chrome/test/data/autofill/heuristics/input/10_register_jbox.com.html

   1 <html>
   2 <!--Form Location: https://www.jbox.com/account/register--><!--ACCOUNT HEADER --><head>
   3 <title>JBOX : Register</title>
   4
   5 <meta name="keywords" content="j-list, anime, toys, japanese bento boxes, figures">
   6 <meta name="description" content="Do you love Japanese stuff? JBOX is a wonderful toybox of things from Japan, with Japanese anime goods, Bento boxes, manga artbook, apparel, and more! You've got a friend in Japan!">
   7 </head>
   8 <body id="jbox">
   9
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  15
  16 <form method="post" action="http://www.jbox.com/search">
  17
  18                                 <input id="keyword" type="text" name="term" class="sf-keyword" value="Search" ><input type="hidden" id="cat" name="cat" value=""><span class="sf_in"> in </span>
  19                                         <div class="dropdown">
  20                                                 <ul id="search-category">
  21 <li class="active"><a href="#" >Everything</a></li>
  22
  23
  24                                                         <li class="first-level cat800"><a href="#" >Books &amp; Magazines</a></li>
  25
  26                                                         <li class="first-level cat807"><a href="#" >Games &amp; Computer</a></li>
  27
  28                                                         <li class="first-level cat813"><a href="#" >Anime &amp; Toys</a></li>
  29
  30                                                         <li class="first-level cat819"><a href="#" >Bento &amp; Kitchen</a></li>
  31
  32                                                         <li class="first-level cat822"><a href="#" >Snacks &amp; Food</a></li>
  33
  34                                                         <li class="first-level cat825"><a href="#" >Traditional &amp; Study</a></li>
  35
  36                                                         <li class="first-level cat826"><a href="#" >Apparel &amp; Cosplay</a></li>
  37
  38                                                 </ul>
  39 </div>
  40                                         <input id="searchbtn" type="image" src="#">
  41 </form>
  42
  43
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  47
  48
  49
  50
  51 <form id="customerinfo" class="" method="post" action="#">
  52
  53                                         <div class="form_description">
  54                                                 <h2>Customer information</h2>
  55                                                 <p>Enter your name, billing address and email on this page.</p>
  56                                         </div>
  57                                         <div id="errors">
  58
  59
  60
  61
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  70
  71                                         </div>
  72
  73                                         <fieldset>
  74 <legend>Name</legend>
  75                                                 <small class="guidelines">Please enter your real name.</small>
  76                                                 <div class="left">
  77                                                         <input name="firstname" class="text medium" maxlength="255" value="" type="text"><label for="firstname">First</label>
  78                                                 </div>
  79
  80                                                 <div>
  81                                                         <input name="lastname" class="text medium" maxlength="255" value="" type="text"><label for="firstname">Last</label>
  82                                                 </div>
  83
  84                                         </fieldset>
  85 <fieldset>
  86 <legend>Billing Address</legend>
  87                                                 <small class="guidelines">Your billing address. You can specify a shipping address later.</small>
  88                                                 <div>
  89                                                         <input name="address1" class="element text large" value="" type="text"><label for="address1">Street Address</label>
  90                                                 </div>
  91                                                 <span>
  92                                                         <div class="left">
  93                                                                 <input name="city" class="element text medium" value="" type="text"><label for="city">City</label>
  94                                                         </div>
  95
  96                                                         <div>
  97                                                                 <input name="state" class="element text medium" value="" type="text"><label for="state">State / Province / Region</label>
  98                                                         </div>
  99                                                 </span>
 100
 101                                                 <span>
 102                                                         <div class="left">
 103                                                                 <input name="zip" class="element text medium" maxlength="15" value="" type="text"><label for="zip">Postal / Zip Code</label>
 104                                                         </div>
 105
 106                                                         <div>
 107                                                                 <select class="element select medium" name="country"><option>Afghanistan</option>
 108 <option>Albania</option>
 109 <option>Algeria</option>
 110 <option>American Samoa</option>
 111 <option>Andorra</option>
 112 <option>Anguilla</option>
 113 <option>Antarctica</option>
 114 <option>Antigua And Barbuda</option>
 115 <option>Argentina</option>
 116 <option>Armenia</option>
 117 <option>Aruba</option>
 118 <option>Australia</option>
 119 <option>Austria</option>
 120 <option>Azerbaijan</option>
 121 <option>Bahamas</option>
 122 <option>Bahrain</option>
 123 <option>Bangladesh</option>
 124 <option>Barbados</option>
 125 <option>Belarus</option>
 126 <option>Belgium</option>
 127 <option>Belize</option>
 128 <option>Benin</option>
 129 <option>Bermuda</option>
 130 <option>Bhutan</option>
 131 <option>Bolivia</option>
 132 <option>Bosnia and Herzegovina</option>
 133 <option>Botswana</option>
 134 <option>Bouvet Island</option>
 135 <option>Brazil</option>
 136 <option>British Indian Ocean Territory</option>
 137 <option>Brunei Darussalam</option>
 138 <option>Bulgaria</option>
 139 <option>Burkina Faso</option>
 140 <option>Burundi</option>
 141 <option>Cambodia</option>
 142 <option>Cameroon</option>
 143 <option>Canada</option>
 144 <option>Cape Verde</option>
 145 <option>Cayman Islands</option>
 146 <option>Central African Republic</option>
 147 <option>Chad</option>
 148 <option>Chile</option>
 149 <option>China</option>
 150 <option>Christmas Island</option>
 151 <option>Cocos (Keeling) Islands</option>
 152 <option>Colombia</option>
 153 <option>Comoros</option>
 154 <option>Congo</option>
 155 <option>Congo, the Democratic Republic of the</option>
 156 <option>Cook Islands</option>
 157 <option>Costa Rica</option>
 158 <option>Cote d'Ivoire</option>
 159 <option>Croatia</option>
 160 <option>Cyprus</option>
 161 <option>Czech Republic</option>
 162 <option>Denmark</option>
 163 <option>Djibouti</option>
 164 <option>Dominica</option>
 165 <option>Dominican Republic</option>
 166 <option>East Timor</option>
 167 <option>Ecuador</option>
 168 <option>Egypt</option>
 169 <option>El Salvador</option>
 170 <option>England</option>
 171 <option>Equatorial Guinea</option>
 172 <option>Eritrea</option>
 173 <option>Espana</option>
 174 <option>Estonia</option>
 175 <option>Ethiopia</option>
 176 <option>Falkland Islands</option>
 177 <option>Faroe Islands</option>
 178 <option>Fiji</option>
 179 <option>Finland</option>
 180 <option>France</option>
 181 <option>French Guiana</option>
 182 <option>French Polynesia</option>
 183 <option>French Southern Territories</option>
 184 <option>Gabon</option>
 185 <option>Gambia</option>
 186 <option>Georgia</option>
 187 <option>Germany</option>
 188 <option>Ghana</option>
 189 <option>Gibraltar</option>
 190 <option>Great Britain</option>
 191 <option>Greece</option>
 192 <option>Greenland</option>
 193 <option>Grenada</option>
 194 <option>Guadeloupe</option>
 195 <option>Guam</option>
 196 <option>Guatemala</option>
 197 <option>Guinea</option>
 198 <option>Guinea-Bissau</option>
 199 <option>Guyana</option>
 200 <option>Haiti</option>
 201 <option>Heard and Mc Donald Islands</option>
 202 <option>Honduras</option>
 203 <option>Hong Kong</option>
 204 <option>Hungary</option>
 205 <option>Iceland</option>
 206 <option>India</option>
 207 <option>Indonesia</option>
 208 <option>Iraq</option>
 209 <option>Ireland</option>
 210 <option>Israel</option>
 211 <option>Italy</option>
 212 <option>Jamaica</option>
 213 <option>Japan</option>
 214 <option>Jordan</option>
 215 <option>Kazakhstan</option>
 216 <option>Kenya</option>
 217 <option>Kiribati</option>
 218 <option>Korea, People's Republic of</option>
 219 <option>Korea (South)</option>
 220 <option>Kuwait</option>
 221 <option>Kyrgyzstan</option>
 222 <option>Lao People's Democratic Republic</option>
 223 <option>Latvia</option>
 224 <option>Lebanon</option>
 225 <option>Lesotho</option>
 226 <option>Liberia</option>
 227 <option>Libya</option>
 228 <option>Liechtenstein</option>
 229 <option>Lithuania</option>
 230 <option>Luxembourg</option>
 231 <option>Macau</option>
 232 <option>Macedonia</option>
 233 <option>Madagascar</option>
 234 <option>Malawi</option>
 235 <option>Malaysia</option>
 236 <option>Maldives</option>
 237 <option>Mali</option>
 238 <option>Malta</option>
 239 <option>Marshall Islands</option>
 240 <option>Martinique</option>
 241 <option>Mauritania</option>
 242 <option>Mauritius</option>
 243 <option>Mayotte</option>
 244 <option>Mexico</option>
 245 <option>Micronesia, Federated States of</option>
 246 <option>Moldova, Republic of</option>
 247 <option>Monaco</option>
 248 <option>Mongolia</option>
 249 <option>Montserrat</option>
 250 <option>Morocco</option>
 251 <option>Mozambique</option>
 252 <option>Myanmar</option>
 253 <option>Namibia</option>
 254 <option>Nauru</option>
 255 <option>Nepal</option>
 256 <option>Netherlands</option>
 257 <option>Netherlands Antilles</option>
 258 <option>New Caledonia</option>
 259 <option>New Zealand</option>
 260 <option>Nicaragua</option>
 261 <option>Niger</option>
 262 <option>Nigeria</option>
 263 <option>Niue</option>
 264 <option>Norfolk Island</option>
 265 <option>Northern Ireland</option>
 266 <option>Northern Mariana Islands</option>
 267 <option>Norway</option>
 268 <option>Oman</option>
 269 <option>Pakistan</option>
 270 <option>Palau</option>
 271 <option>Panama</option>
 272 <option>Papua New Guinea</option>
 273 <option>Paraguay</option>
 274 <option>Peru</option>
 275 <option>Philippines</option>
 276 <option>Pitcairn</option>
 277 <option>Poland</option>
 278 <option>Portugal</option>
 279 <option>Puerto Rico</option>
 280 <option>Qatar</option>
 281 <option>Reunion</option>
 282 <option>Romania</option>
 283 <option>Russia</option>
 284 <option>Russian Federation</option>
 285 <option>Rwanda</option>
 286 <option>Saint Kitts and Nevis</option>
 287 <option>Saint Lucia</option>
 288 <option>Saint Vincent and the Grenadines</option>
 289 <option>Samoa (Independent)</option>
 290 <option>San Marino</option>
 291 <option>Sao Tome and Principe</option>
 292 <option>Saudi Arabia</option>
 293 <option>Scotland</option>
 294 <option>Senegal</option>
 295 <option>Serbia and Montenegro</option>
 296 <option>Seychelles</option>
 297 <option>Sierra Leone</option>
 298 <option>Singapore</option>
 299 <option>Slovakia</option>
 300 <option>Slovenia</option>
 301 <option>Solomon Islands</option>
 302 <option>Somalia</option>
 303 <option>South Africa</option>
 304 <option>South Georgia and the South Sandwich Islands</option>
 305 <option>South Korea</option>
 306 <option>Spain</option>
 307 <option>Sri Lanka</option>
 308 <option>St. Helena</option>
 309 <option>St. Pierre and Miquelon</option>
 310 <option>Suriname</option>
 311 <option>Svalbard and Jan Mayen Islands</option>
 312 <option>Swaziland</option>
 313 <option>Sweden</option>
 314 <option>Switzerland</option>
 315 <option>Taiwan</option>
 316 <option>Tajikistan</option>
 317 <option>Tanzania</option>
 318 <option>Thailand</option>
 319 <option>Togo</option>
 320 <option>Tokelau</option>
 321 <option>Tonga</option>
 322 <option>Trinidad</option>
 323 <option>Trinidad and Tobago</option>
 324 <option>Tunisia</option>
 325 <option>Turkey</option>
 326 <option>Turkmenistan</option>
 327 <option>Turks and Caicos Islands</option>
 328 <option>Tuvalu</option>
 329 <option>Uganda</option>
 330 <option>Ukraine</option>
 331 <option>United Arab Emirates</option>
 332 <option>United Kingdom</option>
 333 <option selected>United States</option>
 334 <option>United States Minor Outlying Islands</option>
 335 <option>Uruguay</option>
 336 <option>Uzbekistan</option>
 337 <option>Vanuatu</option>
 338 <option>Vatican City State (Holy See)</option>
 339 <option>Venezuela</option>
 340 <option>Viet Nam</option>
 341 <option>Virgin Islands (British)</option>
 342 <option>Virgin Islands (U.S.)</option>
 343 <option>Wales</option>
 344 <option>Wallis and Futuna Islands</option>
 345 <option>Western Sahara</option>
 346 <option>Yemen</option>
 347 <option>Yugoslavia</option>
 348 <option>Zambia</option>
 349 <option>Zimbabwe</option></select><label for="country">Country</label>
 350                                                         </div>
 351                                                 </span>
 352
 353                                         </fieldset>
 354 <fieldset>
 355 <legend>Phone (optional)</legend>
 356                                                 <div>
 357                                                         <input id="element_4" name="phone" class="element text medium" type="text" maxlength="255" value="">
 358 </div>
 359                                         </fieldset>
 360 <fieldset>
 361 <legend>Email Address</legend>
 362                                                 <small class="guidelines">This will be your contact email address for order status update, newsletter and more.</small>
 363                                                 <div>
 364                                                 <input type="text" name="email" class="text element medium" value="">
 365 </div>
 366
 367                                         </fieldset>
 368 <fieldset>
 369 <legend>Choose a password</legend>
 370                                                 <span>
 371                                                         <div class="left">
 372                                                                 <input type="password" class="element text medium" name="password" value=""><label for="password">Enter a password</label>
 373                                                         </div>
 374
 375                                                         <div>
 376                                                                 <input type="password" name="password_again" value="" class="element text medium"><label for="password_again">Retype your password</label>
 377                                                         </div>
 378                                                 </span>
 379                                         </fieldset>
 380 <fieldset>
 381 <div>
 382                                                         <label for="referred_by" class="description">Where did you hear about J-List/JBOX?</label>
 383                                                         <select name="referred_by" class="element select medium"><option selected>Don't Know!</option>
 384 <option>3yen.org</option>
 385 <option>4chan.org</option>
 386 <option>Anime Insider</option>
 387 <option>Anime or Comic Convention</option>
 388 <option>Clone Army Manga</option>
 389 <option>Danbooru</option>
 390 <option>Dannychoo.com</option>
 391 <option>Facebook</option>
 392 <option>Froogle / Google Products</option>
 393 <option>Geek Monthly</option>
 394 <option>Giant Robot</option>
 395 <option>Google Search</option>
 396 <option>J-List Theatre Manga</option>
 397 <option>Newtype USA</option>
 398 <option>Nyaa</option>
 399 <option>Otaku USA</option>
 400 <option>PiQ Magazine</option>
 401 <option>Play Magazine</option>
 402 <option>Protoculture Addicts</option>
 403 <option>Sci-Fi Magazine</option>
 404 <option>Something Awful</option>
 405 <option>Sankaku Complex</option>
 406 <option>Track-shun.tv Podcast</option>
 407 <option>Tumblr</option>
 408 <option>Twitter</option>
 409 <option>Word of Mouth</option>
 410 <option>Other</option></select>
 411 </div>
 412
 413                                                 <div>
 414                                                         <label for="referred_by_other" class="description">If other, please specify</label>
 415                                                         <input type="text" class="text element medium" name="referred_by_other" value="" size="30" maxlength="60">
 416 </div>
 417
 418                                         </fieldset>
 419 <input type="hidden" name="form_id" value="257051"><input id="saveForm" class="button_text" type="submit" name="submit" value="Continue">
 420 </form>
 421
 422
 423
 424
 425 </body>
 426 </html>