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Example: account@provider.com",valid:this.getFieldStatus("email"),type:"email",model:".email"}),h.default.createElement(N.default,{label:"Password",hint:"Password must be at least 8 characters long",valid:this.getFieldStatus("password"),type:"password",model:".password"}),h.default.createElement(N.default,{label:"Confirm Password",hint:"Passwords do not match",valid:this.getFieldStatus("confirmPassword"),type:"password",model:".confirmPassword"}),h.default.createElement("h2",null,"Profile"),h.default.createElement(N.default,{label:"First name",hint:"First name is required",valid:this.getFieldStatus("firstname"),model:".firstname"}),h.default.createElement(N.default,{label:"Last name",hint:"Last name is required",valid:this.getFieldStatus("lastname"),model:".lastname"}),h.default.createElement(N.default,{label:"Company",hint:"Company name is required",valid:this.getFieldStatus("company"),model:".company"}),h.default.createElement(N.default,{label:"Website",optional:!0,valid:this.getFieldStatus("website"),model:".website"}),h.default.createElement(F.default,{label:"Industry",emptyText:"Please select your industry",options:w.industryDefinitions,valid:this.getFieldStatus("industry"),model:".industry"}),h.default.createElement("h2",null,"Contact"),h.default.createElement(F.default,{label:"Country",emptyText:"Please select a country",defaultValue:"1",options:this.props.countries,valid:this.getFieldStatus("country"),model:".country",onChange:this.onCountryChange.bind(this)}),this.state.inUS&&h.default.createElement(F.default,{label:"State",emptyText:"Please select a State",options:w.stateDefinitions,valid:this.getFieldStatus("state"),model:".state"}),h.default.createElement(N.default,{label:"City",hint:"City is required",valid:this.getFieldStatus("city"),model:".city"}),h.default.createElement(N.default,{label:"Postal code",hint:"Valid postal code is required",valid:this.getFieldStatus("zipcode"),model:".zipcode"}),h.default.createElement(N.default,{label:"Address 1",hint:"Address is required",valid:this.getFieldStatus("address1"),model:".address1"}),h.default.createElement(N.default,{label:"Address 2",optional:!0,valid:this.getFieldStatus("address2"),model:".address2"}),h.default.createElement(N.default,{label:"Work Phone",type:"phone",hint:"Phone is required",valid:this.getFieldStatus("phone"),model:".phone"}),h.default.createElement("h2",null,"Confirmation"),h.default.createElement(O.default,{label:this.getCertifyText(),hint:"All information will be verified",valid:this.getFieldStatus("certify"),model:".certify"}),h.default.createElement(O.default,{label:"I have read and agree to the FeeTrader® Terms",hint:"Click here to read the terms",hintHref:"/terms",valid:this.getFieldStatus("terms"),model:".terms"}),h.default.createElement(T.default,{style:{borderTopWidth:"1px",marginTop:"35px"},label:"How did you hear of FeeTrader®?",hint:"Field must be completed",valid:this.getFieldStatus("referralPoll"),model:".referralPoll"}),h.default.createElement(y.default,{preset:"submitBlue",caption:this.props.sending?"Sending...":"Send",sending:this.props.sending})))}}]),t}(u.Component);t.default=C},515:function(e,t){e.exports={stylesheet:"body{font-family:Roboto,Helvetica,Arial,sans-serif;background:#fff}.verticalFlex-1nVaL{display:-webkit-box;display:-ms-flexbox;display:flex;-webkit-box-orient:vertical;-webkit-box-direction:normal;-ms-flex-direction:column;flex-direction:column;-webkit-box-pack:center;-ms-flex-pack:center;justify-content:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-ms-flex-line-pack:center;align-content:center}img{-webkit-user-drag:none;-moz-user-drag:none;user-drag:none}a{color:#0091ff;text-decoration:none}a:hover{color:#14a6ff}a:active{color:#0076eb}form{margin:0 auto;max-width:540px;box-sizing:border-box}@media (max-width:960px){form{padding:0 20px}}form h2{margin:40px 0 10px;color:#000;font-size:20px;font-weight:500}",classNames:{verticalFlex:"verticalFlex-1nVaL"}}},721:function(e,t,i){e.exports=i(335)},74:function(e,t,i){"use strict";function a(e){var t=(e.width&&e.width,e.height?e.height:e.width,""),i=null;switch(e.status){case"failed":case"error":t="Failure",i="/static/images/state-failed@2x.png";break;default:t="Valid",i="/static/images/state-valid@2x.png"}return o.default.createElement("img",{src:i,className:e.className,style:e.style,width:e.width,height:e.height,alt:t})}Object.defineProperty(t,"__esModule",{value:!0});var n=i(0),o=function(e){return e&&e.__esModule?e:{default:e}}(n);t.default=a}},[721]);