{literal}
<SCRIPT language='javascript'>
	$(document).ready(function(){
	    $(".req").hide();
		DisplayCountry();
		
		$( "#page-contact_us .ui-icon-arrow-d" ).remove();
		var billing_state_select = $("#billing_state_select").find(":selected").text();
		billing_state_select = (billing_state_select != "") ? billing_state_select : "Please select...";
		$( "#billing_state .ui-btn-inner .ui-btn-text span" ).html(billing_state_select);
		
	});
</SCRIPT>
{/literal}
{literal}
<style type="text/css">
	.fstyle
	{
	display: none;
	}
</style>
{/literal}
<div data-role="header" class="ui-header ui-bar-a" role="banner">
	<h1 class="ui-title" role="heading" aria-level="1">Contact Us</h1>	
</div>
<div class="main-wrapper">
	<br>	
	{if $show_thanks}
	<div>
		<table width="100%" border="0" cellpadding="5" cellspacing="5">
			<tr valign="top">
				<td class="ofc_add">
					<b>Corporate Offices</b><br>
					1525 Western Ave, Albany, NY 12203 USA<br>
					Office: 1-518-218-7676<br>
					<!-- Toll Free USA: 1-888-999-2660<br> -->
					Fax: 1-518-650-6413<br>
					<b>Days:</b> Monday &ndash; Friday<br>
					<b>Hours:</b> 9:00 AM &ndash; 5:00 PM ET<br>
				</td>
				<!--<td class="ofc_add">
					<b>Equipment Yard</b><br>
					899 River Rd, Selkirk, NY 12158 USA<br>
					Office: 1-518-635-4223<br>
					<b>Days:</b> Monday &ndash; Thursday<br>
					<b>Hours:</b> 8:00 AM &ndash; 6:00 PM ET<br>
				</td>-->	
		</table>
		<br><b><span style="color:green;">Your Request for Contact Was Submitted Successfully</span></b><br><br>
		Thank you for your interest in PavementGroup.com - we will respond ASAP!<br><br>
		<a href="http://www.pavementgroup.com/index.php?" style="color:blue;">Return to Home Page</a><br>
		</b><br>
		Thank you,<br>
		PavementGroup.com Team
		<br>
	</div>
	{/if}
	{if $show_form}
	<table width="100%" border="0" cellpadding="5" cellspacing="5">
		<tr valign="top">
			<td class="ofc_add">
				<b>Corporate Offices</b><br>
				1525 Western Ave, Albany, NY 12203 USA<br>
				Office: 1-518-218-7676<br>
				<!-- Toll Free USA: 1-888-999-2660<br> -->
				Fax: 1-518-650-6413<br>
				<b>Days:</b> Monday &ndash; Friday<br>
				<b>Hours:</b> 9:00 AM &ndash; 5:00 PM ET<br>
			</td>
			<!--<td class="ofc_add">
				<b>Equipment Yard</b><br>
				899 River Rd, Selkirk, NY 12158 USA<br>
				Office: 1-518-635-4223<br>
				<b>Days:</b> Monday &ndash; Thursday<br>
				<b>Hours:</b> 8:00 AM &ndash; 6:00 PM ET<br>
			</td>-->	
	</table>
	<TABLE width="99%" border="0" cellpadding="5" cellspacing="5">
		<TR>
			<TD>
				{if count($errmsg)> 0}
				<font color=red>Some errors were found. Please correct these errors and submit the form again.</font>
				<br/><br/>
				{/if}
				<FORM id="FrmInput" name="FrmInput" action="index.php?p=contact_us" onsubmit="contact_submit()" method="post">
					<input type="hidden" name="formaction" value="post" />
					<TABLE width="100%" border="0" cellpadding="5" cellspacing="5">
						<TR>
							<TD width="2%">&nbsp;</TD>
							<TD colspan="2"><FONT color="red">*</FONT> - required field</TD>
						</TR>
						<TR>
							<TD width="15%" align="left"><FONT color="red">*</FONT> {if $errmsg.company != ''} <font color=red>Company</font>
								{else}
								Company
								{/if}
							</TD>
							<TD width="73%">
								<INPUT type="text" name="company" style="width:100%;" size="30" class="formTextbox" value="{$form.company|htmlspecialchars}">
							</TD>
						</TR>
						<TR>
							
							<TD align="left">
								<FONT color="red">*</FONT>
								{if $errmsg.fname != ''}
								<font color=red>First Name</font>
								{else}
								First Name
								{/if}
							</TD>
							<TD>
								<INPUT type="text" name="fname" style="width:100%;" size="30" class="formTextbox" value="{$form.fname|htmlspecialchars}">
							</TD>
						</TR>
						<TR>							
							<TD align="left">
								<FONT color="red">*</FONT>
								{if $errmsg.lname != ''}
								<font color=red>Last Name</font>
								{else}
								Last Name
								{/if}
							</TD>
							<TD>
								<INPUT type="text" name="lname" style="width:100%;" size="30" class="formTextbox" value="{$form.lname|htmlspecialchars}">
							</TD>
						</TR>
						<TR>
							
							<TD align="left">
								Address1
							</TD>
							<TD>
								<INPUT type="text" name="addr1" style="width:100%;" size="30" class="formTextbox" value="{$form.addr1|htmlspecialchars}">
							</TD>
						</TR>
						<TR>
							
							<TD align="left">
								Address2
							</TD>
							<TD>
								<INPUT type="text" name="addr2" style="width:100%;" size="30" class="formTextbox" value="{$form.addr2|htmlspecialchars}">
							</TD>
						</TR>
						<TR>
							
							<TD align="left">
								<FONT color="red">*</FONT>
								{if $errmsg.city != ''}
								<font color=red>City</font>
								{else}
								City
								{/if}
							</TD>
							<TD>
								<INPUT type="text" name="city" style="width:100%;" size="30" class="formTextbox" value="{$form.city|htmlspecialchars}">
							</TD>
						</TR>
						<TR>
							
							<TD align="left" valign="top">
								<FONT color="red">*</FONT>
								{if $errmsg.cmbUSAState != ''}
								<font color=red>State</font>
								{else}
								State
								{/if}
							</TD>
							<TD id="billing_state" >
								<INPUT Type='hidden'   MaxLength="100"  name='_OfficeState93262' id='_OfficeState93262' value=" " class="stdTextField1">
								<SPAN id='DivUS'>
									<SELECT name="cmbUSAState" id="cmbUSAState" style="width:100%;" class="formSelect" onChange='javascript:AssignState(this.value);'>
										<OPTION value=''></OPTION>
										<OPTION size="30" {if $dmp_state == 'AL'}selected{/if} value='AL'>Alabama</OPTION>
										<OPTION size="30" value='AK' {if $dmp_state == 'AK'}selected{/if}>Alaska</OPTION>
										<OPTION size="30" value='AZ' {if $dmp_state == 'AZ'}selected{/if}>Arizona</OPTION>
										<OPTION size="30" value='AR' {if $dmp_state == 'AR'}selected{/if}>Arkansas</OPTION>
										<OPTION size="30" value='CA' {if $dmp_state == 'CA'}selected{/if}>California</OPTION>
										<OPTION size="30" value='CO' {if $dmp_state == 'CO'}selected{/if}>Colorado</OPTION>
										<OPTION size="30" value='CT' {if $dmp_state == 'CT'}selected{/if}>Connecticut</OPTION>
										<OPTION size="30" value='DE' {if $dmp_state == 'DE'}selected{/if}>Delaware</OPTION>
										<OPTION size="30" value='DC' {if $dmp_state == 'DC'}selected{/if}>District of Columbia</OPTION>
										<OPTION size="30" value='FL' {if $dmp_state == 'FL'}selected{/if}>Florida</OPTION>
										<OPTION size="30" value='GA' {if $dmp_state == 'GA'}selected{/if}>Georgia</OPTION>
										<OPTION size="30" value='HI' {if $dmp_state == 'HI'}selected{/if}>Hawaii</OPTION>
										<OPTION size="30" value='ID' {if $dmp_state == 'ID'}selected{/if}>Idaho</OPTION>
										<OPTION size="30" value='IL' {if $dmp_state == 'IL'}selected{/if}>Illinois</OPTION>
										<OPTION size="30" value='IN' {if $dmp_state == 'IN'}selected{/if}>Indiana</OPTION>
										<OPTION size="30" value='IA' {if $dmp_state == 'IA'}selected{/if}>Iowa</OPTION>
										<OPTION size="30" value='KS' {if $dmp_state == 'KS'}selected{/if}>Kansas</OPTION>
										<OPTION size="30" value='KY' {if $dmp_state == 'KY'}selected{/if}>Kentucky</OPTION>
										<OPTION size="30" value='LA' {if $dmp_state == 'LA'}selected{/if}>Louisiana</OPTION>
										<OPTION size="30" value='ME' {if $dmp_state == 'ME'}selected{/if}>Maine</OPTION>
										<OPTION size="30" value='MD' {if $dmp_state == 'MD'}selected{/if}>Maryland</OPTION>
										<OPTION size="30" value='MA' {if $dmp_state == 'MA'}selected{/if}>Massachusetts</OPTION>
										<OPTION size="30" value='MI' {if $dmp_state == 'MI'}selected{/if}>Michigan</OPTION>
										<OPTION size="30" value='MN' {if $dmp_state == 'MN'}selected{/if}>Minnesota</OPTION>
										<OPTION size="30" value='MS' {if $dmp_state == 'MS'}selected{/if}>Mississippi</OPTION>
										<OPTION size="30" value='MO' {if $dmp_state == 'MO'}selected{/if}>Missouri</OPTION>
										<OPTION size="30" value='MT' {if $dmp_state == 'MT'}selected{/if}>Montana</OPTION>
										<OPTION size="30" value='NE' {if $dmp_state == 'NE'}selected{/if}>Nebraska</OPTION>
										<OPTION size="30" value='NV' {if $dmp_state == 'NV'}selected{/if}>Nevada</OPTION>
										<OPTION size="30" value='NH' {if $dmp_state == 'NH'}selected{/if}>New Hampshire</OPTION>
										<OPTION size="30" value='NJ' {if $dmp_state == 'NJ'}selected{/if}>New Jersey</OPTION>
										<OPTION size="30" value='NM' {if $dmp_state == 'NM'}selected{/if}>New Mexico</OPTION>
										<OPTION size="30" value='NY' {if $dmp_state == 'NY'}selected{/if}>New York</OPTION>
										<OPTION size="30" value='NC' {if $dmp_state == 'NC'}selected{/if}>North Carolina</OPTION>
										<OPTION size="30" value='ND' {if $dmp_state == 'ND'}selected{/if}>North Dakota</OPTION>
										<OPTION size="30" value='OH' {if $dmp_state == 'OH'}selected{/if}>Ohio</OPTION>
										<OPTION size="30" value='OK' {if $dmp_state == 'OK'}selected{/if}>Oklahoma</OPTION>
										<OPTION size="30" value='OR' {if $dmp_state == 'OR'}selected{/if}>Oregon</OPTION>
										<OPTION size="30" value='Other' {if $dmp_state == 'OTHER'}selected{/if}>Other</OPTION>
										<OPTION size="30" value='PA' {if $dmp_state == 'PA'}selected{/if}>Pennsylvania</OPTION>
										<OPTION size="30" value='PR' {if $dmp_state == 'PR'}selected{/if}>Puerto Rico</OPTION>
										<OPTION size="30" value='RI' {if $dmp_state == 'RI'}selected{/if}>Rhode Island</OPTION>
										<OPTION size="30" value='SC' {if $dmp_state == 'SC'}selected{/if}>South Carolina</OPTION>
										<OPTION size="30" value='SD' {if $dmp_state == 'SD'}selected{/if}>South Dakota</OPTION>
										<OPTION size="30" value='TN' {if $dmp_state == 'TN'}selected{/if}>Tennessee</OPTION>
										<OPTION size="30" value='TX' {if $dmp_state == 'TX'}selected{/if}>Texas</OPTION>
										<OPTION size="30" value='UT' {if $dmp_state == 'UT'}selected{/if}>Utah</OPTION>
										<OPTION size="30" value='VT' {if $dmp_state == 'VT'}selected{/if}>Vermont</OPTION>
										<OPTION size="30" value='VA' {if $dmp_state == 'VA'}selected{/if}>Virginia</OPTION>
										<OPTION size="30" value='WA' {if $dmp_state == 'WA'}selected{/if}>Washington</OPTION>
										<OPTION size="30" value='WV' {if $dmp_state == 'WV'}selected{/if}>West Virginia</OPTION>
										<OPTION size="30" value='WI' {if $dmp_state == 'WI'}selected{/if}>Wisconsin</OPTION>
										<OPTION size="30" value='WY' {if $dmp_state == 'WY'}selected{/if}>Wyoming</OPTION>
									</SELECT>
								</SPAN>
								<SPAN id='DivCanada' style="display:none">
									<SELECT name="cmbCanadaState" id="cmbCanadaState" class="formSelect" style="width:204px" onChange='javascript:AssignState(this.value);'>
										<OPTION value=''></OPTION>
										<OPTION size="30" value='Alberta' {if $dmp_state == 'Alberta'}selected{/if}>Alberta</OPTION>
										<OPTION size="30" value='British Columbia' {if $dmp_state == 'British Columbia'}selected{/if}>British Columbia</OPTION>
										<OPTION size="30" value='Manitoba' {if $dmp_state == 'Manitoba'}selected{/if}>Manitoba</OPTION>
										<OPTION size="30" value='New Brunswick' {if $dmp_state == 'New Brunswick'}selected{/if}>New Brunswick</OPTION>
										<OPTION size="30" value='Newfoundland' {if $dmp_state == 'Newfoundland'}selected{/if}>Newfoundland</OPTION>
										<OPTION size="30" value='Northwest Territories' {if $dmp_state == 'Northwest Territories'}selected{/if}>Northwest Territories</OPTION>
										<OPTION size="30" value='Nova Scotia' {if $dmp_state == 'Nova Scotia'}selected{/if}>Nova Scotia</OPTION>
										<OPTION size="30" value='Nunavut' {if $dmp_state == 'Nunavut'}selected{/if}>Nunavut</OPTION>
										<OPTION size="30" value='Ontario' {if $dmp_state == 'Ontario'}selected{/if}>Ontario</OPTION>
										<OPTION size="30" value='Prince Edward Island' {if $dmp_state == 'Prince Edward Island'}selected{/if}>Prince Edward Island</OPTION>
										<OPTION size="30" value='Quebec' {if $dmp_state == 'Quebec'}selected{/if}>Quebec</OPTION>
										<OPTION size="30" value='Saskatchewan' {if $dmp_state == 'Saskatchewan'}selected{/if}>Saskatchewan</OPTION>
										<OPTION size="30" value='Yukon' {if $dmp_state == 'Yukon'}selected{/if}>Yukon</OPTION>
									</SELECT>
								</SPAN>
								<SPAN id='DivOthers' style="display:none">
								<INPUT Type=text style="width:100%;"  MaxLength="100"  id='txtOtherState' name='txtOtherState' value="{$dmp_state}" class='stdTextField1' onchange='javascript:AssignState(this.value);'></SPAN>
								{literal}
								<SCRIPT language='javascript'>function AssignState(strState)
									{
									document.FrmInput._OfficeState93262.value = strState;
									}
								</SCRIPT>
								{/literal}
							</TD>
						</TR>
						<TR>
							
							<TD align="left">
								{if $errmsg.zip != ''}
								<font color=red>Zip</font>
								{else}
								Zip
								{/if}
							</TD>
							<TD>
								<INPUT type="text" name="zip" style="width:100%;" size="30" class="formTextbox" value="{$form.zip|htmlspecialchars}">
							</TD>
						</TR>
						<TR>
							
							<TD align="left">
								Country
							</TD>
							<TD id="billing_country" >
								<SELECT style="width:100%;" class="formSelect" name="_OfficeCountry93259" id="_OfficeCountry93259" enabled onChange='javascript:DisplayCountry()' onKeyPress="javascript:chkEnterKey();">
								<OPTION value="Afghanistan" {if $dmp_country == 'Afghanistan'}selected{/if}>Afghanistan</OPTION>
								<OPTION value="Albania" {if $dmp_country == 'Albania'}selected{/if}>Albania</OPTION>
								<OPTION value="Algeria" {if $dmp_country == 'Algeria'}selected{/if}>Algeria</OPTION>
								<OPTION value="Andorra" {if $dmp_country == 'Andorra'}selected{/if}>Andorra</OPTION>
								<OPTION value="Angola" {if $dmp_country == 'Angola'}selected{/if}>Angola</OPTION>
								<OPTION value="Anguilla" {if $dmp_country == 'Anguilla'}selected{/if}>Anguilla</OPTION>
								<OPTION value="Antarctica" {if $dmp_country == 'Antarctica'}selected{/if}>Antarctica</OPTION>
								<OPTION value="Antigua and Barbuda" {if $dmp_country == 'Antigua and Barbuda'}selected{/if}>Antigua and Barbuda</OPTION>
								<OPTION value="Argentina" {if $dmp_country == 'Argentina'}selected{/if}>Argentina</OPTION>
								<OPTION value="Armenia" {if $dmp_country == 'Armenia'}selected{/if}>Armenia</OPTION>
								<OPTION value="Aruba" {if $dmp_country == 'Aruba'}selected{/if}>Aruba</OPTION>
								<OPTION value="Australia" {if $dmp_country == 'Australia'}selected{/if}>Australia</OPTION>
								<OPTION value="Austria" {if $dmp_country == 'Austria'}selected{/if}>Austria</OPTION>
								<OPTION value="Azerbaijan" {if $dmp_country == 'Azerbaijan'}selected{/if}>Azerbaijan</OPTION>
								<OPTION value="Bahamas" {if $dmp_country == 'Bahamas'}selected{/if}>Bahamas</OPTION>
								<OPTION value="Bahrain" {if $dmp_country == 'Bahrain'}selected{/if}>Bahrain</OPTION>
								<OPTION value="Bangladesh" {if $dmp_country == 'Bangladesh'}selected{/if}>Bangladesh</OPTION>
								<OPTION value="Barbados" {if $dmp_country == 'Barbados'}selected{/if}>Barbados</OPTION>
								<OPTION value="Belarus" {if $dmp_country == 'Belarus'}selected{/if}>Belarus</OPTION>
								<OPTION value="Belgium" {if $dmp_country == 'Belgium'}selected{/if}>Belgium</OPTION>
								<OPTION value="Belize" {if $dmp_country == 'Belize'}selected{/if}>Belize</OPTION>
								<OPTION value="Benin" {if $dmp_country == 'Benin'}selected{/if}>Benin</OPTION>
								<OPTION value="Bermuda" {if $dmp_country == 'Bermuda'}selected{/if}>Bermuda</OPTION>
								<OPTION value="Bhutan" {if $dmp_country == 'Bhutan'}selected{/if}>Bhutan</OPTION>
								<OPTION value="Bolivia" {if $dmp_country == 'Bolivia'}selected{/if}>Bolivia</OPTION>
								<OPTION value="Bosnia & Herzegovina" {if $dmp_country == 'Bosnia & Herzegovina'}selected{/if}>Bosnia & Herzegovina</OPTION>
								<OPTION value="Botswana" {if $dmp_country == 'Botswana'}selected{/if}>Botswana</OPTION>
								<OPTION value="Brazil" {if $dmp_country == 'Brazil'}selected{/if}>Brazil</OPTION>
								<OPTION value="Brunei" {if $dmp_country == 'Brunei'}selected{/if}>Brunei</OPTION>
								<OPTION value="Bulgaria" {if $dmp_country == 'Bulgaria'}selected{/if}>Bulgaria</OPTION>
								<OPTION value="Burkina Faso" {if $dmp_country == 'Burkina Faso'}selected{/if}>Burkina Faso</OPTION>
								<OPTION value="Burundi" {if $dmp_country == 'Burundi'}selected{/if}>Burundi</OPTION>
								<OPTION value="Cambodia" {if $dmp_country == 'Cambodia'}selected{/if}>Cambodia</OPTION>
								<OPTION value="Cameroon" {if $dmp_country == 'Cameroon'}selected{/if}>Cameroon</OPTION>
								<OPTION value="Canada" {if $dmp_country == 'Canada'}selected{/if}>Canada</OPTION>
								<OPTION value="Cape Verde" {if $dmp_country == 'Cape Verde'}selected{/if}>Cape Verde</OPTION>
								<OPTION value="Cayman Islands" {if $dmp_country == 'Cayman Islands'}selected{/if}>Cayman Islands</OPTION>
								<OPTION value="Central African Republic" {if $dmp_country == 'Central African Republic'}selected{/if}>Central African Republic</OPTION>
								<OPTION value="Chile" {if $dmp_country == 'Chile'}selected{/if}>Chile</OPTION>
								<OPTION value="China - PRC" {if $dmp_country == 'China - PRC'}selected{/if}>China - PRC</OPTION>
								<OPTION value="Christmas Island" {if $dmp_country == 'Christmas Island'}selected{/if}>Christmas Island</OPTION>
								<OPTION value="Colombia" {if $dmp_country == 'Colombia'}selected{/if}>Colombia</OPTION>
								<OPTION value="Comoros" {if $dmp_country == 'Comoros'}selected{/if}>Comoros</OPTION>
								<OPTION value="Congo" {if $dmp_country == 'Congo'}selected{/if}>Congo</OPTION>
								<OPTION value="Cook Islands" {if $dmp_country == 'Cook Islands'}selected{/if}>Cook Islands</OPTION>
								<OPTION value="Costa Rica" {if $dmp_country == 'Costa Rica'}selected{/if}>Costa Rica</OPTION>
								<OPTION value="Cote D'Ivoire" {if $dmp_country == "Cote D'Ivoire"}selected{/if}>Cote D'Ivoire</OPTION>
								<OPTION value="Croatia" {if $dmp_country == 'Croatia'}selected{/if}>Croatia</OPTION>
								<OPTION value="Cuba" {if $dmp_country == 'Cuba'}selected{/if}>Cuba</OPTION>
								<OPTION value="Cyprus" {if $dmp_country == 'Cyprus'}selected{/if}>Cyprus</OPTION>
								<OPTION value="Czech Republic" {if $dmp_country == 'Czech Republic'}selected{/if}>Czech Republic</OPTION>
								<OPTION value="Democratic Republic of the Congo" {if $dmp_country == 'Democratic Republic of the Congo'}selected{/if}>Democratic Republic of the Congo</OPTION>
								<OPTION value="Denmark" {if $dmp_country == 'Denmark'}selected{/if}>Denmark</OPTION>
								<OPTION value="Djibouti" {if $dmp_country == 'Djibouti'}selected{/if}>Djibouti</OPTION>
								<OPTION value="Dominica" {if $dmp_country == 'Dominica'}selected{/if}>Dominica</OPTION>
								<OPTION value="Dominican Republic" {if $dmp_country == 'Dominican Republic'}selected{/if}>Dominican Republic</OPTION>
								<OPTION value="East Timor" {if $dmp_country == 'East Timor'}selected{/if}>East Timor</OPTION>
								<OPTION value="Ecuador" {if $dmp_country == 'Ecuador'}selected{/if}>Ecuador</OPTION>
								<OPTION value="Egypt" {if $dmp_country == 'Egypt'}selected{/if}>Egypt</OPTION>
								<OPTION value="El Salvador" {if $dmp_country == 'El Salvador'}selected{/if}>El Salvador</OPTION>
								<OPTION value="Equitorial Guinea" {if $dmp_country == 'Equitorial Guinea'}selected{/if}>Equitorial Guinea</OPTION>
								<OPTION value="Eritrea" {if $dmp_country == 'Eritrea'}selected{/if}>Eritrea</OPTION>
								<OPTION value="Estonia" {if $dmp_country == 'Estonia'}selected{/if}>Estonia</OPTION>
								<OPTION value="Ethiopia" {if $dmp_country == 'Ethiopia'}selected{/if}>Ethiopia</OPTION>
								<OPTION value="Falkland Islands" {if $dmp_country == 'Falkland Islands'}selected{/if}>Falkland Islands</OPTION>
								<OPTION value="Faroe Islands" {if $dmp_country == 'Faroe Islands'}selected{/if}>Faroe Islands</OPTION>
								<OPTION value="Fiji" {if $dmp_country == 'Fiji'}selected{/if}>Fiji</OPTION>
								<OPTION value="Finland" {if $dmp_country == 'Finland'}selected{/if}>Finland</OPTION>
								<OPTION value="France" {if $dmp_country == 'France'}selected{/if}>France</OPTION>
								<OPTION value="French Guiana" {if $dmp_country == 'French Guiana'}selected{/if}>French Guiana</OPTION>
								<OPTION value="French Polynesia" {if $dmp_country == 'French Polynesia'}selected{/if}>French Polynesia</OPTION>
								<OPTION value="Gabon" {if $dmp_country == 'Gabon'}selected{/if}>Gabon</OPTION>
								<OPTION value="Gambia" {if $dmp_country == 'Gambia'}selected{/if}>Gambia</OPTION>
								<OPTION value="Georgia" {if $dmp_country == 'Georgia'}selected{/if}>Georgia</OPTION>
								<OPTION value="Germany" {if $dmp_country == 'Germany'}selected{/if}>Germany</OPTION>
								<OPTION value="Ghana" {if $dmp_country == 'Ghana'}selected{/if}>Ghana</OPTION>
								<OPTION value="Gibraltar" {if $dmp_country == 'Gibraltar'}selected{/if}>Gibraltar</OPTION>
								<OPTION value="Greece" {if $dmp_country == 'Greece'}selected{/if}>Greece</OPTION>
								<OPTION value="Greenland" {if $dmp_country == 'Greenland'}selected{/if}>Greenland</OPTION>
								<OPTION value="Grenada" {if $dmp_country == 'Grenada'}selected{/if}>Grenada</OPTION>
								<OPTION value="Guadaloupe" {if $dmp_country == 'Guadaloupe'}selected{/if}>Guadaloupe</OPTION>
								<OPTION value="Guam" {if $dmp_country == 'Guam'}selected{/if}>Guam</OPTION>
								<OPTION value="Guatemala" {if $dmp_country == 'Guatemala'}selected{/if}>Guatemala</OPTION>
								<OPTION value="Guernsey" {if $dmp_country == 'Guernsey'}selected{/if}>Guernsey</OPTION>
								<OPTION value="Guinea" {if $dmp_country == 'Guinea'}selected{/if}>Guinea</OPTION>
								<OPTION value="Guinea-Bissau" {if $dmp_country == 'Guinea-Bissau'}selected{/if}>Guinea-Bissau</OPTIO n>
								<OPTION value="Guyana" {if $dmp_country == 'Guyana'}selected{/if}>Guyana</OPTION>
								<OPTION value="Haiti" {if $dmp_country == 'Haiti'}selected{/if}>Haiti</OPTION>
								<OPTION value="Holland" {if $dmp_country == 'Holland'}selected{/if}>Holland</OPTION>
								<OPTION value="Honduras" {if $dmp_country == 'Honduras'}selected{/if}>Honduras</OPTION>
								<OPTION value="Hong Kong" {if $dmp_country == 'Hong Kong'}selected{/if}>Hong Kong</OPTION>
								<OPTION value="Hungary" {if $dmp_country == 'Hungary'}selected{/if}>Hungary</OPTION>
								<OPTION value="Iceland" {if $dmp_country == 'Iceland'}selected{/if}>Iceland</OPTION>
								<OPTION value="India" {if $dmp_country == 'India'}selected{/if}>India</OPTION>
								<OPTION value="Indonesia" {if $dmp_country == 'Indonesia'}selected{/if}>Indonesia</OPTION>
								<OPTION value="Iran" {if $dmp_country == 'Iran'}selected{/if}>Iran</OPTION>
								<OPTION value="Iraq" {if $dmp_country == 'Iraq'}selected{/if}>Iraq</OPTION>
								<OPTION value="Ireland" {if $dmp_country == 'Ireland'}selected{/if}>Ireland</OPTION>
								<OPTION value="Isle of Man" {if $dmp_country == 'Isle of Man'}selected{/if}>Isle of Man</OPTION>
								<OPTION value="Israel" {if $dmp_country == 'Israel'}selected{/if}>Israel</OPTION>
								<OPTION value="Italy" {if $dmp_country == 'Italy'}selected{/if}>Italy</OPTION>
								<OPTION value="Jamaica" {if $dmp_country == 'Jamaica'}selected{/if}>Jamaica</OPTION>
								<OPTION value="Japan" {if $dmp_country == 'Japan'}selected{/if}>Japan</OPTION>
								<OPTION value="Jersey" {if $dmp_country == 'Jersey'}selected{/if}>Jersey</OPTION>
								<OPTION value="Jordan" {if $dmp_country == 'Jordan'}selected{/if}>Jordan</OPTION>
								<OPTION value="Kazakhstan" {if $dmp_country == 'Kazakhstan'}selected{/if}>Kazakhstan</OPTION>
								<OPTION value="Kenya" {if $dmp_country == 'Kenya'}selected{/if}>Kenya</OPTION>
								<OPTION value="Kiribati" {if $dmp_country == 'Kiribati'}selected{/if}>Kiribati</OPTION>
								<OPTION value="Kitts and Nevis" {if $dmp_country == 'Kitts and Nevis'}selected{/if}>Kitts and Nevis</OPTION>
								<OPTION value="Korea - North" {if $dmp_country == 'Korea - North'}selected{/if}>Korea - North</OPTION>
								<OPTION value="Korea - South" {if $dmp_country == 'Korea - South'}selected{/if}>Korea - South</OPTION>
								<OPTION value="Kuwait" {if $dmp_country == 'Kuwait'}selected{/if}>Kuwait</OPTION>
								<OPTION value="Kyrgyzstan" {if $dmp_country == 'Kyrgyzstan'}selected{/if}>Kyrgyzstan</OPTION>
								<OPTION value="Laos" {if $dmp_country == 'Laos'}selected{/if}>Laos</OPTION>
								<OPTION value="Latvia" {if $dmp_country == 'Latvia'}selected{/if}>Latvia</OPTION>
								<OPTION value="Lebanon" {if $dmp_country == 'Lebanon'}selected{/if}>Lebanon</OPTION>
								<OPTION value="Lesotho" {if $dmp_country == 'Lesotho'}selected{/if}>Lesotho</OPTION>
								<OPTION value="Liberia" {if $dmp_country == 'Liberia'}selected{/if}>Liberia</OPTION>
								<OPTION value="Libya" {if $dmp_country == 'Libya'}selected{/if}>Libya</OPTION>
								<OPTION value="Liechtenstein" {if $dmp_country == 'Liechtenstein'}selected{/if}>Liechtenstein</OPTION>
								<OPTION value="Lithuania" {if $dmp_country == 'Lithuania'}selected{/if}>Lithuania</OPTION>
								<OPTION value="Luxembourg" {if $dmp_country == 'Luxembourg'}selected{/if}>Luxembourg</OPTION>
								<OPTION value="Macau" {if $dmp_country == 'Macau'}selected{/if}>Macau</OPTION>
								<OPTION value="Macedonia" {if $dmp_country == 'Macedonia'}selected{/if}>Macedonia</OPTION>
								<OPTION value="Madagascar" {if $dmp_country == 'Madagascar'}selected{/if}>Madagascar</OPTION>
								<OPTION value="Malawi" {if $dmp_country == 'Malawi'}selected{/if}>Malawi</OPTION>
								<OPTION value="Malaysia" {if $dmp_country == 'Malaysia'}selected{/if}>Malaysia</OPTION>
								<OPTION value="Maldives" {if $dmp_country == 'Maldives'}selected{/if}>Maldives</OPTION>
								<OPTION value="Mali" {if $dmp_country == 'Mali'}selected{/if}>Mali</OPTION>
								<OPTION value="Malta" {if $dmp_country == 'Malta'}selected{/if}>Malta</OPTION>
								<OPTION value="Marshall Islands" {if $dmp_country == 'Marshall Islands'}selected{/if}>Marshall Islands</OPTION>
								<OPTION value="Martinique" {if $dmp_country == 'Martinique'}selected{/if}>Martinique</OPTION>
								<OPTION value="Mauritania" {if $dmp_country == 'Mauritania'}selected{/if}>Mauritania</OPTION>
								<OPTION value="Mauritius" {if $dmp_country == 'Mauritius'}selected{/if}>Mauritius</OPTION>
								<OPTION value="Mayotte" {if $dmp_country == 'Mayotte'}selected{/if}>Mayotte</OPTION>
								<OPTION value="Mexico" {if $dmp_country == 'Mexico'}selected{/if}>Mexico</OPTION>
								<OPTION value="Micronesia" {if $dmp_country == 'Micronesia'}selected{/if}>Micronesia</OPTION>
								<OPTION value="Moldova" {if $dmp_country == 'Moldova'}selected{/if}>Moldova</OPTION>
								<OPTION value="Monaco" {if $dmp_country == 'Monaco'}selected{/if}>Monaco</OPTION>
								<OPTION value="Mongolia" {if $dmp_country == 'Mongolia'}selected{/if}>Mongolia</OPTION>
								<OPTION value="Monte Carlo" {if $dmp_country == 'Monte Carlo'}selected{/if}>Monte Carlo</OPTION>
								<OPTION value="Montserrat" {if $dmp_country == 'Montserrat'}selected{/if}>Montserrat</OPTION>
								<OPTION value="Morocco" {if $dmp_country == 'Morocco'}selected{/if}>Morocco</OPTION>
								<OPTION value="Mozambique" {if $dmp_country == 'Mozambique'}selected{/if}>Mozambique</OPTION>
								<OPTION value="Myanmar" {if $dmp_country == 'Myanmar'}selected{/if}>Myanmar</OPTION>
								<OPTION value="Namibia" {if $dmp_country == 'Namibia'}selected{/if}>Namibia</OPTION>
								<OPTION value="Nauru" {if $dmp_country == 'Nauru'}selected{/if}>Nauru</OPTION>
								<OPTION value="Nepal" {if $dmp_country == 'Nepal'}selected{/if}>Nepal</OPTION>
								<OPTION value="Netherlands" {if $dmp_country == 'Netherlands'}selected{/if}>Netherlands</OPTION>
								<OPTION value="Netherlands Antilles" {if $dmp_country == 'Netherlands Antilles'}selected{/if}>Netherlands Antilles</OPTION>
								<OPTION value="New Caledonia" {if $dmp_country == 'New Caledonia'}selected{/if}>New Caledonia</OPTION>
								<OPTION value="New Zealand" {if $dmp_country == 'New Zealand'}selected{/if}>New Zealand</OPTION>
								<OPTION value="Nicaragua" {if $dmp_country == 'Nicaragua'}selected{/if}>Nicaragua</OPTION>
								<OPTION value="Niger" {if $dmp_country == 'Niger'}selected{/if}>Niger</OPTION>
								<OPTION value="Nigeria" {if $dmp_country == 'Nigeria'}selected{/if}>Nigeria</OPTION>
								<OPTION value="Niue" {if $dmp_country == 'Niue'}selected{/if}>Niue</OPTION>
								<OPTION value="Northern Mariana Islands" {if $dmp_country == 'Northern Mariana Islands'}selected{/if}>Northern Mariana Islands</OPTION>
								<OPTION value="Norway" {if $dmp_country == 'Norway'}selected{/if}>Norway</OPTION>
								<OPTION value="Not Assigned" {if $dmp_country == 'Not Assigned'}selected{/if}>Not Assigned</OPTION>
								<OPTION value="Oman" {if $dmp_country == 'Oman'}selected{/if}>Oman</OPTION>
								<OPTION value="Other (not listed)" {if $dmp_country == 'Other (not listed)'}selected{/if}>Other (not listed)</OPTION>
								<OPTION value="Pakistan" {if $dmp_country == 'Pakistan'}selected{/if}>Pakistan</OPTION>
								<OPTION value="Palau" {if $dmp_country == 'Palau'}selected{/if}>Palau</OPTION>
								<OPTION value="Panama" {if $dmp_country == 'Panama'}selected{/if}>Panama</OPTION>
								<OPTION value="Papua New Guinea" {if $dmp_country == 'Papua New Guinea'}selected{/if}>Papua New Guinea</OPTION>
								<OPTION value="Paraguay" {if $dmp_country == 'Paraguay'}selected{/if}>Paraguay</OPTION>
								<OPTION value="Peru" {if $dmp_country == 'Peru'}selected{/if}>Peru</OPTION>
								<OPTION value="Philippines" {if $dmp_country == 'Philippines'}selected{/if}>Philippines</OPTION>
								<OPTION value="Pitcairn Island" {if $dmp_country == 'Pitcairn Island'}selected{/if}>Pitcairn Island</OPTION>
								<OPTION value="Poland" {if $dmp_country == 'Poland'}selected{/if}>Poland</OPTION>
								<OPTION value="Portugal" {if $dmp_country == 'Portugal'}selected{/if}>Portugal</OPTION>
								<OPTION value="Puerto Rico" {if $dmp_country == 'Puerto Rico'}selected{/if}>Puerto Rico</OPTION>
								<OPTION value="Qatar" {if $dmp_country == 'Qatar'}selected{/if}>Qatar</OPTION>
								<OPTION value="Reunion" {if $dmp_country == 'Reunion'}selected{/if}>Reunion</OPTION>
								<OPTION value="Romania" {if $dmp_country == 'Romania'}selected{/if}>Romania</OPTION>
								<OPTION value="Russia" {if $dmp_country == 'Russia'}selected{/if}>Russia</OPTION>
								<OPTION value="Rwanda" {if $dmp_country == 'Rwanda'}selected{/if}>Rwanda</OPTION>
								<OPTION value="S. Georgia and the S. Sandwich Is." {if $dmp_country == 'S. Georgia and the S. Sandwich Is.'}selected{/if}>S. Georgia and the S. Sandwich Is.</OPTION>
								<OPTION value="Saint Kitts And Nevis" {if $dmp_country == 'Saint Kitts And Nevis'}selected{/if}>Saint Kitts And Nevis</OPTION>
								<OPTION value="Saint Lucia" {if $dmp_country == 'Saint Lucia'}selected{/if}>Saint Lucia</OPTION>
								<OPTION value="Saint Vincent & the Grenadines" {if $dmp_country == 'Saint Vincent & the Grenadines'}selected{/if}>Saint Vincent & the Grenadines</OPTION>
								<OPTION value="Samoa-American" {if $dmp_country == 'Samoa-American'}selected{/if}>Samoa-American</OPTION>
								<OPTION value="Samoa-Western" {if $dmp_country == 'Samoa-Western'}selected{/if}>Samoa-Western</OPTION>
								<OPTION value="San Marino" {if $dmp_country == 'San Marino'}selected{/if}>San Marino</OPTION>
								<OPTION value="Sao Tome and Principe" {if $dmp_country == 'Sao Tome and Principe'}selected{/if}>Sao Tome and Principe</OPTION>
								<OPTION value="Saudi Arabia" {if $dmp_country == 'Saudi Arabia'}selected{/if}>Saudi Arabia</OPTION>
								<OPTION value="Scotland" {if $dmp_country == 'Scotland'}selected{/if}>Scotland</OPTION>
								<OPTION value="Senegal" {if $dmp_country == 'Senegal'}selected{/if}>Senegal</OPTION>
								<OPTION value="Seychelles" {if $dmp_country == 'Seychelles'}selected{/if}>Seychelles</OPTION>
								<OPTION value="Sierra Leone" {if $dmp_country == 'Sierra Leone'}selected{/if}>Sierra Leone</OPTION>
								<OPTION value="Singapore" {if $dmp_country == 'Singapore'}selected{/if}>Singapore</OPTION>
								<OPTION value="Slovakia" {if $dmp_country == 'Slovakia'}selected{/if}>Slovakia</OPTION>
								<OPTION value="Slovenia" {if $dmp_country == 'Slovenia'}selected{/if}>Slovenia</OPTION>
								<OPTION value="Solomon Islands" {if $dmp_country == 'Solomon Islands'}selected{/if}>Solomon Islands</OPTION>
								<OPTION value="Somalia" {if $dmp_country == 'Somalia'}selected{/if}>Somalia</OPTION>
								<OPTION value="South Africa" {if $dmp_country == 'South Africa'}selected{/if}>South Africa</OPTION>
								<OPTION value="Spain" {if $dmp_country == 'Spain'}selected{/if}>Spain</OPTION>
								<OPTION value="Sri Lanka" {if $dmp_country == 'Sri Lanka'}selected{/if}>Sri Lanka</OPTION>
								<OPTION value="Sudan" {if $dmp_country == 'Sudan'}selected{/if}>Sudan</OPTION>
								<OPTION value="Suriname" {if $dmp_country == 'Suriname'}selected{/if}>Suriname</OPTION>
								<OPTION value="Swaziland" {if $dmp_country == 'Swaziland'}selected{/if}>Swaziland</OPTION>
								<OPTION value="Sweden" {if $dmp_country == 'Sweden'}selected{/if}>Sweden</OPTION>
								<OPTION value="Switzerland" {if $dmp_country == 'Switzerland'}selected{/if}>Switzerland</OPTION>
								<OPTION value="Syria" {if $dmp_country == 'Syria'}selected{/if}>Syria</OPTION>
								<OPTION value="Taiwan" {if $dmp_country == 'Taiwan'}selected{/if}>Taiwan</OPTION>
								<OPTION value="Tajikistan" {if $dmp_country == 'Tajikistan'}selected{/if}>Tajikistan</OPTION>
								<OPTION value="Tanzania" {if $dmp_country == 'Tanzania'}selected{/if}>Tanzania</OPTION>
								<OPTION value="Thailand" {if $dmp_country == 'Thailand'}selected{/if}>Thailand</OPTION>
								<OPTION value="Togo" {if $dmp_country == 'Togo'}selected{/if}>Togo</OPTION>
								<OPTION value="Tonga" {if $dmp_country == 'Tonga'}selected{/if}>Tonga</OPTION>
								<OPTION value="Trinidad and Tobago" {if $dmp_country == 'Trinidad and Tobago'}selected{/if}>Trinidad and Tobago</OPTION>
								<OPTION value="Tunisia" {if $dmp_country == 'Tunisia'}selected{/if}>Tunisia</OPTION>
								<OPTION value="Turkey" {if $dmp_country == 'Turkey'}selected{/if}>Turkey</OPTION>
								<OPTION value="Turkmenistan" {if $dmp_country == 'Turkmenistan'}selected{/if}>Turkmenistan</OPTION>
								<OPTION value="Tuvalu" {if $dmp_country == 'Tuvalu'}selected{/if}>Tuvalu</OPTION>
								<OPTION value="Uganda" {if $dmp_country == 'Uganda'}selected{/if}>Uganda</OPTION>
								<OPTION value="Ukraine" {if $dmp_country == 'Ukraine'}selected{/if}>Ukraine</OPTION>
								<OPTION value="United Arab Emirates" {if $dmp_country == 'United Arab Emirates'}selected{/if}>United Arab Emirates</OPTION>
								<OPTION value="United Kingdom" {if $dmp_country == 'United Kingdom'}selected{/if}>United Kingdom</OPTION>
								<OPTION value="Uruguay" {if $dmp_country == 'Uruguay'}selected{/if}>Uruguay</OPTION>
								<OPTION value="USA" {if $dmp_country == 'USA'}selected{/if}>USA</OPTION>
								<OPTION value="Uzbekistan" {if $dmp_country == 'Uzbekistan'}selected{/if}>Uzbekistan</OPTION>
								<OPTION value="Vanuatu" {if $dmp_country == 'Vanuatu'}selected{/if}>Vanuatu</OPTION>
								<OPTION value="Vatican City" {if $dmp_country == 'Vatican City'}selected{/if}>Vatican City</OPTION>
								<OPTION value="Venezuela" {if $dmp_country == 'Venezuela'}selected{/if}>Venezuela</OPTION>
								<OPTION value="Vietnam" {if $dmp_country == 'Vietnam'}selected{/if}>Vietnam</OPTION>
								<OPTION value="Virgin Islands" {if $dmp_country == 'Virgin Islands'}selected{/if}>Virgin Islands</OPTION>
								<OPTION value="Western Sahara" {if $dmp_country == 'Western Sahara'}selected{/if}>Western Sahara</OPTION>
								<OPTION value="Yemen" {if $dmp_country == 'Yemen'}selected{/if}>Yemen</OPTION>
								<OPTION value="Yugoslavia" {if $dmp_country == 'Yugoslavia'}selected{/if}>Yugoslavia</OPTION>
								<OPTION value="Zambia" {if $dmp_country == 'Zambia'}selected{/if}>Zambia</OPTION>
								<OPTION value="Zimbabwe" {if $dmp_country == 'Zimbabwe'}selected{/if}>Zimbabwe</OPTION>
								</SELECT>
								{literal}
								<SCRIPT language='javascript'>
									function DisplayCountry()
									{
									var strDisplayUSA, strDisplayCanada, strDisplayOther;
									var strCountry;
									strDisplayUSA = 'none';
									strDisplayCanada='none';
									strDisplayOther = 'none';
									
									strCountry = document.getElementById('_OfficeCountry93259').value;
									
									if (strCountry == 'USA'){
									document.FrmInput.txtOtherState.value = '';
									strDisplayUSA = '';
									AssignState(document.FrmInput.cmbUSAState.value);
									}else if (strCountry == 'Canada'){
									
									document.FrmInput.txtOtherState.value = '';
									strDisplayCanada = '';
									AssignState(document.FrmInput.cmbCanadaState.value);
									}else{
									strDisplayOther = '';
									AssignState(document.FrmInput.txtOtherState.value);
									};
									if(navigator.appName == 'Netscape') {
									document.getElementById('DivUS').style.display     = strDisplayUSA;
									document.getElementById('DivCanada').style.display = strDisplayCanada;
									document.getElementById('DivOthers').style.display = strDisplayOther;
									}else {
									document.all.DivUS.style.display= strDisplayUSA;
									document.all.DivCanada.style.display= strDisplayCanada;
									document.all.DivOthers.style.display= strDisplayOther;
									};
									}
								</SCRIPT>
								{/literal}
							</TD>
						</TR>
						<TR>
							
							<TD align="left"><FONT color="red">*</FONT> {if $errmsg.phone != ''} <font color=red>Phone</font>
								{else}
								Phone
								{/if}
							</TD>
							<TD>
								<INPUT type="text" name="phone" style="width:100%;" size="20" class="formTextbox" value="{$form.phone|htmlspecialchars}">
							</TD>
						</TR>
						<TR>
							
							<TD align="left">
								<FONT color="red">*</FONT>
								{if $errmsg.email != ''}
								<font color=red>Email</font>
								{else}
								Email
								{/if}
							</TD>
							<TD>
								<INPUT type="text" name="email" style="width:100%;" size="30" class="formTextbox" value="{$form.email|htmlspecialchars}">
							</TD>
						</TR>
						<TR>
							
							<TD align="left" valign="top">
								Comments &amp; Questions
							</TD>
							<TD><TEXTAREA name="description" rows="8" cols="40" style="width:100%;">{$form.description|htmlspecialchars}</TEXTAREA></TD>
						</TR>
						<tr>
							<td></td>
							<td></td>
							<td>
								<div class='req'>
									<input type='text' name='dmp'>
								</div>
							</td>
						</tr>
						
						<p class="fstyle"><input name="chk_subject" id="chk_subject" type="text" value=""/>  </p>
						
						
						<TR>							
							<TD class="pk11">
								<INPUT type=Submit name=save value="Submit" class=formButton ID="Button1">
								&nbsp;&nbsp;&nbsp;&nbsp;
								<INPUT type=button name=cancel value="Cancel" class=formButton onclick="window.location='index.php'" ID="Button2">
							</TD>
							
						</TR>
					</TABLE>
				</FORM>
			</TD>
		</TR>
	</TABLE>
	{/if}
</div>
{literal}
<script type="text/javascript">
  function contact_submit(){
    window.dataLayer = window.dataLayer || [];
      window.dataLayer.push({
        'event' : 'formSubmissionSuccess',
        'formId' : 'contactForm'
      });
  }
</script>
{/literal}

{include file="templates/panels/panel-catalog-quick-links.html"}