chrome/test/data/autofill/heuristics/input/13_register_signup.clicksor.com.html

   1 <html>
   2 <!--Form Location: http://signup.clicksor.com/advertisers_account.php?service=0&aid=&nid=--><head>
   3 <title>Open an advertiser account</title>
   4
   5 <meta name="keywords" content="pay per click advertising, contextual advertising, internet advertising, online advetising, advetise, content targeted advertising, online, advertising, internet, web, www, search, search engine, pay per click, ppc, bid, bids, keywords, keyword bids, keyword management, advertising bids,content target, blog advertising">
   6 <meta name="description" content="Create an online advertising account.">
   7
   8 </head>
   9 <body bgcolor="#FFFFFF" text="#000000" leftmargin="0" topmargin="0" marginwidth="0" marginheight="0" >
  10
  11
  12                 <table width="750" border="0" cellspacing="0" cellpadding="0" class="top_logo" align="center"><tr>
  13 <td class="top_logo" height="55" valign="middle"><a href="/"><img src="#" alt="Clicksor advertiser account" width="275" height="25" border="0"></a></td>
  14                   </tr></table>
  15 <!-- HEADER ENDS --><!-- CENTER COLUMN --><table align="center" cellpadding="0" cellspacing="0" width="750" class="textbody" style="padding-bottom:20px;"><tr>
  16 <td class="border_side_menu">
  17             <table width="100%" border="0" cellspacing="0" cellpadding="0">
  18 <tr class="rightTbTitle">
  19 <td style="padding:5;color:#FFFFFF">Clicksor Advertiser Application</td>
  20               </tr>
  21 <tr>
  22 <td width="100%" align="center" style="padding:20px; ">
  23
  24
  25
  26 <form name="form" id="form" action="advertisers_account.php?nid=100" method="POST">
  27 <!--- for rpc tracking--->
  28 <!--  -->
  29 <!--- for rpc tracking--->
  30
  31 <!--- for rpc tracking--->
  32 <!--
  33
  34 -->
  35 <!--- for rpc tracking--->
  36
  37
  38                         <input type="hidden" name="service" value="0"><input type="hidden" name="srid" value=""><input type="hidden" name="aid" value=""><input type="hidden" name="coupon" value=""><table width="100%" cellpadding="0" cellspacing="0" class="content_table"><tr>
  39 <td class="border_side_menu content_table_title">
  40                         <br>
  41                 &#160;&#160;<span class="text_bold_red">
  42                 1. Account info</span>
  43                  &gt;&gt;
  44                 <span class="text_bold_green">
  45                 2. Campaign info</span>
  46                  &gt;&gt;
  47                 <span class="text_bold_green">
  48                 3. Country target</span>
  49                 &gt;&gt;
  50                 <span class="text_bold_green">
  51                 4. Keyword target</span>
  52                         <br><br>
  53 </td>
  54                   </tr></table>
  55 <br><table width="100%" border="0" cellspacing="0" cellpadding="0" class="content_table"><tr>
  56 <td class="border_side_menu content_table_title">
  57                     <table width="100%" border="0" cellpadding="0" cellspacing="0" class="textbody">
  58 <tr>
  59 <td class="textbody" colspan="4" nowrap height="30">
  60 <font color="#990000">*</font>
  61                           The system automatically reviews the content you fill
  62                           in. please correct the field(s) with "<img src="#" width="8" height="8">".</td>
  63                       </tr>
  64 <tr>
  65 <td width="13%" height="30" align="right" nowrap class="text_bold_green">Email:&#160;</td>
  66                         <td width="31%" height="30" nowrap class="text_bold_green">
  67                                                   <input type="text" name="email1" id="email1" value="" title="emailchecker" class="inputbox" maxlength="100" size="25"><div id="email1Div" style="display:none;">
  68                                                   <img id="email1image" src="#" width="8" height="8">
  69 </div>
  70                         </td>
  71                         <td width="16%" height="30" align="right" nowrap class="text_bold_green">Confirm
  72                           email:&#160;</td>
  73                         <td width="40%" height="30" nowrap class="text_bold_green">
  74                                                   <input type="text" name="email2" id="email2" value="" title="emailchecker" class="inputbox" maxlength="100" size="25"><div id="email2Div" style="display:none;">
  75                                                   <img id="email2image" src="#" width="8" height="8">
  76 </div>
  77                                             </td>
  78                       </tr>
  79 <tr>
  80 <td class="text_bold_green" nowrap align="right" height="30">Website:&#160;</td>
  81                         <td class="text_bold_green" colspan="3" height="30" nowrap>
  82                                                         <input type="text" name="website" id="website" value="" title="checkWeb" class="inputbox" maxlength="255" size="35"><div id="webDiv" style="display:none;">
  83                                                         <img id="websiteimage" src="#" width="8" height="8">
  84 </div>
  85                         </td>
  86                       </tr>
  87 <tr>
  88 <td class="text_bold_green" nowrap align="right" height="30">Phone:&#160;</td>
  89                         <td class="text_bold_green" colspan="3" height="30" nowrap>
  90                                                         <input type="text" name="phone" id="phone" value="" title="checkPhone" class="inputbox" maxlength="20" size="20"><div id="phoneDiv" style="display:none;">
  91                                                         <img id="phoneimage" src="#" width="8" height="8">
  92 </div>
  93                         </td>
  94                       </tr>
  95 <tr>
  96 <td class="text_bold_green" nowrap align="right" height="30">Time Zone:&#160;</td>
  97                         <td class="text_bold_green" height="30" nowrap colspan="3">
  98                   <select name="timezone" id="timezone" title="checkZone" size="1" class="inputbox"><option value="1">(GMT) Casablanca, Monrovia</option>
  99 <option value="2">(GMT) Greenwich Mean Time : Dublin, Edinburgh, Lis</option>
 100 <option value="3">(GMT+01:00) Amsterdam, Berlin, Bern, Rome, Stockho</option>
 101 <option value="4">(GMT+01:00) Belgrade, Bratislava, Budapest, Ljublj</option>
 102 <option value="5">(GMT+01:00) Brussels, Copenhagen, Madrid, Paris</option>
 103 <option value="6">(GMT+01:00) Sarajevo, Skopje, Warsaw, Zagreb</option>
 104 <option value="7">(GMT+01:00) West Central Africa</option>
 105 <option value="8">(GMT+02:00) Athens, Istanbul, Minsk</option>
 106 <option value="9">(GMT+02:00) Bucharest</option>
 107 <option value="10">(GMT+02:00) Cairo</option>
 108 <option value="11">(GMT+02:00) Harare, Pretoria</option>
 109 <option value="12">(GMT+02:00) Helsinki, Kyiv, Riga, Sofia, Tallinn,</option>
 110 <option value="13">(GMT+02:00) Jerusalem</option>
 111 <option value="14">(GMT+03:00) Baghdad</option>
 112 <option value="15">(GMT+03:00) Kuwait, Riyadh</option>
 113 <option value="16">(GMT+03:00) Moscow, St. Petersburg, Volgograd</option>
 114 <option value="17">(GMT+03:00) Nairobi</option>
 115 <option value="18">(GMT+03:30) Tehran</option>
 116 <option value="19">(GMT+04:00) Abu Dhabi, Muscat</option>
 117 <option value="20">(GMT+04:00) Baku, Tbilisi, Yerevan</option>
 118 <option value="21">(GMT+04:30) Kabul</option>
 119 <option value="22">(GMT+05:00) Ekaterinburg</option>
 120 <option value="23">(GMT+05:00) Islamabad, Karachi, Tashkent</option>
 121 <option value="24">(GMT+05:30) Chennai, Kolkata, Mumbai, New Delhi</option>
 122 <option value="25">(GMT+05:45) Kathmandu</option>
 123 <option value="26">(GMT+06:00) Almaty, Novosibirsk</option>
 124 <option value="27">(GMT+06:00) Astana, Dhaka</option>
 125 <option value="28">(GMT+06:00) Sri Jayawardenepura</option>
 126 <option value="29">(GMT+06:30) Rangoon</option>
 127 <option value="30">(GMT+07:00) Bangkok, Hanoi, Jakarta</option>
 128 <option value="31">(GMT+07:00) Krasnoyarsk</option>
 129 <option value="32">(GMT+08:00) Beijing, Chongqing, Hong Kong, Urumqi</option>
 130 <option value="33">(GMT+08:00) Irkutsk, Ulaan Bataar</option>
 131 <option value="34">(GMT+08:00) Kuala Lumpur, Singapore</option>
 132 <option value="35">(GMT+08:00) Perth</option>
 133 <option value="36">(GMT+08:00) Taipei</option>
 134 <option value="37">(GMT+09:00) Osaka, Sapporo, Tokyo</option>
 135 <option value="38">(GMT+09:00) Seoul</option>
 136 <option value="39">(GMT+09:00) Yakutsk</option>
 137 <option value="40">(GMT+09:30) Adelaide</option>
 138 <option value="41">(GMT+09:30) Darwin</option>
 139 <option value="42">(GMT+10:00) Brisbane</option>
 140 <option value="43">(GMT+10:00) Canberra, Melbourne, Sydney</option>
 141 <option value="44">(GMT+10:00) Guam, Port Moresby</option>
 142 <option value="45">(GMT+10:00) Hobart</option>
 143 <option value="46">(GMT+10:00) Vladivostok</option>
 144 <option value="47">(GMT+11:00) Magadan, Solomon Is., New Caledonia</option>
 145 <option value="48">(GMT+12:00) Auckland, Wellington</option>
 146 <option value="49">(GMT+12:00) Fiji, Kamchatka, Marshall Is.</option>
 147 <option value="50">(GMT+13:00) Nuku'alofa</option>
 148 <option value="51">(GMT-01:00) Azores</option>
 149 <option value="52">(GMT-01:00) Cape Verde Is.</option>
 150 <option value="53">(GMT-02:00) Mid-Atlantic</option>
 151 <option value="54">(GMT-03:00) Brasilia</option>
 152 <option value="55">(GMT-03:00) Buenos Aires, Georgetown</option>
 153 <option value="56">(GMT-03:00) Greenland</option>
 154 <option value="57">(GMT-03:30) Newfoundland</option>
 155 <option value="58">(GMT-04:00) Atlantic Time (Canada)</option>
 156 <option value="59">(GMT-04:00) Caracas, La Paz</option>
 157 <option value="60">(GMT-04:00) Santiago</option>
 158 <option value="61">(GMT-05:00) Bogota, Lima, Quito</option>
 159 <option value="62">(GMT-05:00) Eastern Time (US &amp; Canada)</option>
 160 <option value="63">(GMT-05:00) Indiana (East)</option>
 161 <option value="64">(GMT-06:00) Central America</option>
 162 <option value="65">(GMT-06:00) Central Time (US &amp; Canada)</option>
 163 <option value="66">(GMT-06:00) Guadalajara, Mexico City, Monterrey</option>
 164 <option value="67">(GMT-06:00) Saskatchewan</option>
 165 <option value="68">(GMT-07:00) Arizona</option>
 166 <option value="69">(GMT-07:00) Chihuahua, La Paz, Mazatlan</option>
 167 <option value="70">(GMT-07:00) Mountain Time (US &amp; Canada)</option>
 168 <option value="71">(GMT-08:00) Pacific Time (US &amp; Canada); Tijuan</option>
 169 <option value="72">(GMT-09:00) Alaska</option>
 170 <option value="73">(GMT-10:00) Hawaii</option>
 171 <option value="74">(GMT-11:00) Midway Island, Samoa</option>
 172 <option value="75">(GMT-12:00) International Date Line West</option></select><img id="zoneimage" src="#" width="8" height="8">
 173 </td>
 174                       </tr>
 175 <tr>
 176 <td class="text_bold_green" nowrap align="right" height="30">Password:&#160;</td>
 177                         <td class="text_bold_green" height="30" nowrap>
 178                                                   <input type="password" name="password" id="password" title="checkPass" class="inputbox" maxlength="12" size="15"><div id="passDiv" style="display:none;">
 179                                                   <img id="passwordimage" src="#" width="8" height="8">
 180 </div>
 181                         </td>
 182                         <td class="text_bold_green" height="30" nowrap align="right">Confirm
 183                           password:&#160;</td>
 184                         <td class="text_bold_green" height="30" nowrap>
 185                                                            <input type="password" name="RePassword" id="RePassword" title="checkPass" class="inputbox" maxlength="12" size="15"><div id="RepassDiv" style="display:none;">
 186                                                            <img id="RePasswordimage" src="#" width="8" height="8">
 187 </div>
 188                                             </td>
 189                       </tr>
 190 <tr>
 191 <td class="text_bold_green" nowrap align="right" height="30">Name:&#160;</td>
 192                         <td class="text_bold_green" colspan="3" height="30" nowrap>
 193                                                           <input type="text" name="name" id="name" value="" title="checkName" class="inputbox" maxlength="40" size="35"><div id="nameDiv" style="display:none;">
 194                                                           <img id="nameimage" src="#" width="8" height="8">
 195 </div>
 196                         </td>
 197                       </tr>
 198 <tr>
 199 <td class="text_bold_green" nowrap align="right" height="30">Company:&#160;</td>
 200                         <td class="text_bold_green" colspan="3" height="30" nowrap>
 201                                                            <input type="text" name="company" id="company" value="" title="checkCompany" class="inputbox" maxlength="100" size="50"><div id="companyDiv" style="display:none;">
 202                                                            <img id="companyimage" src="#" width="8" height="8">
 203 </div>
 204                         </td>
 205                       </tr>
 206 <tr>
 207 <td class="text_bold_green" nowrap align="right" height="30">Address:&#160;</td>
 208                         <td class="text_bold_green" colspan="3" height="30" nowrap>
 209                                                           <input type="text" name="address" id="address" value="" title="checkAdd" class="inputbox" maxlength="200" size="50"><div id="addDiv" style="display:none;">
 210                                                           <img id="addressimage" src="#" width="8" height="8">
 211 </div>
 212                         </td>
 213                       </tr>
 214 <tr>
 215 <td class="text_bold_green" nowrap align="right" height="30">City:&#160;</td>
 216                         <td class="text_bold_green" colspan="3" height="30" nowrap>
 217                 <input type="text" name="city" id="city" value="" title="checkCity" class="inputbox" maxlength="40" size="25"><div id="cityDiv" style="display:none;">
 218                 <img id="cityimage" src="#" width="8" height="8">
 219 </div>
 220                         </td>
 221                       </tr>
 222 <tr>
 223 <td class="text_bold_green" nowrap align="right" height="30">State:&#160;</td>
 224                         <td class="text_bold_green" height="30" nowrap>
 225                 <input type="text" name="province" id="province" value="" title="checkPro" class="inputbox" maxlength="30" size="25"><div id="provinceDiv" style="display:none;">
 226                 <img id="provinceimage" src="#" width="8" height="8">
 227 </div>
 228                         </td>
 229                         <td class="text_bold_green" align="right" height="30" nowrap>Zip
 230                           code:&#160;</td>
 231                         <td class="text_bold_green" height="30" nowrap>
 232                   <input type="text" name="zipCode" id="zipCode" value="" title="checkZip" class="inputbox" maxlength="7" size="10"><div id="zipDiv" style="display:none;">
 233                   <img id="zipCodeimage" src="#" width="8" height="8">
 234 </div>
 235                         </td>
 236                       </tr>
 237 <tr>
 238 <td class="text_bold_green" nowrap align="right" height="30">Country:&#160;</td>
 239                         <td class="text_bold_green" height="30" nowrap colspan="3">
 240                   <select name="country" id="country" title="checkSelect" size="1" class="inputbox"><option value="AF">Afghanistan</option>
 241 <option value="AL">Albania</option>
 242 <option value="DZ">Algeria</option>
 243 <option value="AS">American Samoa</option>
 244 <option value="AD">Andorra</option>
 245 <option value="AO">Angola</option>
 246 <option value="AI">Anguilla</option>
 247 <option value="AQ">Antarctica</option>
 248 <option value="AG">Antigua and Barbuda</option>
 249 <option value="AR">Argentina</option>
 250 <option value="AM">Armenia</option>
 251 <option value="AW">Aruba</option>
 252 <option value="AP">Asia/Pacific Region</option>
 253 <option value="AU">Australia</option>
 254 <option value="AT">Austria</option>
 255 <option value="AZ">Azerbaijan</option>
 256 <option value="BS">Bahamas</option>
 257 <option value="BH">Bahrain</option>
 258 <option value="BD">Bangladesh</option>
 259 <option value="BB">Barbados</option>
 260 <option value="BY">Belarus</option>
 261 <option value="BE">Belgium</option>
 262 <option value="BZ">Belize</option>
 263 <option value="BJ">Benin</option>
 264 <option value="BM">Bermuda</option>
 265 <option value="BT">Bhutan</option>
 266 <option value="BO">Bolivia</option>
 267 <option value="BA">Bosnia and Herzegovina</option>
 268 <option value="BW">Botswana</option>
 269 <option value="BV">Bouvet Island</option>
 270 <option value="BR">Brazil</option>
 271 <option value="IO">British Indian Ocean Territory</option>
 272 <option value="BN">Brunei Darussalam</option>
 273 <option value="BG">Bulgaria</option>
 274 <option value="BF">Burkina Faso</option>
 275 <option value="BI">Burundi</option>
 276 <option value="KH">Cambodia</option>
 277 <option value="CM">Cameroon</option>
 278 <option value="CA">Canada</option>
 279 <option value="CV">Cape Verde</option>
 280 <option value="KY">Cayman Islands</option>
 281 <option value="CF">Central African Republic</option>
 282 <option value="TD">Chad</option>
 283 <option value="CL">Chile</option>
 284 <option value="CN">China</option>
 285 <option value="CX">Christmas Island</option>
 286 <option value="CC">Cocos (Keeling) Islands</option>
 287 <option value="CO">Colombia</option>
 288 <option value="KM">Comoros</option>
 289 <option value="CG">Congo</option>
 290 <option value="CD">Congo, The Democratic Republic of the</option>
 291 <option value="CK">Cook Islands</option>
 292 <option value="CR">Costa Rica</option>
 293 <option value="CI">Cote D'Ivoire</option>
 294 <option value="HR">Croatia</option>
 295 <option value="CU">Cuba</option>
 296 <option value="CY">Cyprus</option>
 297 <option value="CZ">Czech Republic</option>
 298 <option value="DK">Denmark</option>
 299 <option value="DJ">Djibouti</option>
 300 <option value="DM">Dominica</option>
 301 <option value="DO">Dominican Republic</option>
 302 <option value="TP">East Timor</option>
 303 <option value="EC">Ecuador</option>
 304 <option value="EG">Egypt</option>
 305 <option value="SV">El Salvador</option>
 306 <option value="GQ">Equatorial Guinea</option>
 307 <option value="ER">Eritrea</option>
 308 <option value="EE">Estonia</option>
 309 <option value="ET">Ethiopia</option>
 310 <option value="EU">Europe</option>
 311 <option value="FK">Falkland Islands (Malvinas)</option>
 312 <option value="FO">FaroeIslands</option>
 313 <option value="FJ">Fiji</option>
 314 <option value="FI">Finland</option>
 315 <option value="FR">France</option>
 316 <option value="FX">France, Metropolitan</option>
 317 <option value="PF">French Polynesia</option>
 318 <option value="GF">French Guiana</option>
 319 <option value="TF">French Southern Territories</option>
 320 <option value="GA">Gabon</option>
 321 <option value="GM">Gambia</option>
 322 <option value="GE">Georgia</option>
 323 <option value="DE">Germany</option>
 324 <option value="GH">Ghana</option>
 325 <option value="GI">Gibraltar</option>
 326 <option value="GR">Greece</option>
 327 <option value="GL">Greenland</option>
 328 <option value="GD">Grenada</option>
 329 <option value="GP">Guadeloupe</option>
 330 <option value="GU">Guam</option>
 331 <option value="GT">Guatemala</option>
 332 <option value="GN">Guinea</option>
 333 <option value="GW">Guinea-Bissau</option>
 334 <option value="GY">Guyana</option>
 335 <option value="HT">Haiti</option>
 336 <option value="HM">Heard Island and McDonald Islands</option>
 337 <option value="VA">Holy See (Vatican City State)</option>
 338 <option value="HN">Honduras</option>
 339 <option value="HK">Hong Kong</option>
 340 <option value="HU">Hungary</option>
 341 <option value="IS">Iceland</option>
 342 <option value="IN">India</option>
 343 <option value="ID">Indonesia</option>
 344 <option value="IR">Iran, Islamic Republic of</option>
 345 <option value="IQ">Iraq</option>
 346 <option value="IE">Ireland</option>
 347 <option value="IL">Israel</option>
 348 <option value="IT">Italy</option>
 349 <option value="JM">Jamaica</option>
 350 <option value="JP">Japan</option>
 351 <option value="JO">Jordan</option>
 352 <option value="KZ">Kazakstan</option>
 353 <option value="KE">Kenya</option>
 354 <option value="KI">Kiribati</option>
 355 <option value="KP">Korea, Democratic People's Republic of</option>
 356 <option value="KR">Korea, Republic of</option>
 357 <option value="KW">Kuwait</option>
 358 <option value="KG">Kyrgyzstan</option>
 359 <option value="LA">Lao People's Democratic Republic</option>
 360 <option value="LV">Latvia</option>
 361 <option value="LB">Lebanon</option>
 362 <option value="LS">Lesotho</option>
 363 <option value="LR">Liberia</option>
 364 <option value="LY">Libyan Arab Jamahiriya</option>
 365 <option value="LI">Liechtenstein</option>
 366 <option value="LT">Lithuania</option>
 367 <option value="LU">Luxembourg</option>
 368 <option value="MO">Macau</option>
 369 <option value="MK">Macedonia, the Former Yugoslav Republic of</option>
 370 <option value="MG">Madagascar</option>
 371 <option value="MW">Malawi</option>
 372 <option value="MY">Malaysia</option>
 373 <option value="MV">Maldives</option>
 374 <option value="ML">Mali</option>
 375 <option value="MT">Malta</option>
 376 <option value="MH">Marshall Islands</option>
 377 <option value="MQ">Martinique</option>
 378 <option value="MR">Mauritania</option>
 379 <option value="MU">Mauritius</option>
 380 <option value="YT">Mayotte</option>
 381 <option value="MX">Mexico</option>
 382 <option value="FM">Micronesia, Federated States of</option>
 383 <option value="MD">Moldova, Republic of</option>
 384 <option value="MC">Monaco</option>
 385 <option value="MN">Mongolia</option>
 386 <option value="MS">Montserrat</option>
 387 <option value="MA">Morocco</option>
 388 <option value="MZ">Mozambique</option>
 389 <option value="MM">Myanmar</option>
 390 <option value="NA">Namibia</option>
 391 <option value="NR">Nauru</option>
 392 <option value="NP">Nepal</option>
 393 <option value="NL">Netherlands</option>
 394 <option value="AN">Netherlands Antilles</option>
 395 <option value="NC">New Caledonia</option>
 396 <option value="NZ">New Zealand</option>
 397 <option value="NI">Nicaragua</option>
 398 <option value="NE">Niger</option>
 399 <option value="NG">Nigeria</option>
 400 <option value="NU">Niue</option>
 401 <option value="NF">Norfolk Island</option>
 402 <option value="MP">Northern Mariana Islands</option>
 403 <option value="NO">Norway</option>
 404 <option value="OM">Oman</option>
 405 <option value="PK">Pakistan</option>
 406 <option value="PW">Palau</option>
 407 <option value="PS">Palestinian Territory, Occupied</option>
 408 <option value="PA">Panama</option>
 409 <option value="PG">Papua New Guinea</option>
 410 <option value="PY">Paraguay</option>
 411 <option value="PE">Peru</option>
 412 <option value="PH">Philippines</option>
 413 <option value="PN">Pitcairn</option>
 414 <option value="PL">Poland</option>
 415 <option value="PT">Portugal</option>
 416 <option value="PR">Puerto Rico</option>
 417 <option value="QA">Qatar</option>
 418 <option value="RE">Reunion</option>
 419 <option value="RO">Romania</option>
 420 <option value="RU">Russian Federation</option>
 421 <option value="RW">Rwanda</option>
 422 <option value="PM">Saint Pierre and Miquelon</option>
 423 <option value="SH">Saint Helena</option>
 424 <option value="KN">Saint Kitts and Nevis</option>
 425 <option value="LC">Saint Lucia</option>
 426 <option value="VC">Saint Vincent and the Grenadines</option>
 427 <option value="WS">Samoa</option>
 428 <option value="SM">San Marino</option>
 429 <option value="ST">Sao Tome and Principe</option>
 430 <option value="SA">Saudi Arabia</option>
 431 <option value="SN">Senegal</option>
 432 <option value="SC">Seychelles</option>
 433 <option value="SL">Sierra Leone</option>
 434 <option value="SG">Singapore</option>
 435 <option value="SK">Slovakia</option>
 436 <option value="SI">Slovenia</option>
 437 <option value="SB">Solomon Islands</option>
 438 <option value="SO">Somalia</option>
 439 <option value="ZA">South Africa</option>
 440 <option value="GS">South Georgia and the South Sandwich Islands</option>
 441 <option value="ES">Spain</option>
 442 <option value="LK">Sri Lanka</option>
 443 <option value="SD">Sudan</option>
 444 <option value="SR">Suriname</option>
 445 <option value="SJ">Svalbard and Jan Mayen</option>
 446 <option value="SZ">Swaziland</option>
 447 <option value="SE">Sweden</option>
 448 <option value="CH">Switzerland</option>
 449 <option value="SY">Syrian Arab Republic</option>
 450 <option value="TW">Taiwan</option>
 451 <option value="TJ">Tajikistan</option>
 452 <option value="TZ">Tanzania, United Republic of</option>
 453 <option value="TH">Thailand</option>
 454 <option value="TG">Togo</option>
 455 <option value="TK">Tokelau</option>
 456 <option value="TO">Tonga</option>
 457 <option value="TT">Trinidad and Tobago</option>
 458 <option value="TN">Tunisia</option>
 459 <option value="TR">Turkey</option>
 460 <option value="TM">Turkmenistan</option>
 461 <option value="TC">Turks and Caicos Islands</option>
 462 <option value="TV">Tuvalu</option>
 463 <option value="UG">Uganda</option>
 464 <option value="UA">Ukraine</option>
 465 <option value="AE">United Arab Emirates</option>
 466 <option value="GB">United Kingdom</option>
 467 <option value="US" selected>United States</option>
 468 <option value="UM">United States Minor Outlying Islands</option>
 469 <option value="UY">Uruguay</option>
 470 <option value="UZ">Uzbekistan</option>
 471 <option value="VU">Vanuatu</option>
 472 <option value="VE">Venezuela</option>
 473 <option value="VN">Vietnam</option>
 474 <option value="VG">Virgin Islands, British</option>
 475 <option value="VI">Virgin Islands, U.S.</option>
 476 <option value="WF">Wallis and Futuna</option>
 477 <option value="EH">Western Sahara</option>
 478 <option value="YE">Yemen</option>
 479 <option value="YU">Yugoslavia</option>
 480 <option value="ZR">Zaire</option>
 481 <option value="ZM">Zambia</option>
 482 <option value="ZW">Zimbabwe</option>
 483 <option value="CS">Serbia and Montenegro</option>
 484 <option value="RS">Serbia, Republic of</option></select><img id="countryimage" src="#" width="8" height="8">
 485 </td>
 486                       </tr>
 487 <tr align="center">
 488 <td class="bodytext" colspan="4" nowrap height="30">
 489                                                   <input type="checkbox" name="termcheck" value="ON">
 490                          By checking this box I acknowledge
 491                           that I have read and agree to the Clicksor&#153;
 492                           <a href="http://www.clicksor.com/advertiser-agreement" class="no" style="text-decoration:underline;color:#669900" target="_blank">agreement</a>
 493 </td>
 494                       </tr>
 495 <tr>
 496 <td class="text_bold_green" colspan="2" nowrap align="right" height="30">Enter
 497                           the security code shown below: </td>
 498                         <td class="text_bold_green" height="30" nowrap colspan="2">
 499                                                   <input type="text" name="securityCode" maxlength="5" size="10" class="inputbox">
 500 </td>
 501                       </tr>
 502 <tr>
 503 <td class="bodytext" colspan="2" nowrap align="right" height="45">Picture</td>
 504                         <td class="text_bold_green" height="45" nowrap><img src="#" width="100" height="30" name="imageverify" class="inputbox"></td>
 505                         <td class="text_bold_green" height="45" nowrap><a ><img src="#" width="15" height="15" border="0"></a></td>
 506                       </tr>
 507 <tr>
 508 <td class="text_bold_green" colspan="4" nowrap align="right" height="30" style="padding-right:30;padding-top:20;padding-bottom:15">
 509                                                         <input type="image" src="#" name="Submit" value="Submit" alt="Submit" width="69" height="20"><input type="image" src="#" name="Reset" value="Reset" alt="Reset" width="69" height="20">
 510 </td>
 511                       </tr>
 512 </table>
 513 <table width="540" border="0" cellspacing="0" cellpadding="0" style="padding-top:20"><tr>
 514 <td class="no" width="410" nowrap align="center"><a href="https://www.paypal.com/cgi-bin/webscr?cmd=xpt/general/SolutionGraphics-outside#" target="_blank"><img src="#" width="348" height="34" alt="Paypal" border="0"></a></td>
 515                         <td class="no"></td>
 516                       </tr></table>
 517 </td>
 518                 </tr></table>
 519 <input type="hidden" name="srid" value=""><input type="hidden" name="aid" value="">
 520 </form>                         </td>
 521                                 </tr>
 522 </table>
 523 </td>
 524         </tr></table>
 525
 526 </body>
 527 </html>