{"id":10021,"date":"2013-08-07T21:34:38","date_gmt":"2013-08-07T21:34:38","guid":{"rendered":"http:\/\/sacheminc.com\/academic-sample-request-form-2\/"},"modified":"2013-09-11T03:55:30","modified_gmt":"2013-09-11T03:55:30","slug":"academic-sample-request-form","status":"publish","type":"page","link":"https:\/\/www.sacheminc.com\/zh-hant\/academic-sample-request-form\/","title":{"rendered":"Academic Sample Request Form"},"content":{"rendered":"<div>\n<form id=\"form92\" action=\"https:\/\/s810.t.eloqua.com\/e\/f2\" method=\"post\" name=\"AcademicRequestForm\"><input type=\"hidden\" name=\"elqFormName\" value=\"AcademicRequestForm\" \/><input type=\"hidden\" name=\"elqSiteId\" value=\"810\" \/><input type=\"hidden\" name=\"elqCampaignId\" \/><\/p>\n<div class=\"sc-view form-design-field sc-static-layout sc-regular-size\" id=\"formElement0\" style=\"left: 0px; right: 0px; top: 0px; bottom: 0px; padding: 6px 5px 9px 9px;\">\n<div class=\"field-wrapper\" style=\"float: left; width: 100%; clear: both;\">\n<div class=\"_100\" style=\"float: left; width: 96%; margin-right: 2%; margin-left: 2%;\">\n<p style=\"position: relative; margin: 0px; padding: 0px;\"><label style=\"display: block; line-height: 150%; padding: 1px 0pt 3px; white-space: nowrap;\" for=\"firstName\">First Name<span style=\"color: red !important; display: inline; float: none; font-weight: bold; margin: 0pt 0pt 0pt; padding: 0pt 0pt 0pt;\">*<\/span><\/label><input id=\"field0\" style=\"width: 75%;\" type=\"text\" name=\"firstName\" value=\"\" \/><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sc-view form-design-field sc-static-layout sc-regular-size\" id=\"formElement1\" style=\"left: 0px; right: 0px; top: 0px; bottom: 0px; padding: 6px 5px 9px 9px;\">\n<div class=\"field-wrapper\" style=\"float: left; width: 100%; clear: both;\">\n<div class=\"_100\" style=\"float: left; width: 96%; margin-right: 2%; margin-left: 2%;\">\n<p style=\"position: relative; margin: 0px; padding: 0px;\"><label style=\"display: block; line-height: 150%; padding: 1px 0pt 3px; white-space: nowrap;\" for=\"lastName\">Last Name<span style=\"color: red !important; display: inline; float: none; font-weight: bold; margin: 0pt 0pt 0pt; padding: 0pt 0pt 0pt;\">*<\/span><\/label><input id=\"field1\" style=\"width: 75%;\" type=\"text\" name=\"lastName\" value=\"\" \/><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sc-view form-design-field sc-static-layout sc-regular-size\" id=\"formElement2\" style=\"left: 0px; right: 0px; top: 0px; bottom: 0px; padding: 6px 5px 9px 9px;\">\n<div class=\"field-wrapper\" style=\"float: left; width: 100%; clear: both;\">\n<div class=\"_100\" style=\"float: left; width: 96%; margin-right: 2%; margin-left: 2%;\">\n<p style=\"position: relative; margin: 0px; padding: 0px;\"><label style=\"display: block; line-height: 150%; padding: 1px 0pt 3px; white-space: nowrap;\" for=\"emailAddress\">Email Address<span style=\"color: red !important; display: inline; float: none; font-weight: bold; margin: 0pt 0pt 0pt; padding: 0pt 0pt 0pt;\">*<\/span><\/label><input id=\"field2\" style=\"width: 75%;\" type=\"text\" name=\"emailAddress\" value=\"\" \/><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sc-view form-design-field sc-static-layout sc-regular-size\" id=\"formElement3\" style=\"left: 0px; right: 0px; top: 0px; bottom: 0px; padding: 6px 5px 9px 9px;\">\n<div class=\"field-wrapper\" style=\"float: left; width: 100%; clear: both;\">\n<div class=\"_100\" style=\"float: left; width: 96%; margin-right: 2%; margin-left: 2%;\">\n<p style=\"position: relative; margin: 0px; padding: 0px;\"><label style=\"display: block; line-height: 150%; padding: 1px 0pt 3px; white-space: nowrap;\" for=\"businessPhone\">Phone<span style=\"color: red !important; display: inline; float: none; font-weight: bold; margin: 0pt 0pt 0pt; padding: 0pt 0pt 0pt;\">*<\/span><\/label><input id=\"field3\" style=\"width: 75%;\" type=\"text\" name=\"businessPhone\" value=\"\" \/><label style=\"color: #444444; display: block; font-size: 10px; padding: 6px 0pt 3px; margin: 0px;\">Please include country code and area code<\/label><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sc-view form-design-field sc-static-layout sc-regular-size\" id=\"formElement4\" style=\"left: 0px; right: 0px; top: 0px; bottom: 0px; padding: 6px 5px 9px 9px;\">\n<div class=\"field-wrapper\" style=\"float: left; width: 100%; clear: both;\">\n<div class=\"_100\" style=\"float: left; width: 96%; margin-right: 2%; margin-left: 2%;\">\n<p style=\"position: relative; margin: 0px; padding: 0px;\"><label style=\"display: block; line-height: 150%; padding: 1px 0pt 3px; white-space: nowrap;\" for=\"company\">University\/College<span style=\"color: red !important; display: inline; float: none; font-weight: bold; margin: 0pt 0pt 0pt; padding: 0pt 0pt 0pt;\">*<\/span><\/label><input id=\"field4\" style=\"width: 75%;\" type=\"text\" name=\"company\" value=\"\" \/><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sc-view form-design-field sc-static-layout sc-regular-size\" id=\"formElement5\" style=\"left: 0px; right: 0px; top: 0px; bottom: 0px; padding: 6px 5px 9px 9px;\">\n<div class=\"field-wrapper\" style=\"float: left; width: 100%; clear: both;\">\n<div class=\"_100\" style=\"float: left; width: 96%; margin-right: 2%; margin-left: 2%;\">\n<p style=\"position: relative; margin: 0px; padding: 0px;\"><label style=\"display: block; line-height: 150%; padding: 1px 0pt 3px; white-space: nowrap;\" for=\"country\">Country<span style=\"color: red !important; display: inline; float: none; font-weight: bold; margin: 0pt 0pt 0pt; padding: 0pt 0pt 0pt;\">*<\/span><\/label><br \/>\n<select id=\"field5\" style=\"width: 75%;\" name=\"country\"><option value=\"\">Please select<\/option><option value=\"\">&#8212;&#8212;&#8212;&#8212;&#8211;<\/option><option value=\"US\">United States<\/option><option value=\"GB\">United Kingdom<\/option><option value=\"CA\">Canada<\/option><option value=\"IN\">India<\/option><option value=\"NL\">Netherlands<\/option><option value=\"AU\">Australia<\/option><option value=\"ZA\">South Africa<\/option><option value=\"FR\">France<\/option><option value=\"DE\">Germany<\/option><option value=\"SG\">Singapore<\/option><option value=\"SE\">Sweden<\/option><option value=\"BR\">Brazil<\/option><option value=\"\">&#8212;&#8212;&#8212;&#8212;&#8211;<\/option><option value=\"AF\">Afghanistan<\/option><option value=\"AX\">\u00c5land 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<\/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\">Brit\/Indian Ocean Terr.<\/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 Dem. Republic Of<\/option><option value=\"CK\">Cook Islands<\/option><option value=\"CR\">Costa Rica<\/option><option value=\"CI\">C\u00f4te D&#8217;Ivore<\/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=\"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<\/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 Terr.<\/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=\"GB\">United Kingdom<\/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\/McDonald Isls.<\/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<\/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\">Kazakhstan<\/option><option value=\"KE\">Kenya<\/option><option value=\"KI\">Kiribati<\/option><option value=\"KP\">Korea (North)<\/option><option value=\"KR\">Korea (South)<\/option><option value=\"KW\">Kuwait<\/option><option value=\"KG\">Kyrgyzstan<\/option><option value=\"LA\">Laos<\/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\">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<\/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=\"MP\">N. Mariana Isls.<\/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=\"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\">Reunion<\/option><option value=\"RO\">Romania<\/option><option value=\"RU\">Russian Federation<\/option><option value=\"RW\">Rwanda<\/option><option value=\"KN\">Saint Kitts and Nevis<\/option><option value=\"LC\">Saint Lucia<\/option><option value=\"WS\">Samoa<\/option><option value=\"SM\">San Marino<\/option><option value=\"ST\">Sao Tome\/Principe<\/option><option value=\"SA\">Saudi Arabia<\/option><option value=\"SN\">Senegal<\/option><option value=\"CS\">Serbia and Montenegro<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra Leone<\/option><option value=\"SG\">Singapore<\/option><option value=\"SK\">Slovak Republic<\/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=\"ES\">Spain<\/option><option value=\"LK\">Sri Lanka<\/option><option value=\"SH\">St. Helena<\/option><option value=\"PM\">St. Pierre and Miquelon<\/option><option value=\"VC\">St. Vincent and Grenadines<\/option><option value=\"SD\">Sudan<\/option><option value=\"SR\">Suriname<\/option><option value=\"SJ\">Svalbard\/Jan Mayen Isls.<\/option><option value=\"SZ\">Swaziland<\/option><option value=\"SE\">Sweden<\/option><option value=\"CH\">Switzerland<\/option><option value=\"SY\">Syria<\/option><option value=\"TW\">Taiwan<\/option><option value=\"TJ\">Tajikistan<\/option><option value=\"TZ\">Tanzania<\/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\/Caicos Isls.<\/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=\"US\">United States<\/option><option value=\"UM\">US Minor Outlying Is.<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UZ\">Uzbekistan<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VA\">Vatican City<\/option><option value=\"VE\">Venezuela<\/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\/Futuna Isls.<\/option><option value=\"EH\">Western Sahara<\/option><option value=\"YE\">Yemen<\/option><option value=\"ZM\">Zambia<\/option><option value=\"ZW\">Zimbabwe<\/option><\/select><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"sc-view form-design-field sc-static-layout sc-regular-size\" id=\"formElement6\" style=\"left: 0px; right: 0px; top: 0px; bottom: 0px; padding: 6px 5px 9px 9px;\">\n<div class=\"field-wrapper\" style=\"float: left; width: 100%; clear: both;\">\n<div class=\"_100\" style=\"float: left; width: 96%; margin-right: 2%; margin-left: 2%;\">\n<p style=\"position: relative; margin: 0px; padding: 0px;\"><input style=\"font-size: 100%; height: 24px; width: 100px;\" type=\"submit\" value=\"Submit\" \/><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/form>\n<p><script type=\"text\/javascript\" src=\"https:\/\/img.en25.com\/i\/livevalidation_standalone.compressed.js\"><\/script><\/p>\n<style type=\"text\/css\" media=\"screen\"><!--\n.LV_validation_message{ font-weight:bold; margin: 0 0 0 5px; }\n.LV_valid{ color:#00CC00; display:none; }\n.LV_invalid{ color:#CC0000; font-size:10px; }\n.LV_valid_field, input.LV_valid_field:hover, input.LV_valid_field:active, textarea.LV_valid_field:hover, textarea.LV_valid_field:active { border: 1px solid #00CC00; }\n.LV_invalid_field, input.LV_invalid_field:hover, input.LV_invalid_field:active, textarea.LV_invalid_field:hover, textarea.LV_invalid_field:active { border: 1px solid #CC0000; 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