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<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">

	
<title>SciCanUSA | Contact us</title>


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<link href="/site/ywd_prototype/library/css/main.css" rel="stylesheet" type="text/css">


<link href="/site/ywd_prototype/display/templates/t5/library/main.css" rel="stylesheet" type="text/css">
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<style type="text/css">


	body {
		background-color:#BEBEBE;
		
		
					background-image:none;
				
			
	}


		body {
			background-image:url(/site/scicanusa//assets/images/scican_topbar_usa2.gif);
			background-position:top center;
			background-repeat:no-repeat;
			background-attachment:scroll;
		}
	

	.layoutleft, .navbar, .leftcol {
			border-style:none;
		}


	#shadowbottomrow {
		display:none;
	}


#wrapper {
	width:988px;
}


#wrapperfooter .footer {
	width:988px;
	position:relative;
	text-align: left;
	margin-left: auto;
	margin-right: auto;
}


	.contenttable, .contenttablesub {
		height:350px;
	}


	.footer, #wrapperfooter {
		background-color:#888888;
	}


.footer {
	padding-left:20px;
}

	
.footer {
	padding-right:20px;
}

	
.footer {
	padding-top:20px;
}

	
.footer {
	padding-bottom:5px;
}


	body, td, p, /*input, select,*/ h1, h2, h3, h4, h5, h6, div {
		color:#666666;
	}


		.leftcol, .navleft, .layoutbottomleft {
			background-color:#FFFFFF;
		}
	

		.rightcol, .rightcolsub {
			background-color:#FFFFFF;
		}
	

	.tertiarynav, .footertext, .footerlogo {
		color:#444444;
	}


<!-- global header colours replaced by individual header settings. kept for compatibility --->


#nav {
	padding-top:0px;
	padding-bottom:0px;
}

	.navbararea {
		border-top-width:0px;
		padding-top:0px;
		margin-top:0px;
	}
	.navbar {
		padding-top:0px;
		margin-top:0px;
	}


	.navbararea {
		border-bottom-width:0px;
		padding-bottom:0px;
		margin-bottom:0px;
	}
	.navbar {
		padding-bottom:0px;
		margin-bottom:0px;
	}


	.navbararea, .navbar, #nav, #nav ul, #nav ul:hover {
		background-color:transparent;
		background-image:none;
		height:auto;
	}
	.navbararea {
		border-top-color:transparent;
		border-bottom-color:transparent;
	}


		.navbuttonrollover, .navbuttonon:hover, #nav li:hover, #nav li.sfhover, ul.dropdown li:hover, ul.dropdown ul a:hover {
			background-color:#000000;
			background-image:none;
		}
	

		.navlinks, .navlinks:visited, #nav a {
			color:#53E2B1;
			background-color:transparent;
		}
	

	.navlinkson, .navlinkson:visited {
		color:#F7941D;
		background-color:transparent;
	}
	#nav a.dhtmlnavactive, a.dhtmlnavactive {
		color:#F7941D;
	}


	.navlinks:hover, .navlinkson:hover, #nav:hover, #nav a:hover, #nav li:hover, #nav li.sfhover, ul.dropdown a:hover {
		color:#F7941D;
		background-color:transparent;
	}


	.navlinks, .navlinkson, #nav li, #nav li ul, #css3dnav1 li, #css3dnav1 li ul, ul.dropdown {
	
	}


	.navlinks, .navlinkson, #nav li, #nav li ul, #css3dnav1 li a, #css3dnav1 li ul a, ul.dropdown {
		font-size:15px;
	}
	
		.navlinks, .navlinkson, #nav li, #nav li ul {
			line-height:1.2em;
		}
	

		.navlinks, .navlinkson, #nav a, #css3dnav1 li a, #css3dnav1 li ul a, ul.dropdown {
			text-transform:none;
		}
		

	.navbar, .navbararea, .navbutton, .navbuttonon, .navbuttonrollover {
		height:30px;
	}
	.navbutton a, .navbuttonon a, .navbuttonrollover a, .navlinks a, .navlinkson a, #nav a {
		line-height:15px;
	}


	.navbar {
		margin-left:450px;
		padding-left:0px;
	}


	.navbuttons td {
	
	}


	.navbuttons td {
		border-left-color:#25958F;
	}


	.navleft1current, .navleft2current, .navleft3current {
		background-color:#F0F0F0;
		background-image:none;
	}


	.navleft1:hover, .navleft1current:hover, .navleft2:hover, .navleft2current:hover, .navleft3:hover, .navleft3current:hover {
		background-color:#F0F0F0;
		background-image:none;
	}


	.navleft1current, .navleft2current, .navleft3current {
		color:#5DAD92;
	}


	.navleft1:hover, .navleft1current:hover, .navleft2:hover, .navleft2current:hover, .navleft3:hover, .navleft3current:hover {
		color:#5DAD92;
	}


	.navleft1, .navleft1current, .navleft2, .navleft2current, .navleft3, .navleft3current {
	
	}


	.navleft1, .navleft1current, .navleft2, .navleft2current, .navleft3, .navleft3current {
		font-size:14px;
		line-height:1.2em;
	}


	.navleft1, .navleft1current, .navleft2, .navleft2current, .navleft3, .navleft3current {
		line-height:14px;
	}


	.navleft1, .navleft1current, .navleft2, .navleft2current, .navleft3, .navleft3current {
	
			border-bottom-width:2px;
			border-bottom-style:solid;
		
	}


	.navleft1, .navleft1current, .navleft2, .navleft2current, .navleft3, .navleft3current {
		border-bottom-color:#000000;
	}


		.navleft1, .navleft1current, .navleft2, .navleft2current, .navleft3, .navleft3current {
			text-transform:none;
		}
		

	.navleft2, .navleft2current, .navleft3, .navleft3current {
	
	}


	.navleft2, .navleft2current, .navleft3, .navleft3current {
		font-size:12px;
		line-height:1.2em;
	}


	.navleft2, .navleft2current, .navleft3, .navleft3current {
		line-height:14px;
	}


	.navleft2, .navleft2current, .navleft3, .navleft3current {
	
			border-bottom-width:1px;
			border-bottom-style:dotted;
		
	}


	.navleft2, .navleft2current, .navleft3, .navleft3current {
		border-bottom-color:#C2C2C2;
	}


		.navleft2, .navleft2current, .navleft3, .navleft3current {
			text-transform:none;
		}
		

	.navleft3, .navleft3current {
	
	}


	.navleft3, .navleft3current {
	
	}


		.navleft3, .navleft3current {
			text-transform:none;
		}
		

	.linearnavbar, .linearnavbarsearch {
		height:38px;
	}


	.linearnavbar td a, .linearnavbarsearch td a {
		color:#DEDEDE;
		
	}


	.linearnavbar td a:hover, .linearnavbarsearch td a:hover {
		color:#FFFFFF;
		
	}


	.linearnavbar td a, .linearnavbarsearch td a {
	
	}


	.linearnavbar td a, .linearnavbarsearch td a {
		font-size:10px;
		line-height:1.2em;
	}


	.linearnavbar td a, .linearnavbarsearch td a {
			text-transform:uppercase;
		}
		

	.linearnavbar table, .linearnavbarsearch table {
		margin-right:23px;
	}


	.tertiarynav a {
		color:#EEEEEE;
	}


	.tertiarynav a:hover {
		color:#FFFFFF;
	}


	.tertiarynav a {
	
	}


	.tertiarynav_l2 a {
			font-weight:normal;
		}
		

	.tertiarynav a {
			text-transform:none;
		}
		

	.tertiarynav, .footertext {
		padding-left:0px;
	}


			.tertiarynav a:hover {
				text-decoration:underline;
				border-bottom-style:none;
			}
		

	.contentmaincol, .contentmaincolsub, .breadcrumbs {
		padding-left:30px;
	}


	.contentmaincol, .contentmaincolsub {
		padding-top:25px;
	}


	.contentmaincol {
		padding-right:0px;
	}


	.contentmaincol {
		padding-top:41px;
	}


	.contentmaincol {
		padding-bottom:0px;
	}


	h1 {
		letter-spacing:px;
	}


	h2 {
		letter-spacing:px;
	}


	h3 {
		letter-spacing:px;
	}


	h4 {
		letter-spacing:px;
	}


	h5 {
		letter-spacing:px;
	}


	h6 {
		letter-spacing:px;
	}


	p {
		margin-bottom:0.7em;
	}


	.contentmaincol p, .contentmaincol div, .contentmaincol ul, .contentmaincol li, .contentmaincol td, 
	.contentmaincolsub p, .contentmaincolsub div, .contentmaincolsub ul, .contentmaincolsub li,  .contentmaincolsub td,
	.rightcol p, .rightcol div, .rightcol ul, .rightcol li, .rightcol td,
	.rightcolsub p, .rightcolsub div, .rightcolsub ul, .rightcolsub li, .rightcolsub td,
	#contentheader p, #contentheader div, #contentheader ul, #contentheader li, #contentheader td,
	#contentfooter p, #contentfooter div, #contentfooter ul, #contentfooter li, #contentfooter td  {
		line-height:17px;
	}


	.navleft, #contentleftcol {
		width:170px;
	}
	
	
	.leftcol {
		padding-right:0px;
	}


	.leftcol {
		padding-top:41px;
	}


	.leftcol {
		padding-bottom:0px;
	}


.navleft {
	margin-left:5px;
}
#contentleftcol {
	padding-left:5px;
}


.navleft, #contentleftcol {
	padding-right:0px;
}


	.leftcol, .leftcolsub {
		width:170px;
	}

.navleft, #contentleftcol {
	width:165px;
}


	h1 {
	
	}


	h2 {
	
	}


	h3 {
	
	}


	h4 {
	
	}


	h5 {
	
	}


	h6 {
	
	}


	h1 {
		font-size:28px;
		line-height:1.2em;
	}


	h2 {
		font-size:17px;
		line-height:1.2em;
	}


	h3 {
		font-size:14px;
		line-height:1.2em;
	}


	h4 {
		font-size:12px;
		line-height:1.2em;
	}


	h1 {
		line-height:28px;
	}


	h2 {
		line-height:21px;
	}


	h3 {
		line-height:18px;
	}


	h4 {
		line-height:15px;
	}


	h1 {
		font-weight:normal;
	}


	h2 {
		font-weight:normal;
	}


	h3 {
		font-weight:normal;
	}


	h4 {
		font-weight:normal;
	}


	h5 {
		font-weight:normal;
	}


	h6 {
		font-weight:normal;
	}


	h1 {
		color:#000000;
	}


	h3 {
		color:#000000;
	}


	h4 {
		color:#000000;
	}


		h1 {
			text-transform:none;
		}
		

		h2 {
			text-transform:none;
		}
		

		h3 {
			text-transform:none;
		}
		

		h4 {
			text-transform:none;
		}
		

		h5 {
			text-transform:none;
		}
		

		h6 {
			text-transform:uppercase;
		}
		

	.contentmaincol a, .contentmaincolsub a, #contentrightcol a, .rightcol a, .rightcolsub a, #monthcalendar span.tip a, #contentleftcol a, #contentheader a, #contentfooter a {
		font-weight:normal;
	}


	.contentmaincol a, .contentmaincolsub a, #contentrightcol a, .rightcol a, .rightcolsub a, #monthcalendar span.tip a, #contentleftcol a, #contentheader a, #contentfooter a {
		color:#006699;
	}


	.contentmaincol a:hover, .contentmaincolsub a:hover, #contentrightcol a:hover, .rightcol a:hover, .rightcolsub a:hover, #monthcalendar span.tip a:hover, #contentleftcol a:hover, #contentheader a:hover, #contentfooter a:hover {
		color:#F7941D;
	}


	.contentmaincol a:hover, .contentmaincolsub a:hover, #contentrightcol a:hover, .rightcol a:hover, .rightcolsub a:hover, #monthcalendar span.tip a:hover, #contentleftcol a:hover, #contentheader a:hover, #contentfooter a:hover {
		background-color:transparent;
	}


	.maincolbox, .leftcolbox, .rightcolbox {
		margin-left:0px;
	}


	.maincolbox, .leftcolbox, .rightcolbox {
		margin-right:0px;
	}


	.maincolbox, .leftcolbox, .rightcolbox {
		margin-top:0px;
	}


	.maincolbox, .leftcolbox, .rightcolbox {
		margin-bottom:10px;
	}


		h1 {
	
	
		border-width:2px;
	
	
		border-style:solid;
	
	
		border-color:#77AE9A;
	
	
		padding:5px;
	
	
			border-top:none;
			border-left:none;
			border-right:none;
		
	
		margin-bottom:20px;
	
	}
	
	
#contentrightcol {
	margin-left:18px;
}


#contentrightcol {
	margin-right:10px;
}


	.rightcol, .rightcolsub {
		width:250px;
	}

#contentrightcol {
	width:222px;
}


	.rightcol, .rightcolsub {
		padding-top:75px;
	}


.rightcol #contentrightcol {
	margin-left:18px;
}


.rightcol #contentrightcol {
	margin-right:5px;
}


	.rightcol {
		width:240px;
	}

.rightcol #contentrightcol {
	width:217px;
}


	.rightcol {
		padding-top:42px;
	}


	.rightcol,.rightcolsub {
		background-image:url(site/scicanusa/assets/images/sc_rightcolback.gif);
		background-repeat:no-repeat;
	}


	ul li {
	
		list-style-type:disc;
    
	}


	ul li {
		list-style-image:url(site/scicanusa/assets/images/sc_bullet.gif);
	}


	ul {
		margin-left:1.3em;
	}
	ol {
		margin-left:1.3em;
	}


	hr {
		border-top-color:#EEEEEE;
	}


	hr {
		border-top-width:1px;
	}


	hr {
	
		border-top-style:solid;
    
	}


	hr {
		margin-top:0.5em;
	}


	hr {
		margin-bottom:0.5em;
	}


	.blognavbar #nav li, .blognavbar #nav a {
	
	}


	.BlogButtons, .BlogButtons a {
	
	}


.productListItemImage a, .productListItemImage a:hover {
	background-color:transparent;
}


</style>


<link media="print" href="/site/ywd_prototype/library/css/printerfriendly.css" rel="stylesheet" type="text/css">


	<link href="site/scicanusa/library/css/custom.css" rel="stylesheet" type="text/css">


    <link rel="shortcut icon" href="site/scicanusa/assets/images/favicon.gif" type="image/x-icon">
    <link rel="icon" href="site/scicanusa/assets/images/favicon.gif" type="image/x-icon">


	<script language="JavaScript1.2" src="library/javascript/qforms/c_qforms.js" type="text/javascript"></script>
	<script language="JavaScript" type="text/JavaScript">
		qFormAPI.setLibraryPath("library/javascript/qforms");
		qFormAPI.include("field");
		qFormAPI.include("validation");
		qFormAPI.include("functions");
		qFormAPI.include("functions_js12");
		qFormAPI.include("cookies");
	</script>
	<script language="JavaScript1.2" src="library/javascript/cdkpQformsAlterations/container-ext.js" type="text/javascript"></script>


			<script type="text/javascript">
		_ajaxConfig =  {'_cfscriptLocation':'/library/ajaxcfc/calendar.cfc', 
						'_jsscriptFolder':'/library/ajaxcfc/js',
						'debug':true};
	</script>
	<script src="/library/ajaxcfc/js/ajax.js" type="text/javascript"></script>


	<script language="JavaScript1.2">
		var CalUpdatedContent = '';
		function GetCalContent(CalDate,siteid) {
			var calobj = new Object();
			calobj.CalDate = CalDate;
			calobj.siteid = siteid;
			calobj.URLPATH = "index.cfm?id=17951";
			DWREngine.setAsync(false);
			DWREngine._execute(_ajaxConfig._cfscriptLocation, null, 'getcalcont', calobj,calobj,calobj, DoContent);
		}
		function DoContent(r) {
			$('calendar').innerHTML = r.calcontent;
		}
		function GetCalEvent(EventID) {
			var EventID = EventID;
			DWREngine.setAsync(false);
			DWREngine._execute(_ajaxConfig._cfscriptLocation, null, 'geteventbyid', EventID,EventID, DoEventContent);
		}
		function DoEventContent(r) {
			$('csstips').innerHTML = r;
		}
	</script>


		<script language="JavaScript1.1" type="text/javascript">
		<!--
		
		
		var objCCForm1 = "";
		
		var objCCForm2 = "";
		
		
				function completeform2()
				{
					try {
					
					}
					catch (e)
					{
						window.alert(e);
					}
				}
				
		
		function ONLOADDocumentFunction ()
		{
		
				
				////// start
				
				try {
				
				objCCForm2 = new qForm("ccform2");
			
		
		objCCForm2.name.description = "name";
		
		objCCForm2.name.required = true;
		
		
		objCCForm2.address.description = "address";
		
		objCCForm2.address.required = true;
		
		
		objCCForm2.city.description = "city";
		
		objCCForm2.city.required = true;
		
		
	objCCForm2.stateprovince.description = "StateProvince";
	
	objCCForm2.stateprovince.required = true;
	
	
		objCCForm2.zippostal.description = "ZipPostal";
		
		objCCForm2.zippostal.required = true;
		
		
	objCCForm2.country.description = "Country";
	
	objCCForm2.country.required = true;
	
	
		objCCForm2.email.description = "Email";
		
		objCCForm2.email.required = true;
		
		
		objCCForm2.message.description = "Message";
		
		objCCForm2.message.required = true;
		
		
				}
				catch (e)
				{
					//alert('Qforms attributes error:');
					//window.alert(e);
				}
				
				
				objCCForm2.onSubmit = completeform2;
				
				var els = document.ccform2.elements; 
				
				for(i=0; i<els.length; i++){ 
					if(els[i].type != "hidden" ){
						try {
							
							break;
						}
						catch (e)
						{
							//window.alert(e);
						}
					}
				}
				
				//////// end
				
				
		}
		
		
		//-->
		</script>
		
	
<script language="JavaScript1.2" src="site/ywd_prototype/library/javascript/sitespecific.js" type="text/javascript"></script>
<!-- BROKERBOX HEADER -->
</head>
<body 
		
		onload="ONLOADDocumentFunction()" 
		
		
		>

<div id="calendar"></div>
<div id="caldetail"></div>
<div id="csstips" style="display:none;z-index:100;"></div>


<div id="wrapper">
<div id="layoutsub">


<a name="top"></a>


    <div class="linearnavbar">
        <table border="0" align="right" cellpadding="0" cellspacing="0">	    
            <tr>
            	
                
                            <td>
                                <a href="http://www.scicanusa.com/index.cfm?pagepath=Home&amp;id=17923">Home</a>						
                            </td>
                        
                    
                            <td>
                                <a href="http://www.scicanusa.com/index.cfm?pagepath=Home/About_us/Careers&amp;id=17934">Careers</a>						
                            </td>
                        
                    
                            <td>
                                <a href="http://www.scicanusa.com/index.cfm?pagepath=Home/Contact_us&amp;id=17951">Contact us</a>						
                            </td>
                        
                    
                            <td>
                                <a href="http://www.scicanusa.com/index.cfm?pagepath=Sitemap&amp;id=18037">Sitemap</a>						
                            </td>
                        
                    
                <td style="width:8px;padding:0px;"></td>
                
            </tr>
        </table>
    </div>


<table class="layout" border="0" cellspacing="0" cellpadding="0">
	<tr>
		<td id="shadowvertleft">&nbsp;</td>
		<td class="layoutleft">
        
			
            <div class="navbararea"  onclick="document.location.href='http://www.scicanusa.com/index.cfm?pagepath=Home&amp;id=17923';">
                <div class="navbar">
                    
                        
                        <table class="navbuttons" border="0" cellspacing="0" cellpadding="0">
                            <tr>
								
                                
                                                <td class="navbutton"style=" border-left-style:none;" onmouseover="this.className='navbuttonrollover'" onmouseout="this.className='navbutton'"><a href="http://www.scicanusa.com/index.cfm?pagepath=Testimonials&amp;id=17952" class="navlinks">Testimonials</a></td>
                                            
                                        
                                                <td class="navbutton" onmouseover="this.className='navbuttonrollover'" onmouseout="this.className='navbutton'"><a href="http://www.scicanusa.com/index.cfm?pagepath=Dental_products&amp;id=17957" class="navlinks">Dental products</a></td>
                                            
                                        
                                                <td class="navbutton" onmouseover="this.className='navbuttonrollover'" onmouseout="this.className='navbutton'"><a href="http://www.scicanusa.com/index.cfm?pagepath=Medical_products&amp;id=18006" class="navlinks">Medical products</a></td>
                                            
                                        
                                                <td class="navbutton" onmouseover="this.className='navbuttonrollover'" onmouseout="this.className='navbutton'"><a href="http://www.scicanusa.com/index.cfm?pagepath=My_SciCan&amp;id=18033" class="navlinks">My SciCan</a></td>
                                            
                                        
                            </tr>
                        </table>
                    
                </div>
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			<h1 style="margin-top:0px;">Contact us</h1>
        
		
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<h2><img width="300" hspace="10" height="188" border="1" align="right" alt="" src="/site/scicanusa/assets/images/SciCan_USAOFFICE.jpg" /></h2>
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<h2>SciCan Inc's headquarters is located at:</h2>
<p>701 Technology Drive<br />
Canonsburg, PA 15317<br />
USA</p>
<p>Phone: 724-820-1600<br />
Toll Free: 1.800.572.1211<br />
Fax: 724-820-1479</p>
<p><strong>We would like to hear from you.</strong></p>
<p>Please fill this out this form and press the Submit button at the bottom of this page.</p>
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	<tr><td valign="top" class="displayFieldLabel">State/Province:&nbsp;<span class="requiredField">*&nbsp;</span></td>
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<select name="stateprovince">
	
	<option value="">- select your area -</option>
	
	
		<option value="Other" >Other</option>
	
		<option value="AL" >Alabama</option>
	
		<option value="AK" >Alaska</option>
	
		<option value="AZ" >Arizona</option>
	
		<option value="AR" >Arkansas</option>
	
		<option value="CA" >California</option>
	
		<option value="CO" >Colorado</option>
	
		<option value="CT" >Connecticut</option>
	
		<option value="DE" >Delaware</option>
	
		<option value="DC" >District of Columbia</option>
	
		<option value="FL" >Florida</option>
	
		<option value="GA" >Georgia</option>
	
		<option value="HI" >Hawaii</option>
	
		<option value="ID" >Idaho</option>
	
		<option value="IL" >Illinois</option>
	
		<option value="IN" >Indiana</option>
	
		<option value="IA" >Iowa</option>
	
		<option value="KS" >Kansas</option>
	
		<option value="KY" >Kentucky</option>
	
		<option value="LA" >Louisiana</option>
	
		<option value="ME" >Maine</option>
	
		<option value="MD" >Maryland</option>
	
		<option value="MA" >Massachusetts</option>
	
		<option value="MI" >Michigan</option>
	
		<option value="MN" >Minnesota</option>
	
		<option value="MS" >Mississippi</option>
	
		<option value="MO" >Missouri</option>
	
		<option value="MT" >Montana</option>
	
		<option value="NE" >Nebraska</option>
	
		<option value="NV" >Nevada</option>
	
		<option value="NH" >New Hampshire</option>
	
		<option value="NJ" >New Jersey</option>
	
		<option value="NM" >New Mexico</option>
	
		<option value="NY" >New York</option>
	
		<option value="NC" >North Carolina</option>
	
		<option value="ND" >North Dakota</option>
	
		<option value="OH" >Ohio</option>
	
		<option value="OK" >Oklahoma</option>
	
		<option value="OR" >Oregon</option>
	
		<option value="PA" >Pennsylvania</option>
	
		<option value="RI" >Rhode Island</option>
	
		<option value="SC" >South Carolina</option>
	
		<option value="SD" >South Dakota</option>
	
		<option value="TN" >Tennessee</option>
	
		<option value="TX" >Texas</option>
	
		<option value="UT" >Utah</option>
	
		<option value="VT" >Vermont</option>
	
		<option value="VA" >Virginia</option>
	
		<option value="WA" >Washington</option>
	
		<option value="WV" >West Virginia</option>
	
		<option value="WI" >Wisconsin</option>
	
		<option value="WY" >Wyoming</option>
	
		<option value="AB" >Alberta</option>
	
		<option value="BC" >British Columbia</option>
	
		<option value="MB" >Manitoba</option>
	
		<option value="NB" >New Brunswick</option>
	
		<option value="NL" >Newfoundland and Labrador</option>
	
		<option value="NT" >Northwest Territories</option>
	
		<option value="NS" >Nova Scotia</option>
	
		<option value="NT" >Nunavut</option>
	
		<option value="ON" >Ontario</option>
	
		<option value="PE" >Prince Edward Island</option>
	
		<option value="QC" >Quebec</option>
	
		<option value="SK" >Saskatchewan</option>
	
		<option value="YT" >Yukon</option>
	
</select>


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	<tr><td valign="top" class="displayFieldLabel">Zip/Postal Code:&nbsp;<span class="requiredField">*&nbsp;</span></td><td valign="top" class="displayFieldContents"><input name="zippostal" type="text" value="" size="30" maxlength="30">
	
	
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	<tr><td valign="top" class="displayFieldLabel">Country:&nbsp;<span class="requiredField">*&nbsp;</span></td>
<td valign="top" class="displayFieldContents">
<select name="country">
	
	<option value="">- select a country -</option>
	
	
		<option value="Other">Other</option>
	
		<option value="CA">Canada</option>
	
		<option value="US">United States</option>
	
		<option value="AF">Afghanistan</option>
	
		<option value="AL">Albania</option>
	
		<option value="DZ">Algeria</option>
	
		<option value="AS">American Samoa</option>
	
		<option value="AD">Andorra</option>
	
		<option value="AO">Angola</option>
	
		<option value="AI">Anguilla</option>
	
		<option value="AQ">Antarctica</option>
	
		<option value="AG">Antigua and Barbuda</option>
	
		<option value="AR">Argentina</option>
	
		<option value="AM">Armenia</option>
	
		<option value="AW">Aruba</option>
	
		<option value="AU">Australia</option>
	
		<option value="AT">Austria</option>
	
		<option value="AZ">Azerbaijan</option>
	
		<option value="BS">Bahamas</option>
	
		<option value="BH">Bahrain</option>
	
		<option value="BD">Bangladesh</option>
	
		<option value="BB">Barbados</option>
	
		<option value="BY">Belarus</option>
	
		<option value="BE">Belgium</option>
	
		<option value="BZ">Belize</option>
	
		<option value="BJ">Benin</option>
	
		<option value="BM">Bermuda</option>
	
		<option value="BT">Bhutan</option>
	
		<option value="BO">Bolivia</option>
	
		<option value="BA">Bosnia and Herzegovina</option>
	
		<option value="BW">Botswana</option>
	
		<option value="BV">Bouvet Island</option>
	
		<option value="BR">Brazil</option>
	
		<option value="IO">British Indian Ocean Territory</option>
	
		<option value="BN">Brunei Darussalam</option>
	
		<option value="BG">Bulgaria</option>
	
		<option value="BF">Burkina Faso</option>
	
		<option value="BI">Burundi</option>
	
		<option value="KH">Cambodia</option>
	
		<option value="CM">Cameroon</option>
	
		<option value="CV">Cape Verde</option>
	
		<option value="KY">Cayman Islands</option>
	
		<option value="CF">Central African Republic</option>
	
		<option value="TD">Chad</option>
	
		<option value="CL">Chile</option>
	
		<option value="CN">China</option>
	
		<option value="CX">Christmas Island</option>
	
		<option value="CC">Cocos (Keeling) Islands</option>
	
		<option value="CO">Colombia</option>
	
		<option value="KM">Comoros</option>
	
		<option value="CG">Congo</option>
	
		<option value="CD">Congo (The Democratic Republic of)</option>
	
		<option value="CK">Cook Islands</option>
	
		<option value="CR">Costa Rica</option>
	
		<option value="CI">Côte d'ivoire</option>
	
		<option value="HR">Croatia</option>
	
		<option value="CU">Cuba</option>
	
		<option value="CY">Cyprus</option>
	
		<option value="CZ">Czech Republic</option>
	
		<option value="DK">Denmark</option>
	
		<option value="DJ">Djibouti</option>
	
		<option value="DM">Dominica</option>
	
		<option value="DO">Dominican Republic</option>
	
		<option value="TP">East Timor</option>
	
		<option value="EC">Ecuador</option>
	
		<option value="EG">Egypt</option>
	
		<option value="SV">El Salvador</option>
	
		<option value="GQ">Equatorial Guinea</option>
	
		<option value="ER">Eritrea</option>
	
		<option value="EE">Estonia</option>
	
		<option value="ET">Ethiopia</option>
	
		<option value="FK">Falkland Islands (Malvinas)</option>
	
		<option value="FO">Faroe Islands</option>
	
		<option value="FJ">Fiji</option>
	
		<option value="FI">Finland</option>
	
		<option value="FR">France</option>
	
		<option value="GF">French Guiana</option>
	
		<option value="PF">French Polynesia</option>
	
		<option value="TF">French Southern Territories</option>
	
		<option value="GA">Gabon</option>
	
		<option value="GM">Gambia</option>
	
		<option value="GE">Georgia</option>
	
		<option value="DE">Germany</option>
	
		<option value="GH">Ghana</option>
	
		<option value="GI">Gibraltar</option>
	
		<option value="GR">Greece</option>
	
		<option value="GL">Greenland</option>
	
		<option value="GD">Grenada</option>
	
		<option value="GP">Guadeloupe</option>
	
		<option value="GU">Guam</option>
	
		<option value="GT">Guatemala</option>
	
		<option value="GN">Guinea</option>
	
		<option value="GW">Guinea-Bissau</option>
	
		<option value="GY">Guyana</option>
	
		<option value="HT">Haiti</option>
	
		<option value="HM">Heard Island and McDonald Islands</option>
	
		<option value="VA">Holy See (Vatican City State)</option>
	
		<option value="HN">Honduras</option>
	
		<option value="HK">Hong Kong</option>
	
		<option value="HU">Hungary</option>
	
		<option value="IS">Iceland</option>
	
		<option value="IN">India</option>
	
		<option value="ID">Indonesia</option>
	
		<option value="IR">Iran (Islamic Republic of)</option>
	
		<option value="IQ">Iraq</option>
	
		<option value="IE">Ireland</option>
	
		<option value="IL">Israel</option>
	
		<option value="IT">Italy</option>
	
		<option value="JM">Jamaica</option>
	
		<option value="JP">Japan</option>
	
		<option value="JO">Jordan</option>
	
		<option value="KZ">Kazakstan</option>
	
		<option value="KE">Kenya</option>
	
		<option value="KI">Kiribati</option>
	
		<option value="KP">Korea (Democratic People's Republic of)</option>
	
		<option value="KR">Korea (Republic of)</option>
	
		<option value="KW">Kuwait</option>
	
		<option value="KG">Kyrgyzstan</option>
	
		<option value="LA">Lao People's Democratic Republic</option>
	
		<option value="LV">Latvia</option>
	
		<option value="LB">Lebanon</option>
	
		<option value="LS">Lesotho</option>
	
		<option value="LR">Liberia</option>
	
		<option value="LY">Libyan Arab Jamahiriya</option>
	
		<option value="LI">Liechtenstein</option>
	
		<option value="LT">Lithuania</option>
	
		<option value="LU">Luxembourg</option>
	
		<option value="MO">Macau</option>
	
		<option value="MK">Macedonia</option>
	
		<option value="MG">Madagascar</option>
	
		<option value="MW">Malawi</option>
	
		<option value="MY">Malaysia</option>
	
		<option value="MV">Maldives</option>
	
		<option value="ML">Mali</option>
	
		<option value="MT">Malta</option>
	
		<option value="MH">Marshall Islands</option>
	
		<option value="MQ">Martinique</option>
	
		<option value="MR">Mauritania</option>
	
		<option value="MU">Mauritius</option>
	
		<option value="YT">Mayotte</option>
	
		<option value="MX">Mexico</option>
	
		<option value="FM">Micronesia</option>
	
		<option value="MD">Moldova (Republic of)</option>
	
		<option value="MC">Monaco</option>
	
		<option value="MN">Mongolia</option>
	
		<option value="MS">Montserrat</option>
	
		<option value="MA">Morocco</option>
	
		<option value="MZ">Mozambique</option>
	
		<option value="MM">Myanmar</option>
	
		<option value="NA">Namibia</option>
	
		<option value="NR">Nauru</option>
	
		<option value="NP">Nepal</option>
	
		<option value="NL">Netherlands</option>
	
		<option value="AN">Netherlands Antilles</option>
	
		<option value="NC">New Caledonia</option>
	
		<option value="NZ">New Zealand</option>
	
		<option value="NI">Nicaragua</option>
	
		<option value="NE">Niger</option>
	
		<option value="NG">Nigeria</option>
	
		<option value="NU">Niue</option>
	
		<option value="NF">Norfolk Island</option>
	
		<option value="MP">Northern Mariana Islands</option>
	
		<option value="NO">Norway</option>
	
		<option value="OM">Oman</option>
	
		<option value="PK">Pakistan</option>
	
		<option value="PW">Palau</option>
	
		<option value="PS">Palestinian Territory (Occupied)</option>
	
		<option value="PA">Panama</option>
	
		<option value="PG">Papua New Guinea</option>
	
		<option value="PY">Paraguay</option>
	
		<option value="PE">Peru</option>
	
		<option value="PH">Philippines</option>
	
		<option value="PN">Pitcairn</option>
	
		<option value="PL">Poland</option>
	
		<option value="PT">Portugal</option>
	
		<option value="PR">Puerto Rico</option>
	
		<option value="QA">Qatar</option>
	
		<option value="RE">Réunion</option>
	
		<option value="RO">Romania</option>
	
		<option value="RU">Russian Federation</option>
	
		<option value="RW">Rwanda</option>
	
		<option value="SH">Saint Helena</option>
	
		<option value="KN">Saint Kitts and Nevis</option>
	
		<option value="LC">Saint Lucia</option>
	
		<option value="PM">Saint Pierre and Miquelon</option>
	
		<option value="VC">Saint Vincent and the Grenadines</option>
	
		<option value="WS">Samoa</option>
	
		<option value="SM">San Marino</option>
	
		<option value="ST">Sao Tome and Principe</option>
	
		<option value="SA">Saudi Arabia</option>
	
		<option value="SN">Senegal</option>
	
		<option value="SC">Seychelles</option>
	
		<option value="SL">Sierra Leone</option>
	
		<option value="SG">Singapore</option>
	
		<option value="SK">Slovakia</option>
	
		<option value="SI">Slovenia</option>
	
		<option value="SB">Solomon Islands</option>
	
		<option value="SO">Somalia</option>
	
		<option value="ZA">South Africa</option>
	
		<option value="GS">South Georgia and the South Sandwich Islands</option>
	
		<option value="ES">Spain</option>
	
		<option value="LK">Sri Lanka</option>
	
		<option value="SD">Sudan</option>
	
		<option value="SR">Suriname</option>
	
		<option value="SJ">Svalbard and Jan Mayen</option>
	
		<option value="SZ">Swaziland</option>
	
		<option value="SE">Sweden</option>
	
		<option value="CH">Switzerland</option>
	
		<option value="SY">Syrian Arab Republic</option>
	
		<option value="TW">Taiwan</option>
	
		<option value="TJ">Tajikistan</option>
	
		<option value="TZ">Tanzania (United Republic of)</option>
	
		<option value="TH">Thailand</option>
	
		<option value="TG">Togo</option>
	
		<option value="TK"> Tokelau</option>
	
		<option value="TO">Tonga</option>
	
		<option value="TT">Trinidad and Tobago</option>
	
		<option value="TN">Tunisia</option>
	
		<option value="TR">Turkey</option>
	
		<option value="TM">Turkmenistan</option>
	
		<option value="TC">Turks and Caicos Islands</option>
	
		<option value="TV">Tuvalu</option>
	
		<option value="UG">Uganda</option>
	
		<option value="UA">Ukraine</option>
	
		<option value="AE">United Arab Emirates</option>
	
		<option value="GB">United Kingdom</option>
	
		<option value="UM">United States Minor Outlying Islands</option>
	
		<option value="UY">Uruguay</option>
	
		<option value="UZ">Uzbekistan</option>
	
		<option value="VU">Vanuatu</option>
	
		<option value="VE">Venezuela</option>
	
		<option value="VN">Vietnam</option>
	
		<option value="VG">Virgin Islands (British)</option>
	
		<option value="VI">Virgin Islands (U.S.)</option>
	
		<option value="WF">Wallis and Futuna</option>
	
		<option value="EH">Western Sahara</option>
	
		<option value="YE">Yemen</option>
	
		<option value="YU">Yugoslavia</option>
	
		<option value="ZM">Zambia</option>
	
		<option value="ZW">Zimbabwe</option>
	
</select>


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