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[ 24/11/2024, 04:25 AM ]
 
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<option value="23">Illinois</option>
<option value="24">Indiana</option>
<option value="25">Iowa</option>
<option value="26">Kansas</option>
<option value="27">Kentucky</option>
<option value="28">Louisiana</option>
<option value="29">Maine</option>
<option value="30">Marshall Islands</option>
<option value="31">Maryland</option>
<option value="32">Massachusetts</option>
<option value="33">Michigan</option>
<option value="34">Minnesota</option>
<option value="35">Mississippi</option>
<option value="36">Missouri</option>
<option value="37">Montana</option>
<option value="38">Nebraska</option>
<option value="39">Nevada</option>
<option value="40">New Hampshire</option>
<option value="41">New Jersey</option>
<option value="42">New Mexico</option>
<option value="43">New York</option>
<option value="44">North Carolina</option>
<option value="45">North Dakota</option>
<option value="46">Northern Mariana Islands</option>
<option value="47">Ohio</option>
<option value="48">Oklahoma</option>
<option value="49">Oregon</option>
<option value="51">Pennsylvania</option>
<option value="52">Puerto Rico</option>
<option value="53">Rhode Island</option>
<option value="54">South Carolina</option>
<option value="55">South Dakota</option>
<option value="56">Tennessee</option>
<option value="57">Texas</option>
<option value="58">Utah</option>
<option value="59">Vermont</option>
<option value="60">Virgin Islands</option>
<option value="61">Virginia</option>
<option value="62">Washington</option>
<option value="63">West Virginia</option>
<option value="64">Wisconsin</option>
<option value="65">Wyoming</option>
</select>
&nbsp;<span class="alert">*</span>
<br class="clearBoth" id="stBreak" />
<label class="inputLabel" for="state" id="stateLabel"></label>
<input type="text" name="state" value="&nbsp;" size = "41" maxlength= "96" id="state" />&nbsp;<span class="alert" id="stText">*</span><br class="clearBoth" />

<label class="inputLabel" for="postcode">Postleitzahl:</label>
<input type="text" name="postcode" size = "31" maxlength = "30" id="postcode" /><span class="alert">*</span><b>Don't Empty, it is used for Express </b>
<br class="clearBoth" />

<label class="inputLabel" for="country">Land:</label>
<select name="zone_country_id" id="country" onchange="update_zone(this.form);">
<option value="">Bitte wählen Sie Ihr Land</option>
<option value="223" selected="selected">United States</option>
<option value="240">Aaland Islands</option>
<option value="1">Afghanistan</option>
<option value="2">Albania</option>
<option value="3">Algeria</option>
<option value="4">American Samoa</option>
<option value="5">Andorra</option>
<option value="6">Angola</option>
<option value="7">Anguilla</option>
<option value="8">Antarctica</option>
<option value="9">Antigua and Barbuda</option>
<option value="10">Argentina</option>
<option value="11">Armenia</option>
<option value="12">Aruba</option>
<option value="13">Australia</option>
<option value="14">Austria</option>
<option value="15">Azerbaijan</option>
<option value="16">Bahamas</option>
<option value="17">Bahrain</option>
<option value="18">Bangladesh</option>
<option value="19">Barbados</option>
<option value="20">Belarus</option>
<option value="21">Belgium</option>
<option value="22">Belize</option>
<option value="23">Benin</option>
<option value="24">Bermuda</option>
<option value="25">Bhutan</option>
<option value="26">Bolivia</option>
<option value="27">Bosnia and Herzegowina</option>
<option value="28">Botswana</option>
<option value="29">Bouvet Island</option>
<option value="30">Brazil</option>
<option value="31">British Indian Ocean Territory</option>
<option value="32">Brunei Darussalam</option>
<option value="33">Bulgaria</option>
<option value="34">Burkina Faso</option>
<option value="35">Burundi</option>
<option value="36">Cambodia</option>
<option value="37">Cameroon</option>
<option value="38">Canada</option>
<option value="39">Cape Verde</option>
<option value="40">Cayman Islands</option>
<option value="41">Central African Republic</option>
<option value="42">Chad</option>
<option value="43">Chile</option>
<option value="45">Christmas Island</option>
<option value="46">Cocos (Keeling) Islands</option>
<option value="47">Colombia</option>
<option value="48">Comoros</option>
<option value="49">Congo</option>
<option value="50">Cook Islands</option>
<option value="51">Costa Rica</option>
<option value="52">Cote D&#039;Ivoire</option>
<option value="53">Croatia</option>
<option value="54">Cuba</option>
<option value="55">Cyprus</option>
<option value="56">Czech Republic</option>
<option value="57">Denmark</option>
<option value="58">Djibouti</option>
<option value="59">Dominica</option>
<option value="60">Dominican Republic</option>
<option value="62">Ecuador</option>
<option value="63">Egypt</option>
<option value="64">El Salvador</option>
<option value="65">Equatorial Guinea</option>
<option value="66">Eritrea</option>
<option value="67">Estonia</option>
<option value="68">Ethiopia</option>
<option value="69">Falkland Islands (Malvinas)</option>
<option value="70">Faroe Islands</option>
<option value="71">Fiji</option>
<option value="72">Finland</option>
<option value="73">France</option>
<option value="75">French Guiana</option>
<option value="76">French Polynesia</option>
<option value="77">French Southern Territories</option>
<option value="78">Gabon</option>
<option value="79">Gambia</option>
<option value="80">Georgia</option>
<option value="81">Germany</option>
<option value="82">Ghana</option>
<option value="83">Gibraltar</option>
<option value="84">Greece</option>
<option value="85">Greenland</option>
<option value="86">Grenada</option>
<option value="87">Guadeloupe</option>
<option value="88">Guam</option>
<option value="89">Guatemala</option>
<option value="90">Guinea</option>
<option value="91">Guinea-bissau</option>
<option value="92">Guyana</option>
<option value="93">Haiti</option>
<option value="94">Heard and Mc Donald Islands</option>
<option value="95">Honduras</option>
<option value="96">Hong Kong</option>
<option value="97">Hungary</option>
<option value="98">Iceland</option>
<option value="99">India</option>
<option value="100">Indonesia</option>
<option value="101">Iran (Islamic Republic of)</option>
<option value="102">Iraq</option>
<option value="103">Ireland</option>
<option value="104">Israel</option>
<option value="105">Italy</option>
<option value="106">Jamaica</option>
<option value="107">Japan</option>
<option value="108">Jordan</option>
<option value="109">Kazakhstan</option>
<option value="110">Kenya</option>
<option value="111">Kiribati</option>
<option value="112">Korea, Democratic People&#039;s Republic of</option>
<option value="113">Korea, Republic of</option>
<option value="114">Kuwait</option>
<option value="115">Kyrgyzstan</option>
<option value="116">Lao People&#039;s Democratic Republic</option>
<option value="117">Latvia</option>
<option value="118">Lebanon</option>
<option value="119">Lesotho</option>
<option value="120">Liberia</option>
<option value="121">Libyan Arab Jamahiriya</option>
<option value="122">Liechtenstein</option>
<option value="123">Lithuania</option>
<option value="124">Luxembourg</option>
<option value="125">Macao</option>
<option value="126">Macedonia, The Former Yugoslav Republic of</option>
<option value="127">Madagascar</option>
<option value="128">Malawi</option>
<option value="129">Malaysia</option>
<option value="130">Maldives</option>
<option value="131">Mali</option>
<option value="132">Malta</option>
<option value="133">Marshall Islands</option>
<option value="134">Martinique</option>
<option value="135">Mauritania</option>
<option value="136">Mauritius</option>
<option value="137">Mayotte</option>
<option value="138">Mexico</option>
<option value="139">Micronesia, Federated States of</option>
<option value="140">Moldova</option>
<option value="141">Monaco</option>
<option value="142">Mongolia</option>
<option value="143">Montserrat</option>
<option value="144">Morocco</option>
<option value="145">Mozambique</option>
<option value="146">Myanmar</option>
<option value="147">Namibia</option>
<option value="148">Nauru</option>
<option value="149">Nepal</option>
<option value="150">Netherlands</option>
<option value="151">Netherlands Antilles</option>
<option value="152">New Caledonia</option>
<option value="153">New Zealand</option>
<option value="154">Nicaragua</option>
<option value="155">Niger</option>
<option value="156">Nigeria</option>
<option value="157">Niue</option>
<option value="158">Norfolk Island</option>
<option value="159">Northern Mariana Islands</option>
<option value="160">Norway</option>
<option value="161">Oman</option>
<option value="162">Pakistan</option>
<option value="163">Palau</option>
<option value="164">Panama</option>
<option value="165">Papua New Guinea</option>
<option value="166">Paraguay</option>
<option value="167">Peru</option>
<option value="168">Philippines</option>
<option value="169">Pitcairn</option>
<option value="170">Poland</option>
<option value="171">Portugal</option>
<option value="172">Puerto Rico</option>
<option value="173">Qatar</option>
<option value="174">Reunion</option>
<option value="175">Romania</option>
<option value="176">Russian Federation</option>
<option value="177">Rwanda</option>
<option value="178">Saint Kitts and Nevis</option>
<option value="179">Saint Lucia</option>
<option value="180">Saint Vincent and the Grenadines</option>
<option value="181">Samoa</option>
<option value="182">San Marino</option>
<option value="183">Sao Tome and Principe</option>
<option value="184">Saudi Arabia</option>
<option value="185">Senegal</option>
<option value="236">Serbia</option>
<option value="186">Seychelles</option>
<option value="187">Sierra Leone</option>
<option value="188">Singapore</option>
<option value="189">Slovakia (Slovak Republic)</option>
<option value="190">Slovenia</option>
<option value="191">Solomon Islands</option>
<option value="192">Somalia</option>
<option value="193">South Africa</option>
<option value="194">South Georgia and the South Sandwich Islands</option>
<option value="195">Spain</option>
<option value="196">Sri Lanka</option>
<option value="197">St. Helena</option>
<option value="198">St. Pierre and Miquelon</option>
<option value="199">Sudan</option>
<option value="200">Suriname</option>
<option value="201">Svalbard and Jan Mayen Islands</option>
<option value="202">Swaziland</option>
<option value="203">Sweden</option>
<option value="204">Switzerland</option>
<option value="205">Syrian Arab Republic</option>
<option value="206">Taiwan</option>
<option value="207">Tajikistan</option>
<option value="208">Tanzania, United Republic of</option>
<option value="209">Thailand</option>
<option value="61">Timor-Leste</option>
<option value="210">Togo</option>
<option value="211">Tokelau</option>
<option value="212">Tonga</option>
<option value="213">Trinidad and Tobago</option>
<option value="214">Tunisia</option>
<option value="215">Turkey</option>
<option value="216">Turkmenistan</option>
<option value="217">Turks and Caicos Islands</option>
<option value="218">Tuvalu</option>
<option value="219">Uganda</option>
<option value="220">Ukraine</option>
<option value="221">United Arab Emirates</option>
<option value="222">United Kingdom</option>
<option value="224">United States Minor Outlying Islands</option>
<option value="225">Uruguay</option>
<option value="226">Uzbekistan</option>
<option value="227">Vanuatu</option>
<option value="228">Vatican City State (Holy See)</option>
<option value="229">Venezuela</option>
<option value="230">Viet Nam</option>
<option value="231">Virgin Islands (British)</option>
<option value="232">Virgin Islands (U.S.)</option>
<option value="233">Wallis and Futuna Islands</option>
<option value="234">Western Sahara</option>
<option value="235">Yemen</option>
<option value="238">Zambia</option>
<option value="239">Zimbabwe</option>
</select>
<span class="alert">*</span><br class="clearBoth" />
</fieldset>

<fieldset>
<legend>Wie kann man Sie erreichen?</legend>
<label class="inputLabel" for="telephone">Telefon:</label>
<input type="text" name="telephone" size = "41" maxlength= "96" id="telephone" /><span class="alert">*</span><b>Don't Empty, Postman need contact you by it! </b>
</fieldset>


<fieldset>
<legend>Bitte geben Sie hier Ihre Anmeldedaten ein</legend>
<label class="inputLabel" for="email-address">E-Mail Adresse:</label>
<input type="text" name="email_address" size = "41" maxlength= "288" id="email-address" /><span class="alert">*</span><br class="clearBoth" />


<label class="inputLabel" for="password-new">Passwort:</label>
<input type="password" name="password" size = "21" maxlength= "120" id="password-new" /><span class="alert">* (mindestens 2 Zeichen)</span><br class="clearBoth" />

<label class="inputLabel" for="password-confirm">Passwortbestätigung:</label>
<input type="password" name="confirmation" size = "21" maxlength= "120" id="password-confirm" /><span class="alert">*</span><br class="clearBoth" />
</fieldset>



</fieldset>

<div class="buttonRow forward"><input type="image" src="http://de.swissrolexwatches.top/includes/templates/polo/buttons/german/button_submit.gif" alt="Information senden" title=" Information senden " /></div>
</form>
</div>
</td>



</tr>
</table>
</div>


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