[text* your-name class:form-control placeholder "Name"]
[select* country class:form-control "United Kingdom" "United States" "Canada" "Mexico" "-----"
"Afghanistan" "Albania" "Algeria" "American Samoa" "Andorra" "Angola" "Anguilla" "Antigua and
Barbuda" "Argentina" "Armenia" "Armenia" "Aruba" "Australia" "Austria" "Azerbaijan" "Azerbaijan"
"Bahamas" "Bahrain" "Bangladesh" "Barbados" "Belarus" "Belgium" "Belize" "Benin" "Bermuda" "Bhutan"
"Bolivia" "Bonaire" "Bosnia and Herzegovina" "Botswana" "Bouvet Island (Bouvetoya)" "Brazil"
"British Indian Ocean Territory (Chagos Archipelago)" "British Virgin Islands" "Brunei Darussalam"
"Bulgaria" "Burkina Faso" "Burundi" "Cambodia" "Cameroon" "Cape Verde" "Cayman Islands" "Central
African Republic" "Chad" "Chile" "China" "Christmas Island" "Cocos (Keeling) Islands" "Colombia"
"Comoros" "Congo" "Congo" "Cook Islands" "Costa Rica" "Cote d'Ivoire" "Croatia" "Cuba" "Curaçao"
"Cyprus" "Cyprus" "Czech Republic" "Denmark" "Djibouti" "Dominica" "Dominican Republic" "Ecuador"
"Egypt" "El Salvador" "Equatorial Guinea" "Eritrea" "Estonia" "Ethiopia" "Falkland Islands
(Malvinas)" "Faroe Islands" "Fiji" "Finland" "France" "French Guiana" "French Polynesia" "French
Southern Territories" "Gabon" "Gambia" "Georgia" "Germany" "Ghana" "Gibraltar" "Greece" "Greenland"
"Grenada" "Guadeloupe" "Guam" "Guatemala" "Guernsey" "Guinea" "Guinea-Bissau" "Guyana" "Haiti"
"Heard Island and McDonald Islands" "Holy See (Vatican City State)" "Honduras" "Hong Kong" "Hungary"
"Iceland" "India" "Indonesia" "Iran" "Iraq" "Ireland" "Isle of Man" "Israel" "Italy" "Jamaica"
"Japan" "Jersey" "Jordan" "Kazakhstan" "Kazakhstan" "Kenya" "Kiribati" "Korea" "Korea" "Kuwait"
"Kyrgyz Republic" "Lao People's Democratic Republic" "Latvia" "Lebanon" "Lesotho" "Liberia" "Libyan
Arab Jamahiriya" "Liechtenstein" "Lithuania" "Luxembourg" "Macao" "Macedonia" "Madagascar" "Malawi"
"Malaysia" "Maldives" "Mali" "Malta" "Marshall Islands" "Martinique" "Mauritania" "Mauritius"
"Mayotte" "Micronesia" "Moldova" "Monaco" "Mongolia" "Montenegro" "Montserrat" "Morocco"
"Mozambique" "Myanmar" "Namibia" "Nauru" "Nepal" "Netherlands" "Netherlands Antilles" "New
Caledonia" "New Zealand" "Nicaragua" "Niger" "Nigeria" "Niue" "Norfolk Island" "Northern Mariana
Islands" "Norway" "Oman" "Pakistan" "Palau" "Palestinian Territory" "Panama" "Papua New Guinea"
"Paraguay" "Peru" "Philippines" "Pitcairn Islands" "Poland" "Portugal" "Puerto Rico" "Qatar"
"Reunion" "Romania" "Russian Federation" "Rwanda" "Saint Barthelemy" "Saint Helena" "Saint Kitts and
Nevis" "Saint Lucia" "Saint Martin" "Saint Pierre and Miquelon" "Saint Vincent and the Grenadines"
"Samoa" "San Marino" "Sao Tome and Principe" "Saudi Arabia" "Senegal" "Serbia" "Seychelles" "Sierra
Leone" "Singapore" "Sint Maarten (Netherlands)" "Slovakia (Slovak Republic)" "Slovenia" "Solomon
Islands" "Somalia" "South Africa" "South Georgia & S. Sandwich Islands" "Spain" "Sri Lanka" "Sudan"
"Suriname" "Svalbard & Jan Mayen Islands" "Swaziland" "Sweden" "Switzerland" "Syrian Arab Republic"
"Taiwan" "Tajikistan" "Tanzania" "Thailand" "Timor-Leste" "Togo" "Tokelau" "Tonga" "Trinidad and
Tobago" "Tunisia" "Turkey" "Turkey" "Turkmenistan" "Turks and Caicos Islands" "Tuvalu" "U.S. Virgin
Islands" "U.S. Minor Outlying Islands" "Uganda" "Ukraine" "United Arab Emirates" "Uruguay"
"Uzbekistan" "Vanuatu" "Venezuela" "Vietnam" "Wallis and Futuna" "Western Sahara" "Yemen" "Zambia"
"Zimbabwe"]
[text* your-email class:form-control placeholder "Email"]
[text* your-company class:form-control placeholder "Company / Organisation"]
[select* Howdidyoufindus class:form-control first_as_label "How did you find us?" "Google" "Bing" "Word
of mouth"]
[text* your-tel class:form-control placeholder "Telephone"]
[textarea your-message class:form-control placeholder "Additional comments"]
[checkbox* RequestDemo use_label_element class:checkbox "Request a demonstration/sample."]
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