string(2) "US"
string(2) "OH"
<style type="text/css">
    *,*::after,*::before {box-sizing:border-box;}
    .report-content {display:block;font-size:14px;font-family:"Roboto",Arial;}
    .notification {padding:10px;margin-bottom:20px;border:1px sol idtransparent;border-radius:4px;clear:both;font-size:15px;width:100%;}
    .notification.info {background-color:#d9edf7;border-color:#bce8f1;color:#31708f;}
    .notification.alert {background-color:#fcf8e3;border-color:#faebcc;color:#8a6d3b;}
    .notification.success {background-color:#dff0d8;border-color:#d6e9c6;color:#3c763d;}
    .notification p {margin-bottom:0;}
    .form-item {display:flex;align-items:center;margin-bottom:10px;}
    .form-item.-actions {justify-content:center;margin-top:20px;}
    .form-item label {display:block;flex:0 0 120px;}
    .form-item input[type="text"],.form-item input[type="email"],textarea,select{display:block;flex:1 0 0;height:34px;line-height:32px;padding:0 10px;border:1px solid gray;}
    .form-item textarea {min-height:80px;resize:vertical;padding:10px;line-height:1.4;}
    .form-item input[type="submit"] {display:block;padding:0 20px;height:34px;line-height:34px;background-color:#ff2024;color:#ffffff;border:0 none;cursor:pointer;}
    .form-item input[type="submit"]:hover {background-color:#b90003;}
    .captcha-wrapper {flex:1 0 0;display:flex;flex-flow:row nowrap;}
    .captcha-wrapper img {height:34px;flex:0 0 auto;margin-right:10px;}
    .captcha-wrapper input[type="text"] {flex:1 0 0;}
</style>

<div class="report-content">
    
            <div class="notification info">Please use this form to report any content to us that may be deemed inappropriate.</div>
        <div class="notification info">All fields are mandatory.</div>
        <form method="post" action="">
                            <input type="hidden" name="id" value="33646" />
                        <div class="form-item">
                <label>Name</label>
                <input name="name" type="text" id="name" value="" maxlength="255" />
            </div>

            <div class="form-item">
                <label>Email Address</label>
                <input name="email" type="text" id="email" maxlength="255" />
            </div>

            <div class="form-item">
                <label>Reason</label>
                <select name="reason" id="reason">
                    <option value="">-Select-</option>
                    <option value="Inappropriate Content">Inappropriate (rape, incest, bestiality, etc)</option>
                    <option value="Underage">Underage</option>
                    <option value="Copyright Violation">Copyrighted Material</option>
                    <option value="Video Not Playing">Video Not Playing</option>
                    <option value="Other Reason">Other Reason</option>
                </select>
            </div>

            <div class="form-item">
                <label>Message</label>
                <textarea name="content"></textarea>
            </div>

            <div class="form-item -captcha">
                <label>Solve the math problem and type the answer here</label>
                <div class="captcha-wrapper">
                    <img src="https://hypnotube2.com/captcha.php?ts=1753295379" loading="lazy" />
                    <input class='f02'  name="captchaaa" type="text" id="signup_email" size="10" maxlength="35" value='' />
                </div>
            </div>

            <div class="form-item -actions">
                <input type="submit" name="button" id="button" value="Send report" />
            </div>
        </form>
              
</div>