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<select name="state_code">
            
            <option value="na">-</option>

            <option value="AL">Alabama</option>

            <option value="AK">Alaska</option>

            <option value="AZ">Arizona</option>

            <option value="CA">California</option>

            <option value="CO">Colorado</option>

            <option value="CT">Connecticut</option>

            <option value="DE">Delaware</option>

            <option value="FL">Florida</option>

            <option value="GA">Georgia</option>

            <option value="HI">Hawaii</option>

            <option value="ID">Idaho</option>

            <option value="IN">Indiana</option>

            <option value="IA">Iowa</option>

            <option value="KS">Kansas</option>

            <option value="KY">Kentucky</option>

            <option value="LA">Louisiana</option>

            <option value="ME">Maine</option>

            <option value="MD">Maryland</option>

            <option value="MA">Massachusetts</option>

            <option value="MI">Michigan</option>

            <option value="MN">Minnesota</option>

            <option value="MS">Mississippi</option>

            <option value="MO">Missouri</option>

            <option value="MT">Montana</option>

            <option value="NE">Nebraska</option>

            <option value="NV">Nevada</option>

            <option value="NH">New Hampshire</option>

            <option value="NJ">New Jersey</option>

            <option value="NM">New Mexico</option>

            <option value="NY">New York</option>

            <option value="NC">North Carolina</option>

            <option value="ND">North Dakota</option>

            <option value="OH">Ohio</option>

            <option value="OK">Oklahoma</option>

            <option value="OR">Oregon</option>

            <option value="PA">Pennsylvania</option>

            <option value="RI">Rhode Island</option>

            <option value="SC">South Carolina</option>

            <option value="SD">South Dakota</option>

            <option value="TN">Tennessee</option>

            <option value="TX">Texas</option>

            <option value="UT">Utah</option>

            <option value="VT">Vermont</option>

            <option value="VA">Virginia</option>

            <option value="WA">Washington</option>

            <option value="WV">West Virginia</option>

            <option value="WI">Wisconsin</option>

            <option value="WY">Wyoming</option>

            <option value="DC">Washington DC</option>

        </select>