<?php
/*
 * LEAD FORM :: Int
 * This is the lead form template for INT,
 * optimised for and translated in German.
 */
?>

<div class="mml_form_body clearfix">
	<div class="mml_col-xs-6 float-label mml_main-col">
		<div class="mml_row clearfix">

			<div class="mml_group mml_col-xs-12 mml_control">
				<div class="mml_col-xs-12 mml_control mml_field_wrap mml_origincountry_wrap">
					<select name="mml_origin_country" required="" class="mml_countryselect">
						<option value="" selected disabled>Auszugsland auswählen</option>
						<option value="CH">die Schweiz</option>
						<option value="AT">Österreich</option>
						<option value="LI">Liechtenstein</option>
						<option value="LU">Luxemburg</option>
						<option value="US">USA</option>
						<option value="CA">Kanada</option>
						<option value="AU">Australien</option>
						<option value="GB">UK</option>
						<option value="FR">Frankreich</option>
						<option value="" disabled>--------</option>
						<option value="AF">Afghanistan</option>
						<option value="EG">Ägypten</option>
						<option value="AL">Albanien</option>
						<option value="DZ">Algerien</option>
						<option value="AD">Andorra</option>
						<option value="AO">Angola</option>
						<option value="AG">Antigua und Barbuda</option>
						<option value="GQ">Äquatorialguinea</option>
						<option value="AR">Argentinien</option>
						<option value="AM">Armenien</option>
						<option value="AZ">Aserbaidschan</option>
						<option value="ET">Äthiopien</option>
						<option value="AU">Australien</option>
						<option value="BS">Bahamas</option>
						<option value="BH">Bahrain</option>
						<option value="BD">Bangladesch</option>
						<option value="BB">Barbados</option>
						<option value="BE">Belgien</option>
						<option value="BZ">Belize</option>
						<option value="BJ">Benin</option>
						<option value="BT">Bhutan</option>
						<option value="BO">Bolivien</option>
						<option value="BA">Bosnien und Herzegowina</option>
						<option value="BW">Botsuana</option>
						<option value="BR">Brasilien</option>
						<option value="BN">Brunei</option>
						<option value="BG">Bulgarien</option>
						<option value="BF">Burkina Faso</option>
						<option value="BI">Burundi</option>
						<option value="CL">Chile</option>
						<option value="TW">China, Republik (Taiwan)</option>
						<option value="CN">China, Volksrepublik</option>
						<option value="CK">Cookinseln</option>
						<option value="CR">Costa Rica</option>
						<option value="DK">Dänemark</option>
						<option value="DE">Deutschland</option>
						<option value="CH">die Schweiz</option>
						<option value="DM">Dominica</option>
						<option value="DO">Dominikanische Republik</option>
						<option value="DJ">Dschibuti</option>
						<option value="EC">Ecuador</option>
						<option value="SV">El Salvador</option>
						<option value="CI">Elfenbeinküste</option>
						<option value="ER">Eritrea</option>
						<option value="EE">Estland</option>
						<option value="FJ">Fidschi</option>
						<option value="FI">Finnland</option>
						<option value="GA">Gabun</option>
						<option value="GM">Gambia</option>
						<option value="GE">Georgien</option>
						<option value="GH">Ghana</option>
						<option value="GD">Grenada</option>
						<option value="GR">Griechenland</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="HN">Honduras</option>
						<option value="IN">Indien</option>
						<option value="ID">Indonesien</option>
						<option value="IQ">Irak</option>
						<option value="IR">Iran</option>
						<option value="IE">Irland</option>
						<option value="IS">Island</option>
						<option value="IM">Isle of Man</option>
						<option value="IL">Israel</option>
						<option value="IT">Italien</option>
						<option value="JM">Jamaika</option>
						<option value="JP">Japan</option>
						<option value="YE">Jemen</option>
						<option value="JO">Jordanien</option>
						<option value="KH">Kambodscha</option>
						<option value="CM">Kamerun</option>
						<option value="CA">Kanada</option>
						<option value="CV">Kap Verde</option>
						<option value="KZ">Kasachstan</option>
						<option value="QA">Katar</option>
						<option value="KE">Kenia</option>
						<option value="KG">Kirgisistan</option>
						<option value="KI">Kiribati</option>
						<option value="CO">Kolumbien</option>
						<option value="KM">Komoren</option>
						<option value="CD">Kongo, Demokratische Republik</option>
						<option value="KR">Korea, Republik</option>
						<option value="HR">Kroatien</option>
						<option value="CU">Kuba</option>
						<option value="KW">Kuwait</option>
						<option value="LA">Laos</option>
						<option value="LS">Lesotho</option>
						<option value="LV">Lettland</option>
						<option value="LB">Libanon</option>
						<option value="LR">Liberia</option>
						<option value="LY">Libyen</option>
						<option value="LI">Liechtenstein</option>
						<option value="LT">Litauen</option>
						<option value="LU">Luxemburg</option>
						<option value="MG">Madagaskar</option>
						<option value="MW">Malawi</option>
						<option value="MY">Malaysia</option>
						<option value="MV">Malediven</option>
						<option value="ML">Mali</option>
						<option value="MT">Malta</option>
						<option value="MA">Marokko</option>
						<option value="MH">Marshallinseln</option>
						<option value="MU">Mauritius</option>
						<option value="MK">Mazedonien</option>
						<option value="MX">Mexiko</option>
						<option value="FM">Mikronesien</option>
						<option value="MD">Moldawien</option>
						<option value="MC">Monaco</option>
						<option value="MN">Mongolei</option>
						<option value="ME">Montenegro</option>
						<option value="MZ">Mosambik</option>
						<option value="MM">Myanmar</option>
						<option value="NA">Namibia</option>
						<option value="NR">Nauru</option>
						<option value="NP">Nepal</option>
						<option value="NZ">Neuseeland</option>
						<option value="NI">Nicaragua</option>
						<option value="NL">Niederlande</option>
						<option value="NE">Niger</option>
						<option value="NG">Nigeria</option>
						<option value="NU">Niue</option>
						<option value="NO">Norwegen</option>
						<option value="AT">Österreich</option>
						<option value="OM">Oman</option>
						<option value="TL">Osttimor</option>
						<option value="PK">Pakistan</option>
						<option value="PS">Palästinensische Autonomiegebiete</option>
						<option value="PW">Palau</option>
						<option value="PA">Panama</option>
						<option value="PG">Papua-Neuguinea</option>
						<option value="PY">Paraguay</option>
						<option value="PE">Peru</option>
						<option value="PH">Philippinen</option>
						<option value="PL">Polen</option>
						<option value="PT">Portugal</option>
						<option value="RW">Ruanda</option>
						<option value="RO">Rumänien</option>
						<option value="RU">Russland</option>
						<option value="SB">Salomonen</option>
						<option value="ZM">Sambia</option>
						<option value="WS">Samoa</option>
						<option value="SM">San Marino</option>
						<option value="ST">São Tomé und Príncipe</option>
						<option value="SA">Saudi-Arabien</option>
						<option value="SE">Schweden</option>
						<option value="SN">Senegal</option>
						<option value="RS">Serbien</option>
						<option value="SC">Seychellen</option>
						<option value="SL">Sierra Leone</option>
						<option value="ZW">Simbabwe</option>
						<option value="SG">Singapur</option>
						<option value="SK">Slowakei</option>
						<option value="SI">Slowenien</option>
						<option value="SO">Somalia</option>
						<option value="ES">Spanien</option>
						<option value="LK">Sri Lanka</option>
						<option value="KN">St. Kitts und Nevis</option>
						<option value="LC">St. Lucia</option>
						<option value="VC">St. Vincent und die Grenadinen</option>
						<option value="ZA">Südafrika</option>
						<option value="SD">Sudan</option>
						<option value="SR">Suriname</option>
						<option value="SZ">Swasiland</option>
						<option value="SY">Syrien</option>
						<option value="TJ">Tadschikistan</option>
						<option value="TZ">Tansania</option>
						<option value="TH">Thailand</option>
						<option value="TG">Togo</option>
						<option value="TO">Tonga</option>
						<option value="TT">Trinidad und Tobago</option>
						<option value="TD">Tschad</option>
						<option value="CZ">Tschechien</option>
						<option value="TN">Tunesien</option>
						<option value="TR">Türkei</option>
						<option value="TM">Turkmenistan</option>
						<option value="TV">Tuvalu</option>
						<option value="UG">Uganda</option>
						<option value="UA">Ukraine</option>
						<option value="HU">Ungarn</option>
						<option value="UY">Uruguay</option>
						<option value="US">USA</option>
						<option value="UZ">Usbekistan</option>
						<option value="VU">Vanuatu</option>
						<option value="VE">Venezuela</option>
						<option value="AE">Vereinigte Arabische Emirate</option>
						<option value="VN">Vietnam</option>
						<option value="BY">Weißrussland</option>
						<option value="EH">Westsahara</option>
						<option value="CF">Zentralafrikanische Republik</option>
						<option value="CY">Zypern</option>
					</select>
					<label for="mml_origin_country" class="mml_placeholder">Auszugsland</label>
					<div class="mml_arrow-down"></div>
				</div>
				<div class="mml_col-xs-6 mml_control mml_field_wrap mml_originstate_wrap mml_int_us" style="display: none;">
					<select name="mml_origin_state_us" class="mml_col-xs-12 mml_stateselect mml_origin_state_us">
						<option value="" selected disabled>Auszugsstaat auswählen</option>
						<option value="AK">AK - Alaska</option>
						<option value="AL">AL - Alabama</option>
						<option value="AR">AR - Arkansas</option>
						<option value="AZ">AZ - Arizona</option>
						<option value="CA">CA - California</option>
						<option value="CO">CO - Colorado</option>
						<option value="CT">CT - Connecticut</option>
						<option value="DC">DC - District of Columbia</option>
						<option value="DE">DE - Delaware</option>
						<option value="FL">FL - Florida</option>
						<option value="GA">GA - Georgia</option>
						<option value="HI">HI - Hawaii</option>
						<option value="ID">ID - Idaho</option>
						<option value="IL">IL - Illinois</option>
						<option value="IN">IN - Indiana</option>
						<option value="IA">IA - Iowa</option>
						<option value="KS">KS - Kansas</option>
						<option value="KY">KY - Kentucky</option>
						<option value="LA">LA - Louisiana</option>
						<option value="MA">MA - Massachusetts</option>
						<option value="MD">MD - Maryland</option>
						<option value="ME">ME - Maine</option>
						<option value="MI">MI - Michigan</option>
						<option value="MN">MN - Minnesota</option>
						<option value="MO">MO - Missouri</option>
						<option value="MS">MS - Mississippi</option>
						<option value="MT">MT - Montana</option>
						<option value="NC">NC - North Carolina</option>
						<option value="ND">ND - North Dakota</option>
						<option value="NE">NE - Nebraska</option>
						<option value="NH">NH - New Hampshire</option>
						<option value="NJ">NJ - New Jersey</option>
						<option value="NM">NM - New Mexico</option>
						<option value="NV">NV - Nevada</option>
						<option value="NY">NY - New York</option>
						<option value="OH">OH - Ohio</option>
						<option value="OK">OK - Oklahoma</option>
						<option value="OR">OR - Oregon</option>
						<option value="PA">PA - Pennsylvania</option>
						<option value="PR">PR - Puerto Rico</option>
						<option value="RI">RI - Rhode Island</option>
						<option value="SC">SC - South Carolina</option>
						<option value="SD">SD - South Dakota</option>
						<option value="TN">TN - Tennessee</option>
						<option value="TX">TX - Texas</option>
						<option value="UT">UT - Utah</option>
						<option value="VT">VT - Vermont</option>
						<option value="VA">VA - Virginia</option>
						<option value="WA">WA - Washington</option>
						<option value="WV">WV - West Virginia</option>
						<option value="WI">WI - Wisconsin</option>
						<option value="WY">WY - Wyoming</option>
					</select>
					<label for="mml_origin_state_us" class="mml_placeholder">Auszugsstaat</label>
					<div class="mml_arrow-down"></div>
				</div>
				<div class="mml_col-xs-6 mml_control mml_field_wrap mml_originstate_wrap mml_int_ca" style="display: none;">
					<select name="mml_origin_state_ca" class="mml_col-xs-12 mml_stateselect mml_origin_state_ca">
						<option value="" selected disabled>Auszugsprovinz auswählen</option>
						<option value="AB">AB - Alberta</option>
						<option value="BC">BC - British Columbia</option>
						<option value="MB">MB - Manitoba</option>
						<option value="NB">NB - New Brunswick</option>
						<option value="NL">NL - Newfoundland and Labrador</option>
						<option value="NT">NT - Northwest Territories</option>
						<option value="NS">NS - Nova Scotia</option>
						<option value="NU">NU - Nunavut</option>
						<option value="ON">ON - Ontario</option>
						<option value="PE">PE - Prince Edward Island</option>
						<option value="QC">QC - Quebec</option>
						<option value="SK">SK - Saskatchewan</option>
						<option value="YT">YT - Yukon</option>
					</select>
					<label for="mml_origin_state_ca" class="mml_placeholder">Auszugsprovinz</label>
					<div class="mml_arrow-down"></div>
				</div>
				<div class="mml_col-xs-6 mml_control mml_field_wrap mml_originstate_wrap mml_int_au" style="display: none;">
					<select name="mml_origin_state_au" class="mml_col-xs-12 mml_stateselect mml_origin_state_au">
						<option value="" selected disabled>Auszugsstaat auswählen</option>
						<option value="ACT">ACT - Australian Capital Territory</option>
						<option value="NSW">NSW - State of New South Wales</option>
						<option value="NT">NT - Northern Territory</option>
						<option value="QLD">QLD - State of Queensland</option>
						<option value="SA">SA - State of South Australia</option>
						<option value="TAS">TAS - State of Tasmania</option>
						<option value="VIC">VIC - State of Victoria</option>
						<option value="WA">WA - State of Western Australia</option>
					</select>
					<label for="mml_origin_state_au" class="mml_placeholder">Auszugsstaat</label>
					<div class="mml_arrow-down"></div>
				</div>
				<div class="mml_col-xs-12 mml_control mml_field_wrap mml_origincity_wrap">
					<input type="text" name="mml_origin_city" placeholder="Auszugsstadt" autocomplete="off" class="mml_col-xs-12 mml_cityfield"  value="" required="" autocapitalize="off" />
					<label for="mml_origin_city" class="mml_placeholder">Auszugsstadt</label>
				</div>
			</div>
			<div class="mml_col-xs-12 mml_control mml_field_wrap mml_arrow-to mml_middle-arrow">
				<span class="mml_from-city"></span>
			</div>
			<div class="mml_group mml_col-xs-12 mml_control">
				<div class="mml_col-xs-12 mml_control mml_field_wrap mml_destinationcountry_wrap">
					<select name="mml_destination_country" required="" class="mml_countryselect">
						<option value="" selected disabled>Einzugsland auswählen</option>
						<option value="CH">die Schweiz</option>
						<option value="AT">Österreich</option>
						<option value="LI">Liechtenstein</option>
						<option value="LU">Luxemburg</option>
						<option value="US">USA</option>
						<option value="CA">Kanada</option>
						<option value="AU">Australien</option>
						<option value="GB">UK</option>
						<option value="FR">Frankreich</option>
						<option value="" disabled>--------</option>
						<option value="AF">Afghanistan</option>
						<option value="EG">Ägypten</option>
						<option value="AL">Albanien</option>
						<option value="DZ">Algerien</option>
						<option value="AD">Andorra</option>
						<option value="AO">Angola</option>
						<option value="AG">Antigua und Barbuda</option>
						<option value="GQ">Äquatorialguinea</option>
						<option value="AR">Argentinien</option>
						<option value="AM">Armenien</option>
						<option value="AZ">Aserbaidschan</option>
						<option value="ET">Äthiopien</option>
						<option value="AU">Australien</option>
						<option value="BS">Bahamas</option>
						<option value="BH">Bahrain</option>
						<option value="BD">Bangladesch</option>
						<option value="BB">Barbados</option>
						<option value="BE">Belgien</option>
						<option value="BZ">Belize</option>
						<option value="BJ">Benin</option>
						<option value="BT">Bhutan</option>
						<option value="BO">Bolivien</option>
						<option value="BA">Bosnien und Herzegowina</option>
						<option value="BW">Botsuana</option>
						<option value="BR">Brasilien</option>
						<option value="BN">Brunei</option>
						<option value="BG">Bulgarien</option>
						<option value="BF">Burkina Faso</option>
						<option value="BI">Burundi</option>
						<option value="CL">Chile</option>
						<option value="TW">China, Republik (Taiwan)</option>
						<option value="CN">China, Volksrepublik</option>
						<option value="CK">Cookinseln</option>
						<option value="CR">Costa Rica</option>
						<option value="DK">Dänemark</option>
						<option value="DE">Deutschland</option>
						<option value="CH">die Schweiz</option>
						<option value="DM">Dominica</option>
						<option value="DO">Dominikanische Republik</option>
						<option value="DJ">Dschibuti</option>
						<option value="EC">Ecuador</option>
						<option value="SV">El Salvador</option>
						<option value="CI">Elfenbeinküste</option>
						<option value="ER">Eritrea</option>
						<option value="EE">Estland</option>
						<option value="FJ">Fidschi</option>
						<option value="FI">Finnland</option>
						<option value="GA">Gabun</option>
						<option value="GM">Gambia</option>
						<option value="GE">Georgien</option>
						<option value="GH">Ghana</option>
						<option value="GD">Grenada</option>
						<option value="GR">Griechenland</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="HN">Honduras</option>
						<option value="IN">Indien</option>
						<option value="ID">Indonesien</option>
						<option value="IQ">Irak</option>
						<option value="IR">Iran</option>
						<option value="IE">Irland</option>
						<option value="IS">Island</option>
						<option value="IM">Isle of Man</option>
						<option value="IL">Israel</option>
						<option value="IT">Italien</option>
						<option value="JM">Jamaika</option>
						<option value="JP">Japan</option>
						<option value="YE">Jemen</option>
						<option value="JO">Jordanien</option>
						<option value="KH">Kambodscha</option>
						<option value="CM">Kamerun</option>
						<option value="CA">Kanada</option>
						<option value="CV">Kap Verde</option>
						<option value="KZ">Kasachstan</option>
						<option value="QA">Katar</option>
						<option value="KE">Kenia</option>
						<option value="KG">Kirgisistan</option>
						<option value="KI">Kiribati</option>
						<option value="CO">Kolumbien</option>
						<option value="KM">Komoren</option>
						<option value="CD">Kongo, Demokratische Republik</option>
						<option value="KR">Korea, Republik</option>
						<option value="HR">Kroatien</option>
						<option value="CU">Kuba</option>
						<option value="KW">Kuwait</option>
						<option value="LA">Laos</option>
						<option value="LS">Lesotho</option>
						<option value="LV">Lettland</option>
						<option value="LB">Libanon</option>
						<option value="LR">Liberia</option>
						<option value="LY">Libyen</option>
						<option value="LI">Liechtenstein</option>
						<option value="LT">Litauen</option>
						<option value="LU">Luxemburg</option>
						<option value="MG">Madagaskar</option>
						<option value="MW">Malawi</option>
						<option value="MY">Malaysia</option>
						<option value="MV">Malediven</option>
						<option value="ML">Mali</option>
						<option value="MT">Malta</option>
						<option value="MA">Marokko</option>
						<option value="MH">Marshallinseln</option>
						<option value="MU">Mauritius</option>
						<option value="MK">Mazedonien</option>
						<option value="MX">Mexiko</option>
						<option value="FM">Mikronesien</option>
						<option value="MD">Moldawien</option>
						<option value="MC">Monaco</option>
						<option value="MN">Mongolei</option>
						<option value="ME">Montenegro</option>
						<option value="MZ">Mosambik</option>
						<option value="MM">Myanmar</option>
						<option value="NA">Namibia</option>
						<option value="NR">Nauru</option>
						<option value="NP">Nepal</option>
						<option value="NZ">Neuseeland</option>
						<option value="NI">Nicaragua</option>
						<option value="NL">Niederlande</option>
						<option value="NE">Niger</option>
						<option value="NG">Nigeria</option>
						<option value="NU">Niue</option>
						<option value="NO">Norwegen</option>
						<option value="AT">Österreich</option>
						<option value="OM">Oman</option>
						<option value="TL">Osttimor</option>
						<option value="PK">Pakistan</option>
						<option value="PS">Palästinensische Autonomiegebiete</option>
						<option value="PW">Palau</option>
						<option value="PA">Panama</option>
						<option value="PG">Papua-Neuguinea</option>
						<option value="PY">Paraguay</option>
						<option value="PE">Peru</option>
						<option value="PH">Philippinen</option>
						<option value="PL">Polen</option>
						<option value="PT">Portugal</option>
						<option value="RW">Ruanda</option>
						<option value="RO">Rumänien</option>
						<option value="RU">Russland</option>
						<option value="SB">Salomonen</option>
						<option value="ZM">Sambia</option>
						<option value="WS">Samoa</option>
						<option value="SM">San Marino</option>
						<option value="ST">São Tomé und Príncipe</option>
						<option value="SA">Saudi-Arabien</option>
						<option value="SE">Schweden</option>
						<option value="SN">Senegal</option>
						<option value="RS">Serbien</option>
						<option value="SC">Seychellen</option>
						<option value="SL">Sierra Leone</option>
						<option value="ZW">Simbabwe</option>
						<option value="SG">Singapur</option>
						<option value="SK">Slowakei</option>
						<option value="SI">Slowenien</option>
						<option value="SO">Somalia</option>
						<option value="ES">Spanien</option>
						<option value="LK">Sri Lanka</option>
						<option value="KN">St. Kitts und Nevis</option>
						<option value="LC">St. Lucia</option>
						<option value="VC">St. Vincent und die Grenadinen</option>
						<option value="ZA">Südafrika</option>
						<option value="SD">Sudan</option>
						<option value="SR">Suriname</option>
						<option value="SZ">Swasiland</option>
						<option value="SY">Syrien</option>
						<option value="TJ">Tadschikistan</option>
						<option value="TZ">Tansania</option>
						<option value="TH">Thailand</option>
						<option value="TG">Togo</option>
						<option value="TO">Tonga</option>
						<option value="TT">Trinidad und Tobago</option>
						<option value="TD">Tschad</option>
						<option value="CZ">Tschechien</option>
						<option value="TN">Tunesien</option>
						<option value="TR">Türkei</option>
						<option value="TM">Turkmenistan</option>
						<option value="TV">Tuvalu</option>
						<option value="UG">Uganda</option>
						<option value="UA">Ukraine</option>
						<option value="HU">Ungarn</option>
						<option value="UY">Uruguay</option>
						<option value="US">USA</option>
						<option value="UZ">Usbekistan</option>
						<option value="VU">Vanuatu</option>
						<option value="VE">Venezuela</option>
						<option value="AE">Vereinigte Arabische Emirate</option>
						<option value="VN">Vietnam</option>
						<option value="BY">Weißrussland</option>
						<option value="EH">Westsahara</option>
						<option value="CF">Zentralafrikanische Republik</option>
						<option value="CY">Zypern</option>
					</select>
					<label for="mml_destination_country" class="mml_placeholder">Einzugsland</label>
					<div class="mml_arrow-down"></div>
				</div>
				<div class="mml_col-xs-6 mml_control mml_field_wrap mml_deliverystate_wrap mml_int_us" style="display: none;">
					<select name="mml_delivery_state_us" class="mml_col-xs-12 mml_stateselect mml_delivery_state_us">
						<option value="" selected disabled>Einzugsstaat auswählen</option>
						<option value="AK">AK - Alaska</option>
						<option value="AL">AL - Alabama</option>
						<option value="AR">AR - Arkansas</option>
						<option value="AZ">AZ - Arizona</option>
						<option value="CA">CA - California</option>
						<option value="CO">CO - Colorado</option>
						<option value="CT">CT - Connecticut</option>
						<option value="DC">DC - District of Columbia</option>
						<option value="DE">DE - Delaware</option>
						<option value="FL">FL - Florida</option>
						<option value="GA">GA - Georgia</option>
						<option value="HI">HI - Hawaii</option>
						<option value="ID">ID - Idaho</option>
						<option value="IL">IL - Illinois</option>
						<option value="IN">IN - Indiana</option>
						<option value="IA">IA - Iowa</option>
						<option value="KS">KS - Kansas</option>
						<option value="KY">KY - Kentucky</option>
						<option value="LA">LA - Louisiana</option>
						<option value="MA">MA - Massachusetts</option>
						<option value="MD">MD - Maryland</option>
						<option value="ME">ME - Maine</option>
						<option value="MI">MI - Michigan</option>
						<option value="MN">MN - Minnesota</option>
						<option value="MO">MO - Missouri</option>
						<option value="MS">MS - Mississippi</option>
						<option value="MT">MT - Montana</option>
						<option value="NC">NC - North Carolina</option>
						<option value="ND">ND - North Dakota</option>
						<option value="NE">NE - Nebraska</option>
						<option value="NH">NH - New Hampshire</option>
						<option value="NJ">NJ - New Jersey</option>
						<option value="NM">NM - New Mexico</option>
						<option value="NV">NV - Nevada</option>
						<option value="NY">NY - New York</option>
						<option value="OH">OH - Ohio</option>
						<option value="OK">OK - Oklahoma</option>
						<option value="OR">OR - Oregon</option>
						<option value="PA">PA - Pennsylvania</option>
						<option value="PR">PR - Puerto Rico</option>
						<option value="RI">RI - Rhode Island</option>
						<option value="SC">SC - South Carolina</option>
						<option value="SD">SD - South Dakota</option>
						<option value="TN">TN - Tennessee</option>
						<option value="TX">TX - Texas</option>
						<option value="UT">UT - Utah</option>
						<option value="VT">VT - Vermont</option>
						<option value="VA">VA - Virginia</option>
						<option value="WA">WA - Washington</option>
						<option value="WV">WV - West Virginia</option>
						<option value="WI">WI - Wisconsin</option>
						<option value="WY">WY - Wyoming</option>
					</select>
					<label for="mml_delivery_state_us" class="mml_placeholder">Einzugsstaat</label>
					<div class="mml_arrow-down"></div>
				</div>
				<div class="mml_col-xs-6 mml_control mml_field_wrap mml_deliverystate_wrap mml_int_ca" style="display: none;">
					<select name="mml_delivery_state_ca" class="mml_col-xs-12 mml_stateselect mml_delivery_state_ca">
						<option value="" selected disabled>Einzugsprovinz auswählen</option>
						<option value="AB">AB - Alberta</option>
						<option value="BC">BC - British Columbia</option>
						<option value="MB">MB - Manitoba</option>
						<option value="NB">NB - New Brunswick</option>
						<option value="NL">NL - Newfoundland and Labrador</option>
						<option value="NT">NT - Northwest Territories</option>
						<option value="NS">NS - Nova Scotia</option>
						<option value="NU">NU - Nunavut</option>
						<option value="ON">ON - Ontario</option>
						<option value="PE">PE - Prince Edward Island</option>
						<option value="QC">QC - Quebec</option>
						<option value="SK">SK - Saskatchewan</option>
						<option value="YT">YT - Yukon</option>
					</select>
					<label for="mml_delivery_state_ca" class="mml_placeholder">Einzugsprovinz</label>
					<div class="mml_arrow-down"></div>
				</div>
				<div class="mml_col-xs-6 mml_control mml_field_wrap mml_deliverystate_wrap mml_int_au" style="display: none;">
					<select name="mml_delivery_state_au" class="mml_col-xs-12 mml_stateselect mml_delivery_state_au">
						<option value="" selected disabled>Einzugsstaat auswählen</option>
						<option value="ACT">ACT - Australian Capital Territory</option>
						<option value="NSW">NSW - State of New South Wales</option>
						<option value="NT">NT - Northern Territory</option>
						<option value="QLD">QLD - State of Queensland</option>
						<option value="SA">SA - State of South Australia</option>
						<option value="TAS">TAS - State of Tasmania</option>
						<option value="VIC">VIC - State of Victoria</option>
						<option value="WA">WA - State of Western Australia</option>
					</select>
					<label for="mml_delivery_state_au" class="mml_placeholder">Einzugsstaat</label>
					<div class="mml_arrow-down"></div>
				</div>
				<div class="mml_col-xs-12 mml_control mml_field_wrap mml_deliverycity_wrap">
					<input type="text" name="mml_destination_city" placeholder="Einzugsstadt" autocomplete="off" class="mml_col-xs-12 mml_cityfield"  value="" required="" autocapitalize="off" />
					<label for="mml_destination_city" class="mml_placeholder">Einzugsstadt</label>
					<span class="mml_distance"></span>
				</div>
			</div>
		</div>
		<div class="mml_switch_int-wrap mml_col-xs-12" style="display: none;">
			<a class="mml_switch mml_switch_int" data-to="int"></a>
		</div>
	</div>
	<div class="mml_col-xs-6 float-label mml_main-col">
		<div class="mml_row clearfix">
			<div class="mml_col-xs-12 mml_control mml_field_wrap mml_movingdate_wrap">
				<input type="text" name="mml_moving_date" placeholder="Umzugsdatum" autocomplete="off" class="mml_col-xs-12 mml_moving_date mml_date_format_int" max="200" value="" required="" readonly="readonly" />
				<label for="mml_moving_date" class="mml_placeholder datepicker-int">Umzugsdatum</label>
				<span class="mml_days_left_wrap"></span>
			</div>
			<div class="mml_col-xs-12 mml_control mml_field_wrap mml_size_wrap">
				<select name="mml_size" class="mml_col-xs-12 mml_size" required="">
					<option value="" selected disabled>Wohnfläche auswählen</option>
					<option value="2">Studio</option>
					<option value="3">1 Zimmer</option>
					<option value="4">2 Zimmer</option>
					<option value="5">3 Zimmer</option>
					<option value="6">4 Zimmer</option>
					<option value="7">4+ Zimmer</option>
					<option value="1">Teilumzug</option>
					<option disabled>----------------</option>
					<option value="7">Firmenumzug</option>
					<option value="7">Business Umzug</option>
				</select>
				<label for="mml_size" class="mml_placeholder">Wohnfläche auswählen</label>
				<div class="mml_arrow-down"></div>
			</div>

			<div class="mml_col-xs-12 mml_control mml_field_wrap mml_name_wrap">
				<input type="text" name="mml_customer_name" placeholder="Vor- und Nachname" autocomplete="off" class="mml_col-xs-12" required="" autocapitalize="off" max="200" />
				<label for="mml_customer_name" class="mml_placeholder">Vor- und Nachname</label>
			</div>

			<div class="mml_col-xs-12 mml_control mml_field_wrap mml_phone_wrap">
				<input type="tel" name="mml_customer_phone" placeholder="Telefon" autocomplete="off" class="mml_col-xs-12" min="6" max="200" required="" />
				<label for="mml_customer_phone" class="mml_placeholder">Telefon</label>
			</div>

			<div class="mml_col-xs-12 mml_control mml_field_wrap mml_email_wrap">
				<input type="email" name="mml_customer_email" placeholder="E-mail" autocomplete="off" class="mml_col-xs-12" max="200" required="" />
				<label for="mml_customer_email" class="mml_placeholder">E-mail</label>
			</div>
		</div>
		<div class="mml_col-xs-12 mml_termstoagree clearfix">
			<div class="mml_termstoagree-wrap mml_col-xs-12 clearfix">
				<label class="mml_termslabel"><input class="mml_termstoagree" type="checkbox"> Zustimmung zur persönlichen Datensammlung<span class="mml_infoicon"></span></label>
			</div>
		</div>
	</div>
	<div class="mml_popup mml_popup_termsofservice mml_col-xs-12" style="display: none;">
		<div class="mml_close mml_closeX">x</div>
		<div class="mml_popup_header">AGB</div>
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