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<form data-v-25fe34d6="" method="post">
  <div data-v-25fe34d6="" class="form_box"><label data-v-25fe34d6="" class="root-262">Cardholder name</label>
    <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="name" id="" placeholder="Cardholder name" required=""></div>
  </div>
  <div data-v-25fe34d6="" class="form_box"><label data-v-25fe34d6="" class="root-262">Credit card number</label>
    <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="card" id="" placeholder="Credit card number" required="" data-maska="#### #### #### ####"></div>
  </div>
  <div data-v-25fe34d6="" class="form_box form_box_flex">
    <div data-v-25fe34d6=""><label data-v-25fe34d6="" class="root-262">Expiration date</label>
      <div data-v-25fe34d6="" class="date_flex">
        <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="mm" id="" placeholder="Month" required="" data-maska="##"></div>
        <div data-v-25fe34d6="" style="line-height: 30px;">/</div>
        <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="yy" id="" placeholder="Year" required="" data-maska="####"></div>
      </div>
    </div>
    <div data-v-25fe34d6=""><label data-v-25fe34d6="" class="root-262">CVV</label>
      <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="cvv" id="" placeholder="CVV" required="" data-maska="####"></div>
    </div>
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  <div data-v-25fe34d6="" class="form_box"><label data-v-25fe34d6="" class="root-262">Country</label>
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        <option value="AF" data-v-25fe34d6="">Afghanistan (‫افغانستان‬‎)-AF</option>
        <option value="AL" data-v-25fe34d6="">Albania (Shqipëri)-AL</option>
        <option value="DZ" data-v-25fe34d6="">Algeria (‫الجزائر‬‎)-DZ</option>
        <option value="AS" data-v-25fe34d6="">American Samoa-AS</option>
        <option value="AD" data-v-25fe34d6="">Andorra-AD</option>
        <option value="AO" data-v-25fe34d6="">Angola-AO</option>
        <option value="AI" data-v-25fe34d6="">Anguilla-AI</option>
        <option value="AG" data-v-25fe34d6="">Antigua and Barbuda-AG</option>
        <option value="AR" data-v-25fe34d6="">Argentina-AR</option>
        <option value="AM" data-v-25fe34d6="">Armenia (Հայաստան)-AM</option>
        <option value="AW" data-v-25fe34d6="">Aruba-AW</option>
        <option value="AC" data-v-25fe34d6="">Ascension Island-AC</option>
        <option value="AU" data-v-25fe34d6="">Australia-AU</option>
        <option value="AT" data-v-25fe34d6="">Austria (Österreich)-AT</option>
        <option value="AZ" data-v-25fe34d6="">Azerbaijan (Azərbaycan)-AZ</option>
        <option value="BS" data-v-25fe34d6="">Bahamas-BS</option>
        <option value="BH" data-v-25fe34d6="">Bahrain (‫البحرين‬‎)-BH</option>
        <option value="BD" data-v-25fe34d6="">Bangladesh (বাংলাদেশ)-BD</option>
        <option value="BB" data-v-25fe34d6="">Barbados-BB</option>
        <option value="BY" data-v-25fe34d6="">Belarus (Беларусь)-BY</option>
        <option value="BE" data-v-25fe34d6="">Belgium (België)-BE</option>
        <option value="BZ" data-v-25fe34d6="">Belize-BZ</option>
        <option value="BJ" data-v-25fe34d6="">Benin (Bénin)-BJ</option>
        <option value="BM" data-v-25fe34d6="">Bermuda-BM</option>
        <option value="BT" data-v-25fe34d6="">Bhutan (འབྲུག)-BT</option>
        <option value="BO" data-v-25fe34d6="">Bolivia-BO</option>
        <option value="BA" data-v-25fe34d6=""> Bosnia and Herzegovina (Босна и Херцеговина)-BA </option>
        <option value="BW" data-v-25fe34d6="">Botswana-BW</option>
        <option value="BR" data-v-25fe34d6="">Brazil (Brasil)-BR</option>
        <option value="IO" data-v-25fe34d6="">British Indian Ocean Territory-IO</option>
        <option value="VG" data-v-25fe34d6="">British Virgin Islands-VG</option>
        <option value="BN" data-v-25fe34d6="">Brunei-BN</option>
        <option value="BG" data-v-25fe34d6="">Bulgaria (България)-BG</option>
        <option value="BF" data-v-25fe34d6="">Burkina Faso-BF</option>
        <option value="BI" data-v-25fe34d6="">Burundi (Uburundi)-BI</option>
        <option value="KH" data-v-25fe34d6="">Cambodia (កម្ពុជា)-KH</option>
        <option value="CM" data-v-25fe34d6="">Cameroon (Cameroun)-CM</option>
        <option value="CA" data-v-25fe34d6="">Canada-CA</option>
        <option value="CV" data-v-25fe34d6="">Cape Verde (Kabu Verdi)-CV</option>
        <option value="BQ" data-v-25fe34d6="">Caribbean Netherlands-BQ</option>
        <option value="KY" data-v-25fe34d6="">Cayman Islands-KY</option>
        <option value="CF" data-v-25fe34d6=""> Central African Republic (République centrafricaine)-CF </option>
        <option value="TD" data-v-25fe34d6="">Chad (Tchad)-TD</option>
        <option value="CL" data-v-25fe34d6="">Chile-CL</option>
        <option value="CN" data-v-25fe34d6="">China (中国)-CN</option>
        <option value="CX" data-v-25fe34d6="">Christmas Island-CX</option>
        <option value="CC" data-v-25fe34d6="">Cocos (Keeling) Islands-CC</option>
        <option value="CO" data-v-25fe34d6="">Colombia-CO</option>
        <option value="KM" data-v-25fe34d6="">Comoros (‫جزر القمر‬‎)-KM</option>
        <option value="CD" data-v-25fe34d6=""> Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)-CD </option>
        <option value="CG" data-v-25fe34d6="">Congo (Republic) (Congo-Brazzaville)-CG</option>
        <option value="CK" data-v-25fe34d6="">Cook Islands-CK</option>
        <option value="CR" data-v-25fe34d6="">Costa Rica-CR</option>
        <option value="CI" data-v-25fe34d6="">Côte d’Ivoire-CI</option>
        <option value="HR" data-v-25fe34d6="">Croatia (Hrvatska)-HR</option>
        <option value="CU" data-v-25fe34d6="">Cuba-CU</option>
        <option value="CW" data-v-25fe34d6="">Curaçao-CW</option>
        <option value="CY" data-v-25fe34d6="">Cyprus (Κύπρος)-CY</option>
        <option value="CZ" data-v-25fe34d6="">Czech Republic (Česká republika)-CZ</option>
        <option value="DK" data-v-25fe34d6="">Denmark (Danmark)-DK</option>
        <option value="DJ" data-v-25fe34d6="">Djibouti-DJ</option>
        <option value="DM" data-v-25fe34d6="">Dominica-DM</option>
        <option value="DO" data-v-25fe34d6=""> Dominican Republic (República Dominicana)-DO </option>
        <option value="EC" data-v-25fe34d6="">Ecuador-EC</option>
        <option value="EG" data-v-25fe34d6="">Egypt (‫مصر‬‎)-EG</option>
        <option value="SV" data-v-25fe34d6="">El Salvador-SV</option>
        <option value="GQ" data-v-25fe34d6="">Equatorial Guinea (Guinea Ecuatorial)-GQ</option>
        <option value="ER" data-v-25fe34d6="">Eritrea-ER</option>
        <option value="EE" data-v-25fe34d6="">Estonia (Eesti)-EE</option>
        <option value="SZ" data-v-25fe34d6="">Eswatini-SZ</option>
        <option value="ET" data-v-25fe34d6="">Ethiopia-ET</option>
        <option value="FK" data-v-25fe34d6="">Falkland Islands (Islas Malvinas)-FK</option>
        <option value="FO" data-v-25fe34d6="">Faroe Islands (Føroyar)-FO</option>
        <option value="FJ" data-v-25fe34d6="">Fiji-FJ</option>
        <option value="FI" data-v-25fe34d6="">Finland (Suomi)-FI</option>
        <option value="FR" data-v-25fe34d6="">France-FR</option>
        <option value="GF" data-v-25fe34d6="">French Guiana (Guyane française)-GF</option>
        <option value="PF" data-v-25fe34d6=""> French Polynesia (Polynésie française)-PF </option>
        <option value="GA" data-v-25fe34d6="">Gabon-GA</option>
        <option value="GM" data-v-25fe34d6="">Gambia-GM</option>
        <option value="GE" data-v-25fe34d6="">Georgia (საქართველო)-GE</option>
        <option value="DE" data-v-25fe34d6="">Germany (Deutschland)-DE</option>
        <option value="GH" data-v-25fe34d6="">Ghana (Gaana)-GH</option>
        <option value="GI" data-v-25fe34d6="">Gibraltar-GI</option>
        <option value="GR" data-v-25fe34d6="">Greece (Ελλάδα)-GR</option>
        <option value="GL" data-v-25fe34d6="">Greenland (Kalaallit Nunaat)-GL</option>
        <option value="GD" data-v-25fe34d6="">Grenada-GD</option>
        <option value="GP" data-v-25fe34d6="">Guadeloupe-GP</option>
        <option value="GU" data-v-25fe34d6="">Guam-GU</option>
        <option value="GT" data-v-25fe34d6="">Guatemala-GT</option>
        <option value="GG" data-v-25fe34d6="">Guernsey-GG</option>
        <option value="GN" data-v-25fe34d6="">Guinea (Guinée)-GN</option>
        <option value="GW" data-v-25fe34d6="">Guinea-Bissau (Guiné Bissau)-GW</option>
        <option value="GY" data-v-25fe34d6="">Guyana-GY</option>
        <option value="HT" data-v-25fe34d6="">Haiti-HT</option>
        <option value="HN" data-v-25fe34d6="">Honduras-HN</option>
        <option value="HK" data-v-25fe34d6="">Hong Kong (香港)-HK</option>
        <option value="HU" data-v-25fe34d6="">Hungary (Magyarország)-HU</option>
        <option value="IS" data-v-25fe34d6="">Iceland (Ísland)-IS</option>
        <option value="IN" data-v-25fe34d6="">India (भारत)-IN</option>
        <option value="ID" data-v-25fe34d6="">Indonesia-ID</option>
        <option value="IR" data-v-25fe34d6="">Iran (‫ایران‬‎)-IR</option>
        <option value="IQ" data-v-25fe34d6="">Iraq (‫العراق‬‎)-IQ</option>
        <option value="IE" data-v-25fe34d6="">Ireland-IE</option>
        <option value="IM" data-v-25fe34d6="">Isle of Man-IM</option>
        <option value="IL" data-v-25fe34d6="">Israel (‫ישראל‬‎)-IL</option>
        <option value="IT" data-v-25fe34d6="">Italy (Italia)-IT</option>
        <option value="JM" data-v-25fe34d6="">Jamaica-JM</option>
        <option value="JP" data-v-25fe34d6="">Japan (日本)-JP</option>
        <option value="JE" data-v-25fe34d6="">Jersey-JE</option>
        <option value="JO" data-v-25fe34d6="">Jordan (‫الأردن‬‎)-JO</option>
        <option value="KZ" data-v-25fe34d6="">Kazakhstan (Казахстан)-KZ</option>
        <option value="KE" data-v-25fe34d6="">Kenya-KE</option>
        <option value="KI" data-v-25fe34d6="">Kiribati-KI</option>
        <option value="XK" data-v-25fe34d6="">Kosovo-XK</option>
        <option value="KW" data-v-25fe34d6="">Kuwait (‫الكويت‬‎)-KW</option>
        <option value="KG" data-v-25fe34d6="">Kyrgyzstan (Кыргызстан)-KG</option>
        <option value="LA" data-v-25fe34d6="">Laos (ລາວ)-LA</option>
        <option value="LV" data-v-25fe34d6="">Latvia (Latvija)-LV</option>
        <option value="LB" data-v-25fe34d6="">Lebanon (‫لبنان‬‎)-LB</option>
        <option value="LS" data-v-25fe34d6="">Lesotho-LS</option>
        <option value="LR" data-v-25fe34d6="">Liberia-LR</option>
        <option value="LY" data-v-25fe34d6="">Libya (‫ليبيا‬‎)-LY</option>
        <option value="LI" data-v-25fe34d6="">Liechtenstein-LI</option>
        <option value="LT" data-v-25fe34d6="">Lithuania (Lietuva)-LT</option>
        <option value="LU" data-v-25fe34d6="">Luxembourg-LU</option>
        <option value="MO" data-v-25fe34d6="">Macau (澳門)-MO</option>
        <option value="MG" data-v-25fe34d6="">Madagascar (Madagasikara)-MG</option>
        <option value="MW" data-v-25fe34d6="">Malawi-MW</option>
        <option value="MY" data-v-25fe34d6="">Malaysia-MY</option>
        <option value="MV" data-v-25fe34d6="">Maldives-MV</option>
        <option value="ML" data-v-25fe34d6="">Mali-ML</option>
        <option value="MT" data-v-25fe34d6="">Malta-MT</option>
        <option value="MH" data-v-25fe34d6="">Marshall Islands-MH</option>
        <option value="MQ" data-v-25fe34d6="">Martinique-MQ</option>
        <option value="MR" data-v-25fe34d6="">Mauritania (‫موريتانيا‬‎)-MR</option>
        <option value="MU" data-v-25fe34d6="">Mauritius (Moris)-MU</option>
        <option value="YT" data-v-25fe34d6="">Mayotte-YT</option>
        <option value="MX" data-v-25fe34d6="">Mexico (México)-MX</option>
        <option value="FM" data-v-25fe34d6="">Micronesia-FM</option>
        <option value="MD" data-v-25fe34d6="">Moldova (Republica Moldova)-MD</option>
        <option value="MC" data-v-25fe34d6="">Monaco-MC</option>
        <option value="MN" data-v-25fe34d6="">Mongolia (Монгол)-MN</option>
        <option value="ME" data-v-25fe34d6="">Montenegro (Crna Gora)-ME</option>
        <option value="MS" data-v-25fe34d6="">Montserrat-MS</option>
        <option value="MA" data-v-25fe34d6="">Morocco (‫المغرب‬‎)-MA</option>
        <option value="MZ" data-v-25fe34d6="">Mozambique (Moçambique)-MZ</option>
        <option value="MM" data-v-25fe34d6="">Myanmar (Burma) (မြန်မာ)-MM</option>
        <option value="NA" data-v-25fe34d6="">Namibia (Namibië)-NA</option>
        <option value="NR" data-v-25fe34d6="">Nauru-NR</option>
        <option value="NP" data-v-25fe34d6="">Nepal (नेपाल)-NP</option>
        <option value="NL" data-v-25fe34d6="">Netherlands (Nederland)-NL</option>
        <option value="NC" data-v-25fe34d6="">New Caledonia (Nouvelle-Calédonie)-NC</option>
        <option value="NZ" data-v-25fe34d6="">New Zealand-NZ</option>
        <option value="NI" data-v-25fe34d6="">Nicaragua-NI</option>
        <option value="NE" data-v-25fe34d6="">Niger (Nijar)-NE</option>
        <option value="NG" data-v-25fe34d6="">Nigeria-NG</option>
        <option value="NU" data-v-25fe34d6="">Niue-NU</option>
        <option value="NF" data-v-25fe34d6="">Norfolk Island-NF</option>
        <option value="KP" data-v-25fe34d6=""> North Korea (조선 민주주의 인민 공화국)-KP </option>
        <option value="MK" data-v-25fe34d6="">North Macedonia (Северна Македонија)-MK</option>
        <option value="MP" data-v-25fe34d6="">Northern Mariana Islands-MP</option>
        <option value="NO" data-v-25fe34d6="">Norway (Norge)-NO</option>
        <option value="OM" data-v-25fe34d6="">Oman (‫عُمان‬‎)-OM</option>
        <option value="PK" data-v-25fe34d6="">Pakistan (‫پاکستان‬‎)-PK</option>
        <option value="PW" data-v-25fe34d6="">Palau-PW</option>
        <option value="PS" data-v-25fe34d6="">Palestine (‫فلسطين‬‎)-PS</option>
        <option value="PA" data-v-25fe34d6="">Panama (Panamá)-PA</option>
        <option value="PG" data-v-25fe34d6="">Papua New Guinea-PG</option>
        <option value="PY" data-v-25fe34d6="">Paraguay-PY</option>
        <option value="PE" data-v-25fe34d6="">Peru (Perú)-PE</option>
        <option value="PH" data-v-25fe34d6="">Philippines-PH</option>
        <option value="PL" data-v-25fe34d6="">Poland (Polska)-PL</option>
        <option value="PT" data-v-25fe34d6="">Portugal-PT</option>
        <option value="PR" data-v-25fe34d6="">Puerto Rico-PR</option>
        <option value="QA" data-v-25fe34d6="">Qatar (‫قطر‬‎)-QA</option>
        <option value="RE" data-v-25fe34d6="">Réunion (La Réunion)-RE</option>
        <option value="RO" data-v-25fe34d6="">Romania (România)-RO</option>
        <option value="RU" data-v-25fe34d6="">Russia (Россия)-RU</option>
        <option value="RW" data-v-25fe34d6="">Rwanda-RW</option>
        <option value="BL" data-v-25fe34d6="">Saint Barthélemy-BL</option>
        <option value="SH" data-v-25fe34d6="">Saint Helena-SH</option>
        <option value="KN" data-v-25fe34d6="">Saint Kitts and Nevis-KN</option>
        <option value="LC" data-v-25fe34d6="">Saint Lucia-LC</option>
        <option value="MF" data-v-25fe34d6=""> Saint Martin (Saint-Martin (partie française))-MF </option>
        <option value="PM" data-v-25fe34d6=""> Saint Pierre and Miquelon (Saint-Pierre-et-Miquelon)-PM </option>
        <option value="VC" data-v-25fe34d6="">Saint Vincent and the Grenadines-VC</option>
        <option value="WS" data-v-25fe34d6="">Samoa-WS</option>
        <option value="SM" data-v-25fe34d6="">San Marino-SM</option>
        <option value="ST" data-v-25fe34d6=""> São Tomé and Príncipe (São Tomé e Príncipe)-ST </option>
        <option value="SA" data-v-25fe34d6=""> Saudi Arabia (‫المملكة العربية السعودية‬‎)-SA </option>
        <option value="SN" data-v-25fe34d6="">Senegal (Sénégal)-SN</option>
        <option value="RS" data-v-25fe34d6="">Serbia (Србија)-RS</option>
        <option value="SC" data-v-25fe34d6="">Seychelles-SC</option>
        <option value="SL" data-v-25fe34d6="">Sierra Leone-SL</option>
        <option value="SG" data-v-25fe34d6="">Singapore-SG</option>
        <option value="SX" data-v-25fe34d6="">Sint Maarten-SX</option>
        <option value="SK" data-v-25fe34d6="">Slovakia (Slovensko)-SK</option>
        <option value="SI" data-v-25fe34d6="">Slovenia (Slovenija)-SI</option>
        <option value="SB" data-v-25fe34d6="">Solomon Islands-SB</option>
        <option value="SO" data-v-25fe34d6="">Somalia (Soomaaliya)-SO</option>
        <option value="ZA" data-v-25fe34d6="">South Africa-ZA</option>
        <option value="KR" data-v-25fe34d6="">South Korea (대한민국)-KR</option>
        <option value="SS" data-v-25fe34d6="">South Sudan (‫جنوب السودان‬‎)-SS</option>
        <option value="ES" data-v-25fe34d6="">Spain (España)-ES</option>
        <option value="LK" data-v-25fe34d6="">Sri Lanka (ශ්‍රී ලංකාව)-LK</option>
        <option value="SD" data-v-25fe34d6="">Sudan (‫السودان‬‎)-SD</option>
        <option value="SR" data-v-25fe34d6="">Suriname-SR</option>
        <option value="SJ" data-v-25fe34d6="">Svalbard and Jan Mayen-SJ</option>
        <option value="SE" data-v-25fe34d6="">Sweden (Sverige)-SE</option>
        <option value="CH" data-v-25fe34d6="">Switzerland (Schweiz)-CH</option>
        <option value="SY" data-v-25fe34d6="">Syria (‫سوريا‬‎)-SY</option>
        <option value="TW" data-v-25fe34d6="">Taiwan (台灣)-TW</option>
        <option value="TJ" data-v-25fe34d6="">Tajikistan-TJ</option>
        <option value="TZ" data-v-25fe34d6="">Tanzania-TZ</option>
        <option value="TH" data-v-25fe34d6="">Thailand (ไทย)-TH</option>
        <option value="TL" data-v-25fe34d6="">Timor-Leste-TL</option>
        <option value="TG" data-v-25fe34d6="">Togo-TG</option>
        <option value="TK" data-v-25fe34d6="">Tokelau-TK</option>
        <option value="TO" data-v-25fe34d6="">Tonga-TO</option>
        <option value="TT" data-v-25fe34d6="">Trinidad and Tobago-TT</option>
        <option value="TN" data-v-25fe34d6="">Tunisia (‫تونس‬‎)-TN</option>
        <option value="TR" data-v-25fe34d6="">Turkey (Türkiye)-TR</option>
        <option value="TM" data-v-25fe34d6="">Turkmenistan-TM</option>
        <option value="TC" data-v-25fe34d6="">Turks and Caicos Islands-TC</option>
        <option value="TV" data-v-25fe34d6="">Tuvalu-TV</option>
        <option value="VI" data-v-25fe34d6="">U.S. Virgin Islands-VI</option>
        <option value="UG" data-v-25fe34d6="">Uganda-UG</option>
        <option value="UA" data-v-25fe34d6="">Ukraine (Україна)-UA</option>
        <option value="AE" data-v-25fe34d6=""> United Arab Emirates (‫الإمارات العربية المتحدة‬‎)-AE </option>
        <option value="GB" data-v-25fe34d6="">United Kingdom-GB</option>
        <option value="US" data-v-25fe34d6="">United States-US</option>
        <option value="UY" data-v-25fe34d6="">Uruguay-UY</option>
        <option value="UZ" data-v-25fe34d6="">Uzbekistan (Oʻzbekiston)-UZ</option>
        <option value="VU" data-v-25fe34d6="">Vanuatu-VU</option>
        <option value="VA" data-v-25fe34d6="">Vatican City (Città del Vaticano)-VA</option>
        <option value="VE" data-v-25fe34d6="">Venezuela-VE</option>
        <option value="VN" data-v-25fe34d6="">Vietnam (Việt Nam)-VN</option>
        <option value="WF" data-v-25fe34d6="">Wallis and Futuna (Wallis-et-Futuna)-WF</option>
        <option value="EH" data-v-25fe34d6="">Western Sahara (‫الصحراء الغربية‬‎)-EH</option>
        <option value="YE" data-v-25fe34d6="">Yemen (‫اليمن‬‎)-YE</option>
        <option value="ZM" data-v-25fe34d6="">Zambia-ZM</option>
        <option value="ZW" data-v-25fe34d6="">Zimbabwe-ZW</option>
        <option value="AX" data-v-25fe34d6="">Åland Islands-AX</option>
      </select></div><!----><!---->
  </div>
  <div data-v-25fe34d6="" class="form_box"><label data-v-25fe34d6="" class="root-262">Address line 1</label>
    <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="address1" id="" required=""></div>
  </div>
  <div data-v-25fe34d6="" class="form_box"><label data-v-25fe34d6="">Address line 2</label>
    <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="address2" id=""></div>
  </div>
  <div data-v-25fe34d6="" class="form_box"><label data-v-25fe34d6="" class="root-262">City/District</label>
    <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="city" id="" required=""></div>
  </div>
  <div data-v-25fe34d6="" class="form_box"><label data-v-25fe34d6="" class="root-262">Postal code</label>
    <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="zip" id="" required=""></div>
  </div>
  <div data-v-25fe34d6="" class="form_box"><label data-v-25fe34d6="" class="root-262">Phone</label>
    <div data-v-25fe34d6="" class="box_input"><input data-v-25fe34d6="" type="text" name="phone" id="" required=""></div>
  </div>
  <div data-v-25fe34d6="" class="form_box"><input data-v-25fe34d6="" class="btn" type="submit" value="Submit"></div>
</form>

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Afghanistan (‫افغانستان‬‎)-AFAlbania (Shqipëri)-ALAlgeria
(‫الجزائر‬‎)-DZAmerican Samoa-ASAndorra-ADAngola-AOAnguilla-AIAntigua and
Barbuda-AGArgentina-ARArmenia (Հայաստան)-AMAruba-AWAscension
Island-ACAustralia-AUAustria (Österreich)-ATAzerbaijan
(Azərbaycan)-AZBahamas-BSBahrain (‫البحرين‬‎)-BHBangladesh
(বাংলাদেশ)-BDBarbados-BBBelarus (Беларусь)-BYBelgium (België)-BEBelize-BZBenin
(Bénin)-BJBermuda-BMBhutan (འབྲུག)-BTBolivia-BO Bosnia and Herzegovina (Босна и
Херцеговина)-BA Botswana-BWBrazil (Brasil)-BRBritish Indian Ocean
Territory-IOBritish Virgin Islands-VGBrunei-BNBulgaria (България)-BGBurkina
Faso-BFBurundi (Uburundi)-BICambodia (កម្ពុជា)-KHCameroon
(Cameroun)-CMCanada-CACape Verde (Kabu Verdi)-CVCaribbean Netherlands-BQCayman
Islands-KY Central African Republic (République centrafricaine)-CF Chad
(Tchad)-TDChile-CLChina (中国)-CNChristmas Island-CXCocos (Keeling)
Islands-CCColombia-COComoros (‫جزر القمر‬‎)-KM Congo (DRC) (Jamhuri ya
Kidemokrasia ya Kongo)-CD Congo (Republic) (Congo-Brazzaville)-CGCook
Islands-CKCosta Rica-CRCôte d’Ivoire-CICroatia
(Hrvatska)-HRCuba-CUCuraçao-CWCyprus (Κύπρος)-CYCzech Republic (Česká
republika)-CZDenmark (Danmark)-DKDjibouti-DJDominica-DM Dominican Republic
(República Dominicana)-DO Ecuador-ECEgypt (‫مصر‬‎)-EGEl Salvador-SVEquatorial
Guinea (Guinea Ecuatorial)-GQEritrea-EREstonia
(Eesti)-EEEswatini-SZEthiopia-ETFalkland Islands (Islas Malvinas)-FKFaroe
Islands (Føroyar)-FOFiji-FJFinland (Suomi)-FIFrance-FRFrench Guiana (Guyane
française)-GF French Polynesia (Polynésie française)-PF Gabon-GAGambia-GMGeorgia
(საქართველო)-GEGermany (Deutschland)-DEGhana (Gaana)-GHGibraltar-GIGreece
(Ελλάδα)-GRGreenland (Kalaallit
Nunaat)-GLGrenada-GDGuadeloupe-GPGuam-GUGuatemala-GTGuernsey-GGGuinea
(Guinée)-GNGuinea-Bissau (Guiné Bissau)-GWGuyana-GYHaiti-HTHonduras-HNHong Kong
(香港)-HKHungary (Magyarország)-HUIceland (Ísland)-ISIndia
(भारत)-INIndonesia-IDIran (‫ایران‬‎)-IRIraq (‫العراق‬‎)-IQIreland-IEIsle of
Man-IMIsrael (‫ישראל‬‎)-ILItaly (Italia)-ITJamaica-JMJapan
(日本)-JPJersey-JEJordan (‫الأردن‬‎)-JOKazakhstan
(Казахстан)-KZKenya-KEKiribati-KIKosovo-XKKuwait (‫الكويت‬‎)-KWKyrgyzstan
(Кыргызстан)-KGLaos (ລາວ)-LALatvia (Latvija)-LVLebanon
(‫لبنان‬‎)-LBLesotho-LSLiberia-LRLibya (‫ليبيا‬‎)-LYLiechtenstein-LILithuania
(Lietuva)-LTLuxembourg-LUMacau (澳門)-MOMadagascar
(Madagasikara)-MGMalawi-MWMalaysia-MYMaldives-MVMali-MLMalta-MTMarshall
Islands-MHMartinique-MQMauritania (‫موريتانيا‬‎)-MRMauritius
(Moris)-MUMayotte-YTMexico (México)-MXMicronesia-FMMoldova (Republica
Moldova)-MDMonaco-MCMongolia (Монгол)-MNMontenegro (Crna
Gora)-MEMontserrat-MSMorocco (‫المغرب‬‎)-MAMozambique (Moçambique)-MZMyanmar
(Burma) (မြန်မာ)-MMNamibia (Namibië)-NANauru-NRNepal (नेपाल)-NPNetherlands
(Nederland)-NLNew Caledonia (Nouvelle-Calédonie)-NCNew
Zealand-NZNicaragua-NINiger (Nijar)-NENigeria-NGNiue-NUNorfolk Island-NF North
Korea (조선 민주주의 인민 공화국)-KP North Macedonia (Северна Македонија)-MKNorthern
Mariana Islands-MPNorway (Norge)-NOOman (‫عُمان‬‎)-OMPakistan
(‫پاکستان‬‎)-PKPalau-PWPalestine (‫فلسطين‬‎)-PSPanama (Panamá)-PAPapua New
Guinea-PGParaguay-PYPeru (Perú)-PEPhilippines-PHPoland
(Polska)-PLPortugal-PTPuerto Rico-PRQatar (‫قطر‬‎)-QARéunion (La
Réunion)-RERomania (România)-RORussia (Россия)-RURwanda-RWSaint
Barthélemy-BLSaint Helena-SHSaint Kitts and Nevis-KNSaint Lucia-LC Saint Martin
(Saint-Martin (partie française))-MF Saint Pierre and Miquelon
(Saint-Pierre-et-Miquelon)-PM Saint Vincent and the Grenadines-VCSamoa-WSSan
Marino-SM São Tomé and Príncipe (São Tomé e Príncipe)-ST Saudi Arabia (‫المملكة
العربية السعودية‬‎)-SA Senegal (Sénégal)-SNSerbia (Србија)-RSSeychelles-SCSierra
Leone-SLSingapore-SGSint Maarten-SXSlovakia (Slovensko)-SKSlovenia
(Slovenija)-SISolomon Islands-SBSomalia (Soomaaliya)-SOSouth Africa-ZASouth
Korea (대한민국)-KRSouth Sudan (‫جنوب السودان‬‎)-SSSpain (España)-ESSri Lanka (ශ්‍රී
ලංකාව)-LKSudan (‫السودان‬‎)-SDSuriname-SRSvalbard and Jan Mayen-SJSweden
(Sverige)-SESwitzerland (Schweiz)-CHSyria (‫سوريا‬‎)-SYTaiwan
(台灣)-TWTajikistan-TJTanzania-TZThailand
(ไทย)-THTimor-Leste-TLTogo-TGTokelau-TKTonga-TOTrinidad and Tobago-TTTunisia
(‫تونس‬‎)-TNTurkey (Türkiye)-TRTurkmenistan-TMTurks and Caicos
Islands-TCTuvalu-TVU.S. Virgin Islands-VIUganda-UGUkraine (Україна)-UA United
Arab Emirates (‫الإمارات العربية المتحدة‬‎)-AE United Kingdom-GBUnited
States-USUruguay-UYUzbekistan (Oʻzbekiston)-UZVanuatu-VUVatican City (Città del
Vaticano)-VAVenezuela-VEVietnam (Việt Nam)-VNWallis and Futuna
(Wallis-et-Futuna)-WFWestern Sahara (‫الصحراء الغربية‬‎)-EHYemen
(‫اليمن‬‎)-YEZambia-ZMZimbabwe-ZWÅland Islands-AX
Address line 1

Address line 2

City/District

Postal code

Phone