#form	{
	width:	329px;
	height:	342px;
	background-image:	url('http://img.en25.com/EloquaImages/clients/Axios/{f20726db-3463-4440-94a2-c3707d5db6a5}_form_panel_6fields.png');
	background-repeat:	no-repeat;
	text-align: center;
}

select	{
	width:295px;
	height:34px;
	margin-top:2px;
	margin-left:15px;
	float:left;
	font-family: Arial;
	margin-right:	0px;
	margin-bottom:	0px;
	color: #828282;
}

option	{
	width:295px;
	height:34px;
	margin-top:2px;
	margin-left:15px;
	float:left;
	color: #000000;
	font-family: Arial;
	margin-right:	0px;
	margin-bottom:	0px;
}

#defaultCountry	{
		color: #828282;
}

#defaultIndustry {
		color: #828282;
}

#defaultRole {
		color: #828282;
}

#defaultProvider {
		color: #828282;
}

#defaultHelp {
		color: #828282;
}

#defaultTerritory {
		color: #828282;
}

.textBox	{
	width:	294px;
	height:	34px;
	margin-top: 2px;
	margin-right:	0px;
	margin-left:	0px;
	margin-bottom:	0px;
	margin-left:	15px;
	float: left;
	color: #828282;
	font-family: Arial;
}

#firstName	{
	width: 144px;
}

#lastName	{
	width: 144px;
	margin-left:	3px;
}

#submitButton	{
	margin-top:	20px;
	width: 230px;
	height: 49px;
}