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	Sale of Chametz Form - Sell your Chametz online! - Chabad Lubavitch of Idaho
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			<h1 class="article-header__title js-article-title js-page-title">Sale of Chametz Form</h1>
		
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				<h2 class="article-header__subtitle">Sell your Chametz online!</h2>
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<div id="formContainer"><script type="text/javascript">var defaultCurrency = { value: 'USD', symbol: '$'};
$j(function(){
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window.formJson = Object.extend([{"form_height":450,"10_text":"LEGAL SALE OF CHAMETZ","10_subHeader":"","10_headerType":"Default","10_name":"clickTo","10_qid":10,"10_type":"control_head","10_order":1,"9_text":"\u003cp\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003eSince it is prohibited to possess chametz on Pesach, any chametz left undisposed must be sold to a non-Jew. [Any chametz remaining in the possession of a Jew during Pesach may not be used, eaten, bought or sold even after Pesach.]\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003eTherefore, all chametz that will not be eaten or burned before Pesach and all chametz utensils that will not be thoroughly cleaned by then should be stored away.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003eThe storage area should be locked or taped shut to be leased to the non-Jew at the time of the chametz sale.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003eSince there are many legal intricacies in this sale, only a competent rabbi should be entrusted with its execution. The rabbi acts as our agent both to sell the chametz to the non-Jew on the morning before Pesach starts and also to buy it back the evening after Pesach ends.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003eTo learn more about about the search and removal of chametz,\u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003ca href=\"/Article.asp?AID=1744\"\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003eclick here\u003c/span\u003e\u003c/a\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003e.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003e\u003cem\u003eFor a downloadable PDF version of the Sale of Chametz Contract, please \u003ca href=\"http://www.JewishIdaho.com/media/pdf/43/yVPK435932.pdf\"\u003eclick here\u003c/a\u003e. The form can be mailed to the Chabad Jewish Center at 1803 S. Maple Grove Rd., Boise, ID 83709 or faxed to 208-853-9201 or scanned and\u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003c/span\u003e\u003cem\u003e\u003ca href=\"mailto:rabbi@jewishidaho.com?subject=Sale%20of%20Chametz\"\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003eemailed\u003c/span\u003e\u003c/a\u003e\u003c/em\u003e\u003cspan style=\"color: rgb(0, 0, 255);\"\u003e\u003cem\u003e\u0026nbsp; as an attachment.\u003c/em\u003e\u003c/span\u003e\u003c/p\u003e","9_name":"doubleclickTo","9_qid":9,"9_type":"control_text","9_order":2,"19_text":"Agreement","19_message":"","19_labelAlign":"Auto","19_required":"Yes","19_options":"I the undersigned, fully empower and permit Rabbi Mendel Lifshitz to act in my place and stead, and on my behalf to sell all chametz possessed by me, knowingly or unknowingly as defined by the Torah  and Rabbinic Law (e.g. chametz, possible chametz, and all kinds  of chametz mixtures). Also chametz that tends to harden and adhere to inside surfaces of pans, pots, or cooking utensils, the utensils themselves, and all kinds of live animals and pets that have been eating chametz and mixtures thereof. Rabbi Mendel Lifshitz is also empowered to lease all places wherein  the chametz owned  by me may be found, particularly at the  address/es listed below, and elsewhere. Rabbi Mendel Lifshitz has full right to appoint any agent or substitute  in his stead and said substitute shall have full right to sell and lease as  provided herein. Rabbi Mendel Lifshitz also has the full power and right to act as he  deems fit and proper in accordance with all the details of the Bill of  Sale used in the transaction to sell all my chametz, chametz  mixtures, etc., as provided herein. This power is in conformity with  all Torah, Rabbinic and Civil laws.","19_special":"None","19_allowOther":"No","19_otherText":"Other","19_selected":"I the undersigned, fully empower and permit Rabbi Mendel Lifshitz to act in my place and stead, and on my behalf to sell all chametz possessed by me, knowingly or unknowingly as defined by the Torah  and Rabbinic Law (e.g. chametz, possible chametz, and all kinds  of chametz mixtures). Also chametz that tends to harden and adhere to inside surfaces of pans, pots, or cooking utensils, the utensils themselves, and all kinds of live animals and pets that have been eating chametz and mixtures thereof. Rabbi Mendel Lifshitz is also empowered to lease all places wherein  the chametz owned  by me may be found, particularly at the  address/es listed below, and elsewhere. Rabbi Mendel Lifshitz has full right to appoint any agent or substitute  in his stead and said substitute shall have full right to sell and lease as  provided herein. Rabbi Mendel Lifshitz also has the full power and right to act as he  deems fit and proper in accordance with all the details of the Bill of  Sale used in the transaction to sell all my chametz, chametz  mixtures, etc., as provided herein. This power is in conformity with  all Torah, Rabbinic and Civil laws.","19_spreadCols":"1","19_description":"","19_name":"input19","19_qid":19,"19_type":"control_radio","19_order":3,"1_text":"Full Name","1_message":"","1_labelAlign":"Auto","1_required":"Yes","1_prefix":"No","1_suffix":"No","1_middle":"No","1_description":"","1_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"1_readonly":"No","1_name":"fullName","1_qid":1,"1_type":"control_fullname","1_order":4,"18_text":"Spouse Name","18_message":"","18_labelAlign":"Auto","18_required":"No","18_prefix":"No","18_suffix":"No","18_middle":"No","18_description":"","18_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last 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      <li id="cid_10" class="form-input-wide">
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          <h2 id="header_10" class="form-header">
            LEGAL SALE OF CHAMETZ
          </h2>
        </div>
      </li>
      <li class="form-line" id="id_9">
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            <p><span style="color: rgb(0, 0, 255);">Since it is prohibited to possess chametz on Pesach, any chametz left undisposed must be sold to a non-Jew. [Any chametz remaining in the possession of a Jew during Pesach may not be used, eaten, bought or sold even after Pesach.]</span>
            </p>
            <p><span style="color: rgb(0, 0, 255);">Therefore, all chametz that will not be eaten or burned before Pesach and all chametz utensils that will not be thoroughly cleaned by then should be stored away.</span>
            </p>
            <p><span style="color: rgb(0, 0, 255);">The storage area should be locked or taped shut to be leased to the non-Jew at the time of the chametz sale.</span>
            </p>
            <p><span style="color: rgb(0, 0, 255);">Since there are many legal intricacies in this sale, only a competent rabbi should be entrusted with its execution. The rabbi acts as our agent both to sell the chametz to the non-Jew on the morning before Pesach starts and also to buy it back the evening after Pesach ends.</span>
            </p>
            <p><span style="color: rgb(0, 0, 255);">To learn more about about the search and removal of chametz,  </span>
              <a href="/Article.asp?AID=1744"><span style="color: rgb(0, 0, 255);">click here</span></a><span style="color: rgb(0, 0, 255);">.</span>
            </p>
            <p><span style="color: rgb(0, 0, 255);"><em>
                  For a downloadable PDF version of the Sale of Chametz Contract, please
                  <a href="http://www.JewishIdaho.com/media/pdf/43/yVPK435932.pdf">click here</a>
                  . The form can be mailed to the Chabad Jewish Center at 1803 S. Maple Grove Rd., Boise, ID 83709 or faxed to 208-853-9201 or scanned and  
                </em></span>
              <em>
                <a href="mailto:rabbi@jewishidaho.com?subject=Sale%20of%20Chametz"><span style="color: rgb(0, 0, 255);">emailed</span></a>
              </em><span style="color: rgb(0, 0, 255);"><em>
                    as an attachment.
                </em></span>
            </p>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_19">
        <div class="form-label-left" id="label_19">
          <label for="input_19">
            Agreement<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_19">  </label>
        </div>
        <div id="cid_19" class="form-input">
          <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_19_0" name="q19_input19" checked="checked" value="I the undersigned, fully empower and permit Rabbi Mendel Lifshitz to act in my place and stead, and on my behalf to sell all chametz possessed by me, knowingly or unknowingly as defined by the Torah  and Rabbinic Law (e.g. chametz, possible chametz, and all kinds  of chametz mixtures). Also chametz that tends to harden and adhere to inside surfaces of pans, pots, or cooking utensils, the utensils themselves, and all kinds of live animals and pets that have been eating chametz and mixtures thereof. Rabbi Mendel Lifshitz is also empowered to lease all places wherein  the chametz owned  by me may be found, particularly at the  address/es listed below, and elsewhere. Rabbi Mendel Lifshitz has full right to appoint any agent or substitute  in his stead and said substitute shall have full right to sell and lease as  provided herein. Rabbi Mendel Lifshitz also has the full power and right to act as he  deems fit and proper in accordance with all the details of the Bill of  Sale used in the transaction to sell all my chametz, chametz  mixtures, etc., as provided herein. This power is in conformity with  all Torah, Rabbinic and Civil laws." />
              <label id="label_input_19_0" for="input_19_0"><span>I the undersigned, fully empower and permit Rabbi Mendel Lifshitz to act in my place and stead, and on my behalf to sell all chametz possessed by me, knowingly or unknowingly as defined by the Torah and Rabbinic Law (e.g. chametz, possible chametz, and all kinds of chametz mixtures). Also chametz that tends to harden and adhere to inside surfaces of pans, pots, or cooking utensils, the utensils themselves, and all kinds of live animals and pets that have been eating chametz and mixtures thereof.
                  Rabbi Mendel Lifshitz is also empowered to lease all places wherein the chametz owned by me may be found, particularly at the address/es listed below, and elsewhere. Rabbi Mendel Lifshitz has full right to appoint any agent or substitute in his stead and said substitute shall have full right to sell and lease as provided herein. Rabbi Mendel Lifshitz also has the full power and right to act as he deems fit and proper in accordance with all the details of the Bill of Sale used in the transaction to
                  sell all my chametz, chametz mixtures, etc., as provided herein. This power is in conformity with all Torah, Rabbinic and Civil laws.</span>
              </label></span><span class="clearfix"></span>
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                    <option value="Haiti"> Haiti </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="India"> India </option>
                    <option value="Indonesia"> Indonesia </option>
                    <option value="Iran"> Iran </option>
                    <option value="Iraq"> Iraq </option>
                    <option value="Ireland"> Ireland </option>
                    <option value="Israel"> Israel </option>
                    <option value="Italy"> Italy </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="North Korea"> North Korea </option>
                    <option value="South Korea"> South Korea </option>
                    <option value="Kosovo"> Kosovo </option>
                    <option value="Kuwait"> Kuwait </option>
                    <option value="Kyrgyzstan"> Kyrgyzstan </option>
                    <option value="Laos"> Laos </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="Macau"> Macau </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="Mayotte"> Mayotte </option>
                    <option value="Mexico"> Mexico </option>
                    <option value="Micronesia"> Micronesia </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="Myanmar"> Myanmar </option>
                    <option value="Namibia"> Namibia </option>
                    <option value="Nauru"> Nauru </option>
                    <option value="Nepal"> Nepal </option>
                    <option value="Netherlands"> Netherlands </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="Northern Mariana"> Northern Mariana </option>
                    <option value="Norway"> Norway </option>
                    <option value="Oman"> Oman </option>
                    <option value="Pakistan"> Pakistan </option>
                    <option value="Palau"> Palau </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 Islands"> Pitcairn Islands </option>
                    <option value="Poland"> Poland </option>
                    <option value="Portugal"> Portugal </option>
                    <option value="Puerto Rico"> Puerto Rico </option>
                    <option value="Qatar"> Qatar </option>
                    <option value="Romania"> Romania </option>
                    <option value="Russia"> Russia </option>
                    <option value="Rwanda"> Rwanda </option>
                    <option value="Saint Barthelemy"> Saint Barthelemy </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 Pierre and Miquelon"> Saint Pierre and Miquelon </option>
                    <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </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="Slovakia"> Slovakia </option>
                    <option value="Slovenia"> Slovenia </option>
                    <option value="Solomon Islands"> Solomon Islands </option>
                    <option value="Somalia"> Somalia </option>
                    <option value="Somaliland"> Somaliland </option>
                    <option value="South Africa"> South Africa </option>
                    <option value="South Ossetia"> South Ossetia </option>
                    <option value="Spain"> Spain </option>
                    <option value="Sri Lanka"> Sri Lanka </option>
                    <option value="Sudan"> Sudan </option>
                    <option value="Suriname"> Suriname </option>
                    <option value="Svalbard"> Svalbard </option>
                    <option value="Sweden"> Sweden </option>
                    <option value="Switzerland"> Switzerland </option>
                    <option value="Syria"> Syria </option>
                    <option value="Taiwan"> Taiwan </option>
                    <option value="Tajikistan"> Tajikistan </option>
                    <option value="Tanzania"> Tanzania </option>
                    <option value="Thailand"> Thailand </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="Tristan da Cunha"> Tristan da Cunha </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="United Arab Emirates"> United Arab Emirates </option>
                    <option value="United Kingdom"> United Kingdom </option>
                    <option value="Uruguay"> Uruguay </option>
                    <option value="Uzbekistan"> Uzbekistan </option>
                    <option value="Vanuatu"> Vanuatu </option>
                    <option value="Vatican City"> Vatican City </option>
                    <option value="Venezuela"> Venezuela </option>
                    <option value="Vietnam"> Vietnam </option>
                    <option value="British Virgin Islands"> British Virgin Islands </option>
                    <option value="US Virgin Islands"> US Virgin Islands </option>
                    <option value="Wallis and Futuna"> Wallis and Futuna </option>
                    <option value="Western Sahara"> Western Sahara </option>
                    <option value="Yemen"> Yemen </option>
                    <option value="Zambia"> Zambia </option>
                    <option value="Zimbabwe"> Zimbabwe </option>
                    <option value="other"> Other </option>
                  </select>
                  <label class="form-sub-label" for="input_5_country" id="sublabel_5_country"> Country </label></span>
              </td>
            </tr>
          </tbody></table>
        </div>
      </li>
      <li class="form-line" id="id_7">
        <div class="form-label-left" id="label_7">
          <label for="input_7"> Business Address </label>
          <label class="label-message" for="input_7"> If different than home </label>
        </div>
        <div id="cid_7" class="form-input">
          <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0">
            <tbody><tr>
              <td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q7_address7[addr_line1]" id="input_7_addr_line1" size="46" />
                  <label class="form-sub-label" for="input_7_addr_line1" id="sublabel_7_addr_line1"> Street Address </label></span>
              </td>
            </tr>
            <tr>
              <td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q7_address7[addr_line2]" id="input_7_addr_line2" size="46" />
                  <label class="form-sub-label" for="input_7_addr_line2" id="sublabel_7_addr_line2"> Street Address Line 2 </label></span>
              </td>
            </tr>
            <tr>
              <td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q7_address7[city]" id="input_7_city" size="21" />
                  <label class="form-sub-label" for="input_7_city" id="sublabel_7_city"> City </label></span>
              </td>
              <td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q7_address7[state]" id="input_7_state" size="22" />
                  <label class="form-sub-label" for="input_7_state" id="sublabel_7_state"> State / Province </label></span>
              </td>
            </tr>
            <tr>
              <td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q7_address7[postal]" id="input_7_postal" size="10" />
                  <label class="form-sub-label" for="input_7_postal" id="sublabel_7_postal"> Postal / Zip Code </label></span>
              </td>
              <td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q7_address7[country]" id="input_7_country">
                    <option value="" selected="selected"> Please Select </option>
                    <option value="United States"> United States </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="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="The Bahamas"> The Bahamas </option>
                    <option value="Bahrain"> Bahrain </option>
                    <option value="Bangladesh"> Bangladesh </option>
                    <option value="Barbados"> Barbados </option>
                    <option value="Belarus"> Belarus </option>
                    <option value="Belgium"> Belgium </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="Bosnia and Herzegovina"> Bosnia and Herzegovina </option>
                    <option value="Botswana"> Botswana </option>
                    <option value="Brazil"> Brazil </option>
                    <option value="Brunei"> Brunei </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="Canada"> Canada </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="People's Republic of China"> People's Republic of China </option>
                    <option value="Republic of China"> Republic of 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="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="Cuba"> Cuba </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="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="Eswatini"> Eswatini </option>
                    <option value="Ethiopia"> Ethiopia </option>
                    <option value="Falkland Islands"> Falkland Islands </option>
                    <option value="Faroe Islands"> Faroe Islands </option>
                    <option value="Fiji"> Fiji </option>
                    <option value="Finland"> Finland </option>
                    <option value="France"> France </option>
                    <option value="French Polynesia"> French Polynesia </option>
                    <option value="Gabon"> Gabon </option>
                    <option value="The Gambia"> The 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="Honduras"> Honduras </option>
                    <option value="Hong Kong"> Hong Kong </option>
                    <option value="Hungary"> Hungary </option>
                    <option value="Iceland"> Iceland </option>
                    <option value="India"> India </option>
                    <option value="Indonesia"> Indonesia </option>
                    <option value="Iran"> Iran </option>
                    <option value="Iraq"> Iraq </option>
                    <option value="Ireland"> Ireland </option>
                    <option value="Israel"> Israel </option>
                    <option value="Italy"> Italy </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="North Korea"> North Korea </option>
                    <option value="South Korea"> South Korea </option>
                    <option value="Kosovo"> Kosovo </option>
                    <option value="Kuwait"> Kuwait </option>
                    <option value="Kyrgyzstan"> Kyrgyzstan </option>
                    <option value="Laos"> Laos </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="Macau"> Macau </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="Mayotte"> Mayotte </option>
                    <option value="Mexico"> Mexico </option>
                    <option value="Micronesia"> Micronesia </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="Myanmar"> Myanmar </option>
                    <option value="Namibia"> Namibia </option>
                    <option value="Nauru"> Nauru </option>
                    <option value="Nepal"> Nepal </option>
                    <option value="Netherlands"> Netherlands </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="Northern Mariana"> Northern Mariana </option>
                    <option value="Norway"> Norway </option>
                    <option value="Oman"> Oman </option>
                    <option value="Pakistan"> Pakistan </option>
                    <option value="Palau"> Palau </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 Islands"> Pitcairn Islands </option>
                    <option value="Poland"> Poland </option>
                    <option value="Portugal"> Portugal </option>
                    <option value="Puerto Rico"> Puerto Rico </option>
                    <option value="Qatar"> Qatar </option>
                    <option value="Romania"> Romania </option>
                    <option value="Russia"> Russia </option>
                    <option value="Rwanda"> Rwanda </option>
                    <option value="Saint Barthelemy"> Saint Barthelemy </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 Pierre and Miquelon"> Saint Pierre and Miquelon </option>
                    <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </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="Slovakia"> Slovakia </option>
                    <option value="Slovenia"> Slovenia </option>
                    <option value="Solomon Islands"> Solomon Islands </option>
                    <option value="Somalia"> Somalia </option>
                    <option value="Somaliland"> Somaliland </option>
                    <option value="South Africa"> South Africa </option>
                    <option value="South Ossetia"> South Ossetia </option>
                    <option value="Spain"> Spain </option>
                    <option value="Sri Lanka"> Sri Lanka </option>
                    <option value="Sudan"> Sudan </option>
                    <option value="Suriname"> Suriname </option>
                    <option value="Svalbard"> Svalbard </option>
                    <option value="Sweden"> Sweden </option>
                    <option value="Switzerland"> Switzerland </option>
                    <option value="Syria"> Syria </option>
                    <option value="Taiwan"> Taiwan </option>
                    <option value="Tajikistan"> Tajikistan </option>
                    <option value="Tanzania"> Tanzania </option>
                    <option value="Thailand"> Thailand </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="Tristan da Cunha"> Tristan da Cunha </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="United Arab Emirates"> United Arab Emirates </option>
                    <option value="United Kingdom"> United Kingdom </option>
                    <option value="Uruguay"> Uruguay </option>
                    <option value="Uzbekistan"> Uzbekistan </option>
                    <option value="Vanuatu"> Vanuatu </option>
                    <option value="Vatican City"> Vatican City </option>
                    <option value="Venezuela"> Venezuela </option>
                    <option value="Vietnam"> Vietnam </option>
                    <option value="British Virgin Islands"> British Virgin Islands </option>
                    <option value="US Virgin Islands"> US Virgin Islands </option>
                    <option value="Wallis and Futuna"> Wallis and Futuna </option>
                    <option value="Western Sahara"> Western Sahara </option>
                    <option value="Yemen"> Yemen </option>
                    <option value="Zambia"> Zambia </option>
                    <option value="Zimbabwe"> Zimbabwe </option>
                    <option value="other"> Other </option>
                  </select>
                  <label class="form-sub-label" for="input_7_country" id="sublabel_7_country"> Country </label></span>
              </td>
            </tr>
          </tbody></table>
        </div>
      </li>
      <li class="form-line" id="id_17">
        <div class="form-label-left" id="label_17">
          <label for="input_17">
            Signature<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_17">  </label>
        </div>
        <div id="cid_17" class="form-input">
          <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_17" name="q17_input17" size="20" value="" />
        </div>
      </li>
      <li class="form-line" id="id_8">
        <div class="form-label-left" id="label_8">
          <label for="input_8">
            Submission Date<span class="form-required">*</span>
          </label>
          <label class="label-message" for="input_8">  </label>
        </div>
        <div id="cid_8" class="form-input">
          <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required]" id="month_8" name="q8_input8[month]" type="tel" size="2" maxlength="2" value="02" />
              <label class="form-sub-label" for="month_8" id="sublabel_month"> Month </label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" id="day_8" name="q8_input8[day]" type="tel" size="2" maxlength="2" value="28" />
              <label class="form-sub-label" for="day_8" id="sublabel_day"> Day </label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" id="year_8" name="q8_input8[year]" type="tel" size="4" maxlength="4" value="2021" />
              <label class="form-sub-label" for="year_8" id="sublabel_year"> Year </label></span>
          </div><span class="dir_ltr inline_block" style="white-space: nowrap;"><span class="form-sub-label-container"><span id="at_8" class="form-control-static">at</span>
              <label class="form-sub-label" for="at_8"><span> </span>
              </label></span><span class="form-sub-label-container"><select class="form-dropdown validate[required]" id="hour_8" name="q8_input8[hour]">
                <option>  </option>
                <option value="1"> 1 </option>
                <option value="2"> 2 </option>
                <option value="3"> 3 </option>
                <option value="4"> 4 </option>
                <option value="5"> 5 </option>
                <option value="6"> 6 </option>
                <option value="7"> 7 </option>
                <option value="8"> 8 </option>
                <option value="9"> 9 </option>
                <option value="10"> 10 </option>
                <option selected="selected" value="11"> 11 </option>
                <option value="12"> 12 </option>
              </select>
              <label class="form-sub-label" for="hour_8" id="sublabel_hour"> Hour </label></span><span class="form-sub-label-container"><select class="form-dropdown validate[required]" id="min_8" name="q8_input8[min]">
                <option>  </option>
                <option value="00"> 00 </option>
                <option value="10"> 10 </option>
                <option value="20"> 20 </option>
                <option selected="selected" value="30"> 30 </option>
                <option value="40"> 40 </option>
                <option value="50"> 50 </option>
              </select>
              <label class="form-sub-label" for="min_8" id="sublabel_minutes"> Minutes </label></span><span class="form-sub-label-container"><div class="dir_ltr">
                <select class="form-dropdown validate[required]" id="ampm_8" name="q8_input8[ampm]">
                  <option value="AM"> AM </option>
                  <option selected="selected" value="PM"> PM </option>
                </select>
              </div>
              <label class="form-sub-label" for="ampm_8"><span> </span>
              </label></span></span><span class="form-sub-label-container"><img class="showAutoCalendar" alt="Pick a Date" id="input_8_pick" src="https://w2.chabad.org/images/sitecontrol/formbuilder/calendar.png" align="absmiddle" />
            <label class="form-sub-label" for="input_8_pick"><span> </span>
            </label></span>
        </div>
      </li>
      <li class="form-line" id="id_15">
        <div class="form-label-left" id="label_15">
          <label for="input_15"> Optional Donation </label>
          <label class="label-message" for="input_15">  </label>
        </div>
        <div id="cid_15" class="form-input">
          <div class="form-multiple-column"><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_0" name="q15_input15" value="18.00" />
              <label for="input_15_0"><span>$18.00</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_1" name="q15_input15" value="36.00" />
              <label for="input_15_1"><span>$36.00</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_15_2" name="q15_input15" value="50.00" />
              <label for="input_15_2"><span>$50.00</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_3" name="q15_input15" value="100.00" />
              <label for="input_15_3"><span>$100.00</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_15_4" name="q15_input15" value="180.00" />
              <label for="input_15_4"><span>$180.00</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item"><input type="radio" class="form-radio" id="input_15_5" name="q15_input15" value="360.00" />
              <label for="input_15_5"><span>$360.00</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_15_6" name="q15_input15" value="500.00" />
              <label for="input_15_6"><span>$500.00</span>
              </label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio" name="q15_input15" id="other_15" value="" /><span><input type="number" min="1" class="form-radio-other-input form-textbox" onkeypress="validateNumber(event)" name="q15_input15[other]" data-otherhint="Other" size="15" id="input_15" disabled="disabled" /></span>
              <br /></span>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_16">
        <div class="form-label-left form-label-hidden" id="label_16">
        </div>
        <div id="cid_16" class="form-input">
          <div class="form-single-column form-checkbox-item">
            <input type="checkbox" id="input_16" class="form-checkbox" name="q16_paymentrecurrence" value="Monthly" />
            <label id="label_16" for="input_16"> Yes, I'd like to make this a monthly recurring payment. </label>
            <div class="clearfix">
            </div>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_21">
        <div class="form-label-left" id="label_21">
          <label for="input_21"> Total </label>
        </div>
        <div id="cid_21" class="form-input">
          <div id="total_amount">
            $0.00
          </div>
          <div class="form-single-column form-checkbox-item" id="div_offset_gift_21" style="padding-top: 10px">
            <input type="checkbox" id="input_21" class="form-checkbox" name="q21_offsetGiftPercent" value="3" />
            <label id="label_21" for="input_21"> Yes, I'd like to donate the cost of processing this transaction by adding 3% </label>
            <input type="hidden" id="hidden_21" name="q21_offsetGiftAmount" />
            <div class="clearfix">
            </div>
          </div>
        </div>
      </li>
      <li class="form-line" id="id_14">
        <div class="form-label-left" id="label_14">
          <label for="input_14"> Payment </label>
          <label class="label-message" for="input_14">  </label>
        </div>
        <div id="cid_14" class="form-input">
          <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0">
            <tbody><tr>
              <td colspan="2" class="form-payment-methods form-multiple-column"><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_14_creditCard" name="q14_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" />
                  <label for="input_14_creditCard"> Credit Card </label>
                   </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_14_paypal" name="q14_payment[payment_method]" value="paypal" onclick="BuildSource.paypal(this)" />
                  <label for="input_14_paypal"> Paypal </label>
                   </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_14_other" name="q14_payment[payment_method]" value="other" onclick="BuildSource.other(this)" />
                  <label for="input_14_other"> Check </label>
                   </span>
              </td>
            </tr>
            <tr class="credit_card hide">
              <th colspan="2">
                Credit Card
              </th>
            </tr>
            <tr class="credit_card hide">
              <td colspan="2" style="padding:0">
                <table cellpadding="0" cellspacing="0">
                  <tbody><tr>
                    <td colspan="2"><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q14_payment[cc_type]" id="input_14_cc_type">
                          <option value="Visa"> Visa </option>
                          <option value="Mastercard"> MasterCard </option>
                          <option value="Amex"> American Express </option>
                          <option value="Discover"> Discover </option>
                        </select>
                        <label class="form-sub-label" for="input_14_cc_type" id="sublabel_cc_type"> Credit Card Type </label></span>
                    </td>
                  </tr>
                  <tr>
                    <td><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q14_payment[cc_number]" id="input_14_cc_number" size="20" autocomplete="off" />
                        <label class="form-sub-label" for="input_14_cc_number" id="sublabel_cc_number"> Credit Card Number </label></span>
                    </td>
                    <td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q14_payment[cc_ccv]" id="input_14_cc_ccv" size="6" autocomplete="off" />
                        <label class="form-sub-label" for="input_14_cc_ccv" id="sublabel_cc_ccv"> Security Code </label></span>
                    </td>
                  </tr>
                  <tr>
                    <td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q14_payment[cc_nameOnCard]" id="input_14_cc_nameOnCard" size="33" autocomplete="off" />
                        <label class="form-sub-label" for="input_14_cc_nameOnCard" id="sublabel_cc_nameOnCard"> Name on Card </label></span>
                    </td>
                  </tr>
                  <tr class="credit_card hide">
                    <td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q14_payment[cc_exp_month]" id="input_14_cc_exp_month">
                          <option>  </option>
                          <option value="1"> 1 - January </option>
                          <option value="2"> 2 - February </option>
                          <option value="3"> 3 - March </option>
                          <option value="4"> 4 - April </option>
                          <option value="5"> 5 - May </option>
                          <option value="6"> 6 - June </option>
                          <option value="7"> 7 - July </option>
                          <option value="8"> 8 - August </option>
                          <option value="9"> 9 - September </option>
                          <option value="10"> 10 - October </option>
                          <option value="11"> 11 - November </option>
                          <option value="12"> 12 - December </option>
                        </select>
                        <label class="form-sub-label" for="input_14_cc_exp_month" id="sublabel_cc_exp_month"> Expiration Month </label></span>
                    </td>
                    <td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q14_payment[cc_exp_year]" id="input_14_cc_exp_year">
                          <option>  </option>
                          <option value="2021"> 2021 </option>
                          <option value="2022"> 2022 </option>
                          <option value="2023"> 2023 </option>
                          <option value="2024"> 2024 </option>
                          <option value="2025"> 2025 </option>
                          <option value="2026"> 2026 </option>
                          <option value="2027"> 2027 </option>
                          <option value="2028"> 2028 </option>
                          <option value="2029"> 2029 </option>
                          <option value="2030"> 2030 </option>
                        </select>
                        <label class="form-sub-label" for="input_14_cc_exp_year" id="sublabel_cc_exp_year"> Expiration Year </label></span>
                    </td>
                  </tr>
                </tbody></table>
              </td>
            </tr>
            <tr class="paypal hide">
              <td colspan="2">
                Paypal has been selected. Payment will take place on the next page.
              </td>
            </tr>
            <tr class="other hide">
              <td colspan="2">
                I will mail a check to Chabad at 1803 S. Maple Grove Rd, Boise, ID 83709
              </td>
            </tr>
            <tr class="billing_address hide">
              <th colspan="2">
                Billing Address
              </th>
            </tr>
            <tr class="billing_address hide">
              <td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q14_payment[addr_line1]" id="input_14_addr_line1" />
                  <label class="form-sub-label" for="input_14_addr_line1" id="sublabel_14_addr_line1"> Street Address </label></span>
              </td>
            </tr>
            <tr class="billing_address hide">
              <td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q14_payment[addr_line2]" id="input_14_addr_line2" size="46" />
                  <label class="form-sub-label" for="input_14_addr_line2" id="sublabel_14_addr_line2"> Street Address Line 2 </label></span>
              </td>
            </tr>
            <tr class="billing_address hide">
              <td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q14_payment[city]" id="input_14_city" />
                  <label class="form-sub-label" for="input_14_city" id="sublabel_14_city"> City </label></span>
              </td>
              <td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q14_payment[state]" id="input_14_state" />
                  <label class="form-sub-label" for="input_14_state" id="sublabel_14_state"> State / Province </label></span>
              </td>
            </tr>
            <tr class="billing_address hide">
              <td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q14_payment[postal]" id="input_14_postal" size="10" />
                  <label class="form-sub-label" for="input_14_postal" id="sublabel_14_postal"> Postal / Zip Code </label></span>
              </td>
              <td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q14_payment[country]" id="input_14_country">
                    <option value="" selected="selected"> Please Select </option>
                    <option value="United States"> United States </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="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="The Bahamas"> The Bahamas </option>
                    <option value="Bahrain"> Bahrain </option>
                    <option value="Bangladesh"> Bangladesh </option>
                    <option value="Barbados"> Barbados </option>
                    <option value="Belarus"> Belarus </option>
                    <option value="Belgium"> Belgium </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="Bosnia and Herzegovina"> Bosnia and Herzegovina </option>
                    <option value="Botswana"> Botswana </option>
                    <option value="Brazil"> Brazil </option>
                    <option value="Brunei"> Brunei </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="Canada"> Canada </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="People's Republic of China"> People's Republic of China </option>
                    <option value="Republic of China"> Republic of 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="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="Cuba"> Cuba </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="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="Eswatini"> Eswatini </option>
                    <option value="Ethiopia"> Ethiopia </option>
                    <option value="Falkland Islands"> Falkland Islands </option>
                    <option value="Faroe Islands"> Faroe Islands </option>
                    <option value="Fiji"> Fiji </option>
                    <option value="Finland"> Finland </option>
                    <option value="France"> France </option>
                    <option value="French Polynesia"> French Polynesia </option>
                    <option value="Gabon"> Gabon </option>
                    <option value="The Gambia"> The 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="Honduras"> Honduras </option>
                    <option value="Hong Kong"> Hong Kong </option>
                    <option value="Hungary"> Hungary </option>
                    <option value="Iceland"> Iceland </option>
                    <option value="India"> India </option>
                    <option value="Indonesia"> Indonesia </option>
                    <option value="Iran"> Iran </option>
                    <option value="Iraq"> Iraq </option>
                    <option value="Ireland"> Ireland </option>
                    <option value="Israel"> Israel </option>
                    <option value="Italy"> Italy </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="North Korea"> North Korea </option>
                    <option value="South Korea"> South Korea </option>
                    <option value="Kosovo"> Kosovo </option>
                    <option value="Kuwait"> Kuwait </option>
                    <option value="Kyrgyzstan"> Kyrgyzstan </option>
                    <option value="Laos"> Laos </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="Macau"> Macau </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="Mayotte"> Mayotte </option>
                    <option value="Mexico"> Mexico </option>
                    <option value="Micronesia"> Micronesia </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="Myanmar"> Myanmar </option>
                    <option value="Namibia"> Namibia </option>
                    <option value="Nauru"> Nauru </option>
                    <option value="Nepal"> Nepal </option>
                    <option value="Netherlands"> Netherlands </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="Northern Mariana"> Northern Mariana </option>
                    <option value="Norway"> Norway </option>
                    <option value="Oman"> Oman </option>
                    <option value="Pakistan"> Pakistan </option>
                    <option value="Palau"> Palau </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 Islands"> Pitcairn Islands </option>
                    <option value="Poland"> Poland </option>
                    <option value="Portugal"> Portugal </option>
                    <option value="Puerto Rico"> Puerto Rico </option>
                    <option value="Qatar"> Qatar </option>
                    <option value="Romania"> Romania </option>
                    <option value="Russia"> Russia </option>
                    <option value="Rwanda"> Rwanda </option>
                    <option value="Saint Barthelemy"> Saint Barthelemy </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 Pierre and Miquelon"> Saint Pierre and Miquelon </option>
                    <option value="Saint Vincent and the Grenadines"> Saint Vincent and the Grenadines </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="Slovakia"> Slovakia </option>
                    <option value="Slovenia"> Slovenia </option>
                    <option value="Solomon Islands"> Solomon Islands </option>
                    <option value="Somalia"> Somalia </option>
                    <option value="Somaliland"> Somaliland </option>
                    <option value="South Africa"> South Africa </option>
                    <option value="South Ossetia"> South Ossetia </option>
                    <option value="Spain"> Spain </option>
                    <option value="Sri Lanka"> Sri Lanka </option>
                    <option value="Sudan"> Sudan </option>
                    <option value="Suriname"> Suriname </option>
                    <option value="Svalbard"> Svalbard </option>
                    <option value="Sweden"> Sweden </option>
                    <option value="Switzerland"> Switzerland </option>
                    <option value="Syria"> Syria </option>
                    <option value="Taiwan"> Taiwan </option>
                    <option value="Tajikistan"> Tajikistan </option>
                    <option value="Tanzania"> Tanzania </option>
                    <option value="Thailand"> Thailand </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="Tristan da Cunha"> Tristan da Cunha </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="United Arab Emirates"> United Arab Emirates </option>
                    <option value="United Kingdom"> United Kingdom </option>
                    <option value="Uruguay"> Uruguay </option>
                    <option value="Uzbekistan"> Uzbekistan </option>
                    <option value="Vanuatu"> Vanuatu </option>
                    <option value="Vatican City"> Vatican City </option>
                    <option value="Venezuela"> Venezuela </option>
                    <option value="Vietnam"> Vietnam </option>
                    <option value="British Virgin Islands"> British Virgin Islands </option>
                    <option value="US Virgin Islands"> US Virgin Islands </option>
                    <option value="Wallis and Futuna"> Wallis and Futuna </option>
                    <option value="Western Sahara"> Western Sahara </option>
                    <option value="Yemen"> Yemen </option>
                    <option value="Zambia"> Zambia </option>
                    <option value="Zimbabwe"> Zimbabwe </option>
                    <option value="other"> Other </option>
                  </select>
                  <label class="form-sub-label" for="input_14_country" id="sublabel_14_country"> Country </label></span>
              </td>
          </tr></tbody></table>
        </div>
      </li>
      <li class="form-line" id="id_20">
        <div id="cid_20" class="form-input-wide">
          <div id="text_20" class="form-html">
            <p><span style="font-size: 20px;"><strong><span style="color: rgb(255, 0, 0);">Forms must be submitted no later than 10:00 PM on March 24, 2021.</span>
                </strong></span>
            </p>
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