<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<script type="text/javascript">
function validate_email(field,alerttxt)
{
with (field)
{
apos=value.indexOf("@");
dotpos=value.lastIndexOf(".");
if (apos<1||dotpos-apos<2)
{
alert(alerttxt);return false;
}
else
{
return true;
}
}
}
function validate_required(field,alerttxt)
{
with (field)
{
if (value==null||value=="")
{
alert(alerttxt);return false;
}
else
{
return true;
}
}
}
function validate_form(thisform)
{
with (thisform)
{
if (validate_required(FieldData1,"The 'Your Name' field must be filled out!")==false)
{FieldData1.focus();return false;}
if (validate_required(FieldData2,"The 'City' field must be filled out")==false)
{FieldData2.focus();return false;}
if (validate_required(FieldData3,"The 'State' field must be filled out!")==false)
{FieldData3.focus();return false;}
if (validate_required(FieldData4,"The 'Phone Number' field must be filled out!")==false)
{FieldData4.focus();return false;}
if (validate_email(email,"Valid Email Required!")==false)
{email.focus();return ;}
}
}
</script>
</head>
<body>
<form action="submit.htm" onSubmit="return validate_form(this);" method="post">
<table align="center"cellpadding="2" cellspacing="0" border="0" bgcolor="#7DA7D9">
<tr>
<td align="left">
<font face="Arial" size="3" color="#000000">
<b class="gold">Name</b><p class="contact" style="font-size:16px; font-weight:bold; font-style:inherit; color:#FF0">
Please be sure to fill all text fields so that we can route your message properly</p>
</font>
<div style="" id="mainmsg"></div>
</td>
</tr>
</table>
<br>
<tr valign="top">
<td width="214" align="right"><font face="Arial" size="3" color="#000000">Your Name: </font></td>
<td width="272" align="left"><input type="text" name="FieldData1" size="15"> </td>
</tr>
<tr valign="top"><td align="right"><font face="" size="3" color="#000000">City: </font></td>
<td align="left"><input type="text" name="FieldData2" size="20"> </td>
</tr>
<tr valign="top"> <td align="right"><font face="Arial" size="3" color="#000000">State: </font></td>
<td align="left"><input type="text" name="FieldData3" size="2"> </td>
</tr>
<td align="right"><font face="Arial" size="3" color="#000000">Phone Number: </font></td>
<td align="left"><input type="text" name="FieldData4" size="15"> </td></tr><tr valign="top">
</td>
</tr>
<tr valign="top"> <td align="right"><font face="Arial" size="3" color="#000000">Email: </font></td>
<td align="left"><input type="text" name="email" size="20"> </td>
</tr>
<tr valign="top"> <td align="right"><font face="Arial" size="3" color="#000000">Detailed description of your inquiry: </font>
</td>
<td align="left"><textarea name="FieldData5" cols="30" rows="3"></textarea>
<br>
</td>
</tr>
<tr>
<td colspan="2">
</td>
</tr>
<tr>
<td>
</td>
<td align="right"><input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
<input type="submit" class="btn" value="Submit Request" name="Submit">
<input type="reset" class="btn" value=" Clear Form " name="Clear">
</td>
</tr>
<tr>
<td colspan=2 align="center">
<br>
</td>
</tr>
</table>
</form>
</body>
</html>
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