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display: none;"><input type="text" id="state1" name="state1" class="form-control" style="width:100% !important;"></div> </div> <div class="form-group col-md-6 col-xs-12"> <label for="exampleInputEmail2">Zip code</label><span style="color: #d21114;font-size: 16px;">*</span> <input style="width: 100% !important;" type="text" class="form-control" id="pin" name="pin" placeholder="56884"> </div> <div class="form-group col-md-6 col-xs-12"> <label for="exampleInputEmail2">Phone Number</label><span style="color: #d21114;font-size: 16px;">*</span> <div> <input name="phone11" id="phone11" class="form-control input-txt" maxlength="3" style="width:92px !important;margin-right: 2px !important;text-align: center;display: inline-block;" type="text"> - <input name="phone22" id="phone22" class="form-control input-txt" maxlength="3" style="width:92px !important;margin-right: 2px !important;text-align: center;display: inline-block;" type="text"> - <input name="phone33" id="phone33" class="form-control input-txt" maxlength="4" style="width:87px !important;text-align: center;display: inline-block;" type="text"> <input name="mobno" id="mobno" value="" type="hidden"> </div> </div> <div class="form-group col-md-6 col-xs-12"> <label for="exampleInputEmail2">Business Email</label><span style="color: #d21114;font-size: 16px;">*</span> <input style="width: 100% !important;" type="text" class="form-control" id="email_new" name="email_new" placeholder="Enter the Business Email"> </div> </div> </div> </div> </div> <div class="form-col" id="subs-form" style="margin-top: 0px;margin-bottom: 30px;width: 100%;border-top: 3px solid #94999e;"> <h3 style="font-weight: 300 !important;padding-bottom: 20px;">Qualification</h3> <div class="form-inline row"> <div class="form-inline row"> <div class="col-md-12"> <div class="row"> <div class="col-md-12"> <div class="row"> <div class="col-md-12"> <div class="form-group col-md-12" style=""> <label for="exampleInputName2">Primary job function</label><span style="color: #d21114;font-size: 16px;">*</span> <select class="form-control" style="width: 100% !important;" id="jobfunc" name="jobfunction" onchange="check_jobfunc(this.value);"> <option value="" selected="selected">Select Your job function</option> <option value="Executive Management (CEO, President, Owner, VP, Managing Director)" >Executive Management (CEO, President, Owner, VP, Managing Director)</option> <option value="Technology Management">Technology Management</option> <option value="Information Technology Management">Information Technology Management</option> <option value="Management (Production, Engineering, Explorations, Operations)">Management (Production, Engineering, Explorations, Operations)</option> <option value="Purchasing">Purchasing</option> <option value="Geologist/Geophysicist/Chemist">Geologist/Geophysicist/Chemist</option> <option value="other">Other (please specify)</option> </select> <input type="text" class="form-control" style="width: 100% !important; 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display:none;" id="otherproduct" name="otherproduct" placeholder="Enter your other main activity"/> <select class="form-control" style="width: 100% !important; display: none;" id="energy_producer" name="energy_producer"> <option>Please Select The Category</option> <option value="Coal">Coal</option> <option value="Oil">Oil</option> <option value="Natural Gas">Natural Gas</option> <option value="Nuclear">Nuclear</option> <option value="Hydro">Hydro</option> <option value="Renewables">Renewables</option> <option value="Others">Others</option> </select> </div> <div class="form-group col-md-12" style="padding-bottom: 20px;padding-top: 10px;display: inline-block !important;"> <label for="exampleInputName2">Total number of Employees in your organization</label> <div class=""> <select class="form-control" style="width: 100% !important;" id="EMPLOYEES" name="EMPLOYEES"> <option value="" selected="selected">Total Employees in your entire organization</option> <option value="40,000">1. Over 40,000</option> <option value="30,001 - 40,000">2. 30,001 - 40,000</option> <option value="20,001 - 30,000">3. 20,001 - 30,000</option> <option value="10,001 - 20,000">4. 10,001 - 20,000</option> <option value="5,001 - 10,000">5. 5,001 - 10,000</option> <option value="1,001 - 5,000">6. 1,001 - 5,000</option> <option value="501 - 1,000">7. 501 - 1,000</option> <option value="100-500">8. 100-500</option> <option value="Less than 100">9. Less than 100</option> </select> </div> <div id="text" style="display:none"> <input style="width: 100% !important;" type="text" class="form-control" id="checkboxll_other" name="checkboxll_other" placeholder="please specify"> </div> </div> </div> </div> </div> <div style="" class="form-group col-md-12"> <div class="col-md-12"> <label for="exampleInputName2">SOLUTIONS YOU ARE LOOKING FOR?(CHECK ALL THAT APPLY) <span style="color: #d21114;font-size: 16px;">*</span></label> </div> <div class="col-md-6"> <div class=""> <div class="form-txt"> <ul class="form-ul"> <li><label><input type="checkbox" name="checkboxmk" value="Air Pollution Control Equip & Consumables" class="checkbox" style="padding-right: 10px;margin-right: 5px;"> Air Pollution Control Equip & Consumables</label></li> <li><label><input type="checkbox" name="checkboxmk" value="Boilers, Reactors & Auxiliaries" class="checkbox" style="padding-right: 10px;margin-right: 5px;"> Boilers, Reactors & Auxiliaries</label></li> 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