var jshtml = "<style> .postcode_hidden { display: none; } <\/style><script src=\"https:\/\/www.google.com\/recaptcha\/api.js\" async defer><\/script><div id=\"contact-page\"><div id=\"cPage3\"><h1>Complete the below<\/h1>\n<!-- start contact message -->\n<div id=\"contact-message\"><p><span style=\"background-color: #ffffff; color: #ffffff;\">Dear Mineheart Team,<\/span><\/p>\r\n<p><span style=\"background-color: #ffffff; color: #ffffff;\">A customer has completed a new trade account application form. Kindly process this and get back to the customer with an update.<\/span><\/p><\/div><div id=\"contact-form\"><form name=\"contact_us\" id=\"contact_us\" action=\"https:\/\/portal-euw1.brightpearlapp.com\/index.php?c=studiomold&p=contact&action=send\" method=\"POST\"  onSubmit=\"checkForm662cc4ced169c();return document.returnValue\" data-smartform-id=\"662cc4ced169c\">\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Main Contact First name :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"customers_firstname\"   id=\"customers_firstname\" id=\"customers_firstname\"   id=\"customers_firstname\" id=\"customers_firstname\" \/>  <span class=\"contact-required\">Required<\/span><\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Main Contact Last name :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"customers_lastname\"   id=\"customers_lastname\" id=\"customers_lastname\"   id=\"customers_lastname\" id=\"customers_lastname\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Main Contact Email address :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"customers_email_address\"   id=\"customers_email_address\" id=\"customers_email_address\"   id=\"customers_email_address\" id=\"customers_email_address\" \/>  <span class=\"contact-required\">Required<\/span><\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Company Name :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"entry_company\"   id=\"entry_company\" id=\"entry_company\"   id=\"entry_company\" id=\"entry_company\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Website :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"customers_website\"   id=\"customers_website\" id=\"customers_website\"   id=\"customers_website\" id=\"customers_website\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Post\/Zipcode :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"entry_postcode\"   id=\"entry_postcode\" id=\"entry_postcode\"   id=\"entry_postcode\" id=\"entry_postcode\" \/>  <span class=\"contact-required\">Required<\/span><\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Trading &amp; Correspondence address: Address line 1 :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"entry_street_address\"   id=\"entry_street_address\" id=\"entry_street_address\"   id=\"entry_street_address\" id=\"entry_street_address\" \/>  <span class=\"contact-required\">Required<\/span><\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Address line 2 :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"entry_suburb\"   id=\"entry_suburb\" id=\"entry_suburb\"   id=\"entry_suburb\" id=\"entry_suburb\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>City :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"entry_city\"   id=\"entry_city\" id=\"entry_city\"   id=\"entry_city\" id=\"entry_city\" \/>  <span class=\"contact-required\">Required<\/span><\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>County\/State :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"entry_state\"  id=\"entry_state\"  id=\"entry_state\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Country :<\/b><\/span>\n<span class=\"contact-field\"><select  id=\"entry_country_id\" name=\"entry_country_id\"  class=\"inputText\"><option class=\"select-entry_country_id-222\" value=\"222\" SELECTED>United Kingdom<\/option><option class=\"select-entry_country_id-254\" value=\"254\">Afghanistan<\/option><option class=\"select-entry_country_id-255\" value=\"255\">Aland Islands<\/option><option class=\"select-entry_country_id-256\" value=\"256\">Albania<\/option><option class=\"select-entry_country_id-257\" value=\"257\">Algeria<\/option><option class=\"select-entry_country_id-258\" value=\"258\">American Samoa<\/option><option class=\"select-entry_country_id-259\" value=\"259\">Andorra<\/option><option class=\"select-entry_country_id-260\" value=\"260\">Angola<\/option><option class=\"select-entry_country_id-261\" value=\"261\">Anguilla<\/option><option class=\"select-entry_country_id-262\" value=\"262\">Antarctica<\/option><option class=\"select-entry_country_id-263\" value=\"263\">Antigua and Barbuda<\/option><option class=\"select-entry_country_id-264\" value=\"264\">Argentina<\/option><option class=\"select-entry_country_id-265\" value=\"265\">Armenia<\/option><option class=\"select-entry_country_id-266\" value=\"266\">Aruba<\/option><option class=\"select-entry_country_id-13\" value=\"13\">Australia<\/option><option class=\"select-entry_country_id-14\" value=\"14\">Austria<\/option><option class=\"select-entry_country_id-267\" value=\"267\">Azerbaijan<\/option><option class=\"select-entry_country_id-268\" value=\"268\">Bahamas<\/option><option class=\"select-entry_country_id-269\" value=\"269\">Bahrain<\/option><option class=\"select-entry_country_id-270\" value=\"270\">Bangladesh<\/option><option class=\"select-entry_country_id-271\" value=\"271\">Barbados<\/option><option class=\"select-entry_country_id-272\" value=\"272\">Belarus<\/option><option class=\"select-entry_country_id-21\" value=\"21\">Belgium<\/option><option class=\"select-entry_country_id-273\" value=\"273\">Belize<\/option><option class=\"select-entry_country_id-274\" value=\"274\">Benin<\/option><option class=\"select-entry_country_id-275\" value=\"275\">Bermuda<\/option><option class=\"select-entry_country_id-276\" value=\"276\">Bhutan<\/option><option class=\"select-entry_country_id-277\" value=\"277\">Bolivia<\/option><option class=\"select-entry_country_id-278\" value=\"278\">Bonaire, Sint Eustatius and Saba<\/option><option class=\"select-entry_country_id-279\" value=\"279\">Bosnia and Herzegovina<\/option><option class=\"select-entry_country_id-280\" value=\"280\">Botswana<\/option><option class=\"select-entry_country_id-281\" value=\"281\">Bouvet Island<\/option><option class=\"select-entry_country_id-230\" value=\"230\">Brazil<\/option><option class=\"select-entry_country_id-282\" value=\"282\">British Indian Ocean Territory<\/option><option class=\"select-entry_country_id-283\" value=\"283\">Brunei<\/option><option class=\"select-entry_country_id-233\" value=\"233\">Bulgaria<\/option><option class=\"select-entry_country_id-284\" value=\"284\">Burkina Faso<\/option><option class=\"select-entry_country_id-285\" value=\"285\">Burundi<\/option><option class=\"select-entry_country_id-286\" value=\"286\">Cambodia<\/option><option class=\"select-entry_country_id-287\" value=\"287\">Cameroon<\/option><option class=\"select-entry_country_id-38\" value=\"38\">Canada<\/option><option class=\"select-entry_country_id-288\" value=\"288\">Cape Verde<\/option><option class=\"select-entry_country_id-289\" value=\"289\">Cayman Islands<\/option><option class=\"select-entry_country_id-290\" value=\"290\">Central African Republic<\/option><option class=\"select-entry_country_id-291\" value=\"291\">Chad<\/option><option class=\"select-entry_country_id-225\" value=\"225\">Channel Islands<\/option><option class=\"select-entry_country_id-292\" value=\"292\">Chile<\/option><option class=\"select-entry_country_id-231\" value=\"231\">China<\/option><option class=\"select-entry_country_id-293\" value=\"293\">Christmas Island<\/option><option class=\"select-entry_country_id-294\" value=\"294\">Cocos (Keeling) Islands<\/option><option class=\"select-entry_country_id-295\" value=\"295\">Colombia<\/option><option class=\"select-entry_country_id-296\" value=\"296\">Comoros<\/option><option class=\"select-entry_country_id-297\" value=\"297\">Congo<\/option><option class=\"select-entry_country_id-298\" value=\"298\">Cook Islands<\/option><option class=\"select-entry_country_id-299\" value=\"299\">Costa Rica<\/option><option class=\"select-entry_country_id-300\" value=\"300\">Croatia<\/option><option class=\"select-entry_country_id-301\" value=\"301\">Cuba<\/option><option class=\"select-entry_country_id-302\" value=\"302\">Curacao<\/option><option class=\"select-entry_country_id-303\" value=\"303\">Cyprus<\/option><option class=\"select-entry_country_id-56\" value=\"56\">Czech Republic<\/option><option class=\"select-entry_country_id-304\" value=\"304\">Democratic Republic of the Congo<\/option><option class=\"select-entry_country_id-57\" value=\"57\">Denmark<\/option><option class=\"select-entry_country_id-305\" value=\"305\">Djibouti<\/option><option class=\"select-entry_country_id-306\" value=\"306\">Dominica<\/option><option class=\"select-entry_country_id-307\" value=\"307\">Dominican Republic<\/option><option class=\"select-entry_country_id-308\" value=\"308\">Ecuador<\/option><option class=\"select-entry_country_id-309\" value=\"309\">Egypt<\/option><option class=\"select-entry_country_id-310\" value=\"310\">El Salvador<\/option><option class=\"select-entry_country_id-311\" value=\"311\">Equatorial Guinea<\/option><option class=\"select-entry_country_id-312\" value=\"312\">Eritrea<\/option><option class=\"select-entry_country_id-245\" value=\"245\">Estonia<\/option><option class=\"select-entry_country_id-313\" value=\"313\">Ethiopia<\/option><option class=\"select-entry_country_id-314\" value=\"314\">Falkland Islands<\/option><option class=\"select-entry_country_id-315\" value=\"315\">Faroe Islands<\/option><option class=\"select-entry_country_id-316\" value=\"316\">Fiji<\/option><option class=\"select-entry_country_id-72\" value=\"72\">Finland<\/option><option class=\"select-entry_country_id-73\" value=\"73\">France<\/option><option class=\"select-entry_country_id-246\" value=\"246\">French Guiana<\/option><option class=\"select-entry_country_id-317\" value=\"317\">French Polynesia<\/option><option class=\"select-entry_country_id-318\" value=\"318\">French Southern Territories<\/option><option class=\"select-entry_country_id-319\" value=\"319\">Gabon<\/option><option class=\"select-entry_country_id-320\" value=\"320\">Gambia<\/option><option class=\"select-entry_country_id-321\" value=\"321\">Georgia<\/option><option class=\"select-entry_country_id-81\" value=\"81\">Germany<\/option><option class=\"select-entry_country_id-322\" value=\"322\">Ghana<\/option><option class=\"select-entry_country_id-83\" value=\"83\">Gibraltar<\/option><option class=\"select-entry_country_id-84\" value=\"84\">Greece<\/option><option class=\"select-entry_country_id-323\" value=\"323\">Greenland<\/option><option class=\"select-entry_country_id-324\" value=\"324\">Grenada<\/option><option class=\"select-entry_country_id-325\" value=\"325\">Guadaloupe<\/option><option class=\"select-entry_country_id-326\" value=\"326\">Guam<\/option><option class=\"select-entry_country_id-327\" value=\"327\">Guatemala<\/option><option class=\"select-entry_country_id-328\" value=\"328\">Guernsey<\/option><option class=\"select-entry_country_id-329\" value=\"329\">Guinea<\/option><option class=\"select-entry_country_id-330\" value=\"330\">Guinea-Bissau<\/option><option class=\"select-entry_country_id-331\" value=\"331\">Guyana<\/option><option class=\"select-entry_country_id-332\" value=\"332\">Haiti<\/option><option class=\"select-entry_country_id-333\" value=\"333\">Heard Island and McDonald Islands<\/option><option class=\"select-entry_country_id-334\" value=\"334\">Honduras<\/option><option class=\"select-entry_country_id-234\" value=\"234\">Hong Kong<\/option><option class=\"select-entry_country_id-97\" value=\"97\">Hungary<\/option><option class=\"select-entry_country_id-98\" value=\"98\">Iceland<\/option><option class=\"select-entry_country_id-236\" value=\"236\">India<\/option><option class=\"select-entry_country_id-335\" value=\"335\">Indonesia<\/option><option class=\"select-entry_country_id-336\" value=\"336\">Iran<\/option><option class=\"select-entry_country_id-337\" value=\"337\">Iraq<\/option><option class=\"select-entry_country_id-103\" value=\"103\">Ireland<\/option><option class=\"select-entry_country_id-338\" value=\"338\">Isle of Man<\/option><option class=\"select-entry_country_id-243\" value=\"243\">Israel<\/option><option class=\"select-entry_country_id-105\" value=\"105\">Italy<\/option><option class=\"select-entry_country_id-339\" value=\"339\">Jamaica<\/option><option class=\"select-entry_country_id-224\" value=\"224\">Japan<\/option><option class=\"select-entry_country_id-340\" value=\"340\">Jersey<\/option><option class=\"select-entry_country_id-240\" value=\"240\">Jordan<\/option><option class=\"select-entry_country_id-341\" value=\"341\">Kazakhstan<\/option><option class=\"select-entry_country_id-342\" value=\"342\">Kenya<\/option><option class=\"select-entry_country_id-343\" value=\"343\">Kiribati<\/option><option class=\"select-entry_country_id-344\" value=\"344\">Kosovo<\/option><option class=\"select-entry_country_id-345\" value=\"345\">Kuwait<\/option><option class=\"select-entry_country_id-346\" value=\"346\">Kyrgyzstan<\/option><option class=\"select-entry_country_id-347\" value=\"347\">Laos<\/option><option class=\"select-entry_country_id-253\" value=\"253\">Latvia<\/option><option class=\"select-entry_country_id-238\" value=\"238\">Lebanon<\/option><option class=\"select-entry_country_id-348\" value=\"348\">Lesotho<\/option><option class=\"select-entry_country_id-349\" value=\"349\">Liberia<\/option><option class=\"select-entry_country_id-350\" value=\"350\">Libya<\/option><option class=\"select-entry_country_id-351\" value=\"351\">Liechtenstein<\/option><option class=\"select-entry_country_id-352\" value=\"352\">Lithuania<\/option><option class=\"select-entry_country_id-124\" value=\"124\">Luxembourg<\/option><option class=\"select-entry_country_id-353\" value=\"353\">Macao<\/option><option class=\"select-entry_country_id-354\" value=\"354\">Macedonia<\/option><option class=\"select-entry_country_id-355\" value=\"355\">Madagascar<\/option><option class=\"select-entry_country_id-356\" value=\"356\">Malawi<\/option><option class=\"select-entry_country_id-241\" value=\"241\">Malaysia<\/option><option class=\"select-entry_country_id-357\" value=\"357\">Maldives<\/option><option class=\"select-entry_country_id-358\" value=\"358\">Mali<\/option><option class=\"select-entry_country_id-249\" value=\"249\">Malta<\/option><option class=\"select-entry_country_id-359\" value=\"359\">Marshall Islands<\/option><option class=\"select-entry_country_id-360\" value=\"360\">Martinique<\/option><option class=\"select-entry_country_id-361\" value=\"361\">Mauritania<\/option><option class=\"select-entry_country_id-362\" value=\"362\">Mauritius<\/option><option class=\"select-entry_country_id-363\" value=\"363\">Mayotte<\/option><option class=\"select-entry_country_id-252\" value=\"252\">Mexico<\/option><option class=\"select-entry_country_id-364\" value=\"364\">Micronesia<\/option><option class=\"select-entry_country_id-365\" value=\"365\">Moldava<\/option><option class=\"select-entry_country_id-366\" value=\"366\">Monaco<\/option><option class=\"select-entry_country_id-367\" value=\"367\">Mongolia<\/option><option class=\"select-entry_country_id-368\" value=\"368\">Montenegro<\/option><option class=\"select-entry_country_id-369\" value=\"369\">Montserrat<\/option><option class=\"select-entry_country_id-370\" value=\"370\">Morocco<\/option><option class=\"select-entry_country_id-371\" value=\"371\">Mozambique<\/option><option class=\"select-entry_country_id-372\" value=\"372\">Myanmar (Burma)<\/option><option class=\"select-entry_country_id-373\" value=\"373\">Namibia<\/option><option class=\"select-entry_country_id-374\" value=\"374\">Nauru<\/option><option class=\"select-entry_country_id-375\" value=\"375\">Nepal<\/option><option class=\"select-entry_country_id-150\" value=\"150\">Netherlands<\/option><option class=\"select-entry_country_id-376\" value=\"376\">New Caledonia<\/option><option class=\"select-entry_country_id-153\" value=\"153\">New Zealand<\/option><option class=\"select-entry_country_id-377\" value=\"377\">Nicaragua<\/option><option class=\"select-entry_country_id-378\" value=\"378\">Niger<\/option><option class=\"select-entry_country_id-379\" value=\"379\">Nigeria<\/option><option class=\"select-entry_country_id-380\" value=\"380\">Niue<\/option><option class=\"select-entry_country_id-381\" value=\"381\">Norfolk Island<\/option><option class=\"select-entry_country_id-382\" value=\"382\">North Korea<\/option><option class=\"select-entry_country_id-383\" value=\"383\">Northern Mariana Islands<\/option><option class=\"select-entry_country_id-160\" value=\"160\">Norway<\/option><option class=\"select-entry_country_id-384\" value=\"384\">Oman<\/option><option class=\"select-entry_country_id-385\" value=\"385\">Pakistan<\/option><option class=\"select-entry_country_id-386\" value=\"386\">Palau<\/option><option class=\"select-entry_country_id-387\" value=\"387\">Palestine<\/option><option class=\"select-entry_country_id-388\" value=\"388\">Panama<\/option><option class=\"select-entry_country_id-389\" value=\"389\">Papua New Guinea<\/option><option class=\"select-entry_country_id-390\" value=\"390\">Paraguay<\/option><option class=\"select-entry_country_id-391\" value=\"391\">Peru<\/option><option class=\"select-entry_country_id-248\" value=\"248\">Philippines<\/option><option class=\"select-entry_country_id-392\" value=\"392\">Pitcairn<\/option><option class=\"select-entry_country_id-170\" value=\"170\">Poland<\/option><option class=\"select-entry_country_id-171\" value=\"171\">Portugal<\/option><option class=\"select-entry_country_id-393\" value=\"393\">Puerto Rico<\/option><option class=\"select-entry_country_id-394\" value=\"394\">Qatar<\/option><option class=\"select-entry_country_id-395\" value=\"395\">Reunion<\/option><option class=\"select-entry_country_id-250\" value=\"250\">Romania<\/option><option class=\"select-entry_country_id-228\" value=\"228\">Russia<\/option><option class=\"select-entry_country_id-396\" value=\"396\">Rwanda<\/option><option class=\"select-entry_country_id-397\" value=\"397\">Saint Barthelemy<\/option><option class=\"select-entry_country_id-398\" value=\"398\">Saint Helena<\/option><option class=\"select-entry_country_id-399\" value=\"399\">Saint Kitts and Nevis<\/option><option class=\"select-entry_country_id-400\" value=\"400\">Saint Lucia<\/option><option class=\"select-entry_country_id-401\" value=\"401\">Saint Martin<\/option><option class=\"select-entry_country_id-402\" value=\"402\">Saint Pierre and Miquelon<\/option><option class=\"select-entry_country_id-403\" value=\"403\">Saint Vincent and the Grenadines<\/option><option class=\"select-entry_country_id-404\" value=\"404\">Samoa<\/option><option class=\"select-entry_country_id-405\" value=\"405\">San Marino<\/option><option class=\"select-entry_country_id-406\" value=\"406\">Sao Tome and Principe<\/option><option class=\"select-entry_country_id-226\" value=\"226\">Saudi Arabia<\/option><option class=\"select-entry_country_id-407\" value=\"407\">Senegal<\/option><option class=\"select-entry_country_id-408\" value=\"408\">Serbia<\/option><option class=\"select-entry_country_id-409\" value=\"409\">Seychelles<\/option><option class=\"select-entry_country_id-410\" value=\"410\">Sierra Leone<\/option><option class=\"select-entry_country_id-237\" value=\"237\">Singapore<\/option><option class=\"select-entry_country_id-411\" value=\"411\">Sint Maarten<\/option><option class=\"select-entry_country_id-412\" value=\"412\">Slovakia<\/option><option class=\"select-entry_country_id-232\" value=\"232\">Slovenia<\/option><option class=\"select-entry_country_id-413\" value=\"413\">Solomon Islands<\/option><option class=\"select-entry_country_id-414\" value=\"414\">Somalia<\/option><option class=\"select-entry_country_id-415\" value=\"415\">South Africa<\/option><option class=\"select-entry_country_id-416\" value=\"416\">South Georgia and the South Sandwich Islands<\/option><option class=\"select-entry_country_id-251\" value=\"251\">South Korea<\/option><option class=\"select-entry_country_id-417\" value=\"417\">South Sudan<\/option><option class=\"select-entry_country_id-195\" value=\"195\">Spain<\/option><option class=\"select-entry_country_id-418\" value=\"418\">Sri Lanka<\/option><option class=\"select-entry_country_id-419\" value=\"419\">Sudan<\/option><option class=\"select-entry_country_id-420\" value=\"420\">Suriname<\/option><option class=\"select-entry_country_id-421\" value=\"421\">Svalbard and Jan Mayen<\/option><option class=\"select-entry_country_id-422\" value=\"422\">Swaziland<\/option><option class=\"select-entry_country_id-203\" value=\"203\">Sweden<\/option><option class=\"select-entry_country_id-204\" value=\"204\">Switzerland<\/option><option class=\"select-entry_country_id-423\" value=\"423\">Syria<\/option><option class=\"select-entry_country_id-244\" value=\"244\">Taiwan<\/option><option class=\"select-entry_country_id-424\" value=\"424\">Tajikistan<\/option><option class=\"select-entry_country_id-425\" value=\"425\">Tanzania<\/option><option class=\"select-entry_country_id-235\" value=\"235\">Thailand<\/option><option class=\"select-entry_country_id-426\" value=\"426\">Timor-Leste (East Timor),<\/option><option class=\"select-entry_country_id-427\" value=\"427\">Togo<\/option><option class=\"select-entry_country_id-428\" value=\"428\">Tokelau<\/option><option class=\"select-entry_country_id-429\" value=\"429\">Tonga<\/option><option class=\"select-entry_country_id-430\" value=\"430\">Trinidad and Tobago<\/option><option class=\"select-entry_country_id-431\" value=\"431\">Tunisia<\/option><option class=\"select-entry_country_id-432\" value=\"432\">Turkey<\/option><option class=\"select-entry_country_id-433\" value=\"433\">Turkmenistan<\/option><option class=\"select-entry_country_id-434\" value=\"434\">Turks and Caicos Islands<\/option><option class=\"select-entry_country_id-435\" value=\"435\">Tuvalu<\/option><option class=\"select-entry_country_id-436\" value=\"436\">Uganda<\/option><option class=\"select-entry_country_id-239\" value=\"239\">Ukraine<\/option><option class=\"select-entry_country_id-247\" value=\"247\">United Arab Emirates<\/option><option class=\"select-entry_country_id-227\" value=\"227\">United Kingdom (offshore)<\/option><option class=\"select-entry_country_id-223\" value=\"223\">United States<\/option><option class=\"select-entry_country_id-437\" value=\"437\">United States Minor Outlying Islands<\/option><option class=\"select-entry_country_id-438\" value=\"438\">Uruguay<\/option><option class=\"select-entry_country_id-439\" value=\"439\">Uzbekistan<\/option><option class=\"select-entry_country_id-440\" value=\"440\">Vanuatu<\/option><option class=\"select-entry_country_id-441\" value=\"441\">Vatican City<\/option><option class=\"select-entry_country_id-442\" value=\"442\">Venezuela<\/option><option class=\"select-entry_country_id-443\" value=\"443\">Vietnam<\/option><option class=\"select-entry_country_id-444\" value=\"444\">Virgin Islands, British<\/option><option class=\"select-entry_country_id-445\" value=\"445\">Virgin Islands, US<\/option><option class=\"select-entry_country_id-446\" value=\"446\">Wallis and Futuna<\/option><option class=\"select-entry_country_id-447\" value=\"447\">Western Sahara<\/option><option class=\"select-entry_country_id-448\" value=\"448\">Yemen<\/option><option class=\"select-entry_country_id-449\" value=\"449\">Zambia<\/option><option class=\"select-entry_country_id-450\" value=\"450\">Zimbabwe<\/option><\/select>  <span class=\"contact-required\">Required<\/span><\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Year established :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"PCF_YEARESTA\"   id=\"PCF_YEARESTA\" id=\"PCF_YEARESTA\"   id=\"PCF_YEARESTA\" id=\"PCF_YEARESTA\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Last year annual turnover :<\/b><\/span>\n<span class=\"contact-field\"><select class=\"inputText\" id=\"PCF_LYEARTUR\" name=\"PCF_LYEARTUR\"   id=\"PCF_LYEARTUR\" ><option class=\"select-PCF_LYEARTUR-73\" value=\"73\">Under 100k<\/option><option class=\"select-PCF_LYEARTUR-74\" value=\"74\">Under 250k<\/option><option class=\"select-PCF_LYEARTUR-75\" value=\"75\">Under 500k<\/option><option class=\"select-PCF_LYEARTUR-76\" value=\"76\">Under 1 Million<\/option><option class=\"select-PCF_LYEARTUR-77\" value=\"77\">Over 1 Million<\/option><option class=\"select-PCF_LYEARTUR-88\" value=\"88\">Over 3 million<\/option><option class=\"select-PCF_LYEARTUR-89\" value=\"89\">Over 5 million<\/option><\/select>  <span class=\"contact-required\">Required<\/span><\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Telephone :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"customers_telephone\"   id=\"customers_telephone\" id=\"customers_telephone\"   id=\"customers_telephone\" id=\"customers_telephone\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Accounts contact email :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"PCF_ACC_E\"   id=\"PCF_ACC_E\" id=\"PCF_ACC_E\"   id=\"PCF_ACC_E\" id=\"PCF_ACC_E\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Type of business (other) :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"PCF_TYPEOF_O\"   id=\"PCF_TYPEOF_O\" id=\"PCF_TYPEOF_O\"   id=\"PCF_TYPEOF_O\" id=\"PCF_TYPEOF_O\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Products Area of Business :<\/b><\/span>\n<span class=\"contact-field\"><textarea name=\"PCF_PRODUCTM\" class=\"inputText\" wrap=\"soft\" cols=\"40\" rows=\"10\"  id=\"PCF_PRODUCTM\"><\/textarea> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Products Areas of Business (other) :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"PCF_PROD_OTH\"   id=\"PCF_PROD_OTH\" id=\"PCF_PROD_OTH\"   id=\"PCF_PROD_OTH\" id=\"PCF_PROD_OTH\" \/> <\/span>\n<\/div>\n\n<div class=\"contact-fieldset\">\n<span class=\"contact-fieldtext\"><b>Where did you hear about Mineheart? :<\/b><\/span>\n<span class=\"contact-field\"><input type=\"text\" class=\"inputText\" name=\"PCF_WHEREHEA\"   id=\"PCF_WHEREHEA\" id=\"PCF_WHEREHEA\"   id=\"PCF_WHEREHEA\" id=\"PCF_WHEREHEA\" \/>  <span class=\"contact-required\">Required<\/span><\/span>\n<\/div>      <input type=\"hidden\" name=\"csrf_token\" id=\"csrf_token\" value=\"cfeb0933a466f44367d8b6a3af2e8da7\" \/>\n\n\t\t\t\t <script type=\"text\/javascript\">\n\t\t\t\t <!--\n\n\t\t\t\t\tfunction getCheckedValue(radioObj) {\n\t\t\t\t\t\tif (!radioObj)\n\t\t\t\t\t\t\treturn \"\";\n\t\t\t\t\t\tvar radioLength = radioObj.length;\n\t\t\t\t\t\tif (radioLength == undefined)\n\t\t\t\t\t\t\tif(radioObj.checked)\n\t\t\t\t\t\t\t\treturn radioObj.value;\n\t\t\t\t\t\t\telse\n\t\t\t\t\t\t\t\treturn \"\";\n\t\t\t\t\t\tfor (var i = 0; i < radioLength; i++) {\n\t\t\t\t\t\t\tif (radioObj[i].checked) {\n\t\t\t\t\t\t\t\treturn radioObj[i].value;\n\t\t\t\t\t\t\t}\n\t\t\t\t\t\t}\n\t\t\t\t\t\treturn \"\";\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\tfunction getInput(formId, name) {\n\t\t\t\t\t\treturn document.querySelectorAll(\"form[data-smartform-id='\" + formId + \"']\")[0][name];\n\t\t\t\t\t}\n\n\t\t\t\t\tfunction checkForm662cc4ced169c() {\n\t\t\t\t\t\tdocument.returnValue = true;\n\t\t\t\t\t\tvar required_fields = \"\";\n\t\t\t\t\t\tvar required_fields_count = 0;\n\t\t\t\t\t\t\n\t\t\t\t\tif (getInput('662cc4ced169c', 'customers_firstname').value == '') {\n\t\t\t\t\t\trequired_fields += \"Main Contact First name\" + \"\\n\";\n\t\t\t\t\t\trequired_fields_count++;\n\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\tif (getInput('662cc4ced169c', 'customers_email_address').value == '') {\n\t\t\t\t\t\trequired_fields += \"Main Contact Email address\" + \"\\n\";\n\t\t\t\t\t\trequired_fields_count++;\n\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\tif (getInput('662cc4ced169c', 'entry_postcode').value == '') {\n\t\t\t\t\t\trequired_fields += \"Post\/Zipcode\" + \"\\n\";\n\t\t\t\t\t\trequired_fields_count++;\n\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\tif (getInput('662cc4ced169c', 'entry_street_address').value == '') {\n\t\t\t\t\t\trequired_fields += \"Trading &amp; Correspondence address: Address line 1\" + \"\\n\";\n\t\t\t\t\t\trequired_fields_count++;\n\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\tif (getInput('662cc4ced169c', 'entry_city').value == '') {\n\t\t\t\t\t\trequired_fields += \"City\" + \"\\n\";\n\t\t\t\t\t\trequired_fields_count++;\n\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\tif (getInput('662cc4ced169c', 'entry_country_id').value == '') {\n\t\t\t\t\t\trequired_fields += \"Country\" + \"\\n\";\n\t\t\t\t\t\trequired_fields_count++;\n\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\tif (getInput('662cc4ced169c', 'PCF_LYEARTUR').value == '') {\n\t\t\t\t\t\trequired_fields += \"Last year annual turnover\" + \"\\n\";\n\t\t\t\t\t\trequired_fields_count++;\n\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\tif (getInput('662cc4ced169c', 'PCF_WHEREHEA').value == '') {\n\t\t\t\t\t\trequired_fields += \"Where did you hear about Mineheart?\" + \"\\n\";\n\t\t\t\t\t\trequired_fields_count++;\n\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\t\tif (required_fields != \"\") {\n\t\t\t\t\t\t\tif (required_fields_count > 1) {\n\t\t\t\t\t\t\t\trequired_fields = \"s:\\n\\n\" + required_fields;\n\t\t\t\t\t\t\t} else {\n\t\t\t\t\t\t\t\trequired_fields = \":\\n\\n\" + required_fields;\n\t\t\t\t\t\t\t}\n\t\t\t\t\t\t\talert(\"Please enter a value for the following field\" + required_fields);\n\t\t\t\t\t\t\tdocument.returnValue = false;\n\t\t\t\t\t\t}\n\t\t\t\t\t\t\n\t\t\t\t\t\treturn document.returnValue;\n\t\t\t\t\t}\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t \/\/-->\n\t\t\t\t <\/script><input type=\"hidden\" id=\"smartform\" name=\"smartform\" value=\"1\" \/><div class=\"contact-foot\">\n\t\t\t\t<input type=\"Submit\" class=\"button \" name=\"submit\" value=\" Apply \" \/><input type=\"hidden\" name=\"page_id\" value=\"3\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t      <\/form>\n   <\/div>\n<\/div>\n<\/div>\n<!-- end contact form -->\n";
document.write(jshtml);