<!doctype html public "-//W3C//DTD HTML 4.01 Transitional//EN">
<html dir="LTR" lang="en">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<title>osCommerce</title>
<base >
<link rel="stylesheet" type="text/css" href="stylesheet.css">
<script language="javascript"><!--
var form = "";
var submitted = false;
var error = false;
var error_message = "";

function check_input(field_name, field_size, message) {
  if (form.elements[field_name] && (form.elements[field_name].type != "hidden")) {
    var field_value = form.elements[field_name].value;

    if (field_value == '' || field_value.length < field_size) {
      error_message = error_message + "* " + message + "\n";
      error = true;
    }
  }
}

function check_radio(field_name, message) {
  var isChecked = false;

  if (form.elements[field_name] && (form.elements[field_name].type != "hidden")) {
    var radio = form.elements[field_name];

    for (var i=0; i<radio.length; i++) {
      if (radio[i].checked == true) {
        isChecked = true;
        break;
      }
    }

    if (isChecked == false) {
      error_message = error_message + "* " + message + "\n";
      error = true;
    }
  }
}

function check_select(field_name, field_default, message) {
  if (form.elements[field_name] && (form.elements[field_name].type != "hidden")) {
    var field_value = form.elements[field_name].value;

    if (field_value == field_default) {
      error_message = error_message + "* " + message + "\n";
      error = true;
    }
  }
}

function check_password(field_name_1, field_name_2, field_size, message_1, message_2) {
  if (form.elements[field_name_1] && (form.elements[field_name_1].type != "hidden")) {
    var password = form.elements[field_name_1].value;
    var confirmation = form.elements[field_name_2].value;

    if (password == '' || password.length < field_size) {
      error_message = error_message + "* " + message_1 + "\n";
      error = true;
    } else if (password != confirmation) {
      error_message = error_message + "* " + message_2 + "\n";
      error = true;
    }
  }
}

function check_password_new(field_name_1, field_name_2, field_name_3, field_size, message_1, message_2, message_3) {
  if (form.elements[field_name_1] && (form.elements[field_name_1].type != "hidden")) {
    var password_current = form.elements[field_name_1].value;
    var password_new = form.elements[field_name_2].value;
    var password_confirmation = form.elements[field_name_3].value;

    if (password_current == '' || password_current.length < field_size) {
      error_message = error_message + "* " + message_1 + "\n";
      error = true;
    } else if (password_new == '' || password_new.length < field_size) {
      error_message = error_message + "* " + message_2 + "\n";
      error = true;
    } else if (password_new != password_confirmation) {
      error_message = error_message + "* " + message_3 + "\n";
      error = true;
    }
  }
}

function check_form(form_name) {
  if (submitted == true) {
    alert("This form has already been submitted. Please press Ok and wait for this process to be completed.");
    return false;
  }

  error = false;
  form = form_name;
  error_message = "Errors have occured during the process of your form.\n\nPlease make the following corrections:\n\n";

  check_radio("gender", "Please select your Gender.");

  check_input("firstname", 2, "Your First Name must contain a minimum of 2 characters.");
  check_input("lastname", 2, "Your Last Name must contain a minimum of 2 characters.");

  check_input("dob", 10, "Your Date of Birth must be in this format: MM/DD/YYYY (eg 05/21/1970)");

  check_input("email_address", 6, "Your E-Mail Address must contain a minimum of 6 characters.");
  check_input("street_address", 5, "Your Street Address must contain a minimum of 5 characters.");
  check_input("postcode", 4, "Your Post Code must contain a minimum of 4 characters.");
  check_input("city", 3, "Your City must contain a minimum of 3 characters.");

  check_input("state", 2, "Your State must contain a minimum of 2 characters.");

  check_select("country", "", "You must select a country from the Countries pull down menu.");

  check_input("telephone", 3, "Your Telephone Number must contain a minimum of 3 characters.");

  check_password("password", "confirmation", 5, "Your Password must contain a minimum of 5 characters.", "The Password Confirmation must match your Password.");
  check_password_new("password_current", "password_new", "password_confirmation", 5, "Your Password must contain a minimum of 5 characters.", "Your new Password must contain a minimum of 5 characters.", "The Password Confirmation must match your new Password.");

  if (error == true) {
    alert(error_message);
    return false;
  } else {
    submitted = true;
    return true;
  }
}
//--></script>
</head>
<body marginwidth="0" marginheight="0" topmargin="0" bottommargin="0" leftmargin="0" rightmargin="0">
<!-- header //-->
<!--

              


<table cellspacing=0 cellpadding=0 width=177 align=center> <form name="manufacturers" action="http://osc.template-help.com/9785/index.php" method="get"> <tr><td colspan=2><b>Search by manufacturers:</b></td></tr>
                <tr><td height=2 colspan=2></td></tr>
                <tr><td colspan=2>
           <select name="manufacturers_id" onChange="this.form.submit();" size="1" class=se1><option value="13">Crucial</option><option value="14">Ebokers</option><option value="10">Mecca</option><option value="12">React</option><option value="11">Sky</option></select><input type="hidden" name="osCsid" value="161f914f87e643a51bb08e98dfdb4896"> </td>
          </form>
         </table>
           

-->








  <table cellspacing=0 cellpadding=0 width=720 height=100% align=center>
   <tr><td valign=top>
    <table cellspacing=0 cellpadding=0 width=720 border=0>
     <tr><td height=14></td></tr>
     <tr><td width=50 height=101></td>
     <td><a href=index.php><img src=images/m01.gif width=191 height=101 border=0></a></td>
     <td><img src=images/m02.gif></td>
     <td width=143 height=101 background=images/m03.gif valign=top>
      <table cellspacing=0 cellpadding=0 width=123 align=center>
       <tr><td height=7></td></tr>
       <tr><td valign=top> &nbsp; <a href=specials.php class=ml1>SPECIALS</a></td></tr>
       <tr><td height=2></td></tr>
       <tr><td width=123 height=1 background=images/m05.gif></td></tr>
       <tr><td height=2></td></tr>
       <tr><td valign=top> &nbsp; <a href=advanced_search.php class=ml1>SEARCH</a></td></tr>
       <tr><td height=2></td></tr>
       <tr><td width=123 height=1 background=images/m05.gif></td></tr>
       <tr><td height=2></td></tr>
       <tr><td valign=top> &nbsp; <a href=contact_us.php class=ml1>CONTACT US</a></td></tr>
       <tr><td height=2></td></tr>
       <tr><td width=123 height=1 background=images/m05.gif></td></tr>
       <tr><td height=2></td></tr>
       <tr><td valign=top> &nbsp; <a href=create_account.php class=ml1>CREATE AN ACCOUNT</a></td></tr>
       <tr><td height=2></td></tr>
       <tr><td width=123 height=1 background=images/m05.gif></td></tr>
       <tr><td height=2></td></tr>
       <tr><td valign=top> &nbsp; <a href=login.php class=ml1>CUSTOMER LOGIN</a></td></tr>
      </table>
     </td>
     <td width=1></td>
     <td width=183 height=101 background=images/m04.jpg valign=top>
      <table cellspacing=0 cellpadding=0 border=0>
       <tr><td height=15></td></tr>
       <tr><td colspan=2 class=ch1>SHOPPING CART</td></tr>
       <tr><td colspan=2 height=1></td></tr>
       <tr><td valign=top width=115 height=70>
        <table cellspacing=0 cellpadding=0>
         <tr><td></td></tr>
     <tr><td class=ch9>now in your cart</td></tr>
        <tr><td height=8></td></tr>
        <tr><td class=ch1><a class=ml2  href=shopping_cart.php>0 <span class=ch17> item</span></a></td></tr>
   
        </table>
       </td>
       <td height=70 valig=bottom><a href=shopping_cart.php><img src=images/m45.jpg width=56 height=62 border=0></a></td>
       </tr>
      </table>
     </td></tr>
     <tr><td colspan=6 valig=top>
      <table cellspacing=0 cellpadding=0 width=720 border=0>
       <tr><td width=50><img src=images/m06.jpg width=50 height=181></td>
        <td width=191><img src=images/m07.jpg width=191 height=181 border=0></td>
        <td><img src=images/m08.jpg width=228 height=181></td>
        <td><img src=images/m09.jpg width=251 height=181></td></tr>
      </table>
     </td></tr>
     <tr><td width=720 colspan=6 valign=top>
      <table cellspacing=0 cellpadding=0>
       <tr><td valign=top><img src=images/m10.gif width=42 height=35></td>
       <td><a href=index.php><img src=images/b01.gif width=88 height=35 border=0></a></td>
       <td><a href=products_new.php><img src=images/b02.gif width=148 height=35 border=0></a></td>
       <td><a href=account.php><img src=images/b03.gif width=130 height=35 border=0></a></td>
       <td><a href=shopping_cart.php><img src=images/b04.gif width=149 height=35 border=0></a></td>
       <td><a href=checkout_shipping.php><img src=images/b05.gif width=122 height=35 border=0</a></td>
       <td><img src=images/m11.gif width=41 height=35></td></tr>
      </table>
     </td></tr>
     <tr><td colspan=6><img src=images/m12.gif width=720 height=7></td></tr>
     <tr><td colspan=6 height=5></td></tr>
    </table>
    <table cellspacing=0 cellpadding=0 width=720 border=0>
     <tr><td width=220 valign=top>
      <table cellspacing=0 cellpadding=0 align=center>
       <tr><td width=220 height=59 background=images/m13.gif >
        <table cellspacing=0 cellpadding=0 width=197 align=center>
         <tr>
         <td valign=top>
          <table cellspacing=0 cellpadding=0>
           <tr><td class=ch2 width=95>Choose language:</td></tr>
           <tr><td height=6></td></tr>
           <tr><td>

 <a href="create_account.php@language=en"><img src="includes/languages/english/images/icon.gif" border="0" alt="English" title=" English " width="21" height="13"></a> &nbsp;<img src=images/m15.gif width=1 height=13>&nbsp; <a href="create_account.php@language=de"><img src="includes/languages/german/images/icon.gif" border="0" alt="Deutsch" title=" Deutsch " width="21" height="13"></a> &nbsp;<img src=images/m15.gif width=1 height=13>&nbsp; <a href="create_account.php@language=es"><img src="includes/languages/espanol/images/icon.gif" border="0" alt="Espaņol" title=" Espaņol " width="21" height="13"></a>      

           </td></tr>
          </table></td>
         <td width=15></td>
         <td valign=top>
          <table cellspacing=0 cellpadding=0>
           <tr><td class=ch2>Currensies:</td></tr>
           <tr><td height=3></td></tr>
           <tr><td>
<form name="currencies" action="http://osc.template-help.com/9785/create_account.php" method="get"><select name="currency" onChange="this.form.submit(); " style="width:80px; font-size: 9px" ><option value="USD" SELECTED>US Dollar</option><option value="EUR">Euro</option></select><input type="hidden" name="osCsid" value="161f914f87e643a51bb08e98dfdb4896"></form>               

           </td></tr>
          </table>
         </td></tr>
         <tr><td colspan=2 height=7></td></tr>
         <tr><td></td>
         <td width=15></td>
         </tr>
        </table>
       </td></tr>
       <tr><td height=3></td></tr>
       <tr><td><img src=images/m18.gif width=220 height=5></td></tr>
       <tr><td height=3 bgcolor=#3F6E0F></td></tr>






<tr><td width=220 bgcolor=#3F6E0F class=ch3>&nbsp; <img src=images/m21.gif width=5 height=5 align=absmiddle>&nbsp;<a class=ch3  href=index.php@cPath=53>Gift Shopping</a></td></tr><tr><td height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr> <tr><td width=220 bgcolor=#3F6E0F> &nbsp;&nbsp; <img src=images/m20.gif width=4 height=4 align=absmiddle> &nbsp; <a class=ml3  href=index.php@cPath=53_46>Books and Media</a></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr> <tr><td width=220 bgcolor=#3F6E0F> &nbsp;&nbsp; <img src=images/m20.gif width=4 height=4 align=absmiddle> &nbsp; <a class=ml3  href=index.php@cPath=53_48>Foto & Frames</a></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr> <tr><td width=220 bgcolor=#3F6E0F> &nbsp;&nbsp; <img src=images/m20.gif width=4 height=4 align=absmiddle> &nbsp; <a class=ml3  href=index.php@cPath=53_49>Furniture and Lighting</a></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr> <tr><td width=220 bgcolor=#3F6E0F> &nbsp;&nbsp; <img src=images/m20.gif width=4 height=4 align=absmiddle> &nbsp; <a class=ml3  href=index.php@cPath=53_44>Home&Patio Furniture</a></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr> <tr><td width=220 bgcolor=#3F6E0F> &nbsp;&nbsp; <img src=images/m20.gif width=4 height=4 align=absmiddle> &nbsp; <a class=ml3  href=index.php@cPath=53_47>Kitchen and Tabletop</a></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 bgcolor=#3F6E0F class=ch3>&nbsp; <img src=images/m21.gif width=5 height=5 align=absmiddle>&nbsp;<a class=ch3  href=index.php@cPath=51>Presents For All</a></td></tr><tr><td height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr> <tr><td width=220 bgcolor=#3F6E0F> &nbsp;&nbsp; <img src=images/m20.gif width=4 height=4 align=absmiddle> &nbsp; <a class=ml3  href=index.php@cPath=51_45>Flowers</a></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr> <tr><td width=220 bgcolor=#3F6E0F> &nbsp;&nbsp; <img src=images/m20.gif width=4 height=4 align=absmiddle> &nbsp; <a class=ml3  href=index.php@cPath=51_50>Jewelry and Watches</a></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr><tr><td width=220 background=images/m19.gif></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr> <tr><td width=220 bgcolor=#3F6E0F> &nbsp;&nbsp; <img src=images/m20.gif width=4 height=4 align=absmiddle> &nbsp; <a class=ml3  href=index.php@cPath=51_52>Toys & Games</a></td></tr><tr><td width=220 height=2 bgcolor=#3F6E0F></td></tr>















       <tr><td><img src=images/m22.gif width=220 heigt=12></td></tr>
       <tr><td><a href=product_info.php@products_id=249><img src=images/m23.jpg width=220 height=96 border=0></a></td></tr>
      </table>
     </td>
     <td width=5></td>
     <td width=495 valign=top>
      <table cellspacing=0 cellpadding=0 width=495>
       <tr><td background=images/m24.gif width=495 height=29 valign=middle>


                       
              <table cellspacing=0 cellpadding=0 width=446 align=center>
               <form name="quick_find" action="http://osc.template-help.com/9785/advanced_search_result.php" method="get">               <tr><td width=80 class=ml4>SITE SEARCH</td>
               <td width=185 align=middle>
               <input type="text" name="keywords" size="20" maxlength="30" width=150  class=go>&nbsp;<input type="hidden" name="osCsid" value="161f914f87e643a51bb08e98dfdb4896"></td><td width=20><input type=image src=images/m25.gif align=middle></td>
               <td width=151 align=right><a href=advanced_search.php class=ml5>ADVANCED SEARCH</a></td></tr>
               </form>
              </table>



         


       </td></tr>
       <tr><td height=1></td></tr>
     </table>




<!-- header_eof //-->

<!-- body //-->
<table border="0" width="100%" cellspacing="0" cellpadding="0">
  <tr>
<!-- body_text //-->
    <td width="100%" valign="top"><form name="create_account" action="http://osc.template-help.com/9785/create_account.php" method="post" onSubmit="return check_form(create_account);"><input type="hidden" name="action" value="process"><table border="0" width="100%" cellspacing="0" cellpadding="0">
      <tr>
        <td><table border="0" width="100%" cellspacing="0" cellpadding="0">
          <tr>
            <td class="pageHeading">My Account Information</td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><img src="images/pixel_trans.gif" border="0" alt="" width="100%" height="10"></td>
      </tr>
      <tr>
        <td class="smallText"><br><font color="#FF0000"><small><b>NOTE:</b></font></small> If you already have an account with us, please login at the <a href="login.php"><u>login page</u></a>.</td>
      </tr>
      <tr>
        <td><img src="images/pixel_trans.gif" border="0" alt="" width="100%" height="10"></td>
      </tr>
      <tr>
        <td><table border="0" width="100%" cellspacing="0" cellpadding="2">
          <tr>
            <td class="main"><b>Your Personal Details</b></td>
           <td class="inputRequirement" align="right">* Required information</td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
          <tr class="infoBoxContents">
            <td><table border="0" cellspacing="2" cellpadding="2">
              <tr>
                <td class="main">Gender:</td>
                <td class="main"><input type="radio" name="gender" value="m">&nbsp;&nbsp;Male&nbsp;&nbsp;<input type="radio" name="gender" value="f">&nbsp;&nbsp;Female&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
              <tr>
                <td class="main">First Name:</td>
                <td class="main"><input type="text" name="firstname">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
              <tr>
                <td class="main">Last Name:</td>
                <td class="main"><input type="text" name="lastname">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
              <tr>
                <td class="main">Date of Birth:</td>
                <td class="main"><input type="text" name="dob">&nbsp;<span class="inputRequirement">* (eg. 05/21/1970)</span></td>
              </tr>
              <tr>
                <td class="main">E-Mail Address:</td>
                <td class="main"><input type="text" name="email_address">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
            </table></td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><img src="images/pixel_trans.gif" border="0" alt="" width="100%" height="10"></td>
      </tr>
      <tr>
        <td class="main"><b>Company Details</b></td>
      </tr>
      <tr>
        <td><table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
          <tr class="infoBoxContents">
            <td><table border="0" cellspacing="2" cellpadding="2">
              <tr>
                <td class="main">Company Name:</td>
                <td class="main"><input type="text" name="company">&nbsp;</td>
              </tr>
            </table></td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><img src="images/pixel_trans.gif" border="0" alt="" width="100%" height="10"></td>
      </tr>
      <tr>
        <td class="main"><b>Your Address</b></td>
      </tr>
      <tr>
        <td><table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
          <tr class="infoBoxContents">
            <td><table border="0" cellspacing="2" cellpadding="2">
              <tr>
                <td class="main">Street Address:</td>
                <td class="main"><input type="text" name="street_address">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
              <tr>
                <td class="main">Suburb:</td>
                <td class="main"><input type="text" name="suburb">&nbsp;</td>
              </tr>
              <tr>
                <td class="main">Post Code:</td>
                <td class="main"><input type="text" name="postcode">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
              <tr>
                <td class="main">City:</td>
                <td class="main"><input type="text" name="city">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
              <tr>
                <td class="main">State/Province:</td>
                <td class="main">
<input type="text" name="state">&nbsp;<span class="inputRequirement">*                </td>
              </tr>
              <tr>
                <td class="main">Country:</td>
                <td class="main"><select name="country"><option value="" SELECTED>Please Select</option><option value="1">Afghanistan</option><option value="2">Albania</option><option value="3">Algeria</option><option value="4">American Samoa</option><option value="5">Andorra</option><option value="6">Angola</option><option value="7">Anguilla</option><option value="8">Antarctica</option><option value="9">Antigua and Barbuda</option><option value="10">Argentina</option><option value="11">Armenia</option><option value="12">Aruba</option><option value="13">Australia</option><option value="14">Austria</option><option value="15">Azerbaijan</option><option value="16">Bahamas</option><option value="17">Bahrain</option><option value="18">Bangladesh</option><option value="19">Barbados</option><option value="20">Belarus</option><option value="21">Belgium</option><option value="22">Belize</option><option value="23">Benin</option><option value="24">Bermuda</option><option value="25">Bhutan</option><option value="26">Bolivia</option><option value="27">Bosnia and Herzegowina</option><option value="28">Botswana</option><option value="29">Bouvet Island</option><option value="30">Brazil</option><option value="31">British Indian Ocean Territory</option><option value="32">Brunei Darussalam</option><option value="33">Bulgaria</option><option value="34">Burkina Faso</option><option value="35">Burundi</option><option value="36">Cambodia</option><option value="37">Cameroon</option><option value="38">Canada</option><option value="39">Cape Verde</option><option value="40">Cayman Islands</option><option value="41">Central African Republic</option><option value="42">Chad</option><option value="43">Chile</option><option value="44">China</option><option value="45">Christmas Island</option><option value="46">Cocos (Keeling) Islands</option><option value="47">Colombia</option><option value="48">Comoros</option><option value="49">Congo</option><option value="50">Cook Islands</option><option value="51">Costa Rica</option><option value="52">Cote D&#039;Ivoire</option><option value="53">Croatia</option><option value="54">Cuba</option><option value="55">Cyprus</option><option value="56">Czech Republic</option><option value="57">Denmark</option><option value="58">Djibouti</option><option value="59">Dominica</option><option value="60">Dominican Republic</option><option value="61">East Timor</option><option value="62">Ecuador</option><option value="63">Egypt</option><option value="64">El Salvador</option><option value="65">Equatorial Guinea</option><option value="66">Eritrea</option><option value="67">Estonia</option><option value="68">Ethiopia</option><option value="69">Falkland Islands (Malvinas)</option><option value="70">Faroe Islands</option><option value="71">Fiji</option><option value="72">Finland</option><option value="73">France</option><option value="74">France, Metropolitan</option><option value="75">French Guiana</option><option value="76">French Polynesia</option><option value="77">French Southern Territories</option><option value="78">Gabon</option><option value="79">Gambia</option><option value="80">Georgia</option><option value="81">Germany</option><option value="82">Ghana</option><option value="83">Gibraltar</option><option value="84">Greece</option><option value="85">Greenland</option><option value="86">Grenada</option><option value="87">Guadeloupe</option><option value="88">Guam</option><option value="89">Guatemala</option><option value="90">Guinea</option><option value="91">Guinea-bissau</option><option value="92">Guyana</option><option value="93">Haiti</option><option value="94">Heard and Mc Donald Islands</option><option value="95">Honduras</option><option value="96">Hong Kong</option><option value="97">Hungary</option><option value="98">Iceland</option><option value="99">India</option><option value="100">Indonesia</option><option value="101">Iran (Islamic Republic of)</option><option value="102">Iraq</option><option value="103">Ireland</option><option value="104">Israel</option><option value="105">Italy</option><option value="106">Jamaica</option><option value="107">Japan</option><option value="108">Jordan</option><option value="109">Kazakhstan</option><option value="110">Kenya</option><option value="111">Kiribati</option><option value="112">Korea, Democratic People&#039;s Republic of</option><option value="113">Korea, Republic of</option><option value="114">Kuwait</option><option value="115">Kyrgyzstan</option><option value="116">Lao People&#039;s Democratic Republic</option><option value="117">Latvia</option><option value="118">Lebanon</option><option value="119">Lesotho</option><option value="120">Liberia</option><option value="121">Libyan Arab Jamahiriya</option><option value="122">Liechtenstein</option><option value="123">Lithuania</option><option value="124">Luxembourg</option><option value="125">Macau</option><option value="126">Macedonia, The Former Yugoslav Republic of</option><option value="127">Madagascar</option><option value="128">Malawi</option><option value="129">Malaysia</option><option value="130">Maldives</option><option value="131">Mali</option><option value="132">Malta</option><option value="133">Marshall Islands</option><option value="134">Martinique</option><option value="135">Mauritania</option><option value="136">Mauritius</option><option value="137">Mayotte</option><option value="138">Mexico</option><option value="139">Micronesia, Federated States of</option><option value="140">Moldova, Republic of</option><option value="141">Monaco</option><option value="142">Mongolia</option><option value="143">Montserrat</option><option value="144">Morocco</option><option value="145">Mozambique</option><option value="146">Myanmar</option><option value="147">Namibia</option><option value="148">Nauru</option><option value="149">Nepal</option><option value="150">Netherlands</option><option value="151">Netherlands Antilles</option><option value="152">New Caledonia</option><option value="153">New Zealand</option><option value="154">Nicaragua</option><option value="155">Niger</option><option value="156">Nigeria</option><option value="157">Niue</option><option value="158">Norfolk Island</option><option value="159">Northern Mariana Islands</option><option value="160">Norway</option><option value="161">Oman</option><option value="162">Pakistan</option><option value="163">Palau</option><option value="164">Panama</option><option value="165">Papua New Guinea</option><option value="166">Paraguay</option><option value="167">Peru</option><option value="168">Philippines</option><option value="169">Pitcairn</option><option value="170">Poland</option><option value="171">Portugal</option><option value="172">Puerto Rico</option><option value="173">Qatar</option><option value="174">Reunion</option><option value="175">Romania</option><option value="176">Russian Federation</option><option value="177">Rwanda</option><option value="178">Saint Kitts and Nevis</option><option value="179">Saint Lucia</option><option value="180">Saint Vincent and the Grenadines</option><option value="181">Samoa</option><option value="182">San Marino</option><option value="183">Sao Tome and Principe</option><option value="184">Saudi Arabia</option><option value="185">Senegal</option><option value="186">Seychelles</option><option value="187">Sierra Leone</option><option value="188">Singapore</option><option value="189">Slovakia (Slovak Republic)</option><option value="190">Slovenia</option><option value="191">Solomon Islands</option><option value="192">Somalia</option><option value="193">South Africa</option><option value="194">South Georgia and the South Sandwich Islands</option><option value="195">Spain</option><option value="196">Sri Lanka</option><option value="197">St. Helena</option><option value="198">St. Pierre and Miquelon</option><option value="199">Sudan</option><option value="200">Suriname</option><option value="201">Svalbard and Jan Mayen Islands</option><option value="202">Swaziland</option><option value="203">Sweden</option><option value="204">Switzerland</option><option value="205">Syrian Arab Republic</option><option value="206">Taiwan</option><option value="207">Tajikistan</option><option value="208">Tanzania, United Republic of</option><option value="209">Thailand</option><option value="210">Togo</option><option value="211">Tokelau</option><option value="212">Tonga</option><option value="213">Trinidad and Tobago</option><option value="214">Tunisia</option><option value="215">Turkey</option><option value="216">Turkmenistan</option><option value="217">Turks and Caicos Islands</option><option value="218">Tuvalu</option><option value="219">Uganda</option><option value="220">Ukraine</option><option value="221">United Arab Emirates</option><option value="222">United Kingdom</option><option value="223">United States</option><option value="224">United States Minor Outlying Islands</option><option value="225">Uruguay</option><option value="226">Uzbekistan</option><option value="227">Vanuatu</option><option value="228">Vatican City State (Holy See)</option><option value="229">Venezuela</option><option value="230">Viet Nam</option><option value="231">Virgin Islands (British)</option><option value="232">Virgin Islands (U.S.)</option><option value="233">Wallis and Futuna Islands</option><option value="234">Western Sahara</option><option value="235">Yemen</option><option value="236">Yugoslavia</option><option value="237">Zaire</option><option value="238">Zambia</option><option value="239">Zimbabwe</option></select>&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
            </table></td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><img src="images/pixel_trans.gif" border="0" alt="" width="100%" height="10"></td>
      </tr>
      <tr>
        <td class="main"><b>Your Contact Information</b></td>
      </tr>
      <tr>
        <td><table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
          <tr class="infoBoxContents">
            <td><table border="0" cellspacing="2" cellpadding="2">
              <tr>
                <td class="main">Telephone Number:</td>
                <td class="main"><input type="text" name="telephone">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
              <tr>
                <td class="main">Fax Number:</td>
                <td class="main"><input type="text" name="fax">&nbsp;</td>
              </tr>
            </table></td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><img src="images/pixel_trans.gif" border="0" alt="" width="100%" height="10"></td>
      </tr>
      <tr>
        <td class="main"><b>Options</b></td>
      </tr>
      <tr>
        <td><table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
          <tr class="infoBoxContents">
            <td><table border="0" cellspacing="2" cellpadding="2">
              <tr>
                <td class="main">Newsletter:</td>
                <td class="main"><input type="checkbox" name="newsletter" value="1">&nbsp;</td>
              </tr>
            </table></td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><img src="images/pixel_trans.gif" border="0" alt="" width="100%" height="10"></td>
      </tr>
      <tr>
        <td class="main"><b>Your Password</b></td>
      </tr>
      <tr>
        <td><table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
          <tr class="infoBoxContents">
            <td><table border="0" cellspacing="2" cellpadding="2">
              <tr>
                <td class="main">Password:</td>
                <td class="main"><input type="password" name="password" maxlength="40">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
              <tr>
                <td class="main">Password Confirmation:</td>
                <td class="main"><input type="password" name="confirmation" maxlength="40">&nbsp;<span class="inputRequirement">*</span></td>
              </tr>
            </table></td>
          </tr>
        </table></td>
      </tr>
      <tr>
        <td><img src="images/pixel_trans.gif" border="0" alt="" width="100%" height="10"></td>
      </tr>
      <tr>
        <td><table border="0" width="100%" cellspacing="1" cellpadding="2" class="infoBox">
          <tr class="infoBoxContents">
            <td><table border="0" width="100%" cellspacing="0" cellpadding="2">
              <tr>
                <td width="10"><img src="images/pixel_trans.gif" border="0" alt="" width="10" height="1"></td>
                <td><input type="image" src="includes/languages/english/images/buttons/button_continue.gif" border="0" alt="Continue" title=" Continue "></td>
                <td width="10"><img src="images/pixel_trans.gif" border="0" alt="" width="10" height="1"></td>
              </tr>
            </table></td>
          </tr>
        </table></td>
      </tr>
    </table></form></td>
<!-- body_text_eof //-->
  </tr>
</table>
<!-- body_eof //-->

<!-- footer //-->


     </td></tr>
    </table>
   </td></tr>
   <tr><td valign=bottom>
    <table cellspacing=0 cellpadding=0 width=720>
     <tr><td height=1></td></tr>
     <tr><td align=center><img src=images/m39.gif></td>
     <td width=5></td>
     <td background=images/m40.gif width=495 height=46 class=ch7> &nbsp;  &nbsp; &nbsp; Copyright &copy; 2005 Company Name <a class=ch7 href=../../oscommerce.com/default.htm target=_blank><b>Powered by osCommerce<b></a></td>
     </tr>
     <tr><td height=22></td></tr>
    </table>
   </td></tr>
  </table>



   </td></tr>
   <tr><td height=22></td></tr>
  </table>






<!-- footer_eof //-->
</body>
</html>
