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<li class="nav-item dropdown cats nav-item-orthodontics 
 ">
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<li class="nav-item dropdown dropdown-submenu dropright  
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<div class="modal fade" id="ASKModal" tabindex="-1" aria-labelledby="ASKModalLabel" aria-hidden="true">
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	<form action="/" method="post" name="contact_form" class="form-horizontal contact_form" data-ga-event-category="contact_form" data-ga-event-action="submit" data-ga-event-label="CONTACT5">
	<div align="center" class="error_mess ajax_errors" style="display:none"></div>
	<DIV class="form_err_message error_mess" align="center">
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		 <div class="row form-group mb-3">
		    <label class="col-md-4 col-form-label text-md-end">Full Name:<b class="madatorystar">*</b></label>
		    <div class="col-md-8">
		     <input type="text" value="" name="DATA[LNAME]" size="45" maxlength="255" dir="ltr" id="ASK_LNAME" class=" mandatory form-control" >
		    </div>
		 </div>
		<div class="row form-group mb-3">
		    <label class="col-md-4 col-form-label text-md-end">Company:</label>
		    <div class="col-md-8">
		     <input type="text" value="" name="DATA[COMPANY]" size="45" maxlength="255" dir="ltr" id="ASK_COMPANY" class=" form-control" >
		    </div>
		 </div>
		 <div class="row form-group mb-3">
		    <label class="col-md-4 col-form-label text-md-end">E-mail:<b class="madatorystar">*</b></label>
		    <div class="col-md-8">
		     <input type="text" value="" name="DATA[EMAIL]" size="45" maxlength="255" dir="ltr" id="ASK_EMAIL" class=" mandatory form-control" >
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		 </div>
		 <div class="row form-group mb-3">
		    <label class="col-md-4 col-form-label text-md-end">Phone Number</label>
		    <div class="col-md-8">
		     <input type="text" value="" name="DATA[PHONE]" size="45" maxlength="255" dir="ltr" id="ASK_PHONE" class=" form-control" >
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		 <div class="row form-group mb-3">
		    <label class="col-md-4 col-form-label text-md-end">Please specify the products you’re interested in:</label>
		    <div class="col-md-8">
		    <textarea cols="30" rows="5" id="ASK_COMMENTS" name="DATA[COMMENTS]" dir="ltr" class=" form-control" ></textarea>
		    </div>
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      </div>
      <div class="modal-footer">
       <button type="button" class="btn btn-secondary" data-bs-dismiss="modal">Close</button>
        <input type="submit" name="submit" value=" Send " class="btn btn-primary">

      </div>


<input type="hidden" name="BUFFER" value="CONTACT_US">
<input type="hidden" name="section" value="contact_form">
<input type="hidden" name="TAG" value="CONTACT5">
<input type="hidden" name="ac" value="insert">
<input type="hidden" name="next_action" value="default">
<input type="hidden" name="next_section" value="contact_us_thanks">
<input type="hidden" name="onerror_section" value="products">


	<input type="hidden" name="params[field]" value="MANUF">
	<input type="hidden" name="params[search_value]" value="bio-pure-products,-inc">
	<input type="hidden" name="params[page_idx]" value="552">

</FORM>


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</div>


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<div class="modal fade" ID="main_login_form_popup">
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                        <!--Error messages (the old way, i.e. we DO NOT USE IT NOW!) STARTS-->
                        
                        
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                        <!--Login form Starts-->
                        
                        <form action="https://dental.draft.webcart.us/index.php" method="post" name="login_form" id="main_login_form" class="">
                            <span class="hidden ajax_next_url"><!--replace this comment with URL--></span>
                            <DIV class="text-center form_err_message error_mess"><br>
                                <span class="form_email_error error_mess">Value entered for e-mail is invalid<br></span>
                                <span class="form_password_error error_mess">Passwords don't match<br></span>
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                            <div class="login_form">
                                <div class="form-group row email">
                                    <label class="col-3 col-form-label">E-mail:<b class="madatorystar">*</b></label>
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                                        <input type="text" value="" name="DATA[EMAIL]" size="35" maxlength="255" dir="ltr" id="LOGIN_EMAIL" placeholder="Enter your e-mail used as login" class=" mandatory email form-control form-control-sm" >
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                                    <label class="col-3 col-form-label">Password:<b class="madatorystar">*</b></label>
                                    <div class="col-9">
                                        <input type="password" value="" name="DATA[PASSWORD1]" size="35" maxlength="255" dir="ltr" id="LOGIN_PASSWORD1" placeholder="Enter your account password" class=" mandatory form-control form-control-sm" >
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                                        <input type="text" value="" name="DATA[EMAIL]" size="35" maxlength="255" dir="ltr" id="EMAIL_FORGOT" placeholder="Enter E-mail address you used during registration" class=" mandatory email form-control form-control-sm" >
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                            <input type=hidden name="ACC_TPY" value="CUSTOMERS">
                            <input type=hidden name="DATA[ACC_TPY]" value="CUSTOMERS">

                            <input type="hidden" name="section" value="forgot_pass">
                            <input type="hidden" name="ac" value="update">
                            <input type="hidden" name="userid" value="">

                            <!--Use .ajax_next_url to control redirect after login-->
                        </FORM>
                    </div>

                   <div class="form-group row">
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                        <button type="button" class="btn  btn-danger login_related" id="main_login_dialog_submit_btn" data-login_form="main_login_form">Login to Account</button>
                        <button type="button" class="btn btn-primary forgot_pass_related" id="main_forgot_pass_submit_btn" data-login_form="forgot_form">Recover password</button> 
                        
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<div id="mm-quote" class="modal fade" tabindex="-1" aria-labelledby="mm-quoteLabel" aria-hidden="true">
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	<form action="index.php" method="post" name="contact_form" class="contact_form" data-json="1">

		  <div class="modal-body">

						<div class="text-center alert alert-danger ajax_errors" style="display:none"></div>
						<DIV class="form_err_message text-center alert alert-danger">
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							<span class="form_mandatory_error">Please fill up missing fields below</span>
						</DIV>
						

						  <div class="row form-group mb-3">
							<label class="col-md-4 col-form-label text-md-end">Full Name: <b class="madatorystar">*</b></label>
							 <div class="col-md-8">
							  <input type="text" value="" name="DATA[LNAME]" size="45" maxlength="255" dir="ltr" id="CONTACT10_LNAME" class=" form-control mandatory" >
							</div>
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  							<div class="row form-group mb-3">
							<label class="col-md-4 col-form-label text-md-end">Company:</label>
							 <div class="col-md-8">
							  <input type="text" value="" name="DATA[COMPANY]" size="45" maxlength="255" dir="ltr" id="CONTACT10_COMPANY" class=" form-control mandatory" >
							</div>
						  </div>


						  <div class="row form-group mb-3">
							<label class="col-md-4 col-form-label text-md-end">E-mail: <b class="madatorystar">*</b></label>
							 <div class="col-md-8">
							  <input type="text" value="" name="DATA[EMAIL]" size="45" maxlength="255" dir="ltr" id="CONTACT10_EMAIL" class=" form-control mandatory mail" >
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							<label class="col-md-4 col-form-label text-md-end">Phone Number:</label>
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							  <input type="text" value="" name="DATA[PHONE]" size="45" maxlength="255" dir="ltr" id="CONTACT10_PHONE" class=" form-control" >
							</div>
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<div class="modal fade" id="QUOTEModal" tabindex="-1" role="dialog" aria-labelledby="QUOTEModalLabel">
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<form action="index.php" method="post" name="contact_form" class="form-horizontal contact_form" data-ga-event-category="contact_form" data-ga-event-action="submit" data-ga-event-label="CONTACT3">
<div align="center" class="error_mess ajax_errors" style="display:none"></div>
<DIV class="form_err_message error_mess" align="center">
	<span class="form_email_error">Value entered for e-mail is invalid<br></span>
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</DIV>


	<div class="form-group row">
	    <label class="col-sm-4 control-label">First Name<b class="madatorystar">*</b></label>
	    <div class="col-sm-8">
	      <input type="text" value="" name="DATA[FNAME]" size="45" maxlength="255" dir="ltr" id="CONTACT_FNAME" class=" mandatory form-control" >
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  	<div class="form-group row">
	    <label class="col-sm-4 control-label">Last Name<b class="madatorystar">*</b></label>
	    <div class="col-sm-8">
	      <input type="text" value="" name="DATA[LNAME]" size="45" maxlength="255" dir="ltr" id="CONTACT_LNAME" class=" mandatory form-control" >
	    </div>
  	</div>
	<div class="form-group row">
	    <label class="col-sm-4 control-label">E-mail<b class="madatorystar">*</b></label>
	    <div class="col-sm-8">
	      <input type="text" value="" name="DATA[EMAIL]" size="45" maxlength="255" dir="ltr" id="CONTACT_EMAIL" class=" mandatory form-control" >
	    </div>
  	</div>
	<div class="form-group row">
	    <label class="col-sm-4 control-label">Phone</label>
	    <div class="col-sm-8">
	     <input type="text" value="" name="DATA[PHONE]" size="45" maxlength="255" dir="ltr" id="CONTACT_PHONE" class=" form-control" >
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  	</div>
  	
	<div class="form-group row">
	    <label class="col-sm-4 control-label">Ship to Country<b class="madatorystar">*</b></label>
	    <div class="col-sm-8">
	   	<select size="1" id="CONTACT_COUNTRY" name="DATA[COUNTRY]" dir="ltr" class=" mandatory form-control form-select" ><option value="USA" class=" " >UNITED STATES</option><option value="CA" class=" " >CANADA</option><option value="MX" class=" " >MEXICO</option></select>
	    </div>
  	</div>
  	<div class="form-group row">
	    <label class="col-sm-4 control-label">System you are interested in</label>
	    <div class="col-sm-8">
	   <textarea cols="30" rows="2" id="CONTACT_SYSTEM" name="DATA[SYSTEM]" dir="ltr" class=" form-control" ></textarea>
	    </div>
  	</div>
  	

	<div class="form-group row">
	    <label class="col-sm-4 control-label">Comments</label>
	    <div class="col-sm-8">
	   <textarea cols="30" rows="2" id="CONTACT_COMMENTS" name="DATA[COMMENTS]" dir="ltr" class=" form-control" ></textarea>
	    </div>
  	</div>


      </div>
      <div class="modal-footer">
        <button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
        <input type="hidden" name="DATA[SKU]" value="">
		<input type="hidden" name="DATA[PRODUCT_NAME]" value="">
		<input type="hidden" name="DATA[LINK]" value="https://dental.draft.webcart.us/products/">
		<input type="submit" name="submit" value="Request a Quote" class="btn btn-primary">

      </div>


<input type="hidden" name="BUFFER" value="CONTACT_US">
<input type="hidden" name="section" value="contact_form">
<input type="hidden" name="userid" value="">
<input type="hidden" name="TAG" value="CONTACT3">
<input type="hidden" name="ac" value="insert">
<input type="hidden" name="next_action" value="default">
<input type="hidden" name="next_section" value="contact_us_thanks">
<input type="hidden" name="onerror_section" value="products">
<input type="hidden" name="DATA[THE_TIME]" value="NOW()">


	<input type="hidden" name="params[field]" value="MANUF">
	<input type="hidden" name="params[search_value]" value="bio-pure-products,-inc">
	<input type="hidden" name="params[page_idx]" value="552">

</FORM>

    </div>
  </div>
</div>


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