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Customer Info:

If you want your invoices addressed to a company. Leave blank to use your full name.
We'll never share your email with anyone else.
.com

Address Details:

Security:

After you log in, you will be asked for additional information to confirm your identity and protect your account from being compromised. Learn more.
For extra security, this requires you to confirm your email or phone number when you reset your password. Learn more.

				<div class="card card-custom card-sticky" id="kt_page_sticky_card">
					<div class="card-header">
						<div class="card-title">
							<h3 class="card-label">
								Sticky Form Actions <i class="mr-2"></i>
								<small class="">try to scroll the page</small>
							</h3>
						</div>
						<div class="card-toolbar">
							<a href="#" class="btn btn-light-primary font-weight-bolder mr-2">
								<i class="ki ki-long-arrow-back icon-sm"></i>
								Back
							</a>
							<div class="btn-group">
								<button type="button" class="btn btn-primary font-weight-bolder">
									<i class="ki ki-check icon-sm"></i>
									Save Form
								</button>
								<button type="button" class="btn btn-primary dropdown-toggle dropdown-toggle-split" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">
								</button>
								<div class="dropdown-menu dropdown-menu-sm dropdown-menu-right">
									<ul class="nav nav-hover flex-column">
										<li class="nav-item">
											<a href="#" class="nav-link">
												<i class="nav-icon flaticon2-reload"></i>
												<span class="nav-text">Save & continue</span>
											</a>
										</li>
										<li class="nav-item">
											<a href="#" class="nav-link">
												<i class="nav-icon flaticon2-add-1"></i>
												<span class="nav-text">Save & add new</span>
											</a>
										</li>
										<li class="nav-item">
											<a href="#" class="nav-link">
												<i class="nav-icon flaticon2-power"></i>
												<span class="nav-text">Save & exit</span>
											</a>
										</li>
									</ul>
								</div>
							</div>
						</div>
					</div>
					<div class="card-body">
						<!--begin::Form-->
						<form class="form" id="kt_form">
							<div class="row">
								<div class="col-xl-2"></div>
								<div class="col-xl-8">
									<div class="my-5">
										<h3 class=" text-dark font-weight-bold mb-10">Customer Info:</h3>
										<div class="form-group row">
											<label class="col-3">First Name</label>
											<div class="col-9">
												<input class="form-control form-control-solid" type="text" value="Nick"/>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Last Name</label>
											<div class="col-9">
												<input class="form-control form-control-solid" type="text" value="Watson"/>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Company Name</label>
											<div class="col-9">
												<input class="form-control form-control-solid" type="text" value="Loop Inc."/>
												<span class="form-text text-muted">If you want your invoices addressed to a company. Leave blank to use your full name.</span>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Contact Phone</label>
											<div class="col-9">
												<div class="input-group input-group-solid">
													<div class="input-group-prepend"><span class="input-group-text"><i class="la la-phone"></i></span></div>
													<input type="text" class="form-control form-control-solid" value="+45678967456" placeholder="Phone" />
												</div>
												<span class="form-text text-muted">We'll never share your email with anyone else.</span>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Email Address</label>
											<div class="col-9">
												<div class="input-group input-group-solid">
													<div class="input-group-prepend"><span class="input-group-text"><i class="la la-at"></i></span></div>
													<input type="text" class="form-control form-control-solid" value="nick.watson@loop.com" placeholder="Email" />
												</div>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Company Site</label>
											<div class="col-9">
												<div class="input-group input-group-solid">
													<input type="text" class="form-control form-control-solid" placeholder="Username" value="loop"/>
													<div class="input-group-append"><span class="input-group-text">.com</span></div>
												</div>
											</div>
										</div>
									</div>
									<div class="separator separator-dashed my-10"></div>
									<div class="my-5">
										<h3 class=" text-dark font-weight-bold mb-10">Address Details:</h3>
										<div class="form-group row">
											<label class="col-3">Country</label>
											<div class="col-9">
												<select class="form-control form-control-solid">
													<option value="AF">Afghanistan</option>
													<option value="AX">Åland Islands</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, Plurinational State of</option>
													<option value="BQ">Bonaire, Sint Eustatius and Saba</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="CA">Canada</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 the</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="CW">Curaçao</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="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="GG">Guernsey</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="IM">Isle of Man</option>
													<option value="IL">Israel</option>
													<option value="IT">Italy</option>
													<option value="JM">Jamaica</option>
													<option value="JP">Japan</option>
													<option value="JE">Jersey</option>
													<option value="JO">Jordan</option>
													<option value="KZ">Kazakhstan</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">Libya</option>
													<option value="LI">Liechtenstein</option>
													<option value="LT">Lithuania</option>
													<option value="LU">Luxembourg</option>
													<option value="MO">Macao</option>
													<option value="MK">Macedonia, the former Yugoslav Republic of</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, Federated States of</option>
													<option value="MD">Moldova, Republic of</option>
													<option value="MC">Monaco</option>
													<option value="MN">Mongolia</option>
													<option value="ME">Montenegro</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="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="BL">Saint Barthélemy</option>
													<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
													<option value="KN">Saint Kitts and Nevis</option>
													<option value="LC">Saint Lucia</option>
													<option value="MF">Saint Martin (French part)</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="RS">Serbia</option>
													<option value="SC">Seychelles</option>
													<option value="SL">Sierra Leone</option>
													<option value="SG">Singapore</option>
													<option value="SX">Sint Maarten (Dutch part)</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="SS">South Sudan</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, Province of China</option>
													<option value="TJ">Tajikistan</option>
													<option value="TZ">Tanzania, United Republic of</option>
													<option value="TH">Thailand</option>
													<option value="TL">Timor-Leste</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="US" selected>United States</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, Bolivarian Republic of</option>
													<option value="VN">Viet Nam</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="ZM">Zambia</option>
													<option value="ZW">Zimbabwe</option>
												</select>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Address Line 1</label>
											<div class="col-9">
												<input class="form-control form-control-solid" type="text" value="District 6 1352 W. Olive Ave"/>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Address Line 2</label>
											<div class="col-9">
												<input class="form-control form-control-solid" type="text" value="Fresno 559-488-4020"/>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">City</label>
											<div class="col-9">
												<input class="form-control form-control-solid" type="text" value="Polo Alto"/>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">State / Province / Region</label>
											<div class="col-9">
												<input class="form-control form-control-solid" type="text" value="Los Angeles"/>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Zip / Postal Code</label>
											<div class="col-9">
												<input class="form-control form-control-solid" type="text" value="780456"/>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3"></label>
											<div class="col-9">
												<div class="checkbox-single">
													<label class="checkbox">
														<input type="checkbox"/> Use as shipping address.
														<span></span>
													</label>
												</div>
											</div>
										</div>
									</div>
									<div class="separator separator-dashed my-10"></div>
									<div class="my-52">
										<h3 class=" text-dark font-weight-bold mb-10">Security:</h3>
										<div class="form-group row">
											<label class="col-3">Login verification</label>
											<div class="col-9">
												<button type="button" class="btn btn-light-primary font-weight-bold btn-sm">Setup login verification</button>
												<div class="form-text text-muted mt-3">
													After you log in, you will be asked for additional information to confirm your identity and protect your account from being compromised.
													<a href="#">Learn more</a>.
												</div>
											</div>
										</div>
										<div class="form-group row">
											<label class="col-3">Password reset verification</label>
											<div class="col-9">
												<div class="checkbox-single">
													<label class="checkbox mb-2">
														<input type="checkbox"/> Require personal information to reset your password.
														<span></span>
													</label>
												</div>
												<div class="form-text text-muted">
													For extra security, this requires you to confirm your email or phone number when you reset your password.
													<a href="#" class="font-weight-bold">Learn more</a>.
												</div>
											</div>
										</div>
										<div class="form-group row mt-10">
											<label class="col-3"></label>
											<div class="col-9">
												<button type="button" class="btn btn-light-danger font-weight-bold btn-sm">Deactivate your account ?</button>
											</div>
										</div>
									</div>
								</div>
								<div class="col-xl-2"></div>
							</div>
						</form>
						<!--end::Form-->
					</div>
				</div>
			    

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