function(hasAccountsForAllPricingOptions) {
            if (hasAccountsForAllPricingOptions == true) {
              $('#__passwordInputSection__').css('display', 'none');
              $('#__wasPasswordFieldShown__').val('false');
            } else {
              $('#__passwordInputSection__').css('display', '');
              $('#__wasPasswordFieldShown__').val('true');
            }
          },
          checkIfLinkIsEnabled: function(highlight) {
            var pricingOptionIds = AGORA.getPricingOptionIds();
            $.ajax({
              url: "/LASTCHANCE39MWLLT/EMWLX6CD/generateRetrieveSavedCreditCardsLink",
              data: {
                emailAddress: $('#__billingEmailAddress__').val(),
                pricingOptionIds: pricingOptionIds
              },
              statusCode: {
                400: function() {
                  $('#lightboxDiv').css('display', 'none');
                },
                401: function() {
                  $('#lightboxDiv').css('display', 'none');
                },
                403: function(event) {
                  $('#lightboxDiv').css('display', 'none');
                  AGORA.openLightbox(false);
                }
              },
              success: function(generateRetrieveSavedCreditCardsLink) {
                // Clean out creditCards to prevent dupes && flush out any option to prevent delay time between selection and acceptance:
                AGORA.creditCards.length = 0;
                $('#creditCardSelect option:gt(0)').remove();
                var effortType = "OnePageEffort";
                if (effortType != "MultiPageEffort") {
                  $('#creditCardSelect').css('display', 'none');
                  $('#creditCardElectronicPaymentIdHiddenField').css('display', 'none');
                  $('#lightboxDiv').css('display', 'block');
                  $("#popLinkErrorMessage").html('');
                  if (highlight) {
                    $('#theLightbox').css('color', 'red');
                  } else {
                    $('#theLightbox').css('color', '#428bca');
                  }
                }
              }
            });
          }
        });
      </script>
      <input name="formComponentsMap['order'].emailAddress" type="email" value="ALK1@IX.NETCOM.COM" maxlength="254" id="__billingEmailAddress__" class="form-control" inputmode="email">
    </div>
    <div data-bind="" class="form-group">
      <label class="control-label"> *Retype Email: </label>
      <input name="formComponentsMap['order'].confirmEmailAddress" type="email" value="ALK1@IX.NETCOM.COM" maxlength="254" class="form-control" inputmode="email">
    </div>
  </fieldset>
  <fieldset class="step">
    <legend class="step__header">Step No. 3: Enter Your Billing Address</legend>
    <div class="form-group">
      <label class="control-label"> *Address 1: </label>
      <input name="formComponentsMap['order'].addressLine1" type="text" value="19580 SAWGRASS CIR APT 2402" maxlength="34" class="form-control">
    </div>
    <div class="form-group">
      <label class="control-label"> Address 2: </label>
      <input name="formComponentsMap['order'].addressLine2" type="text" value="" maxlength="34" class="form-control">
    </div>
    <!--  -->
    <div class="form-group">
      <label class="control-label"> *City: </label>
      <input name="formComponentsMap['order'].city" type="text" value="BOCA RATON" maxlength="35" class="form-control">
    </div>
    <div id="__stateInputSection__" class="form-group"> <label class="control-label" id="thstate">
        <span id="stateRequiredIndicator" style="display: inline;">*</span>State: </label>
      <input id="whichStateInput" name="formComponentsMap['order'].whichStateInput" type="hidden" value="dropDown" class="form-control">
      <span id="stateSelect" data-bind=""><select name="formComponentsMap['order'].stateId" onchange="AGORA.__onStateChange__($(this).find('option:selected').text());" class="form-control input-sm">
          <option value="">Select A State</option>undefined<option value="1">AA - ARMED FORCES</option>
          <option value="4">AE - ARMED FORCES</option>
          <option value="5">AK - ALASKA</option>
          <option value="6">AL - ALABAMA</option>
          <option value="7">AP - APO/FPO</option>
          <option value="8">AR - ARKANSAS</option>
          <option value="9">AS - AMERICAN SAMOA</option>
          <option value="10">AZ - ARIZONA</option>
          <option value="12">CA - CALIFORNIA</option>
          <option value="13">CM - N MARIANA IS.</option>
          <option value="14">CO - COLORADO</option>
          <option value="15">CT - CONNECTICUT</option>
          <option value="17">DC - WASHINGTON D C</option>
          <option value="18">DE - DELAWARE</option>
          <option value="19" selected="selected">FL - FLORIDA</option>
          <option value="20">GA - GEORGIA</option>
          <option value="21">GU - GUAM</option>
          <option value="22">HI - HAWAII</option>
          <option value="24">IA - IOWA</option>
          <option value="25">ID - IDAHO</option>
          <option value="26">IL - ILLINOIS</option>
          <option value="27">IN - INDIANA</option>
          <option value="28">KS - KANSAS</option>
          <option value="29">KY - KENTUCKY</option>
          <option value="30">LA - LOUISIANA</option>
          <option value="31">MA - MASSACHUSETTS</option>
          <option value="33">MD - MARYLAND</option>
          <option value="34">ME - MAINE</option>
          <option value="35">MI - MICHIGAN</option>
          <option value="36">MN - MINNESOTA</option>
          <option value="37">MO - MISSOURI</option>
          <option value="39">MP - SAIPAN</option>
          <option value="40">MS - MISSISSIPPI</option>
          <option value="41">MT - MONTANA</option>
          <option value="43">NC - NORTH CAROLINA</option>
          <option value="44">ND - NORTH DAKOTA</option>
          <option value="45">NE - NEBRASKA</option>
          <option value="46">NH - NEW HAMPSHIRE</option>
          <option value="47">NJ - NEW JERSEY</option>
          <option value="49">NM - NEW MEXICO</option>
          <option value="55">NV - NEVADA</option>
          <option value="56">NY - NEW YORK</option>
          <option value="57">OH - OHIO</option>
          <option value="58">OK - OKLAHOMA</option>
          <option value="60">OR - OREGON</option>
          <option value="61">PA - PENNSYLVANIA</option>
          <option value="64">PR - PUERTO RICO</option>
          <option value="65">PW - PALAU</option>
          <option value="68">RI - RHODE ISLAND</option>
          <option value="70">SC - SOUTH CAROLINA</option>
          <option value="71">SD - SOUTH DAKOTA</option>
          <option value="74">TN - TENNESSEE</option>
          <option value="75">TX - TEXAS</option>
          <option value="76">UT - UTAH</option>
          <option value="77">VA - VIRGINIA</option>
          <option value="78">VI - VIRGIN ISLANDS</option>
          <option value="80">VT - VERMONT</option>
          <option value="82">WA - WASHINGTON</option>
          <option value="83">WI - WISCONSIN</option>
          <option value="84">WV - WEST VIRGINIA</option>
          <option value="85">WY - WYOMING</option>
        </select></span>
      <input type="text" data-bind="value:AGORA.viewModel.billingStateName, visible: false " class="form-control" style="display: none;">
    </div>
    <div class="form-group">
      <label class="control-label" id="thzipcode">
        <span id="postalCodeRequiredIndicator" style="display: inline;">*</span>ZIP/Postal Code: </label>
      <input id="__billToZipCode" name="formComponentsMap['order'].postalCode" type="text" value="334343386" maxlength="9" class="form-control">
    </div>
    <div class="form-group">
      <label class="control-label"> *Country: </label>
      <script type="text/javascript">
        //<![CDATA[
        Namespace('AGORA', {
          __onCountryChange__: function(countryId, countryName) {
            var stateSelect = '';
            var whichStateInput = '';
            var stateOptionsArray = new Array();
            var postalCodeRequiredMap = new Object();
            if (countryId != null) {
              //gather country iso2 code:
              $.ajax({
                url: "/LASTCHANCE39MWLLT/EMWLX6CD/getCountryISO2Code",
                data: {
                  countryId: countryId
                },
                success: function(data) {
                  AGORA.viewModel.iso2CountryCode(data);
                  console.log("Country Code is now:  " + AGORA.viewModel.iso2CountryCode() + "\nLocale is now: en-" + AGORA.viewModel.iso2CountryCode());
                  if (window._modoModal) {
                    window._modoModal.updateModal({
                      locale: "en-" + data
                    });
                  }
                },
                async: false // Need to make this ajax call synchronous otherwise we will require callbacks!
              });
            }
            AGORA.viewModel.billingCountryId(countryId);
            AGORA.viewModel.billingCountryName(countryName);
            var stateRequiredIndicator = document.getElementById('stateRequiredIndicator');
            var stateInputSection = $('#__stateInputSection__');
            var postcodeEverywhereSpan = document.getElementById('__billToPostcodeEverywhereSpan__');
            postalCodeRequiredMap["1"] = true;
            postalCodeRequiredMap["14"] = true;
            postalCodeRequiredMap["38"] = true;
            postalCodeRequiredMap["74"] = true;
            postalCodeRequiredMap["83"] = true;
            postalCodeRequiredMap["99"] = true;
            postalCodeRequiredMap["104"] = true;
            postalCodeRequiredMap["195"] = true;
            postalCodeRequiredMap["82"] = true;
            if (postcodeEverywhereSpan && countryId == 82) {
              postcodeEverywhereSpan.style.display = 'inline';
            } else if (postcodeEverywhereSpan) {
              postcodeEverywhereSpan.style.display = 'none';
            }
            AGORA.__onStateChange__();
            stateOptionsArray[1] += '<option value="1"  >AA - ARMED FORCES</option>';
            stateOptionsArray[38] += '<option value="2"  >AB - ALBERTA</option>';
            stateOptionsArray[10] += '<option value="124"  >ABA - BUENOS AIRES</option>';
            stateOptionsArray[30] += '<option value="148"  >AC - Acre</option>';
            stateOptionsArray[10] += '<option value="125"  >ACA - CATAMARCA</option>';
            stateOptionsArray[10] += '<option value="126"  >ACB - CORDOBA</option>';
            stateOptionsArray[10] += '<option value="127"  >ACF - CIUDAD AUTO BA</option>';
            stateOptionsArray[10] += '<option value="128"  >ACH - CHACO</option>';
            stateOptionsArray[10] += '<option value="129"  >ACR - CORRIENTES</option>';
            stateOptionsArray[10] += '<option value="130"  >ACT - CHUBUT</option>';
            stateOptionsArray[14] += '<option value="3"  >ACT - AUS CAPITAL TER</option>';
            stateOptionsArray[1] += '<option value="4"  >AE - ARMED FORCES</option>';
            stateOptionsArray[10] += '<option value="131"  >AER - ENTRE RIOS</option>';
            stateOptionsArray[10] += '<option value="132"  >AFO - FORMOSA</option>';
            stateOptionsArray[10] += '<option value="133"  >AJY - JUJUY</option>';
            stateOptionsArray[1] += '<option value="5"  >AK - ALASKA</option>';
            stateOptionsArray[1] += '<option value="6"  >AL - ALABAMA</option>';
            stateOptionsArray[30] += '<option value="149"  >AL - Alagoas</option>';
            stateOptionsArray[10] += '<option value="134"  >ALP - LA PAMPA</option>';
            stateOptionsArray[10] += '<option value="135"  >ALR - LA RIOJA</option>';
            stateOptionsArray[30] += '<option value="150"  >AM - Amazonas</option>';
            stateOptionsArray[10] += '<option value="136"  >AMI - MISIONES</option>';
            stateOptionsArray[10] += '<option value="137"  >AMZ - MENDOZA</option>';
            stateOptionsArray[99] += '<option value="87"  >ANDAMAN AND NICOBAR ISLANDS</option>';
            stateOptionsArray[10] += '<option value="138"  >ANQ - NEUQUEN</option>';
            stateOptionsArray[30] += '<option value="151"  >AP - Amapá</option>';
            stateOptionsArray[99] += '<option value="88"  >ANDHRA PRADESH</option>';
            stateOptionsArray[1] += '<option value="7"  >AP - APO/FPO</option>';
            stateOptionsArray[1] += '<option value="8"  >AR - ARKANSAS</option>';
            stateOptionsArray[99] += '<option value="89"  >ARUNACHAL PRADESH</option>';
            stateOptionsArray[10] += '<option value="139"  >ARN - RÍO NEGRO</option>';
            stateOptionsArray[99] += '<option value="90"  >ASSAM</option>';
            stateOptionsArray[1] += '<option value="9"  >AS - AMERICAN SAMOA</option>';
            stateOptionsArray[10] += '<option value="140"  >ASA - SALTA</option>';
            stateOptionsArray[10] += '<option value="141"  >ASC - SANTA CRUZ</option>';
            stateOptionsArray[10] += '<option value="142"  >ASE - SANT DEL ESTERO</option>';
            stateOptionsArray[10] += '<option value="143"  >ASF - SANTA FE</option>';
            stateOptionsArray[10] += '<option value="144"  >ASJ - SAN JUAN</option>';
            stateOptionsArray[10] += '<option value="145"  >ASL - SAN LUIS</option>';
            stateOptionsArray[10] += '<option value="146"  >ATF - TIERRA DEL FUEG</option>';
            stateOptionsArray[10] += '<option value="147"  >ATU - TUCUMAN</option>';
            stateOptionsArray[1] += '<option value="10"  >AZ - ARIZONA</option>';
            stateOptionsArray[30] += '<option value="152"  >BA - Bahia</option>';
            stateOptionsArray[38] += '<option value="11"  >BC - BRIT. COLUMBIA</option>';
            stateOptionsArray[99] += '<option value="91"  >BIHAR</option>';
            stateOptionsArray[1] += '<option value="12"  >CA - CALIFORNIA</option>';
            stateOptionsArray[30] += '<option value="153"  >CE - Ceará</option>';
            stateOptionsArray[99] += '<option value="92"  >CHHATTISGARH</option>';
            stateOptionsArray[99] += '<option value="93"  >CHANDIGARH</option>';
            stateOptionsArray[1] += '<option value="13"  >CM - N MARIANA IS.</option>';
            stateOptionsArray[1] += '<option value="14"  >CO - COLORADO</option>';
            stateOptionsArray[1] += '<option value="15"  >CT - CONNECTICUT</option>';
            stateOptionsArray[1] += '<option value="17"  >DC - WASHINGTON D C</option>';
            stateOptionsArray[99] += '<option value="94"  >DAMAN AND DIU</option>';
            stateOptionsArray[1] += '<option value="18"  >DE - DELAWARE</option>';
            stateOptionsArray[30] += '<option value="154"  >DF - Distrito Federal</option>';
            stateOptionsArray[99] += '<option value="95"  >NEW DELHI</option>';
            stateOptionsArray[99] += '<option value="96"  >DADRA AND NAGAR HAVELI</option>';
            stateOptionsArray[30] += '<option value="155"  >ES - Espírito Santo</option>';
            AGORA.__onStateChange__('FL - FLORIDA');
            stateOptionsArray[1] += '<option value="19" selected="selected" >FL - FLORIDA</option>';
            stateOptionsArray[1] += '<option value="20"  >GA - GEORGIA</option>';
            stateOptionsArray[99] += '<option value="97"  >GOA</option>';
            stateOptionsArray[99] += '<option value="98"  >GUJARAT</option>';
            stateOptionsArray[30] += '<option value="156"  >GO - Goiás</option>';
            stateOptionsArray[1] += '<option value="21"  >GU - GUAM</option>';
            stateOptionsArray[1] += '<option value="22"  >HI - HAWAII</option>';
            stateOptionsArray[99] += '<option value="99"  >HIMACHAL PRADESH</option>';
            stateOptionsArray[99] += '<option value="100"  >HARYANA</option>';
            stateOptionsArray[1] += '<option value="24"  >IA - IOWA</option>';
            stateOptionsArray[1] += '<option value="25"  >ID - IDAHO</option>';
            stateOptionsArray[1] += '<option value="26"  >IL - ILLINOIS</option>';
            stateOptionsArray[1] += '<option value="27"  >IN - INDIANA</option>';
            stateOptionsArray[99] += '<option value="101"  >JHARKHAND</option>';
            stateOptionsArray[99] += '<option value="102"  >JAMMU AND KASHMIR</option>';
            stateOptionsArray[99] += '<option value="103"  >KARNATAKA</option>';
            stateOptionsArray[99] += '<option value="104"  >KERALA</option>';
            stateOptionsArray[1] += '<option value="28"  >KS - KANSAS</option>';
            stateOptionsArray[1] += '<option value="29"  >KY - KENTUCKY</option>';
            stateOptionsArray[1] += '<option value="30"  >LA - LOUISIANA</option>';
            stateOptionsArray[99] += '<option value="105"  >LAKSHADWEEP</option>';
            stateOptionsArray[30] += '<option value="157"  >MA - Maranhão</option>';
            stateOptionsArray[1] += '<option value="31"  >MA - MASSACHUSETTS</option>';
            stateOptionsArray[38] += '<option value="32"  >MB - MANITOBA</option>';
            stateOptionsArray[1] += '<option value="33"  >MD - MARYLAND</option>';
            stateOptionsArray[1] += '<option value="34"  >ME - MAINE</option>';
            stateOptionsArray[30] += '<option value="158"  >MG - Minas Gerais</option>';
            stateOptionsArray[99] += '<option value="106"  >MAHARASHTRA</option>';
            stateOptionsArray[1] += '<option value="35"  >MI - MICHIGAN</option>';
            stateOptionsArray[99] += '<option value="107"  >MEGHALAYA</option>';
            stateOptionsArray[99] += '<option value="108"  >MANIPUR</option>';
            stateOptionsArray[1] += '<option value="36"  >MN - MINNESOTA</option>';
            stateOptionsArray[1] += '<option value="37"  >MO - MISSOURI</option>';
            stateOptionsArray[38] += '<option value="38"  >MP - NORTHERN MARIAN</option>';
            stateOptionsArray[1] += '<option value="39"  >MP - SAIPAN</option>';
            stateOptionsArray[99] += '<option value="109"  >MADHYA PRADESH</option>';
            stateOptionsArray[30] += '<option value="159"  >MS - Mato Grosso do Sul</option>';
            stateOptionsArray[1] += '<option value="40"  >MS - MISSISSIPPI</option>';
            stateOptionsArray[1] += '<option value="41"  >MT - MONTANA</option>';
            stateOptionsArray[30] += '<option value="160"  >MT - Mato Grosso</option>';
            stateOptionsArray[99] += '<option value="110"  >MIZORAM</option>';
            stateOptionsArray[38] += '<option value="42"  >NB - NEW BRUNSWICK</option>';
            stateOptionsArray[1] += '<option value="43"  >NC - NORTH CAROLINA</option>';
            stateOptionsArray[1] += '<option value="44"  >ND - NORTH DAKOTA</option>';
            stateOptionsArray[1] += '<option value="45"  >NE - NEBRASKA</option>';
            stateOptionsArray[1] += '<option value="46"  >NH - NEW HAMPSHIRE</option>';
            stateOptionsArray[1] += '<option value="47"  >NJ - NEW JERSEY</option>';
            stateOptionsArray[38] += '<option value="48"  >NL - NEWFOUNDLAND</option>';
            stateOptionsArray[99] += '<option value="112"  >NAGALAND</option>';
            stateOptionsArray[1] += '<option value="49"  >NM - NEW MEXICO</option>';
            stateOptionsArray[38] += '<option value="50"  >NS - NOVA SCOTIA</option>';
            stateOptionsArray[14] += '<option value="51"  >NSW - NEW SOUTH WALES</option>';
            stateOptionsArray[14] += '<option value="52"  >NT - NORTHERN TERR</option>';
            stateOptionsArray[38] += '<option value="53"  >NT - N.W. TERRITORY</option>';
            stateOptionsArray[38] += '<option value="54"  >NU - NUNAVUT TERR.</option>';
            stateOptionsArray[1] += '<option value="55"  >NV - NEVADA</option>';
            stateOptionsArray[1] += '<option value="56"  >NY - NEW YORK</option>';
            stateOptionsArray[1] += '<option value="57"  >OH - OHIO</option>';
            stateOptionsArray[1] += '<option value="58"  >OK - OKLAHOMA</option>';
            stateOptionsArray[38] += '<option value="59"  >ON - ONTARIO</option>';
            stateOptionsArray[1] += '<option value="60"  >OR - OREGON</option>';
            stateOptionsArray[99] += '<option value="113"  >ORISSA</option>';
            stateOptionsArray[30] += '<option value="161"  >PA - Pará</option>';
            stateOptionsArray[1] += '<option value="61"  >PA - PENNSYLVANIA</option>';
            stateOptionsArray[30] += '<option value="162"  >PB - Paraíba</option>';
            stateOptionsArray[99] += '<option value="114"  >PUNJAB</option>';
            stateOptionsArray[30] += '<option value="163"  >PE - Pernambuco</option>';
            stateOptionsArray[38] += '<option value="62"  >PE - PR. EDWARD IS.</option>';
            stateOptionsArray[30] += '<option value="164"  >PI - Piauí</option>';
            stateOptionsArray[38] += '<option value="63"  >PQ - QUEBEC</option>';
            stateOptionsArray[1] += '<option value="64"  >PR - PUERTO RICO</option>';
            stateOptionsArray[30] += '<option value="165"  >PR - Paraná</option>';
            stateOptionsArray[1] += '<option value="65"  >PW - PALAU</option>';
            stateOptionsArray[99] += '<option value="115"  >PUDUCHERRY</option>';
            stateOptionsArray[38] += '<option value="66"  >QC - QUEBEC</option>';
            stateOptionsArray[14] += '<option value="67"  >QLD - QUEENSLAND</option>';
            stateOptionsArray[1] += '<option value="68"  >RI - RHODE ISLAND</option>';
            stateOptionsArray[99] += '<option value="116"  >RAJASTHAN</option>';
            stateOptionsArray[30] += '<option value="166"  >RJ - Rio de Janeiro</option>';
            stateOptionsArray[30] += '<option value="167"  >RN - Rio Grande do Norte</option>';
            stateOptionsArray[30] += '<option value="168"  >RO - Rondônia</option>';
            stateOptionsArray[30] += '<option value="169"  >RR - Roraima</option>';
            stateOptionsArray[30] += '<option value="170"  >RS - Rio Grande do Sul</option>';
            stateOptionsArray[14] += '<option value="69"  >SA - SOUTH AUSTRALIA</option>';
            stateOptionsArray[1] += '<option value="70"  >SC - SOUTH CAROLINA</option>';
            stateOptionsArray[30] += '<option value="171"  >SC - Santa Catarina</option>';
            stateOptionsArray[1] += '<option value="71"  >SD - SOUTH DAKOTA</option>';
            stateOptionsArray[30] += '<option value="172"  >SE - Sergipe</option>';
            stateOptionsArray[99] += '<option value="117"  >SIKKIM</option>';
            stateOptionsArray[38] += '<option value="72"  >SK - SASKATCHEWAN</option>';
            stateOptionsArray[30] += '<option value="173"  >SP - São Paulo</option>';
            stateOptionsArray[14] += '<option value="73"  >TAS - TASMANIA</option>';
            stateOptionsArray[99] += '<option value="123"  >TELANGANA</option>';
            stateOptionsArray[1] += '<option value="74"  >TN - TENNESSEE</option>';
            stateOptionsArray[99] += '<option value="118"  >TAMIL NADU</option>';
            stateOptionsArray[30] += '<option value="174"  >TO - Tocantins</option>';
            stateOptionsArray[99] += '<option value="119"  >TRIPURA</option>';
            stateOptionsArray[1] += '<option value="75"  >TX - TEXAS</option>';
            stateOptionsArray[99] += '<option value="120"  >UTTARAKHAND</option>';
            stateOptionsArray[99] += '<option value="121"  >UTTAR PRADESH</option>';
            stateOptionsArray[1] += '<option value="76"  >UT - UTAH</option>';
            stateOptionsArray[1] += '<option value="77"  >VA - VIRGINIA</option>';
            stateOptionsArray[1] += '<option value="78"  >VI - VIRGIN ISLANDS</option>';
            stateOptionsArray[14] += '<option value="79"  >VIC - VICTORIA</option>';
            stateOptionsArray[1] += '<option value="80"  >VT - VERMONT</option>';
            stateOptionsArray[14] += '<option value="81"  >WA - WESTERN AUS</option>';
            stateOptionsArray[1] += '<option value="82"  >WA - WASHINGTON</option>';
            stateOptionsArray[99] += '<option value="122"  >WEST BENGAL</option>';
            stateOptionsArray[1] += '<option value="83"  >WI - WISCONSIN</option>';
            stateOptionsArray[1] += '<option value="84"  >WV - WEST VIRGINIA</option>';
            stateOptionsArray[1] += '<option value="85"  >WY - WYOMING</option>';
            stateOptionsArray[38] += '<option value="86"  >YT - YUKON TERR.</option>';
            stateOptionsArray[254] = 'UNSUPPORTED';
            stateOptionsArray[242] = 'UNSUPPORTED';
            stateOptionsArray[253] = 'UNSUPPORTED';
            stateOptionsArray[241] = 'UNSUPPORTED';
            stateOptionsArray[240] = 'UNSUPPORTED';
            stateOptionsArray[244] = 'UNSUPPORTED';
            stateOptionsArray[246] = 'UNSUPPORTED';
            stateOptionsArray[249] = 'UNSUPPORTED';
            stateOptionsArray[247] = 'UNSUPPORTED';
            stateOptionsArray[245] = 'UNSUPPORTED';
            stateOptionsArray[248] = 'UNSUPPORTED';
            stateOptionsArray[250] = 'UNSUPPORTED';
            stateOptionsArray[82] = 'UNSUPPORTED';
            stateOptionsArray[251] = 'UNSUPPORTED';
            stateOptionsArray[252] = 'UNSUPPORTED';
            stateOptionsArray[243] = 'UNSUPPORTED';
            if (stateOptionsArray[countryId] != undefined && stateOptionsArray[countryId] != 'UNSUPPORTED') {
              stateSelect = '<select name="formComponentsMap[\'order\'].stateId" onchange="AGORA.__onStateChange__($(this).find(\'option:selected\').text());" class="form-control input-sm" >' + '<option value="">Select A State</option>' +
                stateOptionsArray[countryId] + '</select>';
              whichStateInput = 'dropDown';
              if (stateRequiredIndicator) stateRequiredIndicator.style.display = 'inline';
              stateInputSection.css('display', '');
            } else {
              AGORA.__onStateChange__('');
              stateSelect = '<input name="formComponentsMap[\'order\'].stateName" type="text" value="" data-bind="" onchange="AGORA.__onStateChange__($(this).val());"  class="form-control"/>';
              whichStateInput = 'textBox';
              if (stateRequiredIndicator) stateRequiredIndicator.style.display = 'none';
              if (stateOptionsArray[countryId] == 'UNSUPPORTED' && stateInputSection.size() > 0) {
                stateInputSection.css('display', 'none');
              } else {
                stateInputSection.css('display', '');
              }
            }
            var postalCodeRequiredIndicator = document.getElementById('postalCodeRequiredIndicator');
            if (postalCodeRequiredMap[countryId] && postalCodeRequiredIndicator) {
              postalCodeRequiredIndicator.style.display = 'inline';
            } else if (postalCodeRequiredIndicator) {
              postalCodeRequiredIndicator.style.display = 'none';
            }
            if (document.getElementById('stateSelect') != null) {
              document.getElementById('stateSelect').innerHTML = stateSelect;
              document.getElementById('whichStateInput').value = whichStateInput;
            }
            if (whichStateInput == 'textBox' && false) {
              $('#__stateInputSection__').css('display', 'none');
            } else {
              $('#__stateInputSection__').css('display', '');
            }
            // Argentina:
            if (document.getElementById('argentinaTaxFieldsBlock') != null) {
              if (countryId && countryId != "10") {
                document.getElementById('argentinaTaxFieldsBlock').style.display = 'none';
              } else {
                document.getElementById('argentinaTaxFieldsBlock').style.display = 'block';
              }
            }
            // TaxFields:
            var countryIds = ["43", "47", "134", "170", "60"];
            if (document.getElementById('taxIdLabel') != null) {
              var useTaxIdFields = false;
              for (var i = 0; i < countryIds.length; i++) {
                if (countryIds[i] == countryId) {
                  useTaxIdFields = true;
                  var label = '';
                  if (countryIds[i] == "43") {
                    label = "*CI/RUT";
                  } else if (countryIds[i] == "47") {
                    label = "*CC";
                  } else if (countryIds[i] == "134") {
                    label = "*CURP";
                  } else if (countryIds[i] == "170") {
                    label = "*DNI";
                  } else if (countryIds[i] == "60") {
                    label = "*CI";
                  } else {
                    label = "Tax Id";
                  }
                }
              }
              if (useTaxIdFields == true) {
                document.getElementById('taxIdLabelHidden').value = label;
                if (document.getElementById("taxIdLabel") != null) {
                  var taxIdL = document.getElementById("taxIdLabel");
                  taxIdL.innerHTML = label;
                }
              } else if (document.getElementById("taxIdLabel") != null && useTaxIdFields == false) {
                var taxIdL = document.getElementById("taxIdLabel");
                taxIdL.innerHTML = "Tax Id";
              }
            }
            // Country Tax Id (Brazil/Argentina):
            // EU-VAT:
            checkIfCountryRequiresEuVat(countryId, "billing");
          },
          __onStateChange__: function(stateName) {
            AGORA.viewModel.billingStateName(stateName);
          }
        });
        //]]>
      </script>
      <select id="__billingCountrySelect__" name="formComponentsMap['order'].countryId" data-bind="" onchange="AGORA.__onCountryChange__($(this).val(), $(this).find('option:selected').text());" class="form-control input-sm">
        <option value="1" selected="selected">UNITED STATES</option>
        <option value="3">AFGHANISTAN</option>
        <option value="4">ALBANIA</option>
        <option value="5">ALGERIA</option>
        <option value="6">ANDORRA</option>
        <option value="7">ANGOLA</option>
        <option value="9">ANGUILLA</option>
        <option value="8">ANTARCTICA</option>
        <option value="2">ANTIGUA AND BARBUDA</option>
        <option value="10">ARGENTINA</option>
        <option value="11">ARMENIA</option>
        <option value="12">ARUBA</option>
        <option value="14">AUSTRALIA</option>
        <option value="13">AUSTRIA</option>
        <option value="16">AZERBAIDJAN</option>
        <option value="24">BAHAMAS</option>
        <option value="17">BAHRAIN</option>
        <option value="18">BANGLADESH</option>
        <option value="19">BARBADOS</option>
        <option value="20">BELARUS</option>
        <option value="25">BELGIUM</option>
        <option value="26">BELIZE</option>
        <option value="21">BENIN</option>
        <option value="22">BERMUDA</option>
        <option value="35">BHUTAN</option>
        <option value="27">BOLIVIA</option>
        <option value="254">BONAIRE,ST EUST,SABA</option>
        <option value="28">BOSNIA-HERZEGOVINA</option>
        <option value="29">BOTSWANA</option>
        <option value="30">BRAZIL</option>
        <option value="100">BRITISH INDIAN OCEAN</option>
        <option value="32">BRUNEI DARUSSALAM</option>
        <option value="33">BULGARIA</option>
        <option value="23">BURKINA FASO</option>
        <option value="31">BURUNDI</option>
        <option value="36">CAMBODIA</option>
        <option value="37">CAMEROON</option>
        <option value="38">CANADA</option>
        <option value="40">CAPE VERDE</option>
        <option value="41">CAYMAN ISLANDS</option>
        <option value="39">CENTRAL AFRICAN REPU</option>
        <option value="42">CHAD</option>
        <option value="43">CHILE</option>
        <option value="46">CHINA</option>
        <option value="242">CHRISTMAS ISLAND</option>
        <option value="253">COCOS (KEELING) ISLA</option>
        <option value="47">COLOMBIA</option>
        <option value="48">COMOROS</option>
        <option value="49">CONGO</option>
        <option value="45">COOK ISLANDS</option>
        <option value="50">COSTA RICA</option>
        <option value="51">CROATIA</option>
        <option value="52">CUBA</option>
        <option value="241">CURACAO</option>
        <option value="53">CYPRUS</option>
        <option value="54">CZECH REPUBLIC</option>
        <option value="55">DENMARK</option>
        <option value="56">DJIBOUTI</option>
        <option value="57">DOMINICA</option>
        <option value="58">DOMINICAN REPUBLIC</option>
        <option value="67">EAST TIMOR</option>
        <option value="60">ECUADOR</option>
        <option value="62">EGYPT</option>
        <option value="63">EL SALVADOR</option>
        <option value="61">EQUATIORIAL GUINEA</option>
        <option value="64">ERITREA</option>
        <option value="65">ESTONIA</option>
        <option value="66">ETHIOPIA</option>
        <option value="68">FAEROE ISLANDS</option>
        <option value="69">FALKLAND ISLANDS</option>
        <option value="75">FED STATE MICRONESIA</option>
        <option value="71">FIJI</option>
        <option value="72">FINLAND</option>
        <option value="74">FRANCE</option>
        <option value="70">FRENCH GUIANA</option>
        <option value="73">FRENCH POLYNESIA</option>
        <option value="240">FRENCH SOUTHERN TERR</option>
        <option value="77">GABON</option>
        <option value="79">GAMBIA</option>
        <option value="84">GEORGIA, REPUBLIC OF</option>
        <option value="83">GERMANY</option>
        <option value="85">GHANA</option>
        <option value="86">GIBRALTAR</option>
        <option value="88">GREECE</option>
        <option value="89">GREENLAND</option>
        <option value="87">GRENADA</option>
        <option value="78">GUADELOUPE</option>
        <option value="90">GUATEMALA</option>
        <option value="91">GUINEA</option>
        <option value="81">GUINEA BISSAU</option>
        <option value="92">GUYANA</option>
        <option value="93">HAITI</option>
        <option value="244">HEARD AND MC DONALD</option>
        <option value="95">HONDURAS</option>
        <option value="94">HONG KONG</option>
        <option value="96">HUNGARY</option>
        <option value="97">ICELAND</option>
        <option value="99">INDIA</option>
        <option value="98">INDONESIA</option>
        <option value="101">IRAN</option>
        <option value="103">IRAQ</option>
        <option value="102">IRELAND</option>
        <option value="104">ISRAEL</option>
        <option value="105">ITALY</option>
        <option value="106">IVORY COAST</option>
        <option value="107">JAMAICA</option>
        <option value="108">JAPAN</option>
        <option value="109">JORDAN</option>
        <option value="110">KAZAKHSTAN</option>
        <option value="111">KENYA</option>
        <option value="112">KIRIBATI</option>
        <option value="113">KOREA</option>
        <option value="161">KOREA DEMOCRATIC PE</option>
        <option value="114">KUWAIT</option>
        <option value="115">KYRGYZSTAN</option>
        <option value="116">LAO PEOPLES DEM REP</option>
        <option value="117">LATVIA</option>
        <option value="119">LEBANON</option>
        <option value="122">LESOTHO</option>
        <option value="123">LIBERIA</option>
        <option value="118">LIBYA(N ARAB JAMAHI)</option>
        <option value="124">LIECHTENSTEIN</option>
        <option value="125">LITHUANIA</option>
        <option value="126">LUXEMBOURG</option>
        <option value="127">MACAO</option>
        <option value="133">MACEDONIA</option>
        <option value="128">MADAGASCAR</option>
        <option value="129">MALAWI</option>
        <option value="142">MALAYSIA</option>
        <option value="140">MALDIVES</option>
        <option value="139">MALI</option>
        <option value="141">MALTA</option>
        <option value="137">MARSHALL ISLANDS</option>
        <option value="130">MARTINIQUE</option>
        <option value="131">MAURITANIA</option>
        <option value="147">MAURITIUS</option>
        <option value="132">MAYOTTE</option>
        <option value="134">MEXICO</option>
        <option value="138">MOLDOVA</option>
        <option value="143">MONACO</option>
        <option value="135">MONGOLIA</option>
        <option value="145">MONTSERRAT</option>
        <option value="144">MOROCCO</option>
        <option value="146">MOZAMBIQUE</option>
        <option value="148">MYANMAR</option>
        <option value="149">NAMIBIA</option>
        <option value="151">NAURU</option>
        <option value="153">NEPAL</option>
        <option value="150">NETHERLAND ANTILLES</option>
        <option value="154">NETHERLANDS</option>
        <option value="152">NEW CALEDONIA</option>
        <option value="164">NEW ZEALAND</option>
        <option value="158">NICARAGUA</option>
        <option value="155">NIGER</option>
        <option value="159">NIGERIA</option>
        <option value="160">NIUE</option>
        <option value="246">NORFOLK ISLAND</option>
        <option value="162">NORTHERN MARIANA ISL</option>
        <option value="163">NORWAY</option>
        <option value="165">OMAN</option>
        <option value="166">PAKISTAN</option>
        <option value="167">PALAU</option>
        <option value="168">PANAMA</option>
        <option value="156">PAPUA NEW GUINEA</option>
        <option value="169">PARAGUAY</option>
        <option value="170">PERU</option>
        <option value="171">PHILIPPINES</option>
        <option value="172">PITCAIRN ISLANDS</option>
        <option value="173">POLAND</option>
        <option value="174">PORTUGAL</option>
        <option value="175">QATAR</option>
        <option value="176">REUNION</option>
        <option value="178">ROMANIA</option>
        <option value="225">RUSSIAN FEDERATION</option>
        <option value="179">RWANDA</option>
        <option value="198">SAINT HELENA</option>
        <option value="188">SAINT KITTS AND NEVI</option>
        <option value="191">SAINT LUCIA</option>
        <option value="202">SAINT VINCENT AND GR</option>
        <option value="181">SAMOA</option>
        <option value="193">SAN MARINO</option>
        <option value="197">SAO TOME &amp; PRINCIPE</option>
        <option value="182">SAUDI ARABIA</option>
        <option value="183">SENEGAL</option>
        <option value="236">SERBIA &amp; MONTENEGRO</option>
        <option value="185">SEYCHELLES</option>
        <option value="186">SIERRA LEONE</option>
        <option value="187">SINGAPORE</option>
        <option value="249">SINT MAARTEN</option>
        <option value="190">SLOVAKIA</option>
        <option value="192">SLOVENIA</option>
        <option value="189">SOLOMON ISLANDS</option>
        <option value="194">SOMALIA</option>
        <option value="180">SOUTH AFRICA</option>
        <option value="247">SOUTH GEORGIA &amp; THE S. SANDWICH ISL.</option>
        <option value="177">SOUTH KOREA</option>
        <option value="195">SPAIN</option>
        <option value="196">SRI LANKA</option>
        <option value="245">ST. MARTIN</option>
        <option value="199">ST. PIERRE &amp;MIQUELON</option>
        <option value="200">SUDAN</option>
        <option value="201">SURINAME</option>
        <option value="248">SVALBARD AND JAN MAY</option>
        <option value="206">SWAZILAND</option>
        <option value="204">SWEDEN</option>
        <option value="205">SWITZERLAND</option>
        <option value="207">SYRIA</option>
        <option value="208">TAIWAN</option>
        <option value="209">TAJIKISTAN</option>
        <option value="210">TANZANIA</option>
        <option value="212">THAILAND</option>
        <option value="215">TOGO</option>
        <option value="250">TOKELAU</option>
        <option value="214">TONGA</option>
        <option value="217">TRINIDAD AND TOBAGO</option>
        <option value="218">TUNISIA</option>
        <option value="219">TURKEY</option>
        <option value="213">TURKMENISTAN</option>
        <option value="211">TURKS AND CAICOS</option>
        <option value="220">TUVALU</option>
        <option value="222">UGANDA</option>
        <option value="223">UKRAINE</option>
        <option value="221">UNITED ARAB EMIRATES</option>
        <option value="82">UNITED KINGDOM</option>
        <option value="251">UNITED STATES MINOR</option>
        <option value="224">URUGUAY</option>
        <option value="226">UZBEKISTAN</option>
        <option value="227">VANUATU</option>
        <option value="228">VATICAN CITY STATE</option>
        <option value="229">VENEZUELA</option>
        <option value="230">VIETNAM</option>
        <option value="231">VIRGIN IS, BRIT</option>
        <option value="252">WALLIS AND FUTUNA IS</option>
        <option value="243">WESTERN SAHARA</option>
        <option value="235">YEMEN</option>
        <option value="237">ZAIRE</option>
        <option value="238">ZAMBIA</option>
        <option value="239">ZIMBABWE</option>
      </select>
      <input type="text" data-bind="value:AGORA.viewModel.billingCountryName, visible: false " class="form-control" style="display: none;">
      <script type="text/javascript">
        $(document).ready(function() {
          AGORA.__onCountryChange__($('#__billingCountrySelect__').val(), $('#__billingCountrySelect__').find('option:selected').text())
        });
      </script>
    </div>
    <div class="form-group">
      <label class="control-label"> *Phone: </label>
      <input name="formComponentsMap['order'].phoneNumber" type="tel" data-bind="" value="516 484-3007" maxlength="25" class="form-control" inputmode="tel">
    </div>
    <!--             <div class="form-group">
              <label class="control-label">
                Fax:
              </label>
    <input name="formComponentsMap['order'].faxNumber" type="text" data-bind="" value="516 874-3205" maxlength="25" class="form-control"  />
            </div>
 -->
    <div id="__passwordInputSection__" class="form-group" style="display:none;"> <label class="control-label"> *Create Password: </label>
      <input id="__wasPasswordFieldShown__" name="formComponentsMap['order'].wasPasswordFieldShown" type="hidden" value="false">
      <input name="formComponentsMap['order'].password" type="password" value="" maxlength="20" class="form-control">
      <p class="password1" style="display: inline-block;
color: #0071BC;
font-size: 15px;
padding: 0;
width: 100%;
max-width: 590px;
line-height: 18px;">*Please create a new password that will be used to access your subscription on ManwardPress.com. Recommended: Use a unique password, and keep it secure for your own records.</p>
    </div>
    <div class="form-group form-check">
      <label>
        <input name="formComponentsMap['order'].hasAgreedToBeContactedByAffiliates" type="checkbox" value="true" class="check">
        <input type="hidden" name="_formComponentsMap['order'].hasAgreedToBeContactedByAffiliates"> Please check the box if you’d like to receive additional information on ways to enjoy a richer, healthier life from us and our affiliates. </label>
    </div>
    <div class="form-group form-check">
      <label>
        <input name="formComponentsMap['order'].hasSameShipToAddress" type="checkbox" value="true" data-bind="click: toggleShippingAddressVisibility" checked="checked" class="check">
        <input type="hidden" name="_formComponentsMap['order'].hasSameShipToAddress"> Uncheck to ship to a different address. </label>
    </div>
  </fieldset>
  <div id="shipping_div" data-bind="visible: shippingAddressVisible" style="display: none;">
    <div class="shipping-div">
      <fieldset class="step">
        <legend class="step__header">Enter Your Shipping Information</legend>
        <div class="form-group">
          <label class="control-label"> *First Name: </label>
          <input name="formComponentsMap['order'].shipToFirstName" type="text" value="" maxlength="20" class="form-control">
        </div>
        <div class="form-group">
          <label class="control-label"> *Last Name: </label>
          <input name="formComponentsMap['order'].shipToLastName" type="text" value="" maxlength="30" class="form-control">
        </div>
        <div class="form-group">
          <label class="control-label"> *Address 1: </label>
          <input name="formComponentsMap['order'].shipToAddressLine1" type="text" value="" maxlength="34" class="form-control">
        </div>
        <div class="form-group">
          <label class="control-label"> Address 2: </label>
          <input name="formComponentsMap['order'].shipToAddressLine2" type="text" value="" maxlength="34" class="form-control">
        </div>
        <!--  -->
        <div class="form-group">
          <label class="control-label"> *City: </label>
          <input name="formComponentsMap['order'].shipToCity" type="text" value="" maxlength="35" class="form-control">
        </div>
        <div id="__shipToStateInputSection__" class="form-group"> <label class="control-label" id="thstate">
            <span id="shipToStateRequiredIndicator" style="display: inline;">*</span>State: </label>
          <input id="whichShipToStateInput" name="formComponentsMap['order'].whichShipToStateInput" type="hidden" value="dropDown" class="form-control">
          <span id="shipToStateSelect" data-bind=""><select name="formComponentsMap['order'].shipToStateId" onchange="AGORA.__onShippingStateChange__($(this).find('option:selected').text());" class="form-control input-sm">
              <option value="">Select A State</option>undefined<option value="1">AA - ARMED FORCES</option>
              <option value="4">AE - ARMED FORCES</option>
              <option value="5">AK - ALASKA</option>
              <option value="6">AL - ALABAMA</option>
              <option value="7">AP - APO/FPO</option>
              <option value="8">AR - ARKANSAS</option>
              <option value="9">AS - AMERICAN SAMOA</option>
              <option value="10">AZ - ARIZONA</option>
              <option value="12">CA - CALIFORNIA</option>
              <option value="13">CM - N MARIANA IS.</option>
              <option value="14">CO - COLORADO</option>
              <option value="15">CT - CONNECTICUT</option>
              <option value="17">DC - WASHINGTON D C</option>
              <option value="18">DE - DELAWARE</option>
              <option value="19">FL - FLORIDA</option>
              <option value="20">GA - GEORGIA</option>
              <option value="21">GU - GUAM</option>
              <option value="22">HI - HAWAII</option>
              <option value="24">IA - IOWA</option>
              <option value="25">ID - IDAHO</option>
              <option value="26">IL - ILLINOIS</option>
              <option value="27">IN - INDIANA</option>
              <option value="28">KS - KANSAS</option>
              <option value="29">KY - KENTUCKY</option>
              <option value="30">LA - LOUISIANA</option>
              <option value="31">MA - MASSACHUSETTS</option>
              <option value="33">MD - MARYLAND</option>
              <option value="34">ME - MAINE</option>
              <option value="35">MI - MICHIGAN</option>
              <option value="36">MN - MINNESOTA</option>
              <option value="37">MO - MISSOURI</option>
              <option value="39">MP - SAIPAN</option>
              <option value="40">MS - MISSISSIPPI</option>
              <option value="41">MT - MONTANA</option>
              <option value="43">NC - NORTH CAROLINA</option>
              <option value="44">ND - NORTH DAKOTA</option>
              <option value="45">NE - NEBRASKA</option>
              <option value="46">NH - NEW HAMPSHIRE</option>
              <option value="47">NJ - NEW JERSEY</option>
              <option value="49">NM - NEW MEXICO</option>
              <option value="55">NV - NEVADA</option>
              <option value="56">NY - NEW YORK</option>
              <option value="57">OH - OHIO</option>
              <option value="58">OK - OKLAHOMA</option>
              <option value="60">OR - OREGON</option>
              <option value="61">PA - PENNSYLVANIA</option>
              <option value="64">PR - PUERTO RICO</option>
              <option value="65">PW - PALAU</option>
              <option value="68">RI - RHODE ISLAND</option>
              <option value="70">SC - SOUTH CAROLINA</option>
              <option value="71">SD - SOUTH DAKOTA</option>
              <option value="74">TN - TENNESSEE</option>
              <option value="75">TX - TEXAS</option>
              <option value="76">UT - UTAH</option>
              <option value="77">VA - VIRGINIA</option>
              <option value="78">VI - VIRGIN ISLANDS</option>
              <option value="80">VT - VERMONT</option>
              <option value="82">WA - WASHINGTON</option>
              <option value="83">WI - WISCONSIN</option>
              <option value="84">WV - WEST VIRGINIA</option>
              <option value="85">WY - WYOMING</option>
            </select></span>
          <input type="text" data-bind="value:AGORA.viewModel.shippingStateName, visible: false " class="form-control" style="display: none;">
        </div>
        <div class="form-group">
          <label class="control-label" id="thzipcode">
            <span id="shipToPostalCodeRequiredIndicator" style="display: inline;">*</span>ZIP/Postal Code: </label>
          <input id="__shipToZipCode" name="formComponentsMap['order'].shipToPostalCode" type="text" value="" maxlength="9" class="form-control">
        </div>
        <div class="form-group">
          <label class="control-label"> *Country: </label>
          <script type="text/javascript">
            //<![CDATA[
            Namespace('AGORA', {
              __onShippingCountryChange__: function(countryId, countryName) {
                var stateSelect = '';
                var whichStateInput = '';
                var stateOptionsArray = new Array();
                var postalCodeRequiredMap = new Object();
                if (countryId != null) {
                  //gather country iso2 code:
                  $.ajax({
                    url: "/LASTCHANCE39MWLLT/EMWLX6CD/getCountryISO2Code",
                    data: {
                      countryId: countryId
                    },
                    success: function(data) {
                      AGORA.viewModel.iso2CountryCode(data);
                      console.log("Country Code is now:  " + AGORA.viewModel.iso2CountryCode() + "\nLocale is now: en-" + AGORA.viewModel.iso2CountryCode());
                      if (window._modoModal) {
                        window._modoModal.updateModal({
                          locale: "en-" + data
                        });
                      }
                    },
                    async: false // Need to make this ajax call synchronous otherwise we will require callbacks!
                  });
                }
                AGORA.viewModel.shippingCountryId(countryId);
                AGORA.viewModel.shippingCountryName(countryName);
                var stateRequiredIndicator = document.getElementById('shipToStateRequiredIndicator');
                var stateInputSection = $('#__shipToStateInputSection__');
                var postcodeEverywhereSpan = document.getElementById('__shipToPostcodeEverywhereSpan__');
                postalCodeRequiredMap["1"] = true;
                postalCodeRequiredMap["14"] = true;
                postalCodeRequiredMap["38"] = true;
                postalCodeRequiredMap["74"] = true;
                postalCodeRequiredMap["83"] = true;
                postalCodeRequiredMap["99"] = true;
                postalCodeRequiredMap["104"] = true;
                postalCodeRequiredMap["195"] = true;
                postalCodeRequiredMap["82"] = true;
                if (postcodeEverywhereSpan && countryId == 82) {
                  postcodeEverywhereSpan.style.display = 'inline';
                } else if (postcodeEverywhereSpan) {
                  postcodeEverywhereSpan.style.display = 'none';
                }
                AGORA.__onShippingStateChange__();
                stateOptionsArray[1] += '<option value="1"  >AA - ARMED FORCES</option>';
                stateOptionsArray[38] += '<option value="2"  >AB - ALBERTA</option>';
                stateOptionsArray[10] += '<option value="124"  >ABA - BUENOS AIRES</option>';
                stateOptionsArray[30] += '<option value="148"  >AC - Acre</option>';
                stateOptionsArray[10] += '<option value="125"  >ACA - CATAMARCA</option>';
                stateOptionsArray[10] += '<option value="126"  >ACB - CORDOBA</option>';
                stateOptionsArray[10] += '<option value="127"  >ACF - CIUDAD AUTO BA</option>';
                stateOptionsArray[10] += '<option value="128"  >ACH - CHACO</option>';
                stateOptionsArray[10] += '<option value="129"  >ACR - CORRIENTES</option>';
                stateOptionsArray[10] += '<option value="130"  >ACT - CHUBUT</option>';
                stateOptionsArray[14] += '<option value="3"  >ACT - AUS CAPITAL TER</option>';
                stateOptionsArray[1] += '<option value="4"  >AE - ARMED FORCES</option>';
                stateOptionsArray[10] += '<option value="131"  >AER - ENTRE RIOS</option>';
                stateOptionsArray[10] += '<option value="132"  >AFO - FORMOSA</option>';
                stateOptionsArray[10] += '<option value="133"  >AJY - JUJUY</option>';
                stateOptionsArray[1] += '<option value="5"  >AK - ALASKA</option>';
                stateOptionsArray[1] += '<option value="6"  >AL - ALABAMA</option>';
                stateOptionsArray[30] += '<option value="149"  >AL - Alagoas</option>';
                stateOptionsArray[10] += '<option value="134"  >ALP - LA PAMPA</option>';
                stateOptionsArray[10] += '<option value="135"  >ALR - LA RIOJA</option>';
                stateOptionsArray[30] += '<option value="150"  >AM - Amazonas</option>';
                stateOptionsArray[10] += '<option value="136"  >AMI - MISIONES</option>';
                stateOptionsArray[10] += '<option value="137"  >AMZ - MENDOZA</option>';
                stateOptionsArray[99] += '<option value="87"  >ANDAMAN AND NICOBAR ISLANDS</option>';
                stateOptionsArray[10] += '<option value="138"  >ANQ - NEUQUEN</option>';
                stateOptionsArray[30] += '<option value="151"  >AP - Amapá</option>';
                stateOptionsArray[99] += '<option value="88"  >ANDHRA PRADESH</option>';
                stateOptionsArray[1] += '<option value="7"  >AP - APO/FPO</option>';
                stateOptionsArray[1] += '<option value="8"  >AR - ARKANSAS</option>';
                stateOptionsArray[99] += '<option value="89"  >ARUNACHAL PRADESH</option>';
                stateOptionsArray[10] += '<option value="139"  >ARN - RÍO NEGRO</option>';
                stateOptionsArray[99] += '<option value="90"  >ASSAM</option>';
                stateOptionsArray[1] += '<option value="9"  >AS - AMERICAN SAMOA</option>';
                stateOptionsArray[10] += '<option value="140"  >ASA - SALTA</option>';
                stateOptionsArray[10] += '<option value="141"  >ASC - SANTA CRUZ</option>';
                stateOptionsArray[10] += '<option value="142"  >ASE - SANT DEL ESTERO</option>';
                stateOptionsArray[10] += '<option value="143"  >ASF - SANTA FE</option>';
                stateOptionsArray[10] += '<option value="144"  >ASJ - SAN JUAN</option>';
                stateOptionsArray[10] += '<option value="145"  >ASL - SAN LUIS</option>';
                stateOptionsArray[10] += '<option value="146"  >ATF - TIERRA DEL FUEG</option>';
                stateOptionsArray[10] += '<option value="147"  >ATU - TUCUMAN</option>';
                stateOptionsArray[1] += '<option value="10"  >AZ - ARIZONA</option>';
                stateOptionsArray[30] += '<option value="152"  >BA - Bahia</option>';
                stateOptionsArray[38] += '<option value="11"  >BC - BRIT. COLUMBIA</option>';
                stateOptionsArray[99] += '<option value="91"  >BIHAR</option>';
                stateOptionsArray[1] += '<option value="12"  >CA - CALIFORNIA</option>';
                stateOptionsArray[30] += '<option value="153"  >CE - Ceará</option>';
                stateOptionsArray[99] += '<option value="92"  >CHHATTISGARH</option>';
                stateOptionsArray[99] += '<option value="93"  >CHANDIGARH</option>';
                stateOptionsArray[1] += '<option value="13"  >CM - N MARIANA IS.</option>';
                stateOptionsArray[1] += '<option value="14"  >CO - COLORADO</option>';
                stateOptionsArray[1] += '<option value="15"  >CT - CONNECTICUT</option>';
                stateOptionsArray[1] += '<option value="17"  >DC - WASHINGTON D C</option>';
                stateOptionsArray[99] += '<option value="94"  >DAMAN AND DIU</option>';
                stateOptionsArray[1] += '<option value="18"  >DE - DELAWARE</option>';
                stateOptionsArray[30] += '<option value="154"  >DF - Distrito Federal</option>';
                stateOptionsArray[99] += '<option value="95"  >NEW DELHI</option>';
                stateOptionsArray[99] += '<option value="96"  >DADRA AND NAGAR HAVELI</option>';
                stateOptionsArray[30] += '<option value="155"  >ES - Espírito Santo</option>';
                stateOptionsArray[1] += '<option value="19"  >FL - FLORIDA</option>';
                stateOptionsArray[1] += '<option value="20"  >GA - GEORGIA</option>';
                stateOptionsArray[99] += '<option value="97"  >GOA</option>';
                stateOptionsArray[99] += '<option value="98"  >GUJARAT</option>';
                stateOptionsArray[30] += '<option value="156"  >GO - Goiás</option>';
                stateOptionsArray[1] += '<option value="21"  >GU - GUAM</option>';
                stateOptionsArray[1] += '<option value="22"  >HI - HAWAII</option>';
                stateOptionsArray[99] += '<option value="99"  >HIMACHAL PRADESH</option>';
                stateOptionsArray[99] += '<option value="100"  >HARYANA</option>';
                stateOptionsArray[1] += '<option value="24"  >IA - IOWA</option>';
                stateOptionsArray[1] += '<option value="25"  >ID - IDAHO</option>';
                stateOptionsArray[1] += '<option value="26"  >IL - ILLINOIS</option>';
                stateOptionsArray[1] += '<option value="27"  >IN - INDIANA</option>';
                stateOptionsArray[99] += '<option value="101"  >JHARKHAND</option>';
                stateOptionsArray[99] += '<option value="102"  >JAMMU AND KASHMIR</option>';
                stateOptionsArray[99] += '<option value="103"  >KARNATAKA</option>';
                stateOptionsArray[99] += '<option value="104"  >KERALA</option>';
                stateOptionsArray[1] += '<option value="28"  >KS - KANSAS</option>';
                stateOptionsArray[1] += '<option value="29"  >KY - KENTUCKY</option>';
                stateOptionsArray[1] += '<option value="30"  >LA - LOUISIANA</option>';
                stateOptionsArray[99] += '<option value="105"  >LAKSHADWEEP</option>';
                stateOptionsArray[30] += '<option value="157"  >MA - Maranhão</option>';
                stateOptionsArray[1] += '<option value="31"  >MA - MASSACHUSETTS</option>';
                stateOptionsArray[38] += '<option value="32"  >MB - MANITOBA</option>';
                stateOptionsArray[1] += '<option value="33"  >MD - MARYLAND</option>';
                stateOptionsArray[1] += '<option value="34"  >ME - MAINE</option>';
                stateOptionsArray[30] += '<option value="158"  >MG - Minas Gerais</option>';
                stateOptionsArray[99] += '<option value="106"  >MAHARASHTRA</option>';
                stateOptionsArray[1] += '<option value="35"  >MI - MICHIGAN</option>';
                stateOptionsArray[99] += '<option value="107"  >MEGHALAYA</option>';
                stateOptionsArray[99] += '<option value="108"  >MANIPUR</option>';
                stateOptionsArray[1] += '<option value="36"  >MN - MINNESOTA</option>';
                stateOptionsArray[1] += '<option value="37"  >MO - MISSOURI</option>';
                stateOptionsArray[38] += '<option value="38"  >MP - NORTHERN MARIAN</option>';
                stateOptionsArray[1] += '<option value="39"  >MP - SAIPAN</option>';
                stateOptionsArray[99] += '<option value="109"  >MADHYA PRADESH</option>';
                stateOptionsArray[30] += '<option value="159"  >MS - Mato Grosso do Sul</option>';
                stateOptionsArray[1] += '<option value="40"  >MS - MISSISSIPPI</option>';
                stateOptionsArray[1] += '<option value="41"  >MT - MONTANA</option>';
                stateOptionsArray[30] += '<option value="160"  >MT - Mato Grosso</option>';
                stateOptionsArray[99] += '<option value="110"  >MIZORAM</option>';
                stateOptionsArray[38] += '<option value="42"  >NB - NEW BRUNSWICK</option>';
                stateOptionsArray[1] += '<option value="43"  >NC - NORTH CAROLINA</option>';
                stateOptionsArray[1] += '<option value="44"  >ND - NORTH DAKOTA</option>';
                stateOptionsArray[1] += '<option value="45"  >NE - NEBRASKA</option>';
                stateOptionsArray[1] += '<option value="46"  >NH - NEW HAMPSHIRE</option>';
                stateOptionsArray[1] += '<option value="47"  >NJ - NEW JERSEY</option>';
                stateOptionsArray[38] += '<option value="48"  >NL - NEWFOUNDLAND</option>';
                stateOptionsArray[99] += '<option value="112"  >NAGALAND</option>';
                stateOptionsArray[1] += '<option value="49"  >NM - NEW MEXICO</option>';
                stateOptionsArray[38] += '<option value="50"  >NS - NOVA SCOTIA</option>';
                stateOptionsArray[14] += '<option value="51"  >NSW - NEW SOUTH WALES</option>';
                stateOptionsArray[14] += '<option value="52"  >NT - NORTHERN TERR</option>';
                stateOptionsArray[38] += '<option value="53"  >NT - N.W. TERRITORY</option>';
                stateOptionsArray[38] += '<option value="54"  >NU - NUNAVUT TERR.</option>';
                stateOptionsArray[1] += '<option value="55"  >NV - NEVADA</option>';
                stateOptionsArray[1] += '<option value="56"  >NY - NEW YORK</option>';
                stateOptionsArray[1] += '<option value="57"  >OH - OHIO</option>';
                stateOptionsArray[1] += '<option value="58"  >OK - OKLAHOMA</option>';
                stateOptionsArray[38] += '<option value="59"  >ON - ONTARIO</option>';
                stateOptionsArray[1] += '<option value="60"  >OR - OREGON</option>';
                stateOptionsArray[99] += '<option value="113"  >ORISSA</option>';
                stateOptionsArray[30] += '<option value="161"  >PA - Pará</option>';
                stateOptionsArray[1] += '<option value="61"  >PA - PENNSYLVANIA</option>';
                stateOptionsArray[30] += '<option value="162"  >PB - Paraíba</option>';
                stateOptionsArray[99] += '<option value="114"  >PUNJAB</option>';
                stateOptionsArray[30] += '<option value="163"  >PE - Pernambuco</option>';
                stateOptionsArray[38] += '<option value="62"  >PE - PR. EDWARD IS.</option>';
                stateOptionsArray[30] += '<option value="164"  >PI - Piauí</option>';
                stateOptionsArray[38] += '<option value="63"  >PQ - QUEBEC</option>';
                stateOptionsArray[1] += '<option value="64"  >PR - PUERTO RICO</option>';
                stateOptionsArray[30] += '<option value="165"  >PR - Paraná</option>';
                stateOptionsArray[1] += '<option value="65"  >PW - PALAU</option>';
                stateOptionsArray[99] += '<option value="115"  >PUDUCHERRY</option>';
                stateOptionsArray[38] += '<option value="66"  >QC - QUEBEC</option>';
                stateOptionsArray[14] += '<option value="67"  >QLD - QUEENSLAND</option>';
                stateOptionsArray[1] += '<option value="68"  >RI - RHODE ISLAND</option>';
                stateOptionsArray[99] += '<option value="116"  >RAJASTHAN</option>';
                stateOptionsArray[30] += '<option value="166"  >RJ - Rio de Janeiro</option>';
                stateOptionsArray[30] += '<option value="167"  >RN - Rio Grande do Norte</option>';
                stateOptionsArray[30] += '<option value="168"  >RO - Rondônia</option>';
                stateOptionsArray[30] += '<option value="169"  >RR - Roraima</option>';
                stateOptionsArray[30] += '<option value="170"  >RS - Rio Grande do Sul</option>';
                stateOptionsArray[14] += '<option value="69"  >SA - SOUTH AUSTRALIA</option>';
                stateOptionsArray[1] += '<option value="70"  >SC - SOUTH CAROLINA</option>';
                stateOptionsArray[30] += '<option value="171"  >SC - Santa Catarina</option>';
                stateOptionsArray[1] += '<option value="71"  >SD - SOUTH DAKOTA</option>';
                stateOptionsArray[30] += '<option value="172"  >SE - Sergipe</option>';
                stateOptionsArray[99] += '<option value="117"  >SIKKIM</option>';
                stateOptionsArray[38] += '<option value="72"  >SK - SASKATCHEWAN</option>';
                stateOptionsArray[30] += '<option value="173"  >SP - São Paulo</option>';
                stateOptionsArray[14] += '<option value="73"  >TAS - TASMANIA</option>';
                stateOptionsArray[99] += '<option value="123"  >TELANGANA</option>';
                stateOptionsArray[1] += '<option value="74"  >TN - TENNESSEE</option>';
                stateOptionsArray[99] += '<option value="118"  >TAMIL NADU</option>';
                stateOptionsArray[30] += '<option value="174"  >TO - Tocantins</option>';
                stateOptionsArray[99] += '<option value="119"  >TRIPURA</option>';
                stateOptionsArray[1] += '<option value="75"  >TX - TEXAS</option>';
                stateOptionsArray[99] += '<option value="120"  >UTTARAKHAND</option>';
                stateOptionsArray[99] += '<option value="121"  >UTTAR PRADESH</option>';
                stateOptionsArray[1] += '<option value="76"  >UT - UTAH</option>';
                stateOptionsArray[1] += '<option value="77"  >VA - VIRGINIA</option>';
                stateOptionsArray[1] += '<option value="78"  >VI - VIRGIN ISLANDS</option>';
                stateOptionsArray[14] += '<option value="79"  >VIC - VICTORIA</option>';
                stateOptionsArray[1] += '<option value="80"  >VT - VERMONT</option>';
                stateOptionsArray[14] += '<option value="81"  >WA - WESTERN AUS</option>';
                stateOptionsArray[1] += '<option value="82"  >WA - WASHINGTON</option>';
                stateOptionsArray[99] += '<option value="122"  >WEST BENGAL</option>';
                stateOptionsArray[1] += '<option value="83"  >WI - WISCONSIN</option>';
                stateOptionsArray[1] += '<option value="84"  >WV - WEST VIRGINIA</option>';
                stateOptionsArray[1] += '<option value="85"  >WY - WYOMING</option>';
                stateOptionsArray[38] += '<option value="86"  >YT - YUKON TERR.</option>';
                stateOptionsArray[254] = 'UNSUPPORTED';
                stateOptionsArray[242] = 'UNSUPPORTED';
                stateOptionsArray[253] = 'UNSUPPORTED';
                stateOptionsArray[241] = 'UNSUPPORTED';
                stateOptionsArray[240] = 'UNSUPPORTED';
                stateOptionsArray[244] = 'UNSUPPORTED';
                stateOptionsArray[246] = 'UNSUPPORTED';
                stateOptionsArray[249] = 'UNSUPPORTED';
                stateOptionsArray[247] = 'UNSUPPORTED';
                stateOptionsArray[245] = 'UNSUPPORTED';
                stateOptionsArray[248] = 'UNSUPPORTED';
                stateOptionsArray[250] = 'UNSUPPORTED';
                stateOptionsArray[82] = 'UNSUPPORTED';
                stateOptionsArray[251] = 'UNSUPPORTED';
                stateOptionsArray[252] = 'UNSUPPORTED';
                stateOptionsArray[243] = 'UNSUPPORTED';
                if (stateOptionsArray[countryId] != undefined && stateOptionsArray[countryId] != 'UNSUPPORTED') {
                  stateSelect = '<select name="formComponentsMap[\'order\'].shipToStateId" onchange="AGORA.__onShippingStateChange__($(this).find(\'option:selected\').text());" class="form-control input-sm" >' +
                    '<option value="">Select A State</option>' + stateOptionsArray[countryId] + '</select>';
                  whichStateInput = 'dropDown';
                  if (stateRequiredIndicator) stateRequiredIndicator.style.display = 'inline';
                  stateInputSection.css('display', '');
                } else {
                  AGORA.__onShippingStateChange__('');
                  stateSelect = '<input name="formComponentsMap[\'order\'].shipToStateName" type="text" value="" data-bind="" onchange="AGORA.__onShippingStateChange__($(this).val());"  class="form-control"/>';
                  whichStateInput = 'textBox';
                  if (stateRequiredIndicator) stateRequiredIndicator.style.display = 'none';
                  if (stateOptionsArray[countryId] == 'UNSUPPORTED' && stateInputSection.size() > 0) {
                    stateInputSection.css('display', 'none');
                  } else {
                    stateInputSection.css('display', '');
                  }
                }
                var postalCodeRequiredIndicator = document.getElementById('shipToPostalCodeRequiredIndicator');
                if (postalCodeRequiredMap[countryId] && postalCodeRequiredIndicator) {
                  postalCodeRequiredIndicator.style.display = 'inline';
                } else if (postalCodeRequiredIndicator) {
                  postalCodeRequiredIndicator.style.display = 'none';
                }
                if (document.getElementById('shipToStateSelect') != null) {
                  document.getElementById('shipToStateSelect').innerHTML = stateSelect;
                  document.getElementById('whichShipToStateInput').value = whichStateInput;
                }
                // Argentina:
                if (document.getElementById('argentinaTaxFieldsBlock') != null) {
                  if (countryId && countryId != "10") {
                    document.getElementById('argentinaTaxFieldsBlock').style.display = 'none';
                  } else {
                    document.getElementById('argentinaTaxFieldsBlock').style.display = 'block';
                  }
                }
                // TaxFields:
                var countryIds = ["43", "47", "134", "170", "60"];
                if (document.getElementById('taxIdLabel') != null) {
                  var useTaxIdFields = false;
                  for (var i = 0; i < countryIds.length; i++) {
                    if (countryIds[i] == countryId) {
                      useTaxIdFields = true;
                      var label = '';
                      if (countryIds[i] == "43") {
                        label = "*CI/RUT";
                      } else if (countryIds[i] == "47") {
                        label = "*CC";
                      } else if (countryIds[i] == "134") {
                        label = "*CURP";
                      } else if (countryIds[i] == "170") {
                        label = "*DNI";
                      } else if (countryIds[i] == "60") {
                        label = "*CI";
                      } else {
                        label = "Tax Id";
                      }
                    }
                  }
                  if (useTaxIdFields == true) {
                    document.getElementById('taxIdLabelHidden').value = label;
                    if (document.getElementById("taxIdLabel") != null) {
                      var taxIdL = document.getElementById("taxIdLabel");
                      taxIdL.innerHTML = label;
                    }
                  } else if (document.getElementById("taxIdLabel") != null && useTaxIdFields == false) {
                    var taxIdL = document.getElementById("taxIdLabel");
                    taxIdL.innerHTML = "Tax Id";
                  }
                }
                // Country Tax Id (Brazil/Argentina):
                // EU-VAT:
                checkIfCountryRequiresEuVat(countryId, "shipping");
              },
              __onShippingStateChange__: function(stateName) {
                AGORA.viewModel.shippingStateName(stateName);
              }
            });
            //]]>
          </script>
          <select id="__shippingCountrySelect__" name="formComponentsMap['order'].shipToCountryId" data-bind="" onchange="AGORA.__onShippingCountryChange__($(this).val(), $(this).find('option:selected').text());" class="form-control input-sm">
            <option value="1" selected="selected">UNITED STATES</option>
            <option value="3">AFGHANISTAN</option>
            <option value="4">ALBANIA</option>
            <option value="5">ALGERIA</option>
            <option value="6">ANDORRA</option>
            <option value="7">ANGOLA</option>
            <option value="9">ANGUILLA</option>
            <option value="8">ANTARCTICA</option>
            <option value="2">ANTIGUA AND BARBUDA</option>
            <option value="10">ARGENTINA</option>
            <option value="11">ARMENIA</option>
            <option value="12">ARUBA</option>
            <option value="14">AUSTRALIA</option>
            <option value="13">AUSTRIA</option>
            <option value="16">AZERBAIDJAN</option>
            <option value="24">BAHAMAS</option>
            <option value="17">BAHRAIN</option>
            <option value="18">BANGLADESH</option>
            <option value="19">BARBADOS</option>
            <option value="20">BELARUS</option>
            <option value="25">BELGIUM</option>
            <option value="26">BELIZE</option>
            <option value="21">BENIN</option>
            <option value="22">BERMUDA</option>
            <option value="35">BHUTAN</option>
            <option value="27">BOLIVIA</option>
            <option value="254">BONAIRE,ST EUST,SABA</option>
            <option value="28">BOSNIA-HERZEGOVINA</option>
            <option value="29">BOTSWANA</option>
            <option value="30">BRAZIL</option>
            <option value="100">BRITISH INDIAN OCEAN</option>
            <option value="32">BRUNEI DARUSSALAM</option>
            <option value="33">BULGARIA</option>
            <option value="23">BURKINA FASO</option>
            <option value="31">BURUNDI</option>
            <option value="36">CAMBODIA</option>
            <option value="37">CAMEROON</option>
            <option value="38">CANADA</option>
            <option value="40">CAPE VERDE</option>
            <option value="41">CAYMAN ISLANDS</option>
            <option value="39">CENTRAL AFRICAN REPU</option>
            <option value="42">CHAD</option>
            <option value="43">CHILE</option>
            <option value="46">CHINA</option>
            <option value="242">CHRISTMAS ISLAND</option>
            <option value="253">COCOS (KEELING) ISLA</option>
            <option value="47">COLOMBIA</option>
            <option value="48">COMOROS</option>
            <option value="49">CONGO</option>
            <option value="45">COOK ISLANDS</option>
            <option value="50">COSTA RICA</option>
            <option value="51">CROATIA</option>
            <option value="52">CUBA</option>
            <option value="241">CURACAO</option>
            <option value="53">CYPRUS</option>
            <option value="54">CZECH REPUBLIC</option>
            <option value="55">DENMARK</option>
            <option value="56">DJIBOUTI</option>
            <option value="57">DOMINICA</option>
            <option value="58">DOMINICAN REPUBLIC</option>
            <option value="67">EAST TIMOR</option>
            <option value="60">ECUADOR</option>
            <option value="62">EGYPT</option>
            <option value="63">EL SALVADOR</option>
            <option value="61">EQUATIORIAL GUINEA</option>
            <option value="64">ERITREA</option>
            <option value="65">ESTONIA</option>
            <option value="66">ETHIOPIA</option>
            <option value="68">FAEROE ISLANDS</option>
            <option value="69">FALKLAND ISLANDS</option>
            <option value="75">FED STATE MICRONESIA</option>
            <option value="71">FIJI</option>
            <option value="72">FINLAND</option>
            <option value="74">FRANCE</option>
            <option value="70">FRENCH GUIANA</option>
            <option value="73">FRENCH POLYNESIA</option>
            <option value="240">FRENCH SOUTHERN TERR</option>
            <option value="77">GABON</option>
            <option value="79">GAMBIA</option>
            <option value="84">GEORGIA, REPUBLIC OF</option>
            <option value="83">GERMANY</option>
            <option value="85">GHANA</option>
            <option value="86">GIBRALTAR</option>
            <option value="88">GREECE</option>
            <option value="89">GREENLAND</option>
            <option value="87">GRENADA</option>
            <option value="78">GUADELOUPE</option>
            <option value="90">GUATEMALA</option>
            <option value="91">GUINEA</option>
            <option value="81">GUINEA BISSAU</option>
            <option value="92">GUYANA</option>
            <option value="93">HAITI</option>
            <option value="244">HEARD AND MC DONALD</option>
            <option value="95">HONDURAS</option>
            <option value="94">HONG KONG</option>
            <option value="96">HUNGARY</option>
            <option value="97">ICELAND</option>
            <option value="99">INDIA</option>
            <option value="98">INDONESIA</option>
            <option value="101">IRAN</option>
            <option value="103">IRAQ</option>
            <option value="102">IRELAND</option>
            <option value="104">ISRAEL</option>
            <option value="105">ITALY</option>
            <option value="106">IVORY COAST</option>
            <option value="107">JAMAICA</option>
            <option value="108">JAPAN</option>
            <option value="109">JORDAN</option>
            <option value="110">KAZAKHSTAN</option>
            <option value="111">KENYA</option>
            <option value="112">KIRIBATI</option>
            <option value="113">KOREA</option>
            <option value="161">KOREA DEMOCRATIC PE</option>
            <option value="114">KUWAIT</option>
            <option value="115">KYRGYZSTAN</option>
            <option value="116">LAO PEOPLES DEM REP</option>
            <option value="117">LATVIA</option>
            <option value="119">LEBANON</option>
            <option value="122">LESOTHO</option>
            <option value="123">LIBERIA</option>
            <option value="118">LIBYA(N ARAB JAMAHI)</option>
            <option value="124">LIECHTENSTEIN</option>
            <option value="125">LITHUANIA</option>
            <option value="126">LUXEMBOURG</option>
            <option value="127">MACAO</option>
            <option value="133">MACEDONIA</option>
            <option value="128">MADAGASCAR</option>
            <option value="129">MALAWI</option>
            <option value="142">MALAYSIA</option>
            <option value="140">MALDIVES</option>
            <option value="139">MALI</option>
            <option value="141">MALTA</option>
            <option value="137">MARSHALL ISLANDS</option>
            <option value="130">MARTINIQUE</option>
            <option value="131">MAURITANIA</option>
            <option value="147">MAURITIUS</option>
            <option value="132">MAYOTTE</option>
            <option value="134">MEXICO</option>
            <option value="138">MOLDOVA</option>
            <option value="143">MONACO</option>
            <option value="135">MONGOLIA</option>
            <option value="145">MONTSERRAT</option>
            <option value="144">MOROCCO</option>
            <option value="146">MOZAMBIQUE</option>
            <option value="148">MYANMAR</option>
            <option value="149">NAMIBIA</option>
            <option value="151">NAURU</option>
            <option value="153">NEPAL</option>
            <option value="150">NETHERLAND ANTILLES</option>
            <option value="154">NETHERLANDS</option>
            <option value="152">NEW CALEDONIA</option>
            <option value="164">NEW ZEALAND</option>
            <option value="158">NICARAGUA</option>
            <option value="155">NIGER</option>
            <option value="159">NIGERIA</option>
            <option value="160">NIUE</option>
            <option value="246">NORFOLK ISLAND</option>
            <option value="162">NORTHERN MARIANA ISL</option>
            <option value="163">NORWAY</option>
            <option value="165">OMAN</option>
            <option value="166">PAKISTAN</option>
            <option value="167">PALAU</option>
            <option value="168">PANAMA</option>
            <option value="156">PAPUA NEW GUINEA</option>
            <option value="169">PARAGUAY</option>
            <option value="170">PERU</option>
            <option value="171">PHILIPPINES</option>
            <option value="172">PITCAIRN ISLANDS</option>
            <option value="173">POLAND</option>
            <option value="174">PORTUGAL</option>
            <option value="175">QATAR</option>
            <option value="176">REUNION</option>
            <option value="178">ROMANIA</option>
            <option value="225">RUSSIAN FEDERATION</option>
            <option value="179">RWANDA</option>
            <option value="198">SAINT HELENA</option>
            <option value="188">SAINT KITTS AND NEVI</option>
            <option value="191">SAINT LUCIA</option>
            <option value="202">SAINT VINCENT AND GR</option>
            <option value="181">SAMOA</option>
            <option value="193">SAN MARINO</option>
            <option value="197">SAO TOME &amp; PRINCIPE</option>
            <option value="182">SAUDI ARABIA</option>
            <option value="183">SENEGAL</option>
            <option value="236">SERBIA &amp; MONTENEGRO</option>
            <option value="185">SEYCHELLES</option>
            <option value="186">SIERRA LEONE</option>
            <option value="187">SINGAPORE</option>
            <option value="249">SINT MAARTEN</option>
            <option value="190">SLOVAKIA</option>
            <option value="192">SLOVENIA</option>
            <option value="189">SOLOMON ISLANDS</option>
            <option value="194">SOMALIA</option>
            <option value="180">SOUTH AFRICA</option>
            <option value="247">SOUTH GEORGIA &amp; THE S. SANDWICH ISL.</option>
            <option value="177">SOUTH KOREA</option>
            <option value="195">SPAIN</option>
            <option value="196">SRI LANKA</option>
            <option value="245">ST. MARTIN</option>
            <option value="199">ST. PIERRE &amp;MIQUELON</option>
            <option value="200">SUDAN</option>
            <option value="201">SURINAME</option>
            <option value="248">SVALBARD AND JAN MAY</option>
            <option value="206">SWAZILAND</option>
            <option value="204">SWEDEN</option>
            <option value="205">SWITZERLAND</option>
            <option value="207">SYRIA</option>
            <option value="208">TAIWAN</option>
            <option value="209">TAJIKISTAN</option>
            <option value="210">TANZANIA</option>
            <option value="212">THAILAND</option>
            <option value="215">TOGO</option>
            <option value="250">TOKELAU</option>
            <option value="214">TONGA</option>
            <option value="217">TRINIDAD AND TOBAGO</option>
            <option value="218">TUNISIA</option>
            <option value="219">TURKEY</option>
            <option value="213">TURKMENISTAN</option>
            <option value="211">TURKS AND CAICOS</option>
            <option value="220">TUVALU</option>
            <option value="222">UGANDA</option>
            <option value="223">UKRAINE</option>
            <option value="221">UNITED ARAB EMIRATES</option>
            <option value="82">UNITED KINGDOM</option>
            <option value="251">UNITED STATES MINOR</option>
            <option value="224">URUGUAY</option>
            <option value="226">UZBEKISTAN</option>
            <option value="227">VANUATU</option>
            <option value="228">VATICAN CITY STATE</option>
            <option value="229">VENEZUELA</option>
            <option value="230">VIETNAM</option>
            <option value="231">VIRGIN IS, BRIT</option>
            <option value="252">WALLIS AND FUTUNA IS</option>
            <option value="243">WESTERN SAHARA</option>
            <option value="235">YEMEN</option>
            <option value="237">ZAIRE</option>
            <option value="238">ZAMBIA</option>
            <option value="239">ZIMBABWE</option>
          </select>
          <input type="text" data-bind="value:AGORA.viewModel.shippingCountryName, visible: false " class="form-control" style="display: none;">
          <script type="text/javascript">
            $(document).ready(function() {
              AGORA.__onShippingCountryChange__($('#__shippingCountrySelect__').val(), $('#__shippingCountrySelect__').find('option:selected').text())
            });
          </script>
        </div>
        <div class="form-group">
          <label class="control-label"> Email: </label>
          <input name="formComponentsMap['order'].shipToEmailAddress" type="email" value="" maxlength="254" class="form-control" inputmode="email">
        </div>
        <div data-bind="" class="form-group">
          <label class="control-label"> Retype Email: </label>
          <input name="formComponentsMap['order'].confirmShipToEmailAddress" type="email" value="" maxlength="254" class="form-control" inputmode="email">
        </div>
      </fieldset>
    </div>
  </div>
  <div class="paymentFormContainer">
    <fieldset class="step">
      <legend class="step__header">Step No. 4: Enter Your Payment Information</legend>
      <script type="text/javascript">
        Namespace('AGORA', {
          submitForm: function(isSelfContainedForm, effortPaymentOptionId) {
            if (isSelfContainedForm === undefined) {
              isSelfContainedForm = false;
            }
            if (!isSelfContainedForm) {
              document.getElementById("formComponentsMap['paymentOption'].effortPaymentOptionId").value = effortPaymentOptionId;
            }
            window.setTimeout(AGORA.disableSubmit, 1); // Fix to prevent disable from not submitting the form
            return true;
          },
          disableSubmit: function() {
            $("input[name=btnPaymentOptionSubmit]").attr("disabled", "disabled").val("Your order is being processed....");
          }
        });
      </script>
      <input name="formComponentsMap['paymentOption'].effortPaymentOptionId" id="formComponentsMap['paymentOption'].effortPaymentOptionId" type="hidden" value="">
      <div data-bind="visible: isPaymentOptionSupported(7051686)">
        <!-- START JAVASCRIPT FOR KOUNT OPTION BLOCK -->
        <script type="text/javascript" src="https://ssl.kaptcha.com/collect/sdk?m=171440&amp;s=T2hqURx-f7Mp6x"></script>
        <script type="text/javascript">
          var client = new ka.ClientSDK();
          client.autoLoadEvents();
        </script>
        <!-- END JAVASCRIPT FOR KOUNT OPTION BLOCK -->
        <script src="https://images.web-purchases.com/jQuery/jquery.min.js" type="text/javascript"></script>
        <script type="text/javascript">
          // JavaScript Document
          (function($) {
            var creditCardTypeListLength = 0;
            var creditCardDataArray = [];
            var creditCardData1 = {};
            creditCardData1 = {
              ccId: 1,
              lowBound: 3400,
              highBound: 3499,
              dbId: 1,
              cardName: "American Express",
              useCreditCardMandate: "true"
            };
            creditCardTypeListLength++;
            creditCardDataArray.push(creditCardData1);
            var creditCardData2 = {};
            creditCardData2 = {
              ccId: 1,
              lowBound: 3700,
              highBound: 3799,
              dbId: 2,
              cardName: "American Express",
              useCreditCardMandate: "true"
            };
            creditCardTypeListLength++;
            creditCardDataArray.push(creditCardData2);
            var creditCardData3 = {};
            creditCardData3 = {
              ccId: 2,
              lowBound: 5100,
              highBound: 5599,
              dbId: 3,
              cardName: "MasterCard",
              useCreditCardMandate: "true"
            };
            creditCardTypeListLength++;
            creditCardDataArray.push(creditCardData3);
            var creditCardData14 = {};
            creditCardData14 = {
              ccId: 2,
              lowBound: 2221,
              highBound: 2720,
              dbId: 14,
              cardName: "MasterCard",
              useCreditCardMandate: "true"
            };
            creditCardTypeListLength++;
            creditCardDataArray.push(creditCardData14);
            var creditCardData4 = {};
            creditCardData4 = {
              ccId: 3,
              lowBound: 4000,
              highBound: 4999,
              dbId: 4,
              cardName: "Visa",
              useCreditCardMandate: "true"
            };
            creditCardTypeListLength++;
            creditCardDataArray.push(creditCardData4);
            var creditCardData5 = {};
            creditCardData5 = {
              ccId: 4,
              lowBound: 6011,
              highBound: 6011,
              dbId: 5,
              cardName: "Discover",
              useCreditCardMandate: "true"
            };
            creditCardTypeListLength++;
            creditCardDataArray.push(creditCardData5);
            (function() {
              var cardFromNumber, formatBackExpiry, formatExpiry, formatForwardExpiry, formatForwardSlashAndSpace, hasTextSelected, reFormatExpiry, restrictNumeric, setCardType,
                __slice = [].slice,
                __indexOf = [].indexOf || function(item) {
                  for (var i = 0, l = this.length; i < l; i++) {
                    if (i in this && this[i] === item) return i;
                  }
                  return -1;
                };
              $.payment = {};
              $.payment.fn = {};
              $.fn.payment = function() {
                var args, method;
                method = arguments[0], args = 2 <= arguments.length ? __slice.call(arguments, 1) : [];
                return $.payment.fn[method].apply(this, args);
              };
              cardFromNumber = function(num) {
                var card = {};
                num = (num + '').replace(/\D/g, '');
                var firstFour = num.substring(0, 4);
                for (i = 0; i < creditCardDataArray.length; i++) {
                  if (firstFour >= creditCardDataArray[i].lowBound && firstFour <= creditCardDataArray[i].highBound) {
                    card.type = creditCardDataArray[i].cardName;
                    return card;
                  }
                }
              };
              hasTextSelected = function($target) {
                var _ref;
                if (($target.prop('selectionStart') != null) && $target.prop('selectionStart') !== $target.prop('selectionEnd')) {
                  return true;
                }
                if ((typeof document !== "undefined" && document !== null ? (_ref = document.selection) != null ? _ref.createRange : void 0 : void 0) != null) {
                  if (document.selection.createRange().text) {
                    return true;
                  }
                }
                return false;
              };
              reFormatExpiry = function(e) {
                return setTimeout(function() {
                  var $target, value;
                  $target = $(e.currentTarget);
                  value = $target.val();
                  value = $.payment.formatExpiry(value);
                  return $target.val(value);
                });
              };
              formatForwardExpiry = function(e) {
                var $target, digit, val;
                digit = String.fromCharCode(e.which);
                if (!/^\d+$/.test(digit)) {
                  return;
                }
                $target = $(e.currentTarget);
                val = $target.val();
                if (/^\d\d$/.test(val)) {
                  return $target.val("" + val + " / ");
                }
              };
              formatForwardSlashAndSpace = function(e) {
                var $target, val, which;
                which = String.fromCharCode(e.which);
                if (!(which === '/' || which === ' ')) {
                  return;
                }
                $target = $(e.currentTarget);
                val = $target.val();
                if (/^\d$/.test(val) && val !== '0') {
                  return $target.val("0" + val + " / ");
                }
              };
              formatBackExpiry = function(e) {
                var $target, value;
                $target = $(e.currentTarget);
                value = $target.val();
                if (e.which !== 8) {
                  return;
                }
                if (($target.prop('selectionStart') != null) && $target.prop('selectionStart') !== value.length) {
                  return;
                }
                if (/\d\s\/\s$/.test(value)) {
                  e.preventDefault();
                  return setTimeout(function() {
                    return $target.val(value.replace(/\d\s\/\s$/, ''));
                  });
                }
              };
              restrictNumeric = function(e) {
                var input;
                if (e.metaKey || e.ctrlKey) {
                  return true;
                }
                if (e.which === 32) {
                  return false;
                }
                if (e.which === 0) {
                  return true;
                }
                if (e.which < 33) {
                  return true;
                }
                input = String.fromCharCode(e.which);
                return !!/[\d\s]/.test(input);
              };
              setCardType = function(e) {
                var $target, allTypes, card, cardType, val, useCreditCardMandate;
                $target = $(e.currentTarget);
                val = $target.val();
                cardType = $.payment.cardType(val) || 'unknown';
                if (!$target.hasClass(cardType)) {
                  allTypes = (function() {
                    var _i, _len, _results;
                    _results = [];
                    for (i = 0; i < creditCardDataArray.length; i++) {
                      card = creditCardDataArray[i];
                      card.type = creditCardDataArray[i].cardName
                      card.useCreditCardMandate = creditCardDataArray[i].useCreditCardMandate
                      _results.push(card.type);
                      if (/\s/.test(card.type)) {
                        card.type = card.type.replace(/\s/g, '');
                        _results.push(card.type);
                        _results.push(card.useCreditCardMandate);
                      }
                    }
                    return _results;
                  })();
                  $target.removeClass('unknown');
                  $target.removeClass(allTypes.join(' '));
                  $target.addClass(cardType);
                  $target.toggleClass('identified', cardType !== 'unknown');
                  var useCreditCardMandate = false;
                  for (i = 0; i < creditCardDataArray.length; i++) {
                    card = creditCardDataArray[i];
                    if (cardType === creditCardDataArray[i].cardName) {
                      useCreditCardMandate = creditCardDataArray[i].useCreditCardMandate;
                    }
                  }
                  if (useCreditCardMandate === 'true' && AGORA.viewModel.isAutoRenewChoiceSelected()) {
                    document.getElementById("autoRenewAuth").style.display = "block";
                  } else {
                    document.getElementById("autoRenewAuth").style.display = "none";
                  }
                  cardType = cardType.replace(/\s/g, '');
                  return $target.trigger('payment.cardType', cardType);
                }
              };
              $.payment.fn.formatCardExpiry = function() {
                this.keyup(restrictNumeric);
                this.keyup(formatExpiry);
                this.keyup(formatForwardSlashAndSpace);
                this.keyup(formatForwardExpiry);
                this.keyup(formatBackExpiry);
                this.keyup(reFormatExpiry);
                return this;
              };
              $.payment.fn.formatCardNumber = function() {
                this.keypress(restrictNumeric);
                this.keyup(setCardType);
                return this;
              };
              $.payment.fn.restrictNumeric = function() {
                this.keypress(restrictNumeric);
                return this;
              };
              $.payment.fn.cardExpiryVal = function() {
                return $.payment.cardExpiryVal($(this).val());
              };
              $.payment.cardExpiryVal = function(value) {
                var month, prefix, year, _ref;
                value = value.replace(/\s/g, '');
                _ref = value.split('/', 2), month = _ref[0], year = _ref[1];
                if ((year != null ? year.length : void 0) === 2 && /^\d+$/.test(year)) {
                  prefix = (new Date).getFullYear();
                  prefix = prefix.toString().slice(0, 2);
                  year = prefix + year;
                }
                month = parseInt(month, 10);
                year = parseInt(year, 10);
                return {
                  month: month,
                  year: year
                };
              };
              $.payment.cardType = function(num) {
                var _ref;
                if (!num || num.length <= 3) {
                  return null;
                }
                return ((_ref = cardFromNumber(num)) != null ? _ref.type : void 0) || null;
              };
              $.payment.formatExpiry = function(expiry) {
                var mon, parts, sep, year;
                parts = expiry.match(/^\D*(\d{1,2})(\D+)?(\d{1,4})?/);
                if (!parts) {
                  return '';
                }
                mon = parts[1] || '';
                sep = parts[2] || '';
                year = parts[3] || '';
                if (year.length > 0) {
                  sep = ' / ';
                } else if (sep === ' /') {
                  mon = mon.substring(0, 1);
                  sep = '';
                } else if (mon.length === 2 || sep.length > 0) {
                  sep = ' / ';
                } else if (mon.length === 1 && (mon !== '0' && mon !== '1')) {
                  mon = "0" + mon;
                  sep = ' / ';
                }
                return mon + sep + year;
              };
            }).call(this);;
            (function() {
              jQuery(function($) {
                var cardTypeIdToName, cardTypeNameToId, existing, processField, setCardTypeField;
                existing = {
                  cardType: Number($("input[name$='.creditCardTypeId']:checked").val()),
                  expiryMonth: Number($("select[name$='.creditCardExpirationMonth']").val()),
                  expiryYear: Number($("select[name$='.creditCardExpirationYear']").val())
                };
                if (existing.expiryMonth === 0) {
                  existing.expiryMonth = null;
                }
                if (existing.expiryYear === 0) {
                  existing.expiryYear = null;
                }
                /*
                Input field replacements and modifications
                 */
                $("#cc-cardtype-radio").replaceWith('<input name="formComponentsMap[&#39;paymentOption&#39;].creditCardTypeId" id="cc-cardtype" type="hidden" required>');
                if ((existing.cardType != null) && !isNaN(existing.cardType)) {
                  $('#cc-cardtype').val(existing.cardType);
                }
                $(".cc-expiry-group > div").remove();
                $(".cc-expiry-group").append('<div class="col-sm-6 col-md-6 col-lg-6"><input class="cc-expiry form-control" maxlength="7" type="tel" placeholder="MM / YY"></div>').append(
                  '<input name="formComponentsMap[&#39;paymentOption&#39;].creditCardExpirationMonth" type="hidden">').append('<input name="formComponentsMap[&#39;paymentOption&#39;].creditCardExpirationYear" type="hidden">');
                $("input[name$='.maskedCreditCardNumber']").addClass("cc-cardnumber auto-cardtype").prop("type", "tel");
                /*
                 * Format the specified field as the specified type
                 */
                processField = function(field, type) {
                  return $(field).bind('change paste keyup input', function() {
                    var cardType, expiryVal, value;
                    value = $(this).payment('formatCard' + type).val();
                    switch (type) {
                      case 'Number':
                        $(this).payment;
                        cardType = $.payment.cardType(value);
                        setCardTypeField(cardType);
                        break;
                      case 'Expiry':
                        $(this).payment("formatCardExpiry");
                        expiryVal = $.payment.cardExpiryVal($(this).val());
                        if (10 >= expiryVal.month && 1 === expiryVal.month.toString().length) {
                          expiryVal.month = '0' + expiryVal.month;
                        }
                        $("input[name$='creditCardExpirationMonth']").val(expiryVal.month);
                        $("input[name$='creditCardExpirationYear']").val(expiryVal.year);
                        break;
                    }
                  });
                };
                /*
                 * Set the card type numeric ID from the type name
                 */
                cardTypeNameToId = function(cardType) {
                  var typeNumber;
                  if (cardType != null) {
                    for (i = 0; i < creditCardDataArray.length; i++) {
                      if (cardType == creditCardDataArray[i].cardName) {
                        typeNumber = creditCardDataArray[i].ccId;
                        break;
                      }
                    }
                  }
                  $('#cc-cardtype').val(typeNumber);
                  return typeNumber;
                };
                /*
                 * Set the card type name from the numeric ID
                 */
                cardTypeIdToName = function(cardType) {
                  var typeName;
                  cardType = Number(cardType);
                  for (i = 0; i < creditCardDataArray.length; i++) {
                    if (cardType == creditCardDataArray[i].ccId) {
                      typeName = creditCardDataArray[i].cardName;
                      break;
                    }
                  }
                  return typeName;
                };
                /*
                 * Assign a numeric value for the card type to the hidden field
                 */
                setCardTypeField = function(cardType) {
                  var typeNumber;
                  typeNumber = cardTypeNameToId(cardType);
                  $('#cc-cardtype').val(typeNumber);
                };
                /*
                 * Perform formatting 
                 */
                if ((existing.cardType != null) && !isNaN(existing.cardType)) {
                  existing.cardTypeName = cardTypeIdToName(existing.cardType);
                  $("input[name$='.maskedCreditCardNumber']").addClass(existing.cardTypeName);
                }
                if ((existing.expiryMonth != null) && (existing.expiryYear != null)) {
                  $(".cc-expiry").val(existing.expiryMonth + " / " + existing.expiryYear);
                  $("input[name$='.creditCardExpirationMonth']").val(existing.expiryMonth);
                  $("input[name$='.creditCardExpirationYear']").val(existing.expiryYear);
                }
                processField("input[name$='maskedCreditCardNumber']", "Number");
                processField(".cc-expiry", "Expiry");
                /*
                 * Ancillary form processes
                 */
                $("input[name$='.shouldSaveCreditCard']").click(function() {
                  $("#creditName").toggle("slow");
                });
              });
            }).call(this);
          })(jQuery.noConflict());
        </script>
        <div class="row">
          <div class="form-group">
            <label class="control-label col-sm-4 col-md-4 col-lg-4"></label>
            <div class="col-sm-6 col-md-6 col-lg-6">
              <!-- for regular orders -->
              <div id="lightboxDiv" style="display:none"><a href="#" id="theLightbox">Click to retrieve saved credit cards.</a></div>
              <div id="popLinkErrorMessage"></div>
            </div>
          </div>
        </div>
        <div class="form-notes" style="display: flex; justify-content: center; align-items: center; margin-top: -20px; margin-bottom: 0;">
          <p class="text-suppressed ta-center" style="margin-right: 1em; margin-bottom: 0;"> Secure Credit Card Online <!-- This link contains a Javascript file that generates the new McAffe Image -->
            <script src="https://cdn.ywxi.net/js/inline.js?w=90"></script>
          </p>
          <div
            style="display: inline-block; width: 90px; height: 37px; background-size: contain; background-image: url(&quot;https://cdn.ywxi.net/meter/orders.manwardpress.com/102.svg?ts=1649376132768&amp;l=en-US&quot;); background-position: center top; background-repeat: no-repeat; cursor: pointer;"
            class="mfes-trustmark loaded" data-width="90" data-height="37" data-ext="svg" data-type="102" oncontextmenu="return false;" title="TrustedSite Certified" tabindex="0"></div>
          <p></p>
        </div>
        <div class="form-group">
          <select id="creditCardSelect" style="display:none" data-bind="options: creditCards, optionsText: 'description', optionsCaption: 'Enter a new credit card', value: selectedCreditCard" class="form-control input-sm">
            <option value="">Enter a new credit card</option>
          </select><input id="creditCardElectronicPaymentIdHiddenField" style="display:none" name="formComponentsMap['paymentOption'].electronicPaymentId" type="hidden"
            data-bind="value: AGORA.viewModel.selectedCreditCard()?AGORA.viewModel.selectedCreditCard().electronicPaymentId:''" class="form-control">
        </div>
        <input name="formComponentsMap['paymentOption'].creditCardTypeId" id="cc-cardtype" type="hidden" required=""> <!-- #cc-cardtype-radio-->
        <div class="form-notes ta-center">
          <img src="/img/creditCardType_VI.jpg" id="3">
          <img src="/img/creditCardType_MC.jpg" id="2">
          <img src="/img/creditCardType_AX.jpg" id="1">
          <img src="/img/creditCardType_DI.jpg" id="4">
        </div>
      </div> <!-- .form-notes -->
      <div class="form-group">
        <label class="control-label"> Cardholder Name: </label>
        <input name="formComponentsMap['paymentOption'].accountHolderName1" type="text" value="" maxlength="40" class="form-control">
      </div>
      <div class="form-group">
        <label class="control-label"> Card Number: </label>
        <input name="formComponentsMap['paymentOption'].maskedCreditCardNumber" type="tel" value="" maxlength="25" data-bind="value: selectedCreditCardMaskedNumber, enable: (AGORA.viewModel.selectedCreditCard() == null)" autocomplete="off"
          placeholder="Enter only numbers. No spaces or dashes." class="form-control cc-cardnumber auto-cardtype">
      </div>
      <div class="form-group cc-expiry-group">
        <label class="control-label">Expiration Date: </label>
        <div class="col-sm-6 col-md-6 col-lg-6"><input class="cc-expiry form-control" maxlength="7" type="tel" placeholder="MM / YY"></div><input name="formComponentsMap['paymentOption'].creditCardExpirationMonth" type="hidden"><input
          name="formComponentsMap['paymentOption'].creditCardExpirationYear" type="hidden">
      </div>
      <div class="form-group">
        <label class="control-label"> Security Code/CVV: </label>
        <input name="formComponentsMap['paymentOption'].creditCardSecurityCode" type="text" value="" maxlength="4" autocomplete="off" class="form-control"> <a role="button" class="form-help" id="OpenModalButton">Help me find it</a>
      </div>
      <div class="row">
        <div class="form-group" data-bind="visible: (AGORA.viewModel.selectedCreditCard() == null)">
          <div class="form-group form-check">
            <label>
              <input id="ccSaveCheck" class="ccSaveCheck" data-bind="checked: shouldSaveCreditCard" name="formComponentsMap['paymentOption'].shouldSaveCreditCard" type="checkbox" value="true"> Check this box if you’d like to save this credit card for
              future purchases </label>
          </div>
          <div class="form-group">
            <label class="control-label"> Credit Card Name: </label>
            <input name="formComponentsMap['paymentOption'].creditCardDescription" type="text" value="" maxlength="50" data-bind="enable: shouldSaveCreditCard, value: selectedCreditCardDescription" autocomplete="off" class="form-control" disabled="">
          </div>
        </div>
        <!-- ko ifnot: selectedChoiceHasDirectDebit() -->
        <div class="form-group">
          <label>
            <!-- ko if: isAutoRenewChoiceSelected() --> If you use a debit card for payment, your debit card will be automatically charged when your purchase is due for renewal. <!-- /ko -->
          </label>
        </div>
        <!-- /ko -->
        <div id="autoRenewAuth" style="display:none">
          <div class="form-group form-check">
            <label>
              <input name="formComponentsMap['paymentOption'].hasAgreedToAutoRenewConditions" type="checkbox" value="true" class="check">
              <input type="hidden" name="_formComponentsMap['paymentOption'].hasAgreedToAutoRenewConditions">
              <!-- TODO: Use correct dependent content for choice & terms --> * I understand that each year when my subscription comes up for renewal, my card will automatically be billed at the rate indicated above. I may opt out of this 100% secure
              feature at any time after purchase. </label>
          </div>
        </div>
        <div class="billing-terms">
          <p class="js-billing-terms text-suppressed"><b>Billing Terms:</b> I agree to pay the price mentioned above for a one-year subscription to this service. I understand that each year, my card on file will be billed automatically at the low
            rate of $79 for another year of service, to ensure that I never lose service. If I want to <a href="https://manwardpress.com/contact/" target="_blank">cancel my subscription</a> or remove the automatic renewal feature, I can contact the
            Manward Support Team at any time by <a href="https://manwardpress.com/contact/" target="_blank">clicking here</a> or calling 800.682.5210 or 443.353.4263, Monday through Friday, 8 a.m. to 8 p.m. ET. I have read and accepted the
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            credit card statement. My subscription comes with a 90-day full refund policy.</p>
          <p class="text-suppressed">
            <!-- Tax Language - MW--> *Applicable sales tax applies. For more information, please visit <a href="https://manwardpress.com/sales-tax/" target="_blank">https://manwardpress.com/sales-tax/</a>. International fulfillment will be digital
            only.
          </p>
        </div>
        <div align="center"> <input name="btnPaymentOptionSubmit" onclick="return AGORA.submitForm(false,7051686);" type="submit" value="Place My Secure Order" class="continue">
        </div>
      </div>
    </fieldset>
  </div> <!-- .paymentFormContainer -->
  <div class="order-info">
    <p class="ta-center order-info__item">Your Promotion Code is: <span class="codes"> EMWLX6CD </span>
    </p>
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MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE
MAURITANIA MAURITIUS MAYOTTE MEXICO MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO
MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLAND ANTILLES NETHERLANDS NEW
CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN
MARIANA ISL NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU
PHILIPPINES PITCAIRN ISLANDS POLAND PORTUGAL QATAR REUNION ROMANIA RUSSIAN
FEDERATION RWANDA SAINT HELENA SAINT KITTS AND NEVI SAINT LUCIA SAINT VINCENT
AND GR SAMOA SAN MARINO SAO TOME & PRINCIPE SAUDI ARABIA SENEGAL SERBIA &
MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SINT MAARTEN SLOVAKIA SLOVENIA
SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA & THE S. SANDWICH ISL. SOUTH
KOREA SPAIN SRI LANKA ST. MARTIN ST. PIERRE &MIQUELON SUDAN SURINAME SVALBARD
AND JAN MAY SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKISTAN TANZANIA
THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN
TURKS AND CAICOS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM
UNITED STATES MINOR URUGUAY UZBEKISTAN VANUATU VATICAN CITY STATE VENEZUELA
VIETNAM VIRGIN IS, BRIT WALLIS AND FUTUNA IS WESTERN SAHARA YEMEN ZAIRE ZAMBIA
ZIMBABWE
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