{"id":5973,"date":"2024-02-21T16:44:32","date_gmt":"2024-02-21T16:44:32","guid":{"rendered":"https:\/\/www.countrycreditclub.com\/formulario-de-compra-del-erc\/"},"modified":"2024-08-29T04:04:24","modified_gmt":"2024-08-29T04:04:24","slug":"formulario-de-compra-del-erc","status":"publish","type":"page","link":"https:\/\/www.countrycreditclub.com\/es\/formulario-de-compra-del-erc\/","title":{"rendered":"Formulario de compra del ERC"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1216.8px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_6 1_6 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:16.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:11.52%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:11.52%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:66.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.88%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form fusion-form-builder fusion-form-form-wrapper fusion-form-5848\" style=\"--awb-tooltip-text-color:#ffffff;--awb-tooltip-background-color:#333333;\" data-form-id=\"5848\" data-config=\"{&quot;form_id&quot;:5848,&quot;form_post_id&quot;:5848,&quot;post_id&quot;:5973,&quot;form_type&quot;:&quot;ajax&quot;,&quot;confirmation_type&quot;:&quot;message&quot;,&quot;redirect_url&quot;:&quot;&quot;,&quot;redirect_timeout&quot;:&quot;0&quot;,&quot;field_labels&quot;:{&quot;erc_file_date&quot;:&quot;ERC File Date&quot;,&quot;erc_file_amount&quot;:&quot;ERC File Amount&quot;,&quot;erc_purchase_amount&quot;:&quot;ERC Purchase Amount&quot;,&quot;erc_eligibility_reason&quot;:&quot;ERC Eligibility Reason&quot;,&quot;erc_preparer_name&quot;:&quot;ERC Preparer Name&quot;,&quot;erc_preparer_email&quot;:&quot;ERC Preparer Email&quot;,&quot;erc_preparer_phone_number&quot;:&quot;ERC Preparer Phone Number&quot;,&quot;did_you_use_a_peo_in_the_following_quarters&quot;:&quot;Did you use a PEO in the following quarters?&quot;,&quot;payroll_provider_name&quot;:&quot;Payroll Provider Name&quot;,&quot;cpa_or_tax_preparer_name&quot;:&quot;CPA or Tax Preparer Name&quot;,&quot;payroll_provider_phone&quot;:&quot;Payroll Provider Phone&quot;,&quot;cpa_or_tax_preparer_phone&quot;:&quot;CPA or Tax Preparer Phone&quot;,&quot;payroll_provider_email&quot;:&quot;Payroll Provider Email&quot;,&quot;cpa_or_tax_preparer_email&quot;:&quot;CPA or Tax Preparer Email&quot;,&quot;dba_or_trade_name&quot;:&quot;DBA or Trade Name&quot;,&quot;first_name&quot;:&quot;First Name&quot;,&quot;last_name&quot;:&quot;Last Name&quot;,&quot;name_of_legal_entity&quot;:&quot;Name of Legal Entity&quot;,&quot;entity_type&quot;:&quot;Entity Type&quot;,&quot;ein&quot;:&quot;EIN&quot;,&quot;business_address_city_state_zip&quot;:&quot;Business address, city, state, zip&quot;,&quot;mailing_address_city_state_zip&quot;:&quot;Mailing address, city, state, zip&quot;,&quot;business_email&quot;:&quot;Business email&quot;,&quot;business_website&quot;:&quot;Business website&quot;,&quot;business_phone&quot;:&quot;Business phone&quot;,&quot;date_business_was_formed&quot;:&quot;Date business was formed&quot;,&quot;business_owner_1_first_name&quot;:&quot;First name&quot;,&quot;business_owner_1_last_name&quot;:&quot;Last name&quot;,&quot;%_ownership_1&quot;:&quot;% Ownership&quot;,&quot;dob1&quot;:&quot;DOB&quot;,&quot;ss#1&quot;:&quot;SS#&quot;,&quot;valid_government-issued_photo_id#1&quot;:&quot;VALID Government-issued photo ID#&quot;,&quot;issue_date1&quot;:&quot;Issue date&quot;,&quot;owner\\u2019s_cell_phone1&quot;:&quot;Owner\\u2019s cell phone&quot;,&quot;expiration_date1&quot;:&quot;Expiration date&quot;,&quot;owner\\u2019s_email_address1&quot;:&quot;Owner\\u2019s email address&quot;,&quot;residential_address_city_state_zip1&quot;:&quot;Residential address, city, state, zip&quot;,&quot;country_of_citizenship1&quot;:&quot;Country of citizenship&quot;,&quot;country_of_residence1&quot;:&quot;Country of residence&quot;,&quot;business_owner_2_first_name&quot;:&quot;First name&quot;,&quot;business_owner_2_last_name&quot;:&quot;Last name&quot;,&quot;%_ownership_2&quot;:&quot;% Ownership&quot;,&quot;dob2&quot;:&quot;DOB&quot;,&quot;ss#2&quot;:&quot;SS#&quot;,&quot;valid_government-issued_photo_id#2&quot;:&quot;VALID Government-issued photo ID#&quot;,&quot;issue_date2&quot;:&quot;Issue date&quot;,&quot;owner\\u2019s_cell_phone2&quot;:&quot;Owner\\u2019s cell phone&quot;,&quot;expiration_date2&quot;:&quot;Expiration date&quot;,&quot;owner\\u2019s_email_address2&quot;:&quot;Owner\\u2019s email address&quot;,&quot;residential_address_city_state_zip2&quot;:&quot;Residential address, city, state, zip&quot;,&quot;country_of_citizenship2&quot;:&quot;Country of citizenship&quot;,&quot;country_of_residence2&quot;:&quot;Country of residence&quot;,&quot;business_owner_3_first_name&quot;:&quot;First name&quot;,&quot;business_owner_3_last_name&quot;:&quot;Last name&quot;,&quot;%_ownership_3&quot;:&quot;% Ownership&quot;,&quot;dob3&quot;:&quot;DOB&quot;,&quot;ss#3&quot;:&quot;SS#&quot;,&quot;valid_government-issued_photo_id#3&quot;:&quot;VALID Government-issued photo ID#&quot;,&quot;issue_date3&quot;:&quot;Issue date&quot;,&quot;owner\\u2019s_cell_phone3&quot;:&quot;Owner\\u2019s cell phone&quot;,&quot;expiration_date3&quot;:&quot;Expiration date&quot;,&quot;owner\\u2019s_email_address3&quot;:&quot;Owner\\u2019s email address&quot;,&quot;residential_address_city_state_zip3&quot;:&quot;Residential address, city, state, zip&quot;,&quot;country_of_citizenship3&quot;:&quot;Country of citizenship&quot;,&quot;country_of_residence3&quot;:&quot;Country of residence&quot;,&quot;business_owner_4_first_name&quot;:&quot;First name&quot;,&quot;business_owner_4_last_name&quot;:&quot;Last name&quot;,&quot;%_ownership_4&quot;:&quot;% Ownership&quot;,&quot;dob4&quot;:&quot;DOB&quot;,&quot;ss#4&quot;:&quot;SS#&quot;,&quot;valid_government-issued_photo_id#4&quot;:&quot;VALID Government-issued photo ID#&quot;,&quot;issue_date4&quot;:&quot;Issue date&quot;,&quot;owner\\u2019s_cell_phone4&quot;:&quot;Owner\\u2019s cell phone&quot;,&quot;expiration_date4&quot;:&quot;Expiration date&quot;,&quot;owner\\u2019s_email_address4&quot;:&quot;Owner\\u2019s email address&quot;,&quot;residential_address_city_state_zip4&quot;:&quot;Residential address, city, state, zip&quot;,&quot;country_of_citizenship4&quot;:&quot;Country of citizenship&quot;,&quot;country_of_residence4&quot;:&quot;Country of residence&quot;,&quot;irs_form_8821_&amp;_7216&quot;:&quot;IRS Form 8821 &amp; 7216&quot;,&quot;signed_and_dated_irs_form_941_original_return_and_941x_amended_return_prepared_for_each_quarter_as_submitted_to_the_irs&quot;:&quot;Signed and dated IRS Form 941 (original return) and 941X (amended return) prepared for each quarter as submitted to the IRS&quot;,&quot;documentation_for_erc_qualification_reason_from_erc_filer&quot;:&quot;Documentation for ERC qualification (reason) from ERC filer&quot;,&quot;erc_calculations_to_support_the_erc_filing&quot;:&quot;ERC calculations to support the ERC filing&quot;,&quot;2_most_recent_quarters_of_941s&quot;:&quot;2 most recent quarters of 941s.&quot;,&quot;color_copy_of_government_issued_ids&quot;:&quot;Color copy of government issued ID for all owners listed on the application (front and back)&quot;,&quot;copy_of_2019-2022_tax_returns_along_with_year-to-date_p&amp;l_and_itemized_balance_sheet&quot;:&quot;Copy of 2019-2022 tax returns along with year-to-date P&amp;L and itemized Balance Sheet&quot;,&quot;bank_statements_3_monthsall_pages&quot;:&quot;Bank statements (3 Months\\\/all pages)&quot;},&quot;field_logics&quot;:{&quot;erc_file_date&quot;:&quot;&quot;,&quot;erc_file_amount&quot;:&quot;&quot;,&quot;erc_purchase_amount&quot;:&quot;&quot;,&quot;erc_eligibility_reason&quot;:&quot;&quot;,&quot;erc_preparer_name&quot;:&quot;&quot;,&quot;erc_preparer_email&quot;:&quot;&quot;,&quot;erc_preparer_phone_number&quot;:&quot;&quot;,&quot;did_you_use_a_peo_in_the_following_quarters&quot;:&quot;&quot;,&quot;payroll_provider_name&quot;:&quot;&quot;,&quot;cpa_or_tax_preparer_name&quot;:&quot;&quot;,&quot;payroll_provider_phone&quot;:&quot;&quot;,&quot;cpa_or_tax_preparer_phone&quot;:&quot;&quot;,&quot;payroll_provider_email&quot;:&quot;&quot;,&quot;cpa_or_tax_preparer_email&quot;:&quot;&quot;,&quot;submit_1&quot;:&quot;&quot;,&quot;dba_or_trade_name&quot;:&quot;&quot;,&quot;first_name&quot;:&quot;&quot;,&quot;last_name&quot;:&quot;&quot;,&quot;name_of_legal_entity&quot;:&quot;&quot;,&quot;entity_type&quot;:&quot;&quot;,&quot;ein&quot;:&quot;&quot;,&quot;business_address_city_state_zip&quot;:&quot;&quot;,&quot;mailing_address_city_state_zip&quot;:&quot;&quot;,&quot;business_email&quot;:&quot;&quot;,&quot;business_website&quot;:&quot;&quot;,&quot;business_phone&quot;:&quot;&quot;,&quot;date_business_was_formed&quot;:&quot;&quot;,&quot;submit_2&quot;:&quot;&quot;,&quot;business_owner_1_first_name&quot;:&quot;&quot;,&quot;business_owner_1_last_name&quot;:&quot;&quot;,&quot;%_ownership_1&quot;:&quot;&quot;,&quot;dob1&quot;:&quot;&quot;,&quot;ss#1&quot;:&quot;&quot;,&quot;valid_government-issued_photo_id#1&quot;:&quot;&quot;,&quot;issue_date1&quot;:&quot;&quot;,&quot;owner\\u2019s_cell_phone1&quot;:&quot;&quot;,&quot;expiration_date1&quot;:&quot;&quot;,&quot;owner\\u2019s_email_address1&quot;:&quot;&quot;,&quot;residential_address_city_state_zip1&quot;:&quot;&quot;,&quot;country_of_citizenship1&quot;:&quot;&quot;,&quot;country_of_residence1&quot;:&quot;&quot;,&quot;business_owner_2_first_name&quot;:&quot;&quot;,&quot;business_owner_2_last_name&quot;:&quot;&quot;,&quot;%_ownership_2&quot;:&quot;&quot;,&quot;dob2&quot;:&quot;&quot;,&quot;ss#2&quot;:&quot;&quot;,&quot;valid_government-issued_photo_id#2&quot;:&quot;&quot;,&quot;issue_date2&quot;:&quot;&quot;,&quot;owner\\u2019s_cell_phone2&quot;:&quot;&quot;,&quot;expiration_date2&quot;:&quot;&quot;,&quot;owner\\u2019s_email_address2&quot;:&quot;&quot;,&quot;residential_address_city_state_zip2&quot;:&quot;&quot;,&quot;country_of_citizenship2&quot;:&quot;&quot;,&quot;country_of_residence2&quot;:&quot;&quot;,&quot;business_owner_3_first_name&quot;:&quot;&quot;,&quot;business_owner_3_last_name&quot;:&quot;&quot;,&quot;%_ownership_3&quot;:&quot;&quot;,&quot;dob3&quot;:&quot;&quot;,&quot;ss#3&quot;:&quot;&quot;,&quot;valid_government-issued_photo_id#3&quot;:&quot;&quot;,&quot;issue_date3&quot;:&quot;&quot;,&quot;owner\\u2019s_cell_phone3&quot;:&quot;&quot;,&quot;expiration_date3&quot;:&quot;&quot;,&quot;owner\\u2019s_email_address3&quot;:&quot;&quot;,&quot;residential_address_city_state_zip3&quot;:&quot;&quot;,&quot;country_of_citizenship3&quot;:&quot;&quot;,&quot;country_of_residence3&quot;:&quot;&quot;,&quot;business_owner_4_first_name&quot;:&quot;&quot;,&quot;business_owner_4_last_name&quot;:&quot;&quot;,&quot;%_ownership_4&quot;:&quot;&quot;,&quot;dob4&quot;:&quot;&quot;,&quot;ss#4&quot;:&quot;&quot;,&quot;valid_government-issued_photo_id#4&quot;:&quot;&quot;,&quot;issue_date4&quot;:&quot;&quot;,&quot;owner\\u2019s_cell_phone4&quot;:&quot;&quot;,&quot;expiration_date4&quot;:&quot;&quot;,&quot;owner\\u2019s_email_address4&quot;:&quot;&quot;,&quot;residential_address_city_state_zip4&quot;:&quot;&quot;,&quot;country_of_citizenship4&quot;:&quot;&quot;,&quot;country_of_residence4&quot;:&quot;&quot;,&quot;submit_3&quot;:&quot;&quot;,&quot;irs_form_8821_&amp;_7216&quot;:&quot;&quot;,&quot;signed_and_dated_irs_form_941_original_return_and_941x_amended_return_prepared_for_each_quarter_as_submitted_to_the_irs&quot;:&quot;&quot;,&quot;documentation_for_erc_qualification_reason_from_erc_filer&quot;:&quot;&quot;,&quot;erc_calculations_to_support_the_erc_filing&quot;:&quot;&quot;,&quot;2_most_recent_quarters_of_941s&quot;:&quot;&quot;,&quot;color_copy_of_government_issued_ids&quot;:&quot;&quot;,&quot;copy_of_2019-2022_tax_returns_along_with_year-to-date_p&amp;l_and_itemized_balance_sheet&quot;:&quot;&quot;,&quot;bank_statements_3_monthsall_pages&quot;:&quot;&quot;,&quot;notice_1&quot;:&quot;&quot;,&quot;submit_4&quot;:&quot;&quot;},&quot;field_types&quot;:{&quot;erc_file_date&quot;:&quot;date&quot;,&quot;erc_file_amount&quot;:&quot;number&quot;,&quot;erc_purchase_amount&quot;:&quot;number&quot;,&quot;erc_eligibility_reason&quot;:&quot;radio&quot;,&quot;erc_preparer_name&quot;:&quot;text&quot;,&quot;erc_preparer_email&quot;:&quot;email&quot;,&quot;erc_preparer_phone_number&quot;:&quot;phone_number&quot;,&quot;did_you_use_a_peo_in_the_following_quarters&quot;:&quot;radio&quot;,&quot;payroll_provider_name&quot;:&quot;text&quot;,&quot;cpa_or_tax_preparer_name&quot;:&quot;text&quot;,&quot;payroll_provider_phone&quot;:&quot;phone_number&quot;,&quot;cpa_or_tax_preparer_phone&quot;:&quot;phone_number&quot;,&quot;payroll_provider_email&quot;:&quot;email&quot;,&quot;cpa_or_tax_preparer_email&quot;:&quot;email&quot;,&quot;submit_1&quot;:&quot;submit&quot;,&quot;dba_or_trade_name&quot;:&quot;text&quot;,&quot;first_name&quot;:&quot;text&quot;,&quot;last_name&quot;:&quot;text&quot;,&quot;name_of_legal_entity&quot;:&quot;text&quot;,&quot;entity_type&quot;:&quot;select&quot;,&quot;ein&quot;:&quot;text&quot;,&quot;business_address_city_state_zip&quot;:&quot;text&quot;,&quot;mailing_address_city_state_zip&quot;:&quot;text&quot;,&quot;business_email&quot;:&quot;email&quot;,&quot;business_website&quot;:&quot;text&quot;,&quot;business_phone&quot;:&quot;phone_number&quot;,&quot;date_business_was_formed&quot;:&quot;date&quot;,&quot;submit_2&quot;:&quot;submit&quot;,&quot;business_owner_1_first_name&quot;:&quot;text&quot;,&quot;business_owner_1_last_name&quot;:&quot;text&quot;,&quot;%_ownership_1&quot;:&quot;number&quot;,&quot;dob1&quot;:&quot;date&quot;,&quot;ss#1&quot;:&quot;text&quot;,&quot;valid_government-issued_photo_id#1&quot;:&quot;text&quot;,&quot;issue_date1&quot;:&quot;date&quot;,&quot;owner\\u2019s_cell_phone1&quot;:&quot;phone_number&quot;,&quot;expiration_date1&quot;:&quot;date&quot;,&quot;owner\\u2019s_email_address1&quot;:&quot;email&quot;,&quot;residential_address_city_state_zip1&quot;:&quot;text&quot;,&quot;country_of_citizenship1&quot;:&quot;select&quot;,&quot;country_of_residence1&quot;:&quot;select&quot;,&quot;business_owner_2_first_name&quot;:&quot;text&quot;,&quot;business_owner_2_last_name&quot;:&quot;text&quot;,&quot;%_ownership_2&quot;:&quot;number&quot;,&quot;dob2&quot;:&quot;date&quot;,&quot;ss#2&quot;:&quot;text&quot;,&quot;valid_government-issued_photo_id#2&quot;:&quot;text&quot;,&quot;issue_date2&quot;:&quot;date&quot;,&quot;owner\\u2019s_cell_phone2&quot;:&quot;phone_number&quot;,&quot;expiration_date2&quot;:&quot;date&quot;,&quot;owner\\u2019s_email_address2&quot;:&quot;email&quot;,&quot;residential_address_city_state_zip2&quot;:&quot;text&quot;,&quot;country_of_citizenship2&quot;:&quot;select&quot;,&quot;country_of_residence2&quot;:&quot;select&quot;,&quot;business_owner_3_first_name&quot;:&quot;text&quot;,&quot;business_owner_3_last_name&quot;:&quot;text&quot;,&quot;%_ownership_3&quot;:&quot;number&quot;,&quot;dob3&quot;:&quot;date&quot;,&quot;ss#3&quot;:&quot;text&quot;,&quot;valid_government-issued_photo_id#3&quot;:&quot;text&quot;,&quot;issue_date3&quot;:&quot;date&quot;,&quot;owner\\u2019s_cell_phone3&quot;:&quot;phone_number&quot;,&quot;expiration_date3&quot;:&quot;date&quot;,&quot;owner\\u2019s_email_address3&quot;:&quot;email&quot;,&quot;residential_address_city_state_zip3&quot;:&quot;text&quot;,&quot;country_of_citizenship3&quot;:&quot;select&quot;,&quot;country_of_residence3&quot;:&quot;select&quot;,&quot;business_owner_4_first_name&quot;:&quot;text&quot;,&quot;business_owner_4_last_name&quot;:&quot;text&quot;,&quot;%_ownership_4&quot;:&quot;number&quot;,&quot;dob4&quot;:&quot;date&quot;,&quot;ss#4&quot;:&quot;text&quot;,&quot;valid_government-issued_photo_id#4&quot;:&quot;text&quot;,&quot;issue_date4&quot;:&quot;date&quot;,&quot;owner\\u2019s_cell_phone4&quot;:&quot;phone_number&quot;,&quot;expiration_date4&quot;:&quot;date&quot;,&quot;owner\\u2019s_email_address4&quot;:&quot;email&quot;,&quot;residential_address_city_state_zip4&quot;:&quot;text&quot;,&quot;country_of_citizenship4&quot;:&quot;select&quot;,&quot;country_of_residence4&quot;:&quot;select&quot;,&quot;submit_3&quot;:&quot;submit&quot;,&quot;irs_form_8821_&amp;_7216&quot;:&quot;upload&quot;,&quot;signed_and_dated_irs_form_941_original_return_and_941x_amended_return_prepared_for_each_quarter_as_submitted_to_the_irs&quot;:&quot;upload&quot;,&quot;documentation_for_erc_qualification_reason_from_erc_filer&quot;:&quot;upload&quot;,&quot;erc_calculations_to_support_the_erc_filing&quot;:&quot;upload&quot;,&quot;2_most_recent_quarters_of_941s&quot;:&quot;upload&quot;,&quot;color_copy_of_government_issued_ids&quot;:&quot;upload&quot;,&quot;copy_of_2019-2022_tax_returns_along_with_year-to-date_p&amp;l_and_itemized_balance_sheet&quot;:&quot;upload&quot;,&quot;bank_statements_3_monthsall_pages&quot;:&quot;upload&quot;,&quot;notice_1&quot;:&quot;notice&quot;,&quot;submit_4&quot;:&quot;submit&quot;},&quot;nonce_method&quot;:&quot;ajax&quot;,&quot;form_views&quot;:&quot;ajax&quot;,&quot;form_views_counting&quot;:&quot;all&quot;}\"><section class=\"awb-form-nav awb-form-nav--timeline awb-form-nav--above\" data-steps=\"5\" aria-label=\"Multi-step form with 5 steps.\" style=\"--awb-steps-bor-type:solid;--awb-steps-bor-width:0px;--awb-steps-sep-width:3px;--awb-steps-sep-type:dashed;--awb-steps-sep-type-completed:solid;--awb-step-icon-size:15px;--awb-step-icon-title-gap:10px;--awb-between-steps-size:3;\" role=\"list\" data-aria-current=\"Current step:\" data-aria-completed=\"Completed step:\"><span class=\"awb-form-nav__tl-spacer\"><\/span><div class=\"awb-form-nav__tl-step-wrapper awb-form-nav__tl-step-wrapper--active\" data-step=\"1\" role=\"listitem\"><div class=\"awb-form-nav__tl-step\"><span class=\"awb-form-nav__tl-aria-info screen-reader-text\">Current step:<\/span><span class=\"awb-form-nav__tl-title\">ERC Information<\/span><\/div><\/div><span class=\"awb-form-nav__tl-spacer awb-form-nav__tl-spacer--between\"><\/span><div class=\"awb-form-nav__tl-step-wrapper\" data-step=\"2\" role=\"listitem\"><div class=\"awb-form-nav__tl-step\"><span class=\"awb-form-nav__tl-aria-info screen-reader-text\"><\/span><span class=\"awb-form-nav__tl-title\">Company Info<\/span><\/div><\/div><span class=\"awb-form-nav__tl-spacer awb-form-nav__tl-spacer--between\"><\/span><div class=\"awb-form-nav__tl-step-wrapper\" data-step=\"3\" role=\"listitem\"><div class=\"awb-form-nav__tl-step\"><span class=\"awb-form-nav__tl-aria-info screen-reader-text\"><\/span><span class=\"awb-form-nav__tl-title\">Owner Info<\/span><\/div><\/div><span class=\"awb-form-nav__tl-spacer awb-form-nav__tl-spacer--between\"><\/span><div class=\"awb-form-nav__tl-step-wrapper\" data-step=\"4\" role=\"listitem\"><div class=\"awb-form-nav__tl-step\"><span class=\"awb-form-nav__tl-aria-info screen-reader-text\"><\/span><span class=\"awb-form-nav__tl-title\">Additional Owner Info<\/span><\/div><\/div><span class=\"awb-form-nav__tl-spacer awb-form-nav__tl-spacer--between\"><\/span><div class=\"awb-form-nav__tl-step-wrapper\" data-step=\"5\" role=\"listitem\"><div class=\"awb-form-nav__tl-step\"><span class=\"awb-form-nav__tl-aria-info screen-reader-text\"><\/span><span class=\"awb-form-nav__tl-title\">Upload Documents<\/span><\/div><\/div><span class=\"awb-form-nav__tl-spacer\"><\/span><\/section><form action=\"https:\/\/www.countrycreditclub.com\/es\/formulario-de-compra-del-erc\/\" method=\"post\" class=\"fusion-form fusion-form-5848\" enctype=\"multipart\/form-data\"><div class=\"awb-form-step active\" data-final=\"0\" data-step=\"1\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"erc_file_date\">ERC File Date <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"erc_file_date\" name=\"erc_file_date\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"erc_file_amount\">ERC File Amount <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"number\" autocomplete=\"off\" name=\"erc_file_amount\" id=\"erc_file_amount\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" min=\"1000\" max=\"13000000\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"erc_purchase_amount\">ERC Purchase Amount <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"number\" autocomplete=\"off\" name=\"erc_purchase_amount\" id=\"erc_purchase_amount\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" min=\"800\" max=\"10400000\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-5 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><fieldset><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">ERC Eligibility Reason <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">Check all that apply<\/span><\/div><\/legend><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-erc_eligibility_reason-1-0\" type=\"radio\" value=\"Revenue Reduction\" name=\"erc_eligibility_reason\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-erc_eligibility_reason-1-0\">Revenue Reduction<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-erc_eligibility_reason-1-1\" type=\"radio\" value=\"Government Shutdown\" name=\"erc_eligibility_reason\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-erc_eligibility_reason-1-1\">Government Shutdown<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-erc_eligibility_reason-1-2\" type=\"radio\" value=\"Supply Chain Issues\" name=\"erc_eligibility_reason\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-erc_eligibility_reason-1-2\">Supply Chain Issues<\/label><\/div><\/fieldset><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"erc_preparer_name\">ERC Preparer Name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"erc_preparer_name\" id=\"erc_preparer_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-6 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"erc_preparer_email\">ERC Preparer Email <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"erc_preparer_email\" id=\"erc_preparer_email\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-7 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"erc_preparer_phone_number\">ERC Preparer Phone Number <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"erc_preparer_phone_number\" id=\"erc_preparer_phone_number\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-8 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-radio-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><fieldset><legend class=\"fusion-form-label-wrapper\"><span class=\"label\">Did you use a PEO in the following quarters? <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/span><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">Select all that apply.<\/span><\/div><\/legend><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-did_you_use_a_peo_in_the_following_quarters-2-0\" type=\"radio\" value=\"NA\" name=\"did_you_use_a_peo_in_the_following_quarters\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-did_you_use_a_peo_in_the_following_quarters-2-0\">NA<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-did_you_use_a_peo_in_the_following_quarters-2-1\" type=\"radio\" value=\"2022 Q2\" name=\"did_you_use_a_peo_in_the_following_quarters\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-did_you_use_a_peo_in_the_following_quarters-2-1\">2022 Q2<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-did_you_use_a_peo_in_the_following_quarters-2-2\" type=\"radio\" value=\"2022 Q3\" name=\"did_you_use_a_peo_in_the_following_quarters\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-did_you_use_a_peo_in_the_following_quarters-2-2\">2022 Q3<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-did_you_use_a_peo_in_the_following_quarters-2-3\" type=\"radio\" value=\"2022 Q4\" name=\"did_you_use_a_peo_in_the_following_quarters\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-did_you_use_a_peo_in_the_following_quarters-2-3\">2022 Q4<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-did_you_use_a_peo_in_the_following_quarters-2-4\" type=\"radio\" value=\"2023 Q1\" name=\"did_you_use_a_peo_in_the_following_quarters\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-did_you_use_a_peo_in_the_following_quarters-2-4\">2023 Q1<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-did_you_use_a_peo_in_the_following_quarters-2-5\" type=\"radio\" value=\"2023 Q2\" name=\"did_you_use_a_peo_in_the_following_quarters\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-did_you_use_a_peo_in_the_following_quarters-2-5\">2023 Q2<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-did_you_use_a_peo_in_the_following_quarters-2-6\" type=\"radio\" value=\"2023 Q3\" name=\"did_you_use_a_peo_in_the_following_quarters\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-did_you_use_a_peo_in_the_following_quarters-2-6\">2023 Q3<\/label><\/div><div class=\"fusion-form-radio\"><input tabindex=\"\" id=\"radio-did_you_use_a_peo_in_the_following_quarters-2-7\" type=\"radio\" value=\"2023 Q4\" name=\"did_you_use_a_peo_in_the_following_quarters\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><label for=\"radio-did_you_use_a_peo_in_the_following_quarters-2-7\">2023 Q4<\/label><\/div><\/fieldset><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-9 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"payroll_provider_name\">Payroll Provider Name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"payroll_provider_name\" id=\"payroll_provider_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"cpa_or_tax_preparer_name\">CPA or Tax Preparer Name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"cpa_or_tax_preparer_name\" id=\"cpa_or_tax_preparer_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-10 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"payroll_provider_phone\">Payroll Provider Phone <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"payroll_provider_phone\" id=\"payroll_provider_phone\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"cpa_or_tax_preparer_phone\">CPA or Tax Preparer Phone <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"cpa_or_tax_preparer_phone\" id=\"cpa_or_tax_preparer_phone\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-11 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"payroll_provider_email\">Payroll Provider Email <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"payroll_provider_email\" id=\"payroll_provider_email\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"cpa_or_tax_preparer_email\">CPA or Tax Preparer Email <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"cpa_or_tax_preparer_email\" id=\"cpa_or_tax_preparer_email\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-12 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-submit-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div style=\"text-align:center;\"><button type=\"submit\" class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-1 fusion-button-default-span  button-default form-form-submit\" data-form-number=\"5848\" tabindex=\"\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Next Section<\/span><\/button><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"awb-form-step\" data-final=\"0\" data-step=\"2\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-2 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-13 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"dba_or_trade_name\">DBA or Trade Name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"dba_or_trade_name\" id=\"dba_or_trade_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-14 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"first_name\">First Name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"first_name\" id=\"first_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-15 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"last_name\">Last Name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"last_name\" id=\"last_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-16 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"name_of_legal_entity\">Name of Legal Entity <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"name_of_legal_entity\" id=\"name_of_legal_entity\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-17 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"entity_type\">Entity Type <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"entity_type\" name=\"entity_type\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><option value=\"Sole proprietorship\" >Sole proprietorship<\/option><option value=\"Partnership\" >Partnership<\/option><option value=\"Corporation\" >Corporation<\/option><option value=\"S corporation\" >S corporation<\/option><option value=\"Limited liability company (LLC)\" >Limited liability company (LLC)<\/option><option value=\"Charitable organization\" >Charitable organization<\/option><option value=\"Churches and religious organization\" >Churches and religious organization<\/option><option value=\"Private foundation\" >Private foundation<\/option><option value=\"Political organization\" >Political organization<\/option><option value=\"Other nonprofit\" >Other nonprofit<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-18 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"ein\">EIN <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"\\d{2}-\\d{7}\"  data-invalid-notice=\"Please use the following format: XX-XXXXXXX\" name=\"ein\" id=\"ein\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-19 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_address_city_state_zip\">Business address, city, state, zip <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"business_address_city_state_zip\" id=\"business_address_city_state_zip\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"mailing_address_city_state_zip\">Mailing address, city, state, zip <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"mailing_address_city_state_zip\" id=\"mailing_address_city_state_zip\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-20 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_email\">Business email <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"business_email\" id=\"business_email\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-21 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_website\">Business website <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"(http(s)?:\\\/\\\/.)?(www\\.)?[\\-a-zA-Z0-9@:%._\\+~#=]{2,256}\\.[a-z]{2,6}\\b([\\-a-zA-Z0-9@:%_\\+.~#?&\\\/\\\/=]*)\"  data-invalid-notice=\"Please enter a valid URL\" name=\"business_website\" id=\"business_website\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-22 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_phone\">Business phone <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"business_phone\" id=\"business_phone\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-23 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"date_business_was_formed\">Date business was formed <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"date_business_was_formed\" name=\"date_business_was_formed\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-24 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-submit-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div style=\"text-align:center;\"><button type=\"submit\" class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-2 fusion-button-default-span  button-default form-form-submit\" data-form-number=\"5848\" tabindex=\"\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Next Section<\/span><\/button><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"awb-form-step\" data-final=\"0\" data-step=\"3\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-3 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-25 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\" style=\"--awb-content-alignment:center;\"><div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Please list business owners and % of ownership for anyone owning more than 20%. Guarantor ownership should equal 51% or greater.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-26 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_owner_1_first_name\">First name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z]+\" name=\"business_owner_1_first_name\" id=\"business_owner_1_first_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-27 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_owner_1_last_name\">Last name <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z]+\" name=\"business_owner_1_last_name\" id=\"business_owner_1_last_name\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-28 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"%_ownership_1\">% Ownership <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"number\" autocomplete=\"off\" name=\"%_ownership_1\" id=\"%_ownership_1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" min=\"1\" max=\"100\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-29 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"dob1\">DOB <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"dob1\" name=\"dob1\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-30 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"ss#1\">SS# <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"\\d{3}-\\d{2}-\\d{4}\"  data-invalid-notice=\"Please use the following format: XXX-XX-XXXX\" name=\"ss#1\" id=\"ss#1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-31 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"valid_government-issued_photo_id#1\">VALID Government-issued photo ID# <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z0-9]+\" name=\"valid_government-issued_photo_id#1\" id=\"valid_government-issued_photo_id#1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-32 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"issue_date1\">Issue date <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"issue_date1\" name=\"issue_date1\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"owner\u2019s_cell_phone1\">Owner\u2019s cell phone <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"owner\u2019s_cell_phone1\" id=\"owner\u2019s_cell_phone1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-33 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"expiration_date1\">Expiration date <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"expiration_date1\" name=\"expiration_date1\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"owner\u2019s_email_address1\">Owner\u2019s email address <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"owner\u2019s_email_address1\" id=\"owner\u2019s_email_address1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-34 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"residential_address_city_state_zip1\">Residential address, city, state, zip <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"residential_address_city_state_zip1\" id=\"residential_address_city_state_zip1\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-35 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"country_of_citizenship1\">Country of citizenship <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"country_of_citizenship1\" name=\"country_of_citizenship1\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><option value=\"Option\" >Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bonaire, Sint Eustatius and Saba\" >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos Islands\" >Cocos Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"C\u00f4te d'Ivoire\" >C\u00f4te d'Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Swaziland)\" >Eswatini (Swaziland)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands\" >Falkland Islands<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard and McDonald Islands\" >Heard and McDonald Islands<\/option><option value=\"Holy See\" >Holy See<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macau\" >Macau<\/option><option value=\"Macedonia\" >Macedonia<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Korea\" >North Korea<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine, State of\" >Palestine, State of<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin\" >Saint Martin<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten\" >Sint Maarten<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia\" >South Georgia<\/option><option value=\"South Korea\" >South Korea<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen Islands\" >Svalbard and Jan Mayen Islands<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\"  selected >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"US Minor Outlying Islands\" >US Minor Outlying Islands<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands, British\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" >Virgin Islands, U.S.<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-36 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"country_of_residence1\">Country of residence <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"country_of_residence1\" name=\"country_of_residence1\" class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" data-holds-private-data=\"false\"><option value=\"Option\" >Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bonaire, Sint Eustatius and Saba\" >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos Islands\" >Cocos Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"C\u00f4te d'Ivoire\" >C\u00f4te d'Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Swaziland)\" >Eswatini (Swaziland)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands\" >Falkland Islands<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard and McDonald Islands\" >Heard and McDonald Islands<\/option><option value=\"Holy See\" >Holy See<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macau\" >Macau<\/option><option value=\"Macedonia\" >Macedonia<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Korea\" >North Korea<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine, State of\" >Palestine, State of<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin\" >Saint Martin<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten\" >Sint Maarten<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia\" >South Georgia<\/option><option value=\"South Korea\" >South Korea<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen Islands\" >Svalbard and Jan Mayen Islands<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\"  selected >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"US Minor Outlying Islands\" >US Minor Outlying Islands<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands, British\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" >Virgin Islands, U.S.<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/p><\/div>\n<div class=\"awb-form-step\" data-final=\"0\" data-step=\"4\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-4 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-37 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-2\" style=\"--awb-content-alignment:center;\"><div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Please list business owners and % of ownership for anyone owning more than 20%. Guarantor ownership should equal 51% or greater.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-38 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_owner_2_first_name\">First name<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z]+\" name=\"business_owner_2_first_name\" id=\"business_owner_2_first_name\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-39 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_owner_2_last_name\">Last name<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z]+\" name=\"business_owner_2_last_name\" id=\"business_owner_2_last_name\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-40 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"%_ownership_2\">% Ownership<\/label><\/div><input type=\"number\" autocomplete=\"off\" name=\"%_ownership_2\" id=\"%_ownership_2\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" min=\"1\" max=\"100\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-41 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"dob2\">DOB<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"dob2\" name=\"dob2\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-42 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"ss#2\">SS#<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"\\d{3}-\\d{2}-\\d{4}\"  data-invalid-notice=\"Please use the following format: XXX-XX-XXXX\" name=\"ss#2\" id=\"ss#2\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-43 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"valid_government-issued_photo_id#2\">VALID Government-issued photo ID#<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z0-9]+\" name=\"valid_government-issued_photo_id#2\" id=\"valid_government-issued_photo_id#2\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-44 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"issue_date2\">Issue date<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"issue_date2\" name=\"issue_date2\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"owner\u2019s_cell_phone2\">Owner\u2019s cell phone<\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"owner\u2019s_cell_phone2\" id=\"owner\u2019s_cell_phone2\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-45 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"expiration_date2\">Expiration date<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"expiration_date2\" name=\"expiration_date2\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"owner\u2019s_email_address2\">Owner\u2019s email address<\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"owner\u2019s_email_address2\" id=\"owner\u2019s_email_address2\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-46 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"residential_address_city_state_zip2\">Residential address, city, state, zip<\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"residential_address_city_state_zip2\" id=\"residential_address_city_state_zip2\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-47 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"country_of_citizenship2\">Country of citizenship<\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"country_of_citizenship2\" name=\"country_of_citizenship2\" class=\"fusion-form-input\" data-holds-private-data=\"false\"><option value=\"Option\" >Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bonaire, Sint Eustatius and Saba\" >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos Islands\" >Cocos Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"C\u00f4te d'Ivoire\" >C\u00f4te d'Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Swaziland)\" >Eswatini (Swaziland)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands\" >Falkland Islands<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard and McDonald Islands\" >Heard and McDonald Islands<\/option><option value=\"Holy See\" >Holy See<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macau\" >Macau<\/option><option value=\"Macedonia\" >Macedonia<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Korea\" >North Korea<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine, State of\" >Palestine, State of<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin\" >Saint Martin<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten\" >Sint Maarten<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia\" >South Georgia<\/option><option value=\"South Korea\" >South Korea<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen Islands\" >Svalbard and Jan Mayen Islands<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\"  selected >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"US Minor Outlying Islands\" >US Minor Outlying Islands<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands, British\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" >Virgin Islands, U.S.<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-48 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"country_of_residence2\">Country of residence<\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"country_of_residence2\" name=\"country_of_residence2\" class=\"fusion-form-input\" data-holds-private-data=\"false\"><option value=\"Option\" >Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bonaire, Sint Eustatius and Saba\" >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos Islands\" >Cocos Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"C\u00f4te d'Ivoire\" >C\u00f4te d'Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Swaziland)\" >Eswatini (Swaziland)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands\" >Falkland Islands<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard and McDonald Islands\" >Heard and McDonald Islands<\/option><option value=\"Holy See\" >Holy See<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macau\" >Macau<\/option><option value=\"Macedonia\" >Macedonia<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Korea\" >North Korea<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine, State of\" >Palestine, State of<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin\" >Saint Martin<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten\" >Sint Maarten<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia\" >South Georgia<\/option><option value=\"South Korea\" >South Korea<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen Islands\" >Svalbard and Jan Mayen Islands<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\"  selected >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"US Minor Outlying Islands\" >US Minor Outlying Islands<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands, British\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" >Virgin Islands, U.S.<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-5 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-49 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-3\" style=\"--awb-content-alignment:center;\"><div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Please list business owners and % of ownership for anyone owning more than 20%. Guarantor ownership should equal 51% or greater.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-50 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_owner_3_first_name\">First name<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z]+\" name=\"business_owner_3_first_name\" id=\"business_owner_3_first_name\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-51 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_owner_3_last_name\">Last name<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z]+\" name=\"business_owner_3_last_name\" id=\"business_owner_3_last_name\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-52 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"%_ownership_3\">% Ownership<\/label><\/div><input type=\"number\" autocomplete=\"off\" name=\"%_ownership_3\" id=\"%_ownership_3\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" min=\"1\" max=\"100\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-53 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"dob3\">DOB<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"dob3\" name=\"dob3\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-54 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"ss#3\">SS#<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"\\d{3}-\\d{2}-\\d{4}\"  data-invalid-notice=\"Please use the following format: XXX-XX-XXXX\" name=\"ss#3\" id=\"ss#3\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-55 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"valid_government-issued_photo_id#3\">VALID Government-issued photo ID#<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z0-9]+\" name=\"valid_government-issued_photo_id#3\" id=\"valid_government-issued_photo_id#3\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-56 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"issue_date3\">Issue date<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"issue_date3\" name=\"issue_date3\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"owner\u2019s_cell_phone3\">Owner\u2019s cell phone<\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"owner\u2019s_cell_phone3\" id=\"owner\u2019s_cell_phone3\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-57 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"expiration_date3\">Expiration date<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"expiration_date3\" name=\"expiration_date3\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"owner\u2019s_email_address3\">Owner\u2019s email address<\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"owner\u2019s_email_address3\" id=\"owner\u2019s_email_address3\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-58 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"residential_address_city_state_zip3\">Residential address, city, state, zip<\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"residential_address_city_state_zip3\" id=\"residential_address_city_state_zip3\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-59 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"country_of_citizenship3\">Country of citizenship<\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"country_of_citizenship3\" name=\"country_of_citizenship3\" class=\"fusion-form-input\" data-holds-private-data=\"false\"><option value=\"Option\" >Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bonaire, Sint Eustatius and Saba\" >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos Islands\" >Cocos Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"C\u00f4te d'Ivoire\" >C\u00f4te d'Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Swaziland)\" >Eswatini (Swaziland)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands\" >Falkland Islands<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard and McDonald Islands\" >Heard and McDonald Islands<\/option><option value=\"Holy See\" >Holy See<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macau\" >Macau<\/option><option value=\"Macedonia\" >Macedonia<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Korea\" >North Korea<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine, State of\" >Palestine, State of<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin\" >Saint Martin<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten\" >Sint Maarten<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia\" >South Georgia<\/option><option value=\"South Korea\" >South Korea<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen Islands\" >Svalbard and Jan Mayen Islands<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\"  selected >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"US Minor Outlying Islands\" >US Minor Outlying Islands<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands, British\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" >Virgin Islands, U.S.<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-60 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"country_of_residence3\">Country of residence<\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"country_of_residence3\" name=\"country_of_residence3\" class=\"fusion-form-input\" data-holds-private-data=\"false\"><option value=\"Option\" >Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bonaire, Sint Eustatius and Saba\" >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos Islands\" >Cocos Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"C\u00f4te d'Ivoire\" >C\u00f4te d'Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Swaziland)\" >Eswatini (Swaziland)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands\" >Falkland Islands<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard and McDonald Islands\" >Heard and McDonald Islands<\/option><option value=\"Holy See\" >Holy See<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macau\" >Macau<\/option><option value=\"Macedonia\" >Macedonia<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Korea\" >North Korea<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine, State of\" >Palestine, State of<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin\" >Saint Martin<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten\" >Sint Maarten<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia\" >South Georgia<\/option><option value=\"South Korea\" >South Korea<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen Islands\" >Svalbard and Jan Mayen Islands<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\"  selected >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"US Minor Outlying Islands\" >US Minor Outlying Islands<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands, British\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" >Virgin Islands, U.S.<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-6 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-61 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-4\" style=\"--awb-content-alignment:center;\"><div class=\"page\" title=\"Page 2\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p>Please list business owners and % of ownership for anyone owning more than 20%. Guarantor ownership should equal 51% or greater.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-62 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_owner_4_first_name\">First name<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z]+\" name=\"business_owner_4_first_name\" id=\"business_owner_4_first_name\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-63 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"business_owner_4_last_name\">Last name<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z]+\" name=\"business_owner_4_last_name\" id=\"business_owner_4_last_name\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-64 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"%_ownership_4\">% Ownership<\/label><\/div><input type=\"number\" autocomplete=\"off\" name=\"%_ownership_4\" id=\"%_ownership_4\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" min=\"1\" max=\"100\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-65 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"dob4\">DOB<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"dob4\" name=\"dob4\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-66 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:5.76%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"ss#4\">SS#<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"\\d{3}-\\d{2}-\\d{4}\"  data-invalid-notice=\"Please use the following format: XXX-XX-XXXX\" name=\"ss#4\" id=\"ss#4\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-67 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"valid_government-issued_photo_id#4\">VALID Government-issued photo ID#<\/label><\/div><input type=\"text\" autocomplete=\"off\"  pattern=\"[a-zA-Z0-9]+\" name=\"valid_government-issued_photo_id#4\" id=\"valid_government-issued_photo_id#4\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-68 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"issue_date4\">Issue date<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"issue_date4\" name=\"issue_date4\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-phone-number-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"owner\u2019s_cell_phone4\">Owner\u2019s cell phone<\/label><\/div><div class=\"fusion-form-input-with-icon\"><i class=\"awb-form-icon fa-phone-square-alt fas\"><\/i><input type=\"tel\" autocomplete=\"off\" name=\"owner\u2019s_cell_phone4\" id=\"owner\u2019s_cell_phone4\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-69 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-date-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"expiration_date4\">Expiration date<\/label><input autocomplete=\"off\" type=\"date\" data-first-day=\"1\"  data-format=\"\" tabindex=\"\" id=\"expiration_date4\" name=\"expiration_date4\" data-type=\"custom\" value=\"\" data-holds-private-data=\"false\" class=\"fusion-form-input\"autocomplete=\"no\"\/><\/div><div class=\"fusion-form-field fusion-form-email-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"owner\u2019s_email_address4\">Owner\u2019s email address<\/label><\/div><input type=\"email\" autocomplete=\"off\" name=\"owner\u2019s_email_address4\" id=\"owner\u2019s_email_address4\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-70 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-text-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div class=\"fusion-form-label-wrapper\"><label for=\"residential_address_city_state_zip4\">Residential address, city, state, zip<\/label><\/div><input type=\"text\" autocomplete=\"off\" name=\"residential_address_city_state_zip4\" id=\"residential_address_city_state_zip4\" value=\"\"  class=\"fusion-form-input\" data-holds-private-data=\"false\" minlength=\"0\"\/><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-71 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"country_of_citizenship4\">Country of citizenship<\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"country_of_citizenship4\" name=\"country_of_citizenship4\" class=\"fusion-form-input\" data-holds-private-data=\"false\"><option value=\"Option\" >Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bonaire, Sint Eustatius and Saba\" >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos Islands\" >Cocos Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"C\u00f4te d'Ivoire\" >C\u00f4te d'Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Swaziland)\" >Eswatini (Swaziland)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands\" >Falkland Islands<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard and McDonald Islands\" >Heard and McDonald Islands<\/option><option value=\"Holy See\" >Holy See<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macau\" >Macau<\/option><option value=\"Macedonia\" >Macedonia<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Korea\" >North Korea<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine, State of\" >Palestine, State of<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin\" >Saint Martin<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten\" >Sint Maarten<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia\" >South Georgia<\/option><option value=\"South Korea\" >South Korea<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen Islands\" >Svalbard and Jan Mayen Islands<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\"  selected >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"US Minor Outlying Islands\" >US Minor Outlying Islands<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands, British\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" >Virgin Islands, U.S.<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-72 fusion_builder_column_1_2 1_2 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:50%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-select-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><label for=\"country_of_residence4\">Country of residence<\/label><div class=\"fusion-select-wrapper\"><select autocomplete=\"off\" tabindex=\"\" id=\"country_of_residence4\" name=\"country_of_residence4\" class=\"fusion-form-input\" data-holds-private-data=\"false\"><option value=\"Option\" >Option<\/option><option value=\"Afghanistan\" >Afghanistan<\/option><option value=\"\u00c5land Islands\" >\u00c5land Islands<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algeria\" >Algeria<\/option><option value=\"American Samoa\" >American Samoa<\/option><option value=\"Andorra\" >Andorra<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Anguilla\" >Anguilla<\/option><option value=\"Antarctica\" >Antarctica<\/option><option value=\"Antigua and Barbuda\" >Antigua and Barbuda<\/option><option value=\"Argentina\" >Argentina<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Aruba\" >Aruba<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbaijan\" >Azerbaijan<\/option><option value=\"Bahamas\" >Bahamas<\/option><option value=\"Bahrain\" >Bahrain<\/option><option value=\"Bangladesh\" >Bangladesh<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belarus\" >Belarus<\/option><option value=\"Belgium\" >Belgium<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bermuda\" >Bermuda<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bolivia\" >Bolivia<\/option><option value=\"Bonaire, Sint Eustatius and Saba\" >Bonaire, Sint Eustatius and Saba<\/option><option value=\"Bosnia and Herzegovina\" >Bosnia and Herzegovina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Bouvet Island\" >Bouvet Island<\/option><option value=\"Brazil\" >Brazil<\/option><option value=\"British Indian Ocean Territory\" >British Indian Ocean Territory<\/option><option value=\"Brunei Darussalam\" >Brunei Darussalam<\/option><option value=\"Bulgaria\" >Bulgaria<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Cambodia\" >Cambodia<\/option><option value=\"Cameroon\" >Cameroon<\/option><option value=\"Canada\" >Canada<\/option><option value=\"Cape Verde\" >Cape Verde<\/option><option value=\"Cayman Islands\" >Cayman Islands<\/option><option value=\"Central African Republic\" >Central African Republic<\/option><option value=\"Chad\" >Chad<\/option><option value=\"Chile\" >Chile<\/option><option value=\"China\" >China<\/option><option value=\"Christmas Island\" >Christmas Island<\/option><option value=\"Cocos Islands\" >Cocos Islands<\/option><option value=\"Colombia\" >Colombia<\/option><option value=\"Comoros\" >Comoros<\/option><option value=\"Congo, Democratic Republic of the\" >Congo, Democratic Republic of the<\/option><option value=\"Congo, Republic of the\" >Congo, Republic of the<\/option><option value=\"Cook Islands\" >Cook Islands<\/option><option value=\"Costa Rica\" >Costa Rica<\/option><option value=\"C\u00f4te d'Ivoire\" >C\u00f4te d'Ivoire<\/option><option value=\"Croatia\" >Croatia<\/option><option value=\"Cuba\" >Cuba<\/option><option value=\"Cura\u00e7ao\" >Cura\u00e7ao<\/option><option value=\"Cyprus\" >Cyprus<\/option><option value=\"Czech Republic\" >Czech Republic<\/option><option value=\"Denmark\" >Denmark<\/option><option value=\"Djibouti\" >Djibouti<\/option><option value=\"Dominica\" >Dominica<\/option><option value=\"Dominican Republic\" >Dominican Republic<\/option><option value=\"Ecuador\" >Ecuador<\/option><option value=\"Egypt\" >Egypt<\/option><option value=\"El Salvador\" >El Salvador<\/option><option value=\"Equatorial Guinea\" >Equatorial Guinea<\/option><option value=\"Eritrea\" >Eritrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini (Swaziland)\" >Eswatini (Swaziland)<\/option><option value=\"Ethiopia\" >Ethiopia<\/option><option value=\"Falkland Islands\" >Falkland Islands<\/option><option value=\"Faroe Islands\" >Faroe Islands<\/option><option value=\"Fiji\" >Fiji<\/option><option value=\"Finland\" >Finland<\/option><option value=\"France\" >France<\/option><option value=\"French Guiana\" >French Guiana<\/option><option value=\"French Polynesia\" >French Polynesia<\/option><option value=\"French Southern Territories\" >French Southern Territories<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Georgia\" >Georgia<\/option><option value=\"Germany\" >Germany<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Gibraltar\" >Gibraltar<\/option><option value=\"Greece\" >Greece<\/option><option value=\"Greenland\" >Greenland<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Guadeloupe\" >Guadeloupe<\/option><option value=\"Guam\" >Guam<\/option><option value=\"Guatemala\" >Guatemala<\/option><option value=\"Guernsey\" >Guernsey<\/option><option value=\"Guinea\" >Guinea<\/option><option value=\"Guinea-Bissau\" >Guinea-Bissau<\/option><option value=\"Guyana\" >Guyana<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Heard and McDonald Islands\" >Heard and McDonald Islands<\/option><option value=\"Holy See\" >Holy See<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Hong Kong\" >Hong Kong<\/option><option value=\"Hungary\" >Hungary<\/option><option value=\"Iceland\" >Iceland<\/option><option value=\"India\" >India<\/option><option value=\"Indonesia\" >Indonesia<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Iraq\" >Iraq<\/option><option value=\"Ireland\" >Ireland<\/option><option value=\"Isle of Man\" >Isle of Man<\/option><option value=\"Israel\" >Israel<\/option><option value=\"Italy\" >Italy<\/option><option value=\"Jamaica\" >Jamaica<\/option><option value=\"Japan\" >Japan<\/option><option value=\"Jersey\" >Jersey<\/option><option value=\"Jordan\" >Jordan<\/option><option value=\"Kazakhstan\" >Kazakhstan<\/option><option value=\"Kenya\" >Kenya<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kuwait\" >Kuwait<\/option><option value=\"Kyrgyzstan\" >Kyrgyzstan<\/option><option value=\"Lao People's Democratic Republic\" >Lao People's Democratic Republic<\/option><option value=\"Latvia\" >Latvia<\/option><option value=\"Lebanon\" >Lebanon<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libya\" >Libya<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Lithuania\" >Lithuania<\/option><option value=\"Luxembourg\" >Luxembourg<\/option><option value=\"Macau\" >Macau<\/option><option value=\"Macedonia\" >Macedonia<\/option><option value=\"Madagascar\" >Madagascar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malaysia\" >Malaysia<\/option><option value=\"Maldives\" >Maldives<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Marshall Islands\" >Marshall Islands<\/option><option value=\"Martinique\" >Martinique<\/option><option value=\"Mauritania\" >Mauritania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Mayotte\" >Mayotte<\/option><option value=\"Mexico\" >Mexico<\/option><option value=\"Micronesia\" >Micronesia<\/option><option value=\"Moldova\" >Moldova<\/option><option value=\"Monaco\" >Monaco<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Montenegro\" >Montenegro<\/option><option value=\"Montserrat\" >Montserrat<\/option><option value=\"Morocco\" >Morocco<\/option><option value=\"Mozambique\" >Mozambique<\/option><option value=\"Myanmar\" >Myanmar<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Netherlands\" >Netherlands<\/option><option value=\"New Caledonia\" >New Caledonia<\/option><option value=\"New Zealand\" >New Zealand<\/option><option value=\"Nicaragua\" >Nicaragua<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Niue\" >Niue<\/option><option value=\"Norfolk Island\" >Norfolk Island<\/option><option value=\"North Korea\" >North Korea<\/option><option value=\"Northern Mariana Islands\" >Northern Mariana Islands<\/option><option value=\"Norway\" >Norway<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Palestine, State of\" >Palestine, State of<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua New Guinea\" >Papua New Guinea<\/option><option value=\"Paraguay\" >Paraguay<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Philippines\" >Philippines<\/option><option value=\"Pitcairn\" >Pitcairn<\/option><option value=\"Poland\" >Poland<\/option><option value=\"Portugal\" >Portugal<\/option><option value=\"Puerto Rico\" >Puerto Rico<\/option><option value=\"Qatar\" >Qatar<\/option><option value=\"R\u00e9union\" >R\u00e9union<\/option><option value=\"Romania\" >Romania<\/option><option value=\"Russia\" >Russia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Barth\u00e9lemy\" >Saint Barth\u00e9lemy<\/option><option value=\"Saint Helena\" >Saint Helena<\/option><option value=\"Saint Kitts and Nevis\" >Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Martin\" >Saint Martin<\/option><option value=\"Saint Pierre and Miquelon\" >Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\" >Saint Vincent and the Grenadines<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Sao Tome and Principe\" >Sao Tome and Principe<\/option><option value=\"Saudi Arabia\" >Saudi Arabia<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seychelles\" >Seychelles<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapore\" >Singapore<\/option><option value=\"Sint Maarten\" >Sint Maarten<\/option><option value=\"Slovakia\" >Slovakia<\/option><option value=\"Slovenia\" >Slovenia<\/option><option value=\"Solomon Islands\" >Solomon Islands<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"South Africa\" >South Africa<\/option><option value=\"South Georgia\" >South Georgia<\/option><option value=\"South Korea\" >South Korea<\/option><option value=\"South Sudan\" >South Sudan<\/option><option value=\"Spain\" >Spain<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Suriname\" >Suriname<\/option><option value=\"Svalbard and Jan Mayen Islands\" >Svalbard and Jan Mayen Islands<\/option><option value=\"Sweden\" >Sweden<\/option><option value=\"Switzerland\" >Switzerland<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Taiwan\" >Taiwan<\/option><option value=\"Tajikistan\" >Tajikistan<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Thailand\" >Thailand<\/option><option value=\"Timor-Leste\" >Timor-Leste<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tokelau\" >Tokelau<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trinidad and Tobago\" >Trinidad and Tobago<\/option><option value=\"Tunisia\" >Tunisia<\/option><option value=\"Turkey\" >Turkey<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Turks and Caicos Islands\" >Turks and Caicos Islands<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraine\" >Ukraine<\/option><option value=\"United Arab Emirates\" >United Arab Emirates<\/option><option value=\"United Kingdom\" >United Kingdom<\/option><option value=\"United States\"  selected >United States<\/option><option value=\"Uruguay\" >Uruguay<\/option><option value=\"US Minor Outlying Islands\" >US Minor Outlying Islands<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Venezuela\" >Venezuela<\/option><option value=\"Vietnam\" >Vietnam<\/option><option value=\"Virgin Islands, British\" >Virgin Islands, British<\/option><option value=\"Virgin Islands, U.S.\" >Virgin Islands, U.S.<\/option><option value=\"Wallis and Futuna\" >Wallis and Futuna<\/option><option value=\"Western Sahara\" >Western Sahara<\/option><option value=\"Yemen\" >Yemen<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><\/select><div class=\"select-arrow\"><svg width=\"12\" height=\"8\" viewBox=\"0 0 12 8\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"> <path d=\"M1.5 1.75L6 6.25L10.5 1.75\" stroke=\"#6D6D6D\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/> <\/svg><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-73 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-form-field fusion-form-submit-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div style=\"text-align:center;\"><button type=\"submit\" class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-3 fusion-button-default-span  button-default form-form-submit\" data-form-number=\"5848\" tabindex=\"\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Next Section<\/span><\/button><\/div><\/div><\/div><\/div><\/div><\/div><\/p><\/div>\n<div class=\"awb-form-step\" data-final=\"1\" data-step=\"5\"><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1-7 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"width:104% !important;max-width:104% !important;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-74 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-5\"><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p><strong>IRS Form 8821 &amp; 7216\u00a0<\/strong><\/p>\n<p>Complete the information on pages 1 &amp; 3. Documents must be hand-signed in black ink. The address must match the most recent IRS filing.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"5848\"><label for=\"irs_form_8821_&amp;_7216\">IRS Form 8821 &amp; 7216 <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">Please note that only PDF files are allowed in this field.<\/span><\/div><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"irs_form_8821_&amp;_7216\" name=\"irs_form_8821_&amp;_7216[]\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" placeholder=\"Click or drag pdf files to this area to upload. *\" data-size=\"25\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag pdf files to this area to upload.\">Click or drag pdf files to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-4 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-double\" style=\"--awb-height:20px;--awb-amount:20px;border-color:var(--awb-color2);border-top-width:1px;border-bottom-width:1px;\"><\/div><\/div><div class=\"fusion-text fusion-text-6\"><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p><strong>Signed and dated IRS Form 941 (original return) and 941X (amended return) prepared for each quarter as submitted to the IRS.<\/strong><\/p>\n<p>Proof of postage will be needed if 941X\u2019s are dated within 6 weeks.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"5848\"><label for=\"signed_and_dated_irs_form_941_original_return_and_941x_amended_return_prepared_for_each_quarter_as_submitted_to_the_irs\">Signed and dated IRS Form 941 (original return) and 941X (amended return) prepared for each quarter as submitted to the IRS <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">Only PDF files are allowed in this field.<\/span><\/div><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"signed_and_dated_irs_form_941_original_return_and_941x_amended_return_prepared_for_each_quarter_as_submitted_to_the_irs\" name=\"signed_and_dated_irs_form_941_original_return_and_941x_amended_return_prepared_for_each_quarter_as_submitted_to_the_irs[]\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" placeholder=\"Click or drag pdf files to this area to upload. *\" data-size=\"30\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag pdf files to this area to upload.\">Click or drag pdf files to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-5 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-double\" style=\"--awb-height:20px;--awb-amount:20px;border-color:var(--awb-color2);border-top-width:1px;border-bottom-width:1px;\"><\/div><\/div><div class=\"fusion-text fusion-text-7\"><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p><strong>Documentation for ERC qualification (reason) from ERC filer<\/strong><\/p>\n<p>Eligibility reason and qualifying documentation to support from ERC preparer (revenue reduction, supply chain and government mandate\/shutdown).<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"5848\"><label for=\"documentation_for_erc_qualification_reason_from_erc_filer\">Documentation for ERC qualification (reason) from ERC filer <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">All file types are supported in this field.<\/span><\/div><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"documentation_for_erc_qualification_reason_from_erc_filer\" name=\"documentation_for_erc_qualification_reason_from_erc_filer[]\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" placeholder=\"Click or drag files to this area to upload. *\" data-size=\"48\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag files to this area to upload.\">Click or drag files to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-6 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-double\" style=\"--awb-height:20px;--awb-amount:20px;border-color:var(--awb-color2);border-top-width:1px;border-bottom-width:1px;\"><\/div><\/div><div class=\"fusion-text fusion-text-8\"><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p><strong>ERC calculations to support the ERC filing<\/strong><\/p>\n<p>Wage summary report broken down by employee and quarter - must match 941x filings. Confirm that PPP calculation is subtracted from ERC.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"5848\"><label for=\"erc_calculations_to_support_the_erc_filing\">ERC calculations to support the ERC filing <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">All file types are supported in this field.<\/span><\/div><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"erc_calculations_to_support_the_erc_filing\" name=\"erc_calculations_to_support_the_erc_filing[]\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" placeholder=\"Click or drag files to this area to upload. *\" data-size=\"50\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag files to this area to upload.\">Click or drag files to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-7 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-double\" style=\"--awb-height:20px;--awb-amount:20px;border-color:var(--awb-color2);border-top-width:1px;border-bottom-width:1px;\"><\/div><\/div><div class=\"fusion-text fusion-text-9\"><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p><strong>2 most recent quarters of 941s.<\/strong><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"5848\"><label for=\"2_most_recent_quarters_of_941s\">2 most recent quarters of 941s. <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">Only PDF files are allowed in this field<\/span><\/div><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"2_most_recent_quarters_of_941s\" name=\"2_most_recent_quarters_of_941s[]\" value=\"\"  class=\"fusion-form-input\"accept=\".pdf\" required=\"true\" aria-required=\"true\" placeholder=\"Click or drag pdf files to this area to upload. *\" data-size=\"20\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag pdf files to this area to upload.\">Click or drag pdf files to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-8 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-double\" style=\"--awb-height:20px;--awb-amount:20px;border-color:var(--awb-color2);border-top-width:1px;border-bottom-width:1px;\"><\/div><\/div><div class=\"fusion-text fusion-text-10\"><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p><strong>Color copy of government issued ID for all owners listed on the application (front and back)<\/strong><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"5848\"><label for=\"color_copy_of_government_issued_ids\">Color copy of government issued ID for all owners listed on the application (front and back) <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">Only PDF, PNG, and JPEG files are allowed in this field<\/span><\/div><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"color_copy_of_government_issued_ids\" name=\"color_copy_of_government_issued_ids[]\" value=\"\"  class=\"fusion-form-input\"accept=\".pdf,.jpg,.png\" required=\"true\" aria-required=\"true\" placeholder=\"Click or drag image files to this area to upload. *\" data-size=\"20\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag image files to this area to upload.\">Click or drag image files to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-9 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-double\" style=\"--awb-height:20px;--awb-amount:20px;border-color:var(--awb-color2);border-top-width:1px;border-bottom-width:1px;\"><\/div><\/div><div class=\"fusion-text fusion-text-11\"><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p><strong>Copy of 2019-2022 tax returns along with year-to-date P&amp;L and itemized Balance Sheet<\/strong><\/p>\n<p>Tax Returns must include a schedule C if filed on a 1040 and K-1.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"5848\"><label for=\"copy_of_2019-2022_tax_returns_along_with_year-to-date_p&amp;l_and_itemized_balance_sheet\">Copy of 2019-2022 tax returns along with year-to-date P&amp;L and itemized Balance Sheet <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">All file types are allowed in this field<\/span><\/div><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"copy_of_2019-2022_tax_returns_along_with_year-to-date_p&amp;l_and_itemized_balance_sheet\" name=\"copy_of_2019-2022_tax_returns_along_with_year-to-date_p&amp;l_and_itemized_balance_sheet[]\" value=\"\"  class=\"fusion-form-input\" required=\"true\" aria-required=\"true\" placeholder=\"Click or drag files to this area to upload. *\" data-size=\"50\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag files to this area to upload.\">Click or drag files to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-10 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;width:100%;\"><div class=\"fusion-separator-border sep-double\" style=\"--awb-height:20px;--awb-amount:20px;border-color:var(--awb-color2);border-top-width:1px;border-bottom-width:1px;\"><\/div><\/div><div class=\"fusion-text fusion-text-12\"><div class=\"page\" title=\"Page 1\">\n<div class=\"section\">\n<div class=\"layoutArea\">\n<div class=\"column\">\n<p><strong>Bank statements (3 Months\/all pages)<\/strong><\/p>\n<p>Our technology partner will send you a secure link via email that will allow you to automatically transmit your bank statements required for the underwriting process.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"fusion-form-field fusion-form-upload-field fusion-form-label-above\" style=\"--awb-preview-thumb-width:115px;\" data-form-id=\"5848\"><label for=\"bank_statements_3_monthsall_pages\">Bank statements (3 Months\/all pages) <abbr class=\"fusion-form-element-required\" title=\"required\">*<\/abbr><\/label><div class=\"fusion-form-tooltip\"><i class=\"awb-icon-question-circle\"><\/i><span class=\"fusion-form-tooltip-content\">Only image files are allowed in thi field.<\/span><\/div><div class=\"fusion-form-input-with-icon\"><i class=\" fa-upload fas\"><\/i><div class=\"fusion-form-upload-field-container\"><input type=\"file\" id=\"bank_statements_3_monthsall_pages\" name=\"bank_statements_3_monthsall_pages[]\" value=\"\"  class=\"fusion-form-input\"accept=\".jpg,.png,.pdf\" required=\"true\" aria-required=\"true\" placeholder=\"Click or drag image files to this area to upload. *\" data-size=\"20\" multiple data-single-add-remove=\"no\" data-min-upload-files=\"0\" data-max-upload-files=\"0\" data-uploads-preview=\"filenames\"\/><div class=\"fusion-form-upload-field\"  data-holds-private-data=\"false\"><span class=\"awb-upload-placeholder\" data-default=\"Click or drag image files to this area to upload.\">Click or drag image files to this area to upload.<\/span><div class=\"awb-uploads-preview\"><div class=\"awb-preview-thumbs\"><\/div><\/div><\/div><div ><a class=\"fusion-button button-flat button-medium button-default fusion-button-default button-11 fusion-button-default-span fusion-button-default-type fusion-form-upload-field-button\" style=\"--button-border-radius-top-left:0px;--button-border-radius-top-right:0px;--button-border-radius-bottom-right:0px;--button-border-radius-bottom-left:0px;\" target=\"_self\" href=\"javascript:void();\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Choose File<\/span><\/a><\/div><\/div><\/div><\/div><div class=\"form-submission-notices data-notice_1\" id=\"fusion-notices-1\" data-instance=\"1\"><div class=\"fusion-alert alert success alert-success fusion-alert-center fusion-form-response fusion-form-response-success awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"alert-icon\"><i class=\"awb-icon-check-circle\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-alert-content\">Thank you for your application. It has been submitted.<\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div><div class=\"fusion-alert alert error alert-danger fusion-alert-center fusion-form-response fusion-form-response-error awb-alert-native-link-color alert-dismissable awb-alert-close-boxed\" role=\"alert\"><div class=\"fusion-alert-content-wrapper\"><span class=\"alert-icon\"><i class=\"awb-icon-exclamation-triangle\" aria-hidden=\"true\"><\/i><\/span><span class=\"fusion-alert-content\">There was an error trying to send your message. Please try again later.<\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div><\/div><div class=\"fusion-form-field fusion-form-submit-field fusion-form-label-above\" style=\"\" data-form-id=\"5848\"><div style=\"text-align:center;\"><button type=\"submit\" class=\"fusion-button button-flat fusion-button-default-size button-default fusion-button-default button-12 fusion-button-default-span  button-default form-form-submit\" data-form-number=\"5848\" tabindex=\"\"><span class=\"fusion-button-text awb-button__text awb-button__text--default\">Submit<\/span><\/button><\/div><\/div><\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"fusion_privacy_expiration_interval\" value=\"48\"><input type=\"hidden\" name=\"privacy_expiration_action\" value=\"anonymize\"><\/form><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-75 fusion_builder_column_1_6 1_6 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:16.666666666667%;--awb-flex-grow:0;--awb-flex-shrink:0;--awb-margin-top-large:0px;--awb-spacing-right-large:11.52%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:11.52%;--awb-width-medium:100%;--awb-order-medium:0;--awb-flex-grow-medium:;--awb-flex-shrink-medium:;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-flex-grow-small:;--awb-flex-shrink-small:;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5973","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.countrycreditclub.com\/es\/wp-json\/wp\/v2\/pages\/5973","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.countrycreditclub.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.countrycreditclub.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.countrycreditclub.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.countrycreditclub.com\/es\/wp-json\/wp\/v2\/comments?post=5973"}],"version-history":[{"count":2,"href":"https:\/\/www.countrycreditclub.com\/es\/wp-json\/wp\/v2\/pages\/5973\/revisions"}],"predecessor-version":[{"id":5976,"href":"https:\/\/www.countrycreditclub.com\/es\/wp-json\/wp\/v2\/pages\/5973\/revisions\/5976"}],"wp:attachment":[{"href":"https:\/\/www.countrycreditclub.com\/es\/wp-json\/wp\/v2\/media?parent=5973"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}