<div class="wpforms-container wpforms-container-full form-toadd" id="wpforms-3296"><form id="wpforms-form-3296" class="wpforms-validate wpforms-form wpforms-ajax-form" data-formid="3296" method="post" enctype="multipart/form-data" action="/my-account-2/" data-token="aa7c0482704ac30d7bbf3592b78fc863"><noscript class="wpforms-error-noscript">Please enable JavaScript in your browser to complete this form.</noscript><div class="wpforms-field-container"><div id="wpforms-3296-field_1-container" class="wpforms-field wpforms-field-name" data-field-id="1"><label class="wpforms-field-label" for="wpforms-3296-field_1">Name <span class="wpforms-required-label">*</span></label><div class="wpforms-field-row wpforms-field-large"><div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-3296-field_1" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][1][first]" required><label for="wpforms-3296-field_1" class="wpforms-field-sublabel after ">First</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-3296-field_1-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][1][last]" required><label for="wpforms-3296-field_1-last" class="wpforms-field-sublabel after ">Last</label></div></div></div><div id="wpforms-3296-field_10-container" class="wpforms-field wpforms-field-layout" data-field-id="10"><label class="wpforms-field-label wpforms-label-hide" for="wpforms-3296-field_10">Layout</label><div class="wpforms-field-layout-columns wpforms-field-layout-preset-50-50"><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-3296-field_2-container" class="wpforms-field wpforms-field-email" data-field-id="2"><label class="wpforms-field-label" for="wpforms-3296-field_2">Work Email <span class="wpforms-required-label">*</span></label><input type="email" id="wpforms-3296-field_2" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][2]" required></div></div><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-3296-field_12-container" class="wpforms-field wpforms-field-phone" data-field-id="12"><label class="wpforms-field-label" for="wpforms-3296-field_12">Phone <span class="wpforms-required-label">*</span></label><input type="tel" id="wpforms-3296-field_12" class="wpforms-field-medium wpforms-field-required wpforms-smart-phone-field" data-rule-smart-phone-field="true" name="wpforms[fields][12]" required></div></div></div></div><div id="wpforms-3296-field_9-container" class="wpforms-field wpforms-field-layout" data-field-id="9"><label class="wpforms-field-label wpforms-label-hide" for="wpforms-3296-field_9">Layout</label><div class="wpforms-field-layout-columns wpforms-field-layout-preset-50-50"><div class="wpforms-layout-column wpforms-layout-column-50"><div id="wpforms-3296-field_4-container" class="wpforms-field wpforms-field-text" data-field-id="4"><label class="wpforms-field-label" for="wpforms-3296-field_4">Company <span class="wpforms-required-label">*</span></label><input type="text" id="wpforms-3296-field_4" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][4]" required></div><div id="wpforms-3296-field_14-container" class="wpforms-field wpforms-field-select form-control wpforms-field-select-style-classic" data-field-id="14"><label class="wpforms-field-label" for="wpforms-3296-field_14">Country <span class="wpforms-required-label">*</span></label><select id="wpforms-3296-field_14" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][14]" required="required"><option value="Select a country" >Select a country</option><option value="Afghanistan" >Afghanistan</option><option value="Algeria" >Algeria</option><option value="Angola" >Angola</option><option value="Argentina" >Argentina</option><option value="Australia" >Australia</option><option value="Austria" >Austria</option><option value="Azerbaijan" >Azerbaijan</option><option value="Bahrain" >Bahrain</option><option value="Bangladesh" >Bangladesh</option><option value="Belarus" >Belarus</option><option value="Belgium" >Belgium</option><option value="Benin" >Benin</option><option value="Bolivia" >Bolivia</option><option value="Brazil" >Brazil</option><option value="Bulgaria" >Bulgaria</option><option value="Cambodia" >Cambodia</option><option value="Cameroon" >Cameroon</option><option value="Canada" >Canada</option><option value="Central African Republic" >Central African Republic</option><option value="Chad" >Chad</option><option value="China" >China</option><option value="Colombia" >Colombia</option><option value="Cuba" >Cuba</option><option value="Cyprus" >Cyprus</option><option value="Czechia" >Czechia</option><option value="Congo" >Congo</option><option value="Denmark" >Denmark</option><option value="Dominican Republic" >Dominican Republic</option><option value="Ecuador" >Ecuador</option><option value="Egypt" >Egypt</option><option value="El Salvador" >El Salvador</option><option value="Ethiopia" >Ethiopia</option><option value="Finland" >Finland</option><option value="France" >France</option><option value="Germany" >Germany</option><option value="Ghana" >Ghana</option><option value="Greece" >Greece</option><option value="Guatemala" >Guatemala</option><option value="Guinea" >Guinea</option><option value="Haiti" >Haiti</option><option value="Honduras" >Honduras</option><option value="Hungary" >Hungary</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="Italy" >Italy</option><option value="Japan" >Japan</option><option value="Jordan" >Jordan</option><option value="Kazakhstan" >Kazakhstan</option><option value="Kenya" >Kenya</option><option value="Kuwait" >Kuwait</option><option value="Kyrgyzstan" >Kyrgyzstan</option><option value="Laos" >Laos</option><option value="Lebanon" >Lebanon</option><option value="Liberia" >Liberia</option><option value="Libya" >Libya</option><option value="Madagascar" >Madagascar</option><option value="Malawi" >Malawi</option><option value="Malaysia" >Malaysia</option><option value="Mali" >Mali</option><option value="Mauritania" >Mauritania</option><option value="Mexico" >Mexico</option><option value="Morocco" >Morocco</option><option value="Mozambique" >Mozambique</option><option value="Nepal" >Nepal</option><option value="Netherlands" >Netherlands</option><option value="New Zealand" >New Zealand</option><option value="Nigeria" >Nigeria</option><option value="Norway" >Norway</option><option value="Oman" >Oman</option><option value="Pakistan" >Pakistan</option><option value="Palestine" >Palestine</option><option value="Papua New Guinea" >Papua New Guinea</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="Saudi Arabia" >Saudi Arabia</option><option value="Senegal" >Senegal</option><option value="Singapore" >Singapore</option><option value="South Africa" >South Africa</option><option value="Spain" >Spain</option><option value="Sudan" >Sudan</option><option value="Sri Lanka" >Sri Lanka</option><option value="Thailand" >Thailand</option><option value="Tunisia" >Tunisia</option><option value="Turkey" >Turkey</option><option value="United Arab Emirates" >United Arab Emirates</option><option value="United Kingdom" >United Kingdom</option><option value="United States" >United States</option><option value="" ></option></select></div><div id="wpforms-3296-field_16-container" class="wpforms-field wpforms-field-richtext" data-field-id="16"><label class="wpforms-field-label" for="wpforms-3296-field_16">Comment</label><div 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