Become an Avaya Sales Agent | Start Selling Cloud Solutions

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xlink:href="/etc.clientlibs/aem-avaya-portal/clientlibs/clientlib-site/resources/images/svg/symbol-defs.svg#icon-arrow-right"> </use> </svg> </a> <p> Synchronize experiences for more personalized, effective journeys. </p> </li> <li class="mega-menu--link-item mega-menu--link-item-anchor "> <a href="https://www.avaya.com/en/solutions/business-growth/#proactive-customer-care" target="_self">Proactive Customer Care <svg class="icon icon-arrow-right"> <use xlink:href="/etc.clientlibs/aem-avaya-portal/clientlibs/clientlib-site/resources/images/svg/symbol-defs.svg#icon-arrow-right"> </use> </svg> </a> <p> AI-led predictive analytics answer questions before they’re asked. </p> </li> </ul> </li> </ul> </div> </div> </div> <div class="mega-menu--spotlight"> <div class="spotlight"> <h4 class="spotlight-title">Industries</h4> <ul class="spotlight-list"> <li class="spotlight-item"> <a target="_self" href="https://www.avaya.com/en/solutions/healthcare/">Healthcare</a> </li> <li 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<section class="mega-menu"> <div class="mega-menu--wrapper"> <div class="mega-menu--content-wrapper"> <div class="mega-menu--content"> <div class="mega-menu--content-header"> <h4 class="content-title ">Services for customer success</h4> <h5 class="content-header"><a href="https://www.avaya.com/en/services/" role="menu-item" target="_self"> Avaya Services</a></h5> <p> Our team of experts to help you get the most out of Avaya. </p> </div> <div class="mega-menu--link-wrapper"> <ul class="mega-menu--link-list three-columns"> <li> <ul class="mega-menu--column "> <li class="mega-menu--link-item"> <a href="https://www.avaya.com/en/services/avaya-professional-services/" target="_self"> <span class="link-item--wrapper"> ACES Professional Services <svg class="icon icon-arrow-right"> <use xlink:href="/etc.clientlibs/aem-avaya-portal/clientlibs/clientlib-site/resources/images/svg/symbol-defs.svg#icon-arrow-right"> </use> </svg> </span> </a> <p> Consult with our team to support robust customer 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world. </p> </li> </ul> </li> <li> <ul class="mega-menu--column "> <li class="mega-menu--link-item"> <a href="https://www.avaya.com/en/partners/devconnect/sdks/" target="_self"> <span class="link-item--wrapper"> APIs and SDKs <svg class="icon icon-arrow-right"> <use xlink:href="/etc.clientlibs/aem-avaya-portal/clientlibs/clientlib-site/resources/images/svg/symbol-defs.svg#icon-arrow-right"> </use> </svg> </span> </a> <p> Access the latest Avaya SDKs and API resources. </p> </li> </ul> </li> </ul> </div> </div> </div> <div class="mega-menu--spotlight"> <div class="spotlight"> <h4 class="spotlight-title">Become a Partner</h4> <ul class="spotlight-list"> <li class="spotlight-item"> <a target="_self" href="https://www.avaya.com/en/partners/">All Programs</a> <p>Explore all of the partner types and programs available at Avaya.</p> </li> <li class="spotlight-item"> <a target="_self" href="https://www.avaya.com/en/partners/channelpartners/">Channel Partners</a> </li> <li class="spotlight-item"> <a target="_self" href="https://www.avaya.com/en/partners/salesagents/">Sales Agents</a> </li> <li class="spotlight-item"> <a target="_self" href="https://www.avaya.com/en/partners/serviceprovider/">Service Provider</a> </li> </ul> </div> </div> </div> </section> </div> </div> </div> </div>  </li> <li class="main-menu--item" role="none"> <a class="main-menu--item-link" href="#" aria-haspopup="true" aria-expanded="false" aria-controls="submenu-" role="menuitem" target="_self"> <span class="main-menu--item-link-text"> Resources </span> <span class="main-menu--item-link-icon"> <svg class="icon icon-dropdown-arrow"> <use xlink:href="/etc.clientlibs/aem-avaya-portal/clientlibs/clientlib-homepage/resources/images/svg/symbol-defs.svg#icon-dropdown-arrow"> </use> </svg> </span> </a>  <div class="xfpage page basicpage"> <div id="container-cce26288b1" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="megamenu aem-GridColumn 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class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" class=\"elq-item-input\" name=\"phone\" id=\"fe90760\" value=\"\" style=\"width:100%;\"></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement4\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe90761\">Company</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" class=\"elq-item-input\" name=\"company_name\" id=\"fe90761\" value=\"\" style=\"width:100%;\"></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement5\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe92847\">HQ Address</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" class=\"elq-item-input\" name=\"address_1\" id=\"fe92847\" value=\"\" style=\"width:100%;\"></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement6\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe92848\">City</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" class=\"elq-item-input\" name=\"city\" id=\"fe92848\" value=\"\" style=\"width:100%;\"></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement7\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe94316\">Postal Code</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" class=\"elq-item-input\" name=\"postal_code\" id=\"fe94316\" value=\"\" style=\"width:100%;\"></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement8\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe90762\">Country/Region</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><select class=\"elq-item-select\" id=\"fe90762\" name=\"country\" style=\"width:100%;\" data-value=\"~~eloqua..type--emailfield..syntax--Country~~\"><option value=\"\">Please Select</option><option value=\"Belgium\">Belgium</option><option value=\"Canada\">Canada</option><option value=\"India\">India</option><option value=\"Ireland\">Ireland</option><option value=\"Netherlands\">Netherlands</option><option value=\"Portugal\">Portugal</option><option value=\"South Africa\">South Africa</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><option value=\"Afghanistan\">Afghanistan</option><option value=\"Albania\">Albania</option><option value=\"Algeria\">Algeria</option><option value=\"American Samoa\">American Samoa</option><option value=\"Andorra\">Andorra</option><option value=\"Angola\">Angola</option><option value=\"Anguilla\">Anguilla</option><option value=\"Antarctica\">Antarctica</option><option value=\"Antigua and Barbuda\">Antigua and Barbuda</option><option value=\"Argentina\">Argentina</option><option value=\"Armenia\">Armenia</option><option value=\"Aruba\">Aruba</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=\"Belize\">Belize</option><option value=\"Benin\">Benin</option><option value=\"Bermuda\">Bermuda</option><option value=\"Bhutan\">Bhutan</option><option value=\"Bolivia\">Bolivia</option><option value=\"Bonaire, Saint Eustatius and Saba\">Bonaire, Saint Eustatius and Saba</option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina</option><option value=\"Botswana\">Botswana</option><option value=\"Brazil\">Brazil</option><option value=\"British Indian Ocean Territory\">British Indian Ocean Territory</option><option value=\"Brunei Darussalam\">Brunei Darussalam</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=\"Cape Verde\">Cape Verde</option><option value=\"Cayman Islands\">Cayman Islands</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=\"Christmas Island\">Christmas Island</option><option value=\"Cocos (Keeling) Islands\">Cocos (Keeling) Islands</option><option value=\"Colombia\">Colombia</option><option value=\"Comoros\">Comoros</option><option value=\"Congo\">Congo</option><option value=\"Congo, The Democratic Republic Of The\">Congo, The Democratic Republic Of The</option><option value=\"Cook Islands\">Cook Islands</option><option value=\"Costa Rica\">Costa Rica</option><option value=\"Cote D'Ivoire\">Cote D'Ivoire</option><option value=\"Croatia\">Croatia</option><option value=\"Curacao\">Curacao</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\">East Timor</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=\"Falkland Islands (Malvinas)\">Falkland Islands (Malvinas)</option><option value=\"Faroe Islands\">Faroe Islands</option><option value=\"French Guiana\">French Guiana</option><option value=\"Fiji\">Fiji</option><option value=\"Finland\">Finland</option><option value=\"France\">France</option><option value=\"Gabon\">Gabon</option><option value=\"Gambia\">Gambia</option><option value=\"Georgia\">Georgia</option><option value=\"Germany\">Germany</option><option value=\"Ghana\">Ghana</option><option value=\"Gibraltar\">Gibraltar</option><option value=\"Greece\">Greece</option><option value=\"Greenland\">Greenland</option><option value=\"Grenada\">Grenada</option><option value=\"Guadeloupe\">Guadeloupe</option><option value=\"Guam\">Guam</option><option value=\"Guatemala\">Guatemala</option><option value=\"Guernsey\">Guernsey</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=\"Heard and McDonald Islands\">Heard and McDonald Islands</option><option value=\"Honduras\">Honduras</option><option value=\"Hong Kong\">Hong Kong</option><option value=\"Hungary\">Hungary</option><option value=\"Iceland\">Iceland</option><option value=\"Indonesia\">Indonesia</option><option value=\"Iraq\">Iraq</option><option value=\"Isle Of Man\">Isle Of Man</option><option value=\"Israel\">Israel</option><option value=\"Italy\">Italy</option><option value=\"Ivory Coast (Cote D'Ivoire)\">Ivory Coast (Cote D'Ivoire)</option><option value=\"Jamaica\">Jamaica</option><option value=\"Japan\">Japan</option><option value=\"Jersey\">Jersey</option><option value=\"Jordan\">Jordan</option><option value=\"Kazakhstan\">Kazakhstan</option><option value=\"Kenya\">Kenya</option><option value=\"Kiribati\">Kiribati</option><option value=\"Korea Republic of\">Korea Republic of</option><option value=\"Korea Democratic People'S Republic Of\">Korea Democratic People'S Republic of</option><option value=\"Kosovo\">Kosovo</option><option value=\"Kuwait\">Kuwait</option><option value=\"Kyrgyzstan\">Kyrgyzstan</option><option value=\"Lao People's Democratic Republic\">Lao People's Democratic Republic</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=\"Macao\">Macao</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=\"Martinique\">Martinique</option><option value=\"Mauritania\">Mauritania</option><option value=\"Mauritius\">Mauritius</option><option value=\"Mexico\">Mexico</option><option value=\"Micronesia, Federated States of\">Micronesia, Federated States of</option><option value=\"Moldova\">Moldova</option><option value=\"Monaco\">Monaco</option><option value=\"Mongolia\">Mongolia</option><option value=\"Montenegro\">Montenegro</option><option value=\"Montserrat\">Montserrat</option><option value=\"Morocco\">Morocco</option><option value=\"Mozambique\">Mozambique</option><option value=\"Namibia\">Namibia</option><option value=\"Nauru\">Nauru</option><option value=\"Netherlands Antilles\">Netherlands Antilles</option><option value=\"New Caledonia\">New Caledonia</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=\"Niue\">Niue</option><option value=\"Norfolk Island\">Norfolk Island</option><option value=\"Norway\">Norway</option><option value=\"Oman\">Oman</option><option value=\"Pakistan\">Pakistan</option><option value=\"Palau\">Palau</option><option value=\"Palestinian Territory, Occupied\">Palestinian Territory, Occupied</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=\"Pitcairn\">Pitcairn</option><option value=\"Poland\">Poland</option><option value=\"Puerto Rico\">Puerto Rico</option><option value=\"Qatar\">Qatar</option><option value=\"Reunion\">Reunion</option><option value=\"Romania\">Romania</option><option value=\"Rwanda\">Rwanda</option><option value=\"Saint Helena\">Saint Helena</option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis</option><option value=\"Saint Lucia\">Saint Lucia</option><option value=\"Saint Martin\">Saint Martin</option><option value=\"Saint Vincent and the Grenedines\">Saint Vincent and the Grenedines</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=\"Sint Maarten (Dutch Part)\">Sint Maarten (Dutch Part)</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 Georgia and the South Sandwich Islands\">South Georgia and the South Sandwich Islands</option><option value=\"Spain\">Spain</option><option value=\"Sri Lanka\">Sri Lanka</option><option value=\"Suriname\">Suriname</option><option value=\"Swaziland\">Swaziland</option><option value=\"Sweden\">Sweden</option><option value=\"Switzerland\">Switzerland</option><option value=\"Taiwan\">Taiwan</option><option value=\"Tajikistan\">Tajikistan</option><option value=\"Tanzania\">Tanzania</option><option value=\"Tanzania, United Republic Of\">Tanzania, United Republic Of</option><option value=\"Thailand\">Thailand</option><option value=\"The Federal Democratic Republic of Nepal\">The Federal Democratic Republic of Nepal</option><option value=\"Timor-Leste\">Timor-Leste</option><option value=\"Togo\">Togo</option><option value=\"Tokelau\">Tokelau</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=\"Turks and Caicos Islands\">Turks and Caicos Islands</option><option value=\"Tuvalu\">Tuvalu</option><option value=\"Uganda\">Uganda</option><option value=\"Ukraine\">Ukraine</option><option value=\"Uruguay\">Uruguay</option><option value=\"Minor Outlying Islands - United States\">Minor Outlying Islands - United States</option><option value=\"Uzbekistan\">Uzbekistan</option><option value=\"Vanuatu\">Vanuatu</option><option value=\"Holy See (Vatican City State)\">Holy See (Vatican City State)</option><option value=\"Vietnam\">Vietnam</option><option value=\"Virgin Islands, British\">Virgin Islands, British</option><option value=\"Virgin Islands, U.S.\">Virgin Islands, U.S.</option><option value=\"Western Sahara\">Western Sahara</option><option value=\"Zambia\">Zambia</option><option value=\"Zimbabwe\">Zimbabwe</option></select></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement9\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe92849\">State or Province</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><select class=\"elq-item-select\" id=\"fe92849\" name=\"stateProv\" style=\"width:100%;\" data-value=\"\"><option value=\"\">Please Select...</option><option value=\"AK\">Alaska</option><option value=\"AL\">Alabama</option><option value=\"AR\">Arkansas</option><option value=\"AZ\">Arizona</option><option value=\"CA\">California</option><option value=\"CO\">Colorado</option><option value=\"CT\">Connecticut</option><option value=\"DC\">District of Columbia</option><option value=\"DE\">Delaware</option><option value=\"FL\">Florida</option><option value=\"GA\">Georgia</option><option value=\"HI\">Hawaii</option><option value=\"IA\">Iowa</option><option value=\"ID\">Idaho</option><option value=\"IL\">Illinois</option><option value=\"IN\">Indiana</option><option value=\"KS\">Kansas</option><option value=\"KY\">Kentucky</option><option value=\"LA\">Louisiana</option><option value=\"MA\">Massachusetts</option><option value=\"MD\">Maryland</option><option value=\"ME\">Maine</option><option value=\"MI\">Michigan</option><option value=\"MN\">Minnesota</option><option value=\"MO\">Missouri</option><option value=\"MS\">Mississippi</option><option value=\"MT\">Montana</option><option value=\"NC\">North Carolina</option><option value=\"ND\">North Dakota</option><option value=\"NE\">Nebraska</option><option value=\"NH\">New Hampshire</option><option value=\"NJ\">New Jersey</option><option value=\"NM\">New Mexico</option><option value=\"NV\">Nevada</option><option value=\"NY\">New York</option><option value=\"OH\">Ohio</option><option value=\"OK\">Oklahoma</option><option value=\"OR\">Oregon</option><option value=\"PA\">Pennsylvania</option><option value=\"PR\">Puerto Rico</option><option value=\"RI\">Rhode Island</option><option value=\"SC\">South Carolina</option><option value=\"SD\">South Dakota</option><option value=\"TN\">Tennessee</option><option value=\"TX\">Texas</option><option value=\"UT\">Utah</option><option value=\"VA\">Virginia</option><option value=\"VT\">Vermont</option><option value=\"WA\">Washington</option><option value=\"WI\">Wisconsin</option><option value=\"WV\">West Virginia</option><option value=\"WY\">Wyoming</option></select></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement10\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe92325\">Are you affiliated with a Master Agent?</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><select class=\"elq-item-select\" id=\"fe92325\" name=\"Affiliated-Master-Agent\" style=\"width:100%;\" data-value=\"\"><option value=\"First\">First</option><option value=\"Second\">Second</option><option value=\"Third\">Third</option></select></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement11\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe92326\">Master Agent Name</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" class=\"elq-item-input\" name=\"MasterAgentDetails\" id=\"fe92326\" value=\"\" style=\"width:100%;\"></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement12\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe92327\">Your role</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><select class=\"elq-item-select\" id=\"fe92327\" name=\"YourRole\" style=\"width:100%;\" data-value=\"\"><option value=\"First\">First</option><option value=\"Second\">Second</option><option value=\"Third\">Third</option></select></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement13\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe92329\">Additional comments</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><textarea class=\"elq-item-textarea\" style=\"width:100%;\" name=\"comments\" id=\"fe92329\"></textarea></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement14\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe90763\">Address 3</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" class=\"elq-item-input\" name=\"address3\" id=\"fe90763\" value=\"\" style=\"width:100%;\"></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement15\" class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label \" for=\"fe90775\">Yes, I also agree to receive marketing emails from Avaya.</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" class=\"elq-item-input\" name=\"optin\" id=\"fe90775\" value=\"\" style=\"width:100%;\"></div></div></div></div></div></div></div></div><div id=\"elq-FormLastRow\" class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div class=\"elq-field-style form-element-layout row\"><div style=\"text-align:left;\" class=\"col-sm-12 col-xs-12\"><label class=\"elq-label\">address1</label></div><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div class=\"field-control-wrapper\"><input type=\"text\" value=\"\" tabindex=\"-1\" autocomplete=\"off\" style=\"width:100%;\" class=\"elq-item-input\" name=\"address1\" id=\"honeypotFieldId\"></div></div></div></div></div></div></div></div><div class=\"row\"><div class=\"grid-layout-col\"><div class=\"layout-col col-sm-12 col-xs-12\"><div id=\"formElement16\" class=\"elq-field-style form-element-layout row\"><div class=\"col-sm-12 col-xs-12\"><div class=\"row\"><div class=\"col-xs-12\"><div style=\"text-align:center;\"><input type=\"Submit\" class=\"submit-button-style \" value=\"Submit\" id=\"fe90783\"></div></div></div></div></div></div></div></div><input type=\"hidden\" name=\"country_iso\" id=\"fe90764\" value=\"\"><input type=\"hidden\" name=\"cta_code\" id=\"fe90765\" value=\"20AVAYA-CLOUD-AGENT\"><input type=\"hidden\" name=\"tactic_code\" id=\"fe90766\" value=\"20AVAYA-CLOUD-AGENT\"><input type=\"hidden\" name=\"leadSourceMostRecent\" id=\"fe90767\" value=\"Responder\"><input type=\"hidden\" name=\"permissionemail\" id=\"fe90768\" value=\"\"><input type=\"hidden\" name=\"contentTitle1\" id=\"fe90769\" value=\"\"><input type=\"hidden\" name=\"contentURL1\" id=\"fe90770\" value=\"\"><input type=\"hidden\" name=\"emailOptinDate1\" id=\"fe90771\" value=\"\"><input type=\"hidden\" name=\"emailOptinSource1\" id=\"fe90772\" value=\"\"><input type=\"hidden\" name=\"emailOptOutDate1\" id=\"fe90773\" value=\"\"><input type=\"hidden\" name=\"emailOptOutSource1\" id=\"fe90774\" value=\"\"><input type=\"hidden\" name=\"contact_source_detailed\" id=\"fe90776\" value=\"Avaya Cloud Agent Registration\"><input type=\"hidden\" name=\"contact_source_hl\" id=\"fe90777\" value=\"Avaya.com\"><input type=\"hidden\" name=\"buying_cycle\" id=\"fe90778\" value=\"Evaluation\"><input type=\"hidden\" name=\"area_of_interest\" id=\"fe90779\" value=\"ACO\"><input type=\"hidden\" name=\"content_vertical\" id=\"fe90780\" value=\"General Business\"><input type=\"hidden\" name=\"content_persona\" id=\"fe90781\" value=\"All\"><input type=\"hidden\" name=\"FormName\" id=\"fe90782\" value=\"20AVAYA-CLOUD-AGENT\"><input type=\"hidden\" name=\"GACLIENTID\" id=\"fe104060\" value=\"\"><input type=\"hidden\" name=\"GAUSERID\" id=\"fe104061\" value=\"\"><input type=\"hidden\" name=\"GATRACKID\" id=\"fe104062\" value=\"UA-50549933-1\"><input type=\"hidden\" name=\"kickfireFormEmailAddress\" id=\"fe114140\" value=\"\"><input type=\"hidden\" name=\"kickfireFormCompany\" id=\"fe114141\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyName\" id=\"fe114142\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyTradeName\" id=\"fe114143\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyWebsite\" id=\"fe114144\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyStreet\" id=\"fe114145\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyCity\" id=\"fe114146\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyRegion\" id=\"fe114147\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyCountry\" id=\"fe114148\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyPostal\" id=\"fe114149\" value=\"\"><input type=\"hidden\" name=\"kickfireCompanyPhone\" id=\"fe114150\" value=\"\"><input type=\"hidden\" name=\"kickfireEmployees\" id=\"fe114151\" value=\"\"><input type=\"hidden\" name=\"kickfireRevenue\" id=\"fe114152\" value=\"\"><input type=\"hidden\" name=\"kickfireIndustrySIC\" id=\"fe114153\" value=\"\"><input type=\"hidden\" name=\"kickfireIndustryNAICS\" id=\"fe114154\" value=\"\"><input type=\"hidden\" name=\"kickfireVisitorCity\" id=\"fe114155\" value=\"\"><input type=\"hidden\" name=\"kickfireVisitorRegionShort\" id=\"fe114156\" value=\"\"><input type=\"hidden\" name=\"kickfireVisitorRegion\" id=\"fe114157\" value=\"\"><input type=\"hidden\" name=\"kickfireVisitorCountryShort\" id=\"fe114158\" value=\"\"><input type=\"hidden\" name=\"kickfireVisitorCountry\" id=\"fe114159\" value=\"\"><input type=\"hidden\" name=\"kickfireVisitorLatitude\" id=\"fe114160\" value=\"\"><input type=\"hidden\" name=\"kickfireVisitorLongitude\" id=\"fe114161\" value=\"\"><input type=\"hidden\" name=\"nameAnalyzerStatus1\" id=\"fe147829\" value=\"\"><input type=\"hidden\" name=\"state_province\" id=\"fe147830\" value=\"\"><input type=\"hidden\" name=\"companyPhone1\" id=\"fe147831\" value=\"\"><input type=\"hidden\" name=\"industry\" id=\"fe147832\" value=\"\"><input type=\"hidden\" name=\"FormID\" id=\"fe147833\" value=\"3195\"><input type=\"hidden\" name=\"employees_total_range\" id=\"fe147834\" value=\"\"></div></form><script type=\"text/javascript\" src=\"https://img03.en25.com/i/livevalidation_standalone.compressed.js\"></script><script>function handleFormSubmit(ele) { var submitButton = ele.querySelector('input[type=submit]'); var spinner = document.createElement('span'); spinner.setAttribute('class', 'loader'); submitButton.setAttribute('disabled', true); submitButton.style.cursor = 'wait'; submitButton.parentNode.appendChild(spinner); return true; }function resetSubmitButton(e){ var submitButtons = e.target.form.getElementsByClassName('submit-button'); for(var i=0;i<submitButtons.length;i++){ submitButtons[i].disabled = false; } }function addChangeHandler(elements){ for(var i=0; i<elements.length; i++){ elements[i].addEventListener('change', resetSubmitButton); } }var form = document.getElementById('form3195'); addChangeHandler(form.getElementsByTagName('input')); addChangeHandler(form.getElementsByTagName('select')); addChangeHandler(form.getElementsByTagName('textarea'));var nodes = document.querySelectorAll('#form3195 input[data-subscription]'); if (nodes) { for (var i = 0, len = nodes.length; i < len; i++) {var status = nodes[i].dataset ? nodes[i].dataset.subscription : nodes[i].getAttribute('data-subscription'); if(status ==='true') {nodes[i].checked = true;}}};var nodes = document.querySelectorAll('#form3195 select[data-value]'); if (nodes) { for (var i = 0; i < nodes.length; i++) { var node = nodes[i]; var selectedValue = node.dataset ? node.dataset.value : node.getAttribute('data-value'); if (selectedValue) { for (var j = 0; j < node.options.length; j++) { if(node.options[j].value === selectedValue) { node.options[j].selected = 'selected';break;}}}}}this.getParentElement = function(list) { return list[list.length-1].parentElement};var dom0 = document.querySelector('#form3195 #fe90757');var fe90757 = new LiveValidation(dom0, {validMessage: \"\", onlyOnBlur: false, wait: 300, isPhoneField: false});var dom1 = document.querySelector('#form3195 #fe90758');var fe90758 = new LiveValidation(dom1, {validMessage: \"\", onlyOnBlur: false, wait: 300, isPhoneField: false});var dom2 = document.querySelector('#form3195 #fe90759');var fe90759 = new LiveValidation(dom2, {validMessage: \"\", onlyOnBlur: false, wait: 300, isPhoneField: false});var dom3 = document.querySelector('#form3195 #fe90760');var fe90760 = new LiveValidation(dom3, {validMessage: \"\", onlyOnBlur: false, wait: 300, isPhoneField: false});var dom4 = document.querySelector('#form3195 #fe90761');var fe90761 = new LiveValidation(dom4, {validMessage: \"\", 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data-cmp-contentfragment-path="/content/dam/aem-avaya-portal/eloqua/content-fragments/20AVAYA-CLOUD-AGENT-RAW"> <div class="cmp-contentfragment__elements"> <form method="post" name="20AVAYA-CLOUD-AGENT-RAW" action="https://s1737033466.t.eloqua.com/e/f2" onsubmit="return handleFormSubmit(this)" id="form3195" class="elq-form"><input value="20AVAYA-CLOUD-AGENT-RAW" type="hidden" name="elqFormName"><input value="1737033466" type="hidden" name="elqSiteId"><input name="elqCampaignId" type="hidden"><div class="layout container-fluid"><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement0" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe90757">First Name</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><input type="text" class="elq-item-input" name="first_name" id="fe90757" value="" style="width:100%;"></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement1" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe90758">Last Name</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><input type="text" class="elq-item-input" name="last_name" id="fe90758" value="" style="width:100%;"></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement2" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe90759">Email Address</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><input type="text" class="elq-item-input" name="email" id="fe90759" value="" style="width:100%;"></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement3" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe90760">Business Phone</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><input type="text" class="elq-item-input" name="phone" id="fe90760" value="" style="width:100%;"></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement4" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe90761">Company</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><input type="text" class="elq-item-input" name="company_name" id="fe90761" value="" style="width:100%;"></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement5" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe92847">HQ Address</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><input type="text" class="elq-item-input" name="address_1" id="fe92847" value="" style="width:100%;"></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement6" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe92848">City</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><input type="text" class="elq-item-input" name="city" id="fe92848" value="" style="width:100%;"></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement7" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe94316">Postal Code</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><input type="text" class="elq-item-input" name="postal_code" id="fe94316" value="" style="width:100%;"></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement8" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe90762">Country/Region</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><select class="elq-item-select" id="fe90762" name="country" style="width:100%;" data-value="~~eloqua..type--emailfield..syntax--Country~~"><option value="">Please Select</option><option value="Belgium">Belgium</option><option value="Canada">Canada</option><option value="India">India</option><option value="Ireland">Ireland</option><option value="Netherlands">Netherlands</option><option value="Portugal">Portugal</option><option value="South Africa">South Africa</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><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antarctica">Antarctica</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</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="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bonaire, Saint Eustatius and Saba">Bonaire, Saint Eustatius and Saba</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="British Indian Ocean Territory">British Indian Ocean Territory</option><option value="Brunei Darussalam">Brunei Darussalam</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="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</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="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Congo, The Democratic Republic Of The">Congo, The Democratic Republic Of The</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote D'Ivoire">Cote D'Ivoire</option><option value="Croatia">Croatia</option><option value="Curacao">Curacao</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">East Timor</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="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option><option value="Faroe Islands">Faroe Islands</option><option value="French Guiana">French Guiana</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="Gabon">Gabon</option><option value="Gambia">Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</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="Heard and McDonald Islands">Heard and McDonald Islands</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="Indonesia">Indonesia</option><option value="Iraq">Iraq</option><option value="Isle Of Man">Isle Of Man</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Ivory Coast (Cote D'Ivoire)">Ivory Coast (Cote D'Ivoire)</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="Korea Republic of">Korea Republic of</option><option value="Korea Democratic People'S Republic Of">Korea Democratic People'S Republic of</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Lao People's Democratic Republic">Lao People's Democratic Republic</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="Macao">Macao</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="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mexico">Mexico</option><option value="Micronesia, Federated States of">Micronesia, Federated States of</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Netherlands Antilles">Netherlands Antilles</option><option value="New Caledonia">New Caledonia</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="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</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="Pitcairn">Pitcairn</option><option value="Poland">Poland</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Reunion">Reunion</option><option value="Romania">Romania</option><option value="Rwanda">Rwanda</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Vincent and the Grenedines">Saint Vincent and the Grenedines</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="Sint Maarten (Dutch Part)">Sint Maarten (Dutch Part)</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 Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Suriname">Suriname</option><option value="Swaziland">Swaziland</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Tanzania, United Republic Of">Tanzania, United Republic Of</option><option value="Thailand">Thailand</option><option value="The Federal Democratic Republic of Nepal">The Federal Democratic Republic of Nepal</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</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="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="Uruguay">Uruguay</option><option value="Minor Outlying Islands - United States">Minor Outlying Islands - United States</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option><option value="Vietnam">Vietnam</option><option value="Virgin Islands, British">Virgin Islands, British</option><option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option><option value="Western Sahara">Western Sahara</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option></select></div></div></div></div></div></div></div></div><div class="row"><div class="grid-layout-col"><div class="layout-col col-sm-12 col-xs-12"><div id="formElement9" class="elq-field-style form-element-layout row"><div style="text-align:left;" class="col-sm-12 col-xs-12"><label class="elq-label " for="fe92849">State or Province</label></div><div class="col-sm-12 col-xs-12"><div class="row"><div class="col-xs-12"><div class="field-control-wrapper"><select class="elq-item-select" id="fe92849" name="stateProv" style="width:100%;" data-value=""><option value="">Please Select...</option><option value="AK">Alaska</option><option value="AL">Alabama</option><option value="AR">Arkansas</option><option value="AZ">Arizona</option><option value="CA">California</option><option value="CO">Colorado</option><option value="CT">Connecticut</option><option value="DC">District of Columbia</option><option value="DE">Delaware</option><option value="FL">Florida</option><option value="GA">Georgia</option><option value="HI">Hawaii</option><option value="IA">Iowa</option><option value="ID">Idaho</option><option value="IL">Illinois</option><option value="IN">Indiana</option><option value="KS">Kansas</option><option value="KY">Kentucky</option><option value="LA">Louisiana</option><option value="MA">Massachusetts</option><option 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