<form accept-charset="utf-8" action="" method="post">
<h3>Select Billing Options</h3>
<div class="panel">
<h4>
<label for="id_term_10">
<input checked="" id="id_term_10" name="bdf-term" type="radio" value="">Cote D'ivoire</option>
<option value="">Korea, Democratic People's Republic Of</option>
<option value="">Lao People's Democratic Republic</option>
<option value=""/>
</form>