resources/1230000692/widget-forms/12300006921599264958.php<div class="wrapper" style="font-family: Arial; font-size: 13px; background-color: rgb(154, 169, 173); border: 1px solid rgb(236, 236, 236); border-radius: 5px; margin: 10px auto; padding: 1%; width: 95%; display: table;">
  <div class="form-header" style="padding: 2% 1%; background-color: rgb(255, 199, 69);">
   <h1 style="color:#909090;font-size:22px;font-weight:normal;margin:0;padding:0;cursor:pointer;" id="h1" class="h1 editable" title=" Click To Edit" onclick="window.parent.Editable('h1')">Signup</h1>
 </div>
 <div class="message" style="color: blue;font-size: 14px;text-transform: capitalize;display:none"> here</div>
 <fieldset class="signup-form" style="padding: 1%; border: none; background-color: rgb(240, 240, 240);">
   <h3 style="font-size:18px;margin:10px 0 0;cursor:pointer;" class="headline h2 editable" id="h2" title=" Click To Edit" onclick="window.parent.Editable('h2')">1914 translation by H. Rackham</h3>
   <p style="font-size:14px;margin:10px 0 0;cursor:pointer;" class="headline h3 editable" id="h3" title=" Click To Edit" onclick="window.parent.Editable('h3')">Lorem Ipsum</p>
   <ul class="" style="float: left;margin:0;width: 100%; list-style:none; padding:0">
     <!--<form  action="#">-->
     <li style="width: 100%; float: left; margin: 10px 0px 0px;" class="field first_name">
      <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 150px;">First Name:<i class="valid first_name1" style="color: rgb(255, 0, 0);"> *</i></label>
      <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="first_name" placeholder="First name" class="input-fields" id="first_name" onclick="window.parent.EditablePlaceholder('first_name')">
    </li>
    <li style="width: 100%; float: left; margin: 10px 0px 0px;" class="field last_name">
      <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 150px;">Last Name:<i class="valid last_name1" style="color: rgb(255, 0, 0);"> *</i></label>
      <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="last_name" placeholder="Last name" class="input-fields" id="last_name" onclick="window.parent.EditablePlaceholder('last_name')">
    </li>
    <li style="width: 100%; float: left; margin: 10px 0px 0px;" class="field email">
      <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 150px;">Email:<i class="valid email1" style="color: rgb(255, 0, 0); display: none;"> *</i></label>
      <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="email" name="email" placeholder="Enter email" class="input-fields" required="" id="email" onclick="window.parent.EditablePlaceholder('email')">
    </li>
    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field phone">
      <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 100%;">Landline Number:<i class="valid phone1" style="color: rgb(255, 0, 0); display: none;"> *</i></label>
      <select name="country_hplead_phonecode" class="input-fields country_code" select-group="first" style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 0px 2%; width: 20%;">
       <option value="+1" selected="selected">(+1)</option>
       <option value="+61">(+61)</option>
       <option value="+44">(+44)</option>
       <option value="+64">(+64)</option>
     </select>
     <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 70%;" type="text" name="phone" placeholder="Landline Number" class="input-fields" required="" maxlength="10" id="phone_number" onclick="window.parent.EditablePlaceholder('phone_number')">
   </li>
   <li style="width: 100%; float: left; margin: 10px 0px 0px;" class="field mobile">
    <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 100%;">Mobile Number:<i class="valid mobile1" style="color: rgb(255, 0, 0); display: inline;"> *</i></label>
    <select name="country_hplead_mobilecode" class="input-fields country_code" select-group="first" style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 0px 2%; width: 20%;">
     <option value="+1" selected="selected">(+1)</option>
     <option value="+61">(+61)</option>
     <option value="+44">(+44)</option>
     <option value="+64">(+64)</option>
   </select>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 70%;" type="text" name="mobile" placeholder="Mobile Number" class="input-fields" maxlength="10" id="mobile_number" onclick="window.parent.EditablePlaceholder('mobile_number')">
  </li>
  <li style="width: 100%; float: left; margin: 10px 0px 0px;" class="field company">
    <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 150px;">Company Name:<i class="valid company1" style="color: rgb(255, 0, 0); display: inline;"> *</i></label>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="company" placeholder="Company Name" class="input-fields" id="company_name" onclick="window.parent.EditablePlaceholder('company_name')">
  </li>
  <li style="width: 100%; float: left; margin: 10px 0px 0px;" class="field website">
    <label style="color: rgb(15, 61, 189); float: left; font-weight: bold; width: 150px;">Website:<i class="valid website1" style="color: rgb(255, 0, 0); display: none;"> *</i></label>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="website" placeholder="Website" class="input-fields" id="website" onclick="window.parent.EditablePlaceholder('website')">
  </li>
  <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field address">
    <label style="color: rgb(15, 61, 189); float: left; font-weight: bold; width: 150px;">Address:<i class="valid address1" style="color:#FF0000; display:none"> *</i></label>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="address" placeholder="Address" class="input-fields" id="address" onclick="window.parent.EditablePlaceholder('address')">
  </li>
  <li style="width: 100%; float: left; margin: 10px 0px 0px;" class="field city">
    <label style="color: rgb(15, 61, 189); float: left; font-weight: bold; width: 150px;">City:<i class="valid city1" style="color: rgb(255, 0, 0);"> *</i></label>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="city" placeholder="City" class="input-fields" id="city" onclick="window.parent.EditablePlaceholder('city')">
  </li>
  <li style="width: 100%; float: left; margin: 10px 0px 0px;" class="field state">
    <label style="color: rgb(15, 61, 189); float: left; font-weight: bold; width: 150px;">State:<i class="valid state1" style="color: rgb(255, 0, 0);"> *</i></label>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="state" placeholder="State" class="input-fields" id="state" onclick="window.parent.EditablePlaceholder('state')">
  </li>
  <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field zip">
    <label style="color: rgb(15, 61, 189); float: left; font-weight: bold; width: 150px;">Zip Code:<i class="valid zip1" style="color:#FF0000; display:none"> *</i></label>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="zip" placeholder="Zip Code" class="input-fields" id="zip_code" onclick="window.parent.EditablePlaceholder('zip_code')">
  </li>

  <li style="width: 100%; float: left; margin: 10px 0px 0px; display: list-item;" class="field additional_Info">
    <label style="color: rgb(15, 61, 189); float: left; font-weight: bold; width: 100%;">Additional Information:<i class="valid additional_Info1" style="color: rgb(255, 0, 0);"> *</i></label>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="additional_Info" placeholder="Additional Information" class="input-fields" id="additional_info" onclick="window.parent.EditablePlaceholder('additional_info')">
  </li>
  <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field title">
    <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 150px;">Title:<i class="valid title1" style="color:#FF0000; display:none"> *</i></label>
    <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 90%;" type="text" name="title" placeholder="Title" class="input-fields" id="title" onclick="window.parent.EditablePlaceholder('title')">
  </li>
        <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field api_uid">
            <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 100%; position: static;">Api uid:<i class="api_uid1" style="color:#FF0000; display:none"> *</i></label>
                        <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 1%; width: 98%;" type="text" id="api_uid" name="custom[api_uid]" placeholder="api uid" class="input-fields" onclick="window.parent.EditablePlaceholder('api_uid')">
                      </li>
            <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field api_key">
            <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 100%; position: static;">Api key:<i class="api_key1" style="color:#FF0000; display:none"> *</i></label>
                        <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 1%; width: 98%;" type="text" id="api_key" name="custom[api_key]" placeholder="api key" class="input-fields" onclick="window.parent.EditablePlaceholder('api_key')">
                      </li>
            <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field deal_status">
            <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 100%; position: static;">Deal status:<i class="deal_status1" style="color:#FF0000; display:none"> *</i></label>
                        <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 1%; width: 98%;" type="text" id="deal_status" name="custom[deal_status]" placeholder="deal status" class="input-fields" onclick="window.parent.EditablePlaceholder('deal_status')">
                      </li>
            <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field email1">
            <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 100%; position: static;">Email1:<i class="email11" style="color:#FF0000; display:none"> *</i></label>
                          <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 1%; width: 98%;" type="text" id="email1" name="custom_fields[email1]" placeholder="Enter custom email" class="input-fields" onclick="window.parent.EditablePlaceholder('email1')">
                      </li>
            <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field phone1">
            <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 100%; position: static;">Phone1:<i class="phone11" style="color:#FF0000; display:none"> *</i></label>
                          <select name="country_hplead_phonecode" class="input-fields country_code" select-group="first" style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 0px 2%; width: 20%;">
               <option value="+1" selected="selected">(+1)</option>
               <option value="+61">(+61)</option>
               <option value="+44">(+44)</option>
               <option value="+64">(+64)</option>
             </select>
             <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 2%; width: 70%;" type="text" name="custom_fields_numbers[phone1]" placeholder="Landline without country code" class="input-fields" id="phone1" onclick="window.parent.EditablePlaceholder('phone1')">

                      </li>
            <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field mobile1">
            <label style="color: rgb(15, 61, 189); display: table; float: left; font-weight: bold; width: 100%; position: static;">Mobile1:<i class="mobile11" style="color:#FF0000; display:none"> *</i></label>
                          <select name="country_hplead_phonecode" class="input-fields country_code" select-group="first" style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 0px 2%; width: 20%;">
               <option value="+1" selected="selected">(+1)</option>
               <option value="+61">(+61)</option>
               <option value="+44">(+44)</option>
               <option value="+64">(+64)</option>
             </select>
             <input style="background-color: rgb(255, 255, 255); border: 1px solid rgb(213, 213, 213); border-radius: 4px; color: rgb(11, 16, 18); display: inline-block; height: 36px; margin: 5px 0px 0px; padding: 1%; width: 70%;" type="text" id="mobile1" name="custom_fields_numbers[mobile1]" placeholder="Mobile without country code" class="input-fields" onclick="window.parent.EditablePlaceholder('mobile1')">
                       </li>
        <li style="clear: both; width: 100%;"></li>
  <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none;" class="field payment">
   <span style="width:100%; margin-bottom:8px; float:left;font-family: Georgia;color: #505050;" class="description">
    <span class="descrp">
          </span>
    <strong>Amount:&nbsp;</strong>
    0.00$
  </span>
  <br>
  <span style="float: left; width: 100%; text-align: left;" class="inOff-btn">
   <img src="https://app.agencyelephant.com/glu/assests/hpimages/widget-img/" alt="Pay Now" style="cursor:pointer;height: 34px;" title="Pay Now" onclick="ThisHappen();" id="lead_formSubmit" class="payment-icon">
 </span>
</li>
<li style="width: 100%; text-align: left;" class="field buttonClass2">
 <input style="width: auto; color: rgb(15, 61, 189); cursor: pointer; margin: 31px 0px 0px; border-radius: 4px; padding: 1.6% 4%; border: 0px; height: auto; background-image: url(&quot;&quot;); background-position: center top; background-size: cover;" class="submit buttonClass" type="button" name="submit" id="lead_formSubmit" value="Submit" onclick="ThisHappen();">
</li>
<img src="https://app.agencyelephant.com/glu/assests/hpimages/widget-img/processingbar_blue_diagonal_sm_ani.gif" alt="submitting" style="display:none;" id="lead_formImage">
<!--</form>-->
</ul>
</fieldset>
</div>
<script type="text/javascript" src="http://code.jquery.com/jquery-1.7.1.min.js"></script>
<script type="text/javascript">
  $(document).ready(function(){
    $(".country_code").change(function(){
     var _value=$(this).val();
     var select_group=$(this).attr("select-group");
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