{"id":268,"date":"2019-09-09T16:09:01","date_gmt":"2019-09-09T16:09:01","guid":{"rendered":"https:\/\/affordable-website-hosting-for-you.com\/mariemont\/?page_id=268"},"modified":"2024-02-09T17:47:07","modified_gmt":"2024-02-09T17:47:07","slug":"service-request","status":"publish","type":"page","link":"https:\/\/affordable-website-hosting-for-you.com\/mariemont\/service-request\/","title":{"rendered":"Service Request"},"content":{"rendered":"\t\t\t\t\t\t<style>\r\n\t\t\t\t<style>\r\n#wpsm_accordion_520 .wpsm_panel-heading{\r\n\tpadding:0px !important;\r\n}\r\n#wpsm_accordion_520 .wpsm_panel-title {\r\n\tmargin:0px !important; \r\n\ttext-transform:none !important;\r\n\tline-height: 1 !important;\r\n}\r\n#wpsm_accordion_520 .wpsm_panel-title a{\r\n\ttext-decoration:none;\r\n\toverflow:hidden;\r\n\tdisplay:block;\r\n\tpadding:0px;\r\n\tfont-size: 14px !important;\r\n\tfont-family: Open Sans !important;\r\n\tcolor:#000000 !important;\r\n\tborder-bottom:0px !important;\r\n}\r\n\r\n#wpsm_accordion_520 .wpsm_panel-title a:focus {\r\noutline: 0px !important;\r\n}\r\n\r\n#wpsm_accordion_520 .wpsm_panel-title a:hover, #wpsm_accordion_520 .wpsm_panel-title a:focus {\r\n\tcolor:#000000 !important;\r\n}\r\n#wpsm_accordion_520 .acc-a{\r\n\tcolor: #000000 !important;\r\n\tbackground-color:#e8e8e8 !important;\r\n\tborder-color: #ddd;\r\n}\r\n#wpsm_accordion_520 .wpsm_panel-default > .wpsm_panel-heading{\r\n\tcolor: #000000 !important;\r\n\tbackground-color: #e8e8e8 !important;\r\n\tborder-color: #e8e8e8 !important;\r\n\tborder-top-left-radius: 0px;\r\n\tborder-top-right-radius: 0px;\r\n}\r\n#wpsm_accordion_520 .wpsm_panel-default {\r\n\t\tborder:1px solid transparent !important;\r\n\t}\r\n#wpsm_accordion_520 {\r\n\tmargin-bottom: 20px;\r\n\toverflow: hidden;\r\n\tfloat: none;\r\n\twidth: 100%;\r\n\tdisplay: block;\r\n}\r\n#wpsm_accordion_520 .ac_title_class{\r\n\tdisplay: block;\r\n\tpadding-top: 12px;\r\n\tpadding-bottom: 12px;\r\n\tpadding-left: 15px;\r\n\tpadding-right: 15px;\r\n}\r\n#wpsm_accordion_520  .wpsm_panel {\r\n\toverflow:hidden;\r\n\t-webkit-box-shadow: 0 0px 0px rgba(0, 0, 0, .05);\r\n\tbox-shadow: 0 0px 0px rgba(0, 0, 0, .05);\r\n\t\tborder-radius: 4px;\r\n\t}\r\n#wpsm_accordion_520  .wpsm_panel + .wpsm_panel {\r\n\t\tmargin-top: 5px;\r\n\t}\r\n#wpsm_accordion_520  .wpsm_panel-body{\r\n\tbackground-color:#ffffff !important;\r\n\tcolor:#000000 !important;\r\n\tborder-top-color: #e8e8e8 !important;\r\n\tfont-size:12px !important;\r\n\tfont-family: Open Sans !important;\r\n\toverflow: hidden;\r\n\t\tborder: 2px solid #e8e8e8 !important;\r\n\t}\r\n\r\n#wpsm_accordion_520 .ac_open_cl_icon{\r\n\tbackground-color:#e8e8e8 !important;\r\n\tcolor: #000000 !important;\r\n\tfloat:right !important;\r\n\tpadding-top: 12px !important;\r\n\tpadding-bottom: 12px !important;\r\n\tline-height: 1.0 !important;\r\n\tpadding-left: 15px !important;\r\n\tpadding-right: 15px !important;\r\n\tdisplay: inline-block !important;\r\n}\r\n\r\n\t\t\t\r\n\t\t\t<\/style>\t\r\n\t\t\t<\/style>\r\n\t\t\t<div class=\"wpsm_panel-group\" id=\"wpsm_accordion_520\" >\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t<!-- Inner panel Start -->\r\n\t\t\t\t\t<div class=\"wpsm_panel wpsm_panel-default\">\r\n\t\t\t\t\t\t<div class=\"wpsm_panel-heading\" role=\"tab\" >\r\n\t\t\t\t\t\t  <h4 class=\"wpsm_panel-title\">\r\n\t\t\t\t\t\t\t<a  class=\"\"  data-toggle=\"collapse\" data-parent=\"#wpsm_accordion_520 \" href=\"javascript:void(0)\" data-target=\"#ac_520_collapse1\" onclick=\"do_resize()\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ac_open_cl_icon fa fa-plus\"><\/span>\r\n\t\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t \r\n\t\t\t\t\t\t\t\t<span class=\"ac_title_class\">\r\n\t\t\t\t\t\t\t\t\tRequest Auto ID Card\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/a>\r\n\t\t\t\t\t\t  <\/h4>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div id=\"ac_520_collapse1\" class=\"wpsm_panel-collapse collapse \"  >\r\n\t\t\t\t\t\t  <div class=\"wpsm_panel-body\">\r\n\t\t\t\t\t\t\t<div id=\"vfb-form-14\" class=\"visual-form-builder-container\"><form id=\"auto-id-card-14\" class=\"visual-form-builder vfb-form-14 \" method=\"post\" enctype=\"multipart\/form-data\">\n\t  \t<input type=\"hidden\" name=\"form_id\" value=\"14\" \/><fieldset class=\"vfb-fieldset vfb-fieldset-1 please-provide-the-following-information \" id=\"item-vfb-113\"><div class=\"vfb-legend\"><h3>Please Provide The Following information<\/h3><\/div><ul class=\"vfb-section vfb-section-1\"><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-117\"><label for=\"vfb-117\" class=\"vfb-desc\">Your Name  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-117\" id=\"vfb-117\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li><li class=\"vfb-item vfb-item-email  \" id=\"item-vfb-118\"><label for=\"vfb-118\" class=\"vfb-desc\">Your Email Address <\/label><input type=\"email\" name=\"vfb-118\" id=\"vfb-118\" value=\"\" class=\"vfb-text  vfb-medium   email \" \/><\/li><li class=\"vfb-item vfb-item-phone  \" id=\"item-vfb-119\"><label for=\"vfb-119\" class=\"vfb-desc\">Your Phone Number  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"tel\" name=\"vfb-119\" id=\"vfb-119\" value=\"\" class=\"vfb-text  vfb-medium  required  phone \" \/><\/li><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-122\"><label for=\"vfb-122\" class=\"vfb-desc\">Your Policy Number ( Not Required) <\/label><input type=\"text\" name=\"vfb-122\" id=\"vfb-122\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-2 verification \" id=\"item-vfb-114\" style=\"display:block\"><div class=\"vfb-legend\"><h3>Verification<\/h3><\/div><ul class=\"vfb-section vfb-section-2\"><li class=\"vfb-item vfb-item-secret\"  style=\"display:block\"><label for=\"vfb-115\" class=\"vfb-desc\">Please enter any two digits <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"hidden\" name=\"_vfb-secret\" value=\"vfb-115\" \/><span class=\"vfb-span\"><input type=\"text\" name=\"vfb-115\" id=\"vfb-115\" value=\"\" class=\"vfb-text  vfb-medium  required {digits:true,maxlength:2,minlength:2} \" style=\"display:block\" \/><label>Example: 12<\/label><\/span><li style=\"display:none;\"><label>This box is for spam protection - &lt;strong&gt;please leave it blank&lt;\/strong&gt;:<\/label><div><input name=\"vfb-spam\" \/><\/div><\/li>\n\t\t\t<li class=\"vfb-item vfb-item-submit\" id=\"item-vfb-116\">\n\t\t\t\t<input type=\"submit\" name=\"vfb-submit\" id=\"vfb-116\" value=\"Submit\" class=\"vfb-submit \" \/>\n\t\t\t\t<\/li><\/ul>\n\t\t\t<\/fieldset><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/mariemont\/wp-json\/wp\/v2\/pages\/268\" \/><\/form><\/div> <!-- .visual-form-builder-container -->\t\t\t\t\t\t  <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Inner panel End -->\r\n\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t<!-- Inner panel Start -->\r\n\t\t\t\t\t<div class=\"wpsm_panel wpsm_panel-default\">\r\n\t\t\t\t\t\t<div class=\"wpsm_panel-heading\" role=\"tab\" >\r\n\t\t\t\t\t\t  <h4 class=\"wpsm_panel-title\">\r\n\t\t\t\t\t\t\t<a  class=\"collapsed\"  data-toggle=\"collapse\" data-parent=\"#wpsm_accordion_520 \" href=\"javascript:void(0)\" data-target=\"#ac_520_collapse2\" onclick=\"do_resize()\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ac_open_cl_icon fa fa-plus\"><\/span>\r\n\t\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t \r\n\t\t\t\t\t\t\t\t<span class=\"ac_title_class\">\r\n\t\t\t\t\t\t\t\t\tGeneral Requests\/Questions\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/a>\r\n\t\t\t\t\t\t  <\/h4>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div id=\"ac_520_collapse2\" class=\"wpsm_panel-collapse collapse \"  >\r\n\t\t\t\t\t\t  <div class=\"wpsm_panel-body\">\r\n\t\t\t\t\t\t\t<div id=\"vfb-form-15\" class=\"visual-form-builder-container\"><form id=\"general-requests-questions-15\" class=\"visual-form-builder vfb-form-15 \" method=\"post\" enctype=\"multipart\/form-data\">\n\t  \t<input type=\"hidden\" name=\"form_id\" value=\"15\" \/><fieldset class=\"vfb-fieldset vfb-fieldset-1 please-fill-in-the-following-information \" id=\"item-vfb-123\"><div class=\"vfb-legend\"><h3>Please Fill In the Following Information<\/h3><\/div><ul class=\"vfb-section vfb-section-1\"><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-127\"><label for=\"vfb-127\" class=\"vfb-desc\">Name  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-127\" id=\"vfb-127\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li><li class=\"vfb-item vfb-item-email  \" id=\"item-vfb-128\"><label for=\"vfb-128\" class=\"vfb-desc\">Email <\/label><input type=\"email\" name=\"vfb-128\" id=\"vfb-128\" value=\"\" class=\"vfb-text  vfb-medium   email \" \/><\/li><li class=\"vfb-item vfb-item-phone  \" id=\"item-vfb-129\"><label for=\"vfb-129\" class=\"vfb-desc\">Phone  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"tel\" name=\"vfb-129\" id=\"vfb-129\" value=\"\" class=\"vfb-text  vfb-medium  required  phone \" \/><\/li><li class=\"vfb-item vfb-item-textarea  \" id=\"item-vfb-130\"><label for=\"vfb-130\" class=\"vfb-desc\">Your Request\/Question <\/label><div><textarea name=\"vfb-130\" id=\"vfb-130\" class=\"vfb-textarea  vfb-large  \"><\/textarea><\/div><\/li><\/ul>&nbsp;<\/fieldset><fieldset class=\"vfb-fieldset vfb-fieldset-2 verification \" id=\"item-vfb-124\" style=\"display:block\"><div class=\"vfb-legend\"><h3>Verification<\/h3><\/div><ul class=\"vfb-section vfb-section-2\"><li class=\"vfb-item vfb-item-secret\"  style=\"display:block\"><label for=\"vfb-125\" class=\"vfb-desc\">Please enter any two digits <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"hidden\" name=\"_vfb-secret\" value=\"vfb-125\" \/><span class=\"vfb-span\"><input type=\"text\" name=\"vfb-125\" id=\"vfb-125\" value=\"\" class=\"vfb-text  vfb-medium  required {digits:true,maxlength:2,minlength:2} \" style=\"display:block\" \/><label>Example: 12<\/label><\/span><li style=\"display:none;\"><label>This box is for spam protection - &lt;strong&gt;please leave it blank&lt;\/strong&gt;:<\/label><div><input name=\"vfb-spam\" \/><\/div><\/li>\n\t\t\t<li class=\"vfb-item vfb-item-submit\" id=\"item-vfb-126\">\n\t\t\t\t<input type=\"submit\" name=\"vfb-submit\" id=\"vfb-126\" value=\"Submit\" class=\"vfb-submit \" \/>\n\t\t\t\t<\/li><\/ul>\n\t\t\t<\/fieldset><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/mariemont\/wp-json\/wp\/v2\/pages\/268\" \/><\/form><\/div> <!-- .visual-form-builder-container -->\t\t\t\t\t\t  <\/div>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<!-- Inner panel End -->\r\n\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t<!-- Inner panel Start -->\r\n\t\t\t\t\t<div class=\"wpsm_panel wpsm_panel-default\">\r\n\t\t\t\t\t\t<div class=\"wpsm_panel-heading\" role=\"tab\" >\r\n\t\t\t\t\t\t  <h4 class=\"wpsm_panel-title\">\r\n\t\t\t\t\t\t\t<a  class=\"collapsed\"  data-toggle=\"collapse\" data-parent=\"#wpsm_accordion_520 \" href=\"javascript:void(0)\" data-target=\"#ac_520_collapse3\" onclick=\"do_resize()\">\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ac_open_cl_icon fa fa-plus\"><\/span>\r\n\t\t\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t\t \r\n\t\t\t\t\t\t\t\t<span class=\"ac_title_class\">\r\n\t\t\t\t\t\t\t\t\tCONDO Certificate of Insurance Request\t\t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t\t<\/a>\r\n\t\t\t\t\t\t  <\/h4>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t<div id=\"ac_520_collapse3\" class=\"wpsm_panel-collapse collapse \"  >\r\n\t\t\t\t\t\t  <div class=\"wpsm_panel-body\">\r\n\t\t\t\t\t\t\t<div id=\"vfb-form-13\" class=\"visual-form-builder-container\"><form id=\"certificate-of-condo-insurance-request-13\" class=\"visual-form-builder vfb-form-13  left-label\" method=\"post\" enctype=\"multipart\/form-data\">\n\t  \t<input type=\"hidden\" name=\"form_id\" value=\"13\" \/><fieldset class=\"vfb-fieldset vfb-fieldset-1 condo-certificate-of-insurance-request \" id=\"item-vfb-100\"><div class=\"vfb-legend\"><h3>Condo Certificate of Insurance Request<\/h3><\/div><ul class=\"vfb-section vfb-section-1\"><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-104\"><label for=\"vfb-104\" class=\"vfb-desc\">Your Complete Legal Name as Owner <\/label><input type=\"text\" name=\"vfb-104\" id=\"vfb-104\" value=\"\" class=\"vfb-text  vfb-medium   \" \/><\/li><li class=\"vfb-item vfb-item-address  \" id=\"item-vfb-105\"><label class=\"vfb-desc\">Your Unit Address  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-105[address]\" id=\"vfb-105-address\" maxlength=\"150\" class=\"vfb-text vfb-medium  required \" \/><label for=\"vfb-105-address\">Street Address<\/label><\/span><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-105[address-2]\" id=\"vfb-105-address-2\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-105-address-2\">Apt, Suite, Bldg. (optional)<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-105[city]\" id=\"vfb-105-city\" maxlength=\"150\" class=\"vfb-text vfb-medium  required \" \/><label for=\"vfb-105-city\">City<\/label><\/span><span class=\"vfb-right\"><input type=\"text\" name=\"vfb-105[state]\" id=\"vfb-105-state\" maxlength=\"150\" class=\"vfb-text vfb-medium  required \" \/><label for=\"vfb-105-state\">State \/ Province \/ Region<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-105[zip]\" id=\"vfb-105-zip\" maxlength=\"150\" class=\"vfb-text vfb-medium  required \" \/><label for=\"vfb-105-zip\">Postal \/ Zip Code<\/label><\/span><span class=\"vfb-right\"><select name=\"vfb-105[country]\" class=\"vfb-select  required \" id=\"vfb-105-country\"><option value=\"\" selected='selected'><\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"Brunei\">Brunei<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option><option value=\"Congo\">Congo<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cote d\\'Ivoire\">Cote d\\'Ivoire<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"East Timor (Timor Timur)\">East Timor (Timor Timur)<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia, The\">Gambia, The<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Greece\">Greece<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran\">Iran<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Korea, North\">Korea, North<\/option><option value=\"Korea, South\">Korea, South<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Laos\">Laos<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macedonia\">Macedonia<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia\">Micronesia<\/option><option value=\"Moldova\">Moldova<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palestinian Territory\">Palestinian Territory<\/option><option value=\"Palau\">Palau<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russia\">Russia<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Vincent\">Saint Vincent<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Serbia\">Serbia<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Sierra Leone\">Sierra Leone<\/option><option value=\"Singapore\">Singapore<\/option><option value=\"Slovakia\">Slovakia<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Solomon Islands\">Solomon Islands<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"Spain\">Spain<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"Sudan\">Sudan<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Syria\">Syria<\/option><option value=\"Taiwan\">Taiwan<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Tanzania\">Tanzania<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Togo\">Togo<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"United States of America\">United States of America<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Vatican City\">Vatican City<\/option><option value=\"Venezuela\">Venezuela<\/option><option value=\"Vietnam\">Vietnam<\/option><option value=\"Western Sahara\">Western Sahara<\/option><option value=\"Western Samoa\">Western Samoa<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><label for=\"vfb-105-country\">Country<\/label><\/span><\/div><\/li><li class=\"vfb-item vfb-item-address  \" id=\"item-vfb-106\"><label class=\"vfb-desc\">Your Mailing Address If Different Than Unit <\/label><div><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-106[address]\" id=\"vfb-106-address\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-106-address\">Street Address<\/label><\/span><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-106[address-2]\" id=\"vfb-106-address-2\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-106-address-2\">Apt, Suite, Bldg. (optional)<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-106[city]\" id=\"vfb-106-city\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-106-city\">City<\/label><\/span><span class=\"vfb-right\"><input type=\"text\" name=\"vfb-106[state]\" id=\"vfb-106-state\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-106-state\">State \/ Province \/ Region<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-106[zip]\" id=\"vfb-106-zip\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-106-zip\">Postal \/ Zip Code<\/label><\/span><span class=\"vfb-right\"><select name=\"vfb-106[country]\" class=\"vfb-select  \" id=\"vfb-106-country\"><option value=\"\" selected='selected'><\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"Brunei\">Brunei<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option><option value=\"Congo\">Congo<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cote d\\'Ivoire\">Cote d\\'Ivoire<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"East Timor (Timor Timur)\">East Timor (Timor Timur)<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia, The\">Gambia, The<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Greece\">Greece<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran\">Iran<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Korea, North\">Korea, North<\/option><option value=\"Korea, South\">Korea, South<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Laos\">Laos<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macedonia\">Macedonia<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia\">Micronesia<\/option><option value=\"Moldova\">Moldova<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palestinian Territory\">Palestinian Territory<\/option><option value=\"Palau\">Palau<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russia\">Russia<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Vincent\">Saint Vincent<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Serbia\">Serbia<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Sierra Leone\">Sierra Leone<\/option><option value=\"Singapore\">Singapore<\/option><option value=\"Slovakia\">Slovakia<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Solomon Islands\">Solomon Islands<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"Spain\">Spain<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"Sudan\">Sudan<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Syria\">Syria<\/option><option value=\"Taiwan\">Taiwan<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Tanzania\">Tanzania<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Togo\">Togo<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"United States of America\">United States of America<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Vatican City\">Vatican City<\/option><option value=\"Venezuela\">Venezuela<\/option><option value=\"Vietnam\">Vietnam<\/option><option value=\"Western Sahara\">Western Sahara<\/option><option value=\"Western Samoa\">Western Samoa<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><label for=\"vfb-106-country\">Country<\/label><\/span><\/div><\/li><li class=\"vfb-item vfb-item-text  \" id=\"item-vfb-107\"><label for=\"vfb-107\" class=\"vfb-desc\">Mortgage Holder Name  <span class=\"vfb-required-asterisk\">*<\/span><\/label><input type=\"text\" name=\"vfb-107\" id=\"vfb-107\" value=\"\" class=\"vfb-text  vfb-medium  required  \" \/><\/li><li class=\"vfb-item vfb-item-address  \" id=\"item-vfb-110\"><label class=\"vfb-desc\">Mortgage Holder Address  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class='vfb-span'><label>(Hint: This generally is not the same as where you send your payment, if you are not sure, please check with your lender. Ask them how they want their mortgage clause to read on the certificate.)<\/label><\/span><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-110[address]\" id=\"vfb-110-address\" maxlength=\"150\" class=\"vfb-text vfb-medium  required \" \/><label for=\"vfb-110-address\">Street Address<\/label><\/span><span class=\"vfb-full\"><input type=\"text\" name=\"vfb-110[address-2]\" id=\"vfb-110-address-2\" maxlength=\"150\" class=\"vfb-text vfb-medium  \" \/><label for=\"vfb-110-address-2\">Apt, Suite, Bldg. (optional)<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-110[city]\" id=\"vfb-110-city\" maxlength=\"150\" class=\"vfb-text vfb-medium  required \" \/><label for=\"vfb-110-city\">City<\/label><\/span><span class=\"vfb-right\"><input type=\"text\" name=\"vfb-110[state]\" id=\"vfb-110-state\" maxlength=\"150\" class=\"vfb-text vfb-medium  required \" \/><label for=\"vfb-110-state\">State \/ Province \/ Region<\/label><\/span><span class=\"vfb-left\"><input type=\"text\" name=\"vfb-110[zip]\" id=\"vfb-110-zip\" maxlength=\"150\" class=\"vfb-text vfb-medium  required \" \/><label for=\"vfb-110-zip\">Postal \/ Zip Code<\/label><\/span><span class=\"vfb-right\"><select name=\"vfb-110[country]\" class=\"vfb-select  required \" id=\"vfb-110-country\"><option value=\"\" selected='selected'><\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"Brunei\">Brunei<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Congo (Brazzaville)\">Congo (Brazzaville)<\/option><option value=\"Congo\">Congo<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cote d\\'Ivoire\">Cote d\\'Ivoire<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"East Timor (Timor Timur)\">East Timor (Timor Timur)<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia, The\">Gambia, The<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Greece\">Greece<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran\">Iran<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Korea, North\">Korea, North<\/option><option value=\"Korea, South\">Korea, South<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Laos\">Laos<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macedonia\">Macedonia<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia\">Micronesia<\/option><option value=\"Moldova\">Moldova<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palestinian Territory\">Palestinian Territory<\/option><option value=\"Palau\">Palau<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russia\">Russia<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Vincent\">Saint Vincent<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Serbia\">Serbia<\/option><option 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value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"United States of America\">United States of America<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Vatican City\">Vatican City<\/option><option value=\"Venezuela\">Venezuela<\/option><option value=\"Vietnam\">Vietnam<\/option><option value=\"Western Sahara\">Western Sahara<\/option><option value=\"Western Samoa\">Western Samoa<\/option><option value=\"Yemen\">Yemen<\/option><option 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