Attached you will find the existing Address Form and the New Address Form design.
The design must be exactly the same as the design in the jpg
Text must be Helvetica Neue 12px
Save button must be same css/style as design
The Country drop-down must show all countries
When a country is selected (for example United States), the region drop-down must automatically refresh and show all regions from that country.
An example of how this works can be seen when you add this product to the shopping cart and go to the checkout:
[url removed, login to view]