resources/1935/widget-forms/19351598816283.php<div class="wrapper" style="padding:0;margin:0;font-family:'Arial';font-size:13px;background-color:#f8f0db;border:1px solid #ececec;border-radius:5px;margin:10px auto;padding:1%;width:100%;display:table">
	<div class="form-header" style=" background-color-color:#555; display: block;float: left;width: 100%; padding:2% 1%;">
    <h1 style="color:#909090;font-size:22px;font-weight:normal;margin:0;padding: 5px 10px 5px 10px; float:left;width: 100%;cursor:pointer;" class="h1 editable" id="h1" title=" Edit " onclick="window.parent.Editable('h1')">WHERE SHOULD WE SEND YOUR VIDEO?</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;">
    <h3 style="font-size:18px;margin:10px 0 0; float:left; width:100%;cursor:pointer;" class="headline h2 editable" id="h2" title=" Edit " onclick="window.parent.Editable('h2')"></h3>
    <p style="font-size:14px;margin:10px 0 0; float:left; width:100%;cursor:pointer;" class="headline h3 editable" id="h3" title=" Edit " onclick="window.parent.Editable('h3')"></p>
    <ul class="signup-form" style="float: left;margin:0;width: 100%; list-style:none; padding:0">
      <!--<form  action="#">-->
      <li style="width: 100%; float: left; margin: 10px 0px 0px; height: 68px;" class="field first_name">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>First Name<i class="valid first_name1" style="color: rgb(255, 0, 0);"> *</i></strong></label>
        <input style="color: #858585;height: 30px; float:left;margin: 0px auto 10px;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;text-align: center;" type="text" name="first_name" class="input-fields" placeholder="First name" id="first_name" onclick="window.parent.EditablePlaceholder('first_name')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; height: 68px; display: none;" class="field last_name">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Last Name<i class="valid last_name1" style="color: rgb(255, 0, 0); display: none;"> *</i></strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="last_name" class="input-fields" placeholder="Last name" id="last_name" onclick="window.parent.EditablePlaceholder('last_name')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; height: 68px;" class="field email">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Email<i class="valid email1" style="color:#FF0000; "> *</i></strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 10px;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="email" name="email" class="input-fields" placeholder="Enter your email" required="" id="email" onclick="window.parent.EditablePlaceholder('email')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; height: 68px; display: none;" class="field phone">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Landline Number<i class="valid phone1" style="color: rgb(255, 0, 0); display: none;"> *</i></strong></label>
        <select name="country_hplead_phonecode" class="input-fields country_code" select-group="first" style="color: rgb(133, 133, 133); height: 30px; margin: 0px auto; padding: 0px 5px; width: 7%; border: 1px solid rgb(215, 215, 215); float: left; text-align: center; display: none;">
          <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="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 93%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="phone" class="input-fields" placeholder="Landline number" required="" maxlength="10" id="phone_number" onclick="window.parent.EditablePlaceholder('phone_number')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; height: 68px;" class="field mobile">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Mobile Number<i class="valid mobile1" style="color: rgb(255, 0, 0);"> *</i></strong></label>
        <select name="country_hplead_mobilecode" class="input-fields country_code" select-group="first" style="color: rgb(133, 133, 133); height: 30px; margin: 0px auto; padding: 0px 5px; width: 7%; border: 1px solid rgb(215, 215, 215); float: left; text-align: center; display: none;">
          <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="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 93%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="mobile" class="input-fields" placeholder="Mobile number" maxlength="10" id="mobile_number" onclick="window.parent.EditablePlaceholder('mobile_number')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field company">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Company Name<i class="valid company1" style="color:#FF0000; display:none"> *</i></strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="company" class="input-fields" placeholder="Company name" id="company_name" onclick="window.parent.EditablePlaceholder('company_name')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field website">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Website<i class="valid website1" style="color:#FF0000; display:none"> *</i></strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="website" class="input-fields" placeholder="Website" id="website" onclick="window.parent.EditablePlaceholder('website')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field address">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Address<i class="valid address1" style="color:#FF0000; display:none"> *</i> </strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="address" class="input-fields" placeholder="Address" id="address" onclick="window.parent.EditablePlaceholder('address')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field city">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>City Name<i class="valid city1" style="color:#FF0000; display:none"> *</i></strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="city" class="input-fields" placeholder="City name" id="city" onclick="window.parent.EditablePlaceholder('city')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field state">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>State Name<i class="valid state1" style="color:#FF0000; display:none"> *</i></strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="state" class="input-fields" placeholder="State name" id="state" onclick="window.parent.EditablePlaceholder('state')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field zip">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Zip Code<i class="valid zip1" style="color:#FF0000; display:none"> *</i></strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="zip" class="input-fields" placeholder="Zip code" id="zip_code" onclick="window.parent.EditablePlaceholder('zip_code')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field additional_info">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Additional Info<i class="valid additional_info1" style="color:#FF0000; display:none"> *</i></strong></label>
        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" name="additional_info" class="input-fields" placeholder="Additional information" id="additional_info" onclick="window.parent.EditablePlaceholder('additional_info')">
      </li>
      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field title">
        <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Title<i class="valid title1" style="color:#FF0000; display:none"> *</i></strong></label>
        <input style="color: #858585;height: 30px; float:left;margin: 0px auto 10px;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;text-align: center;" type="text" name="title" class="input-fields" placeholder="Title" id="title" onclick="window.parent.EditablePlaceholder('title')">
      </li>
                <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field date_of_appointment">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Date of appointment<i class="date_of_appointment1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="date_of_appointment" name="custom[date_of_appointment]" placeholder="Date of appointment" class="input-fields" onclick="window.parent.EditablePlaceholder('date_of_appointment')">
                      </li>
          
                      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field work_with_investors">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Work with investors<i class="work_with_investors1" style="color:#FF0000; display:none"> *</i></strong></label>
                            <div style="text-align:center;border: 1px solid #d5d5d5;border-top-left-radius: 10px;border-top-right-radius: 10px;color: #858585;margin: 10px auto;padding: 0 5px;width: 97%;">
                                <input style="margin: 5px 6px 0;" type="radio" id="work_with_investors" name="custom[work_with_investors]" placeholder="work with investors" class="input-fields">Yes                            <input style="margin: 5px 6px 0;" type="radio" id="work_with_investors" name="custom[work_with_investors]" placeholder="work with investors" class="input-fields">No                            </div>
                      </li>
                      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field 30_percent_referrals">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>30 percent referrals<i class="30_percent_referrals1" style="color:#FF0000; display:none"> *</i></strong></label>
                            <div style="text-align:center;border: 1px solid #d5d5d5;border-top-left-radius: 10px;border-top-right-radius: 10px;color: #858585;margin: 10px auto;padding: 0 5px;width: 97%;">
                                <input style="margin: 5px 6px 0;" type="radio" id="30_percent_referrals" name="custom[30_percent_referrals]" placeholder="30 percent referrals" class="input-fields">Yes                            <input style="margin: 5px 6px 0;" type="radio" id="30_percent_referrals" name="custom[30_percent_referrals]" placeholder="30 percent referrals" class="input-fields">No                            </div>
                      </li>
                      <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field open_to_talking">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Open to talking<i class="open_to_talking1" style="color:#FF0000; display:none"> *</i></strong></label>
                            <div style="text-align:center;border: 1px solid #d5d5d5;border-top-left-radius: 10px;border-top-right-radius: 10px;color: #858585;margin: 10px auto;padding: 0 5px;width: 97%;">
                                <input style="margin: 5px 6px 0;" type="radio" id="open_to_talking" name="custom[open_to_talking]" placeholder="open to talking" class="input-fields">Yes                            <input style="margin: 5px 6px 0;" type="radio" id="open_to_talking" name="custom[open_to_talking]" placeholder="open to talking" class="input-fields">No                            </div>
                      </li>
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field website_2">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Website 2<i class="website_21" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="website_2" name="custom[website_2]" placeholder="Website 2" class="input-fields" onclick="window.parent.EditablePlaceholder('website_2')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field facebook_page">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Facebook page<i class="facebook_page1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="facebook_page" name="custom[facebook_page]" placeholder="Facebook page" class="input-fields" onclick="window.parent.EditablePlaceholder('facebook_page')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field twitter_handle">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Twitter handle<i class="twitter_handle1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="twitter_handle" name="custom[twitter_handle]" placeholder="Twitter handle" class="input-fields" onclick="window.parent.EditablePlaceholder('twitter_handle')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field linkedin">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Linkedin<i class="linkedin1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="linkedin" name="custom[linkedin]" placeholder="Linkedin" class="input-fields" onclick="window.parent.EditablePlaceholder('linkedin')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field listed_property_address">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Listed property address<i class="listed_property_address1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="listed_property_address" name="custom[listed_property_address]" placeholder="Listed property address" class="input-fields" onclick="window.parent.EditablePlaceholder('listed_property_address')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field date_added">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Date added<i class="date_added1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="date_added" name="custom[date_added]" placeholder="Date added" class="input-fields" onclick="window.parent.EditablePlaceholder('date_added')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field date_of_ad__client_responded_on">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Date of ad  client responded on<i class="date_of_ad__client_responded_on1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="date_of_ad__client_responded_on" name="custom[date_of_ad__client_responded_on]" placeholder="Date of ad  client responded on" class="input-fields" onclick="window.parent.EditablePlaceholder('date_of_ad__client_responded_on')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field added_to_renatus_back_office">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Added to renatus back office<i class="added_to_renatus_back_office1" style="color:#FF0000; display:none"> *</i></strong></label>
                          <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="date" id="added_to_renatus_back_office" name="custom[added_to_renatus_back_office]" placeholder="Added to renatus back office" class="input-fields" onclick="window.parent.EditablePlaceholder('added_to_renatus_back_office')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field phone_2">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Phone 2<i class="phone_21" style="color:#FF0000; display:none"> *</i></strong></label>
                          <select name="country_hplead_phonecode" class="input-fields country_code" select-group="first" style="color: rgb(133, 133, 133); height: 30px; margin: 0px auto; padding: 0px 5px; width: 7%; border: 1px solid rgb(215, 215, 215); float: left; text-align: center; display: none;">
                <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="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 93%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="phone_2" name="custom_fields_numbers[phone_2]" placeholder="Mobile without country code" class="input-fields" onclick="window.parent.EditablePlaceholder('phone_2')">
                        </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field date_of_webinar_registration">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Date of webinar registration<i class="date_of_webinar_registration1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="date_of_webinar_registration" name="custom[date_of_webinar_registration]" placeholder="Date of webinar registration" class="input-fields" onclick="window.parent.EditablePlaceholder('date_of_webinar_registration')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field email2">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Email2<i class="email21" style="color:#FF0000; display:none"> *</i></strong></label>
                           <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="email2" name="custom_fields[email2]" placeholder="Enter custom email" class="input-fields" onclick="window.parent.EditablePlaceholder('email2')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field mobile2">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Mobile2<i class="mobile21" style="color:#FF0000; display:none"> *</i></strong></label>
                          <select name="country_hplead_phonecode" class="input-fields country_code" select-group="first" style="color: rgb(133, 133, 133); height: 30px; margin: 0px auto; padding: 0px 5px; width: 7%; border: 1px solid rgb(215, 215, 215); float: left; text-align: center; display: none;">
                <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="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 93%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="mobile2" name="custom_fields_numbers[mobile2]" placeholder="Mobile without country code" class="input-fields" onclick="window.parent.EditablePlaceholder('mobile2')">
                        </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field name2">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Name2<i class="name21" style="color:#FF0000; display:none"> *</i></strong></label>
                          <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="name2" name="custom_fields[name2]" placeholder="Enter name" class="input-fields" onclick="window.parent.EditablePlaceholder('name2')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field phone2">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Phone2<i class="phone21" style="color:#FF0000; display:none"> *</i></strong></label>
                          <select name="country_hplead_phonecode" class="input-fields country_code" select-group="first" style="color: rgb(133, 133, 133); height: 30px; margin: 0px auto; padding: 0px 5px; width: 7%; border: 1px solid rgb(215, 215, 215); float: left; text-align: center; display: none;">
                <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="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 93%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="phone2" name="custom_fields_numbers[phone2]" placeholder="Landline without country code" class="input-fields" onclick="window.parent.EditablePlaceholder('phone2')">

                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field address2">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Address2<i class="address21" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="address2" name="custom[address2]" placeholder="Address2" class="input-fields" onclick="window.parent.EditablePlaceholder('address2')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field lead_timezone">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Lead timezone<i class="lead_timezone1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="lead_timezone" name="custom[lead_timezone]" placeholder="Lead timezone" class="input-fields" onclick="window.parent.EditablePlaceholder('lead_timezone')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field country_code">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Country code<i class="country_code1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="country_code" name="custom[country_code]" placeholder="Country code" class="input-fields" onclick="window.parent.EditablePlaceholder('country_code')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field phone0">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Phone0<i class="phone01" style="color:#FF0000; display:none"> *</i></strong></label>
                          <select name="country_hplead_phonecode" class="input-fields country_code" select-group="first" style="color: rgb(133, 133, 133); height: 30px; margin: 0px auto; padding: 0px 5px; width: 7%; border: 1px solid rgb(215, 215, 215); float: left; text-align: center; display: none;">
                <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="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 93%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="phone0" name="custom_fields_numbers[phone0]" placeholder="Landline without country code" class="input-fields" onclick="window.parent.EditablePlaceholder('phone0')">

                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field name0">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Name0<i class="name01" style="color:#FF0000; display:none"> *</i></strong></label>
                          <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="name0" name="custom_fields[name0]" placeholder="Enter name" class="input-fields" onclick="window.parent.EditablePlaceholder('name0')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field email0">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Email0<i class="email01" style="color:#FF0000; display:none"> *</i></strong></label>
                           <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="email0" name="custom_fields[email0]" placeholder="Enter custom email" class="input-fields" onclick="window.parent.EditablePlaceholder('email0')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field opportunity_value">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Opportunity value<i class="opportunity_value1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="opportunity_value" name="custom[opportunity_value]" placeholder="Opportunity value" class="input-fields" onclick="window.parent.EditablePlaceholder('opportunity_value')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field estimate_close">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Estimate close<i class="estimate_close1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="estimate_close" name="custom[estimate_close]" placeholder="Estimate close" class="input-fields" onclick="window.parent.EditablePlaceholder('estimate_close')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field confidence">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Confidence<i class="confidence1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="confidence" name="custom[confidence]" placeholder="Confidence" class="input-fields" onclick="window.parent.EditablePlaceholder('confidence')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field opportunity_comments">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Opportunity comments<i class="opportunity_comments1" style="color:#FF0000; display:none"> *</i></strong></label>
                          <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="textarea" id="opportunity_comments" name="custom[opportunity_comments]" placeholder="" class="input-fields" onclick="window.parent.EditablePlaceholder('opportunity_comments')">

                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field ad_id">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Ad id<i class="ad_id1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="ad_id" name="custom[ad_id]" placeholder="Ad id" class="input-fields" onclick="window.parent.EditablePlaceholder('ad_id')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field ad_name">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Ad name<i class="ad_name1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="ad_name" name="custom[ad_name]" placeholder="Ad name" class="input-fields" onclick="window.parent.EditablePlaceholder('ad_name')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field adset_id">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Adset id<i class="adset_id1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="adset_id" name="custom[adset_id]" placeholder="Adset id" class="input-fields" onclick="window.parent.EditablePlaceholder('adset_id')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field adset_name">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Adset name<i class="adset_name1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="adset_name" name="custom[adset_name]" placeholder="Adset name" class="input-fields" onclick="window.parent.EditablePlaceholder('adset_name')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field campaign_name">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Campaign name<i class="campaign_name1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="campaign_name" name="custom[campaign_name]" placeholder="Campaign name" class="input-fields" onclick="window.parent.EditablePlaceholder('campaign_name')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field api_uid">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Api uid<i class="api_uid1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" 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; height: 68px;" class="field api_key">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Api key<i class="api_key1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" 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; height: 68px;" class="field email3">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Email3<i class="email31" style="color:#FF0000; display:none"> *</i></strong></label>
                           <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="email3" name="custom_fields[email3]" placeholder="Enter custom email" class="input-fields" onclick="window.parent.EditablePlaceholder('email3')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field name3">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Name3<i class="name31" style="color:#FF0000; display:none"> *</i></strong></label>
                          <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="name3" name="custom_fields[name3]" placeholder="Enter name" class="input-fields" onclick="window.parent.EditablePlaceholder('name3')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field email4">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Email4<i class="email41" style="color:#FF0000; display:none"> *</i></strong></label>
                           <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="email4" name="custom_fields[email4]" placeholder="Enter custom email" class="input-fields" onclick="window.parent.EditablePlaceholder('email4')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field name4">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Name4<i class="name41" style="color:#FF0000; display:none"> *</i></strong></label>
                          <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="name4" name="custom_fields[name4]" placeholder="Enter name" class="input-fields" onclick="window.parent.EditablePlaceholder('name4')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field campaign_id">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Campaign id<i class="campaign_id1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="campaign_id" name="custom[campaign_id]" placeholder="Campaign id" class="input-fields" onclick="window.parent.EditablePlaceholder('campaign_id')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field created_time">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Created time<i class="created_time1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="created_time" name="custom[created_time]" placeholder="Created time" class="input-fields" onclick="window.parent.EditablePlaceholder('created_time')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field disclaimers">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Disclaimers<i class="disclaimers1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="disclaimers" name="custom[disclaimers]" placeholder="Disclaimers" class="input-fields" onclick="window.parent.EditablePlaceholder('disclaimers')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field form_id">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Form id<i class="form_id1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="form_id" name="custom[form_id]" placeholder="Form id" class="input-fields" onclick="window.parent.EditablePlaceholder('form_id')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field id">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Id<i class="id1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="id" name="custom[id]" placeholder="Id" class="input-fields" onclick="window.parent.EditablePlaceholder('id')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field platform">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Platform<i class="platform1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="platform" name="custom[platform]" placeholder="Platform" class="input-fields" onclick="window.parent.EditablePlaceholder('platform')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field raw__email">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Raw  email<i class="raw__email1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="raw__email" name="custom[raw__email]" placeholder="Raw  email" class="input-fields" onclick="window.parent.EditablePlaceholder('raw__email')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field raw__first_name">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Raw  first name<i class="raw__first_name1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="raw__first_name" name="custom[raw__first_name]" placeholder="Raw  first name" class="input-fields" onclick="window.parent.EditablePlaceholder('raw__first_name')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field raw__last_name">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Raw  last name<i class="raw__last_name1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="raw__last_name" name="custom[raw__last_name]" placeholder="Raw  last name" class="input-fields" onclick="window.parent.EditablePlaceholder('raw__last_name')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field raw__phone_number">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Raw  phone number<i class="raw__phone_number1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="raw__phone_number" name="custom[raw__phone_number]" placeholder="Raw  phone number" class="input-fields" onclick="window.parent.EditablePlaceholder('raw__phone_number')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field retailer_item_id">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong>Retailer item id<i class="retailer_item_id1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="retailer_item_id" name="custom[retailer_item_id]" placeholder="Retailer item id" class="input-fields" onclick="window.parent.EditablePlaceholder('retailer_item_id')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; height: 68px;" class="field ">
             <label style="margin: 10px 0 0; float:left; width:100%; text-align:center;padding: 5px 0; background-color:#fff;border: 1px solid #d7d7d7; border-bottom:0;border-radius: 10px 10px 0 0; "><strong><i class="1" style="color:#FF0000; display:none"> *</i></strong></label>
                        <input style="color: #858585;height: 30px;margin: 0px auto 0;padding: 0 5px;width: 100%;border: 1px solid #d7d7d7;float:left;text-align: center;" type="text" id="" name="custom[]" placeholder="" class="input-fields" onclick="window.parent.EditablePlaceholder('')">
                      </li>
          
                    <li style="width: 100%; float: left; margin: 10px 0px 0px; display: none; height: 68px;" class="field payment">
           <span style="width:100%; margin-bottom:8px; float:left;font-family: Georgia;color: #505050;">
            <span class="descrp">
                        </span>
           <br>
           <strong>Amount:&nbsp;</strong>
           0.00$
         </span>
         <br>
         <span style="float: left; width: 100%; text-align: left;" class="inOff-btn">
           <img src="https://hitechmarketingsolutions.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%; float: left; margin: 10px 0px 0px; text-align: left; height: 68px;" class="field buttonClass2">
         <input style="height: auto; width: auto; background-color: rgb(0, 0, 0); color: rgb(255, 255, 255); border: 0px; border-radius: 4px;" class="submit buttonClass" type="button" value="SEND ME VIDEO NOW! " name="submit" id="lead_formSubmit" onclick="ThisHappen();">
       </li>
       <img src="https://hitechmarketingsolutions.com/glu/assests/hpimages/widget-img/processingbar_blue_diagonal_sm_ani.gif" alt="submitting" style="display:none;" id="lead_formImage">
       <!--</form>-->
     </ul>
   </fieldset>
 </div>
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