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function monthCheck(field) { if (field.value == 0) { alert("Please specify the month in which you were born"); field.focus(); return false; } return true; } function addressCheck(field) { if (field.value == 0) { alert("Please enter your address"); field.focus(); return false; } return true; } function dayCheck(field) { if (field.value == 0) { alert("Please specify the day on which you were born"); field.focus(); return false; } return true; } function yearCheck(field) { if (field.value == 0) { alert("Please specify the year in which you were born"); field.focus(); return false; } return true; } function genderCheck(field) { if (field.value == 0) { alert("Please specify your gender"); field.focus(); return false; } return true; } function heightCheck(field) { if (field.value == 0) { alert("Please specify your height in feet"); field.focus(); return false; } return true; } function tobaccoCheck(field) { if (field.value == 0) { alert("Please specify your tobacco usage"); field.focus(); return false; } return true; } function weightCheck(field) { var valid = "0123456789"; if (field.value.length < 2) { alert("Please specify a valid weight"); field.focus(); return false; } if (field.value < 55) { alert("Please specify a valid weight (> 55lbs)"); field.focus(); return false; } for (var i=0; i < field.value.length; i++) { temp = "" + field.value.substring(i, i+1); if (valid.indexOf(temp) == "-1") { alert("Invalid characters in your weight"); field.focus(); return false; } } return true; } function nameCheck(field){ var space = " "; var valid = "qwertyuiopasdfghjklzxcvbnmQWERTYUIOPASDFGHJKLZXCVBNM '"; for (var i=0; i < field.value.length; i++) { temp = "" + field.value.substring(i, i+1); if (valid.indexOf(temp) == "-1") { alert("Invalid characters in your name"); return false; } } if (field.value.indexOf(space) == -1) { alert("Both first and last names are required"); field.focus(); return false; } return true; } function phoneaCheck(field){ var space = " "; var valid = "0123456789"; if (field.value.length < 3) { alert("Please specify a valid area code"); field.focus(); return false; } for (var i=0; i < field.value.length; i++) { temp = "" + field.value.substring(i, i+1); if (valid.indexOf(temp) == "-1") { alert("Invalid characters in area code"); field.focus(); return false; } } return true; } function phonepCheck(field){ var space = " "; var valid = "0123456789"; if (field.value.length < 3) { alert("Please specify a valid phone prefix"); field.focus(); return false; } for (var i=0; i < field.value.length; i++) { temp = "" + field.value.substring(i, i+1); if (valid.indexOf(temp) == "-1") { alert("Invalid characters in phone prefix"); field.focus(); return false; } } return true; } function phonesCheck(field){ var space = " "; var valid = "0123456789"; if (field.value.length < 4) { alert("Please specify a valid phone suffix"); field.focus(); return false; } for (var i=0; i < field.value.length; i++) { temp = "" + field.value.substring(i, i+1); if (valid.indexOf(temp) == "-1") { alert("Invalid characters in phone suffix"); field.focus(); return false; } } return true; } function vendoridCheck(field){ if (field.value == "") { alert("Please specify a valid vendor id"); field.focus(); return false; } return true; } function coverageCheck(field){ if (field.value == 0) { alert("Please specify the amount of coverage you desire"); field.focus(); return false; } return true; } function timeCheck(field){ if (field.value == 0) { alert("Please specify the best time to call"); field.focus(); return false; } return true; } function validateForm(form1) { if (!monthCheck(form1.month)) return false; if (!dayCheck(form1.day)) return false; if (!yearCheck(form1.year)) return false; if (!genderCheck(form1.gender)) return false; if (!heightCheck(form1.feet)) return false; if (!weightCheck(form1.weight)) return false; if (!tobaccoCheck(form1.tobacco)) return false; if (!coverageCheck(form1.desiredcoverage)) return false; if (!nameCheck(form1.full_name)) return false; if (!emailCheck(form1.email.value, form1.email)) return false; if (!addressCheck(form1.address)) return false; if (!zipCheck(form1.zipcode.value, form1.zipcode)) return false; if (!phoneaCheck(form1.home_phone_a)) return false; if (!phonepCheck(form1.home_phone_p)) return false; if (!phonesCheck(form1.home_phone_s)) return false; if (!timeCheck(form1.best_call_time)) return false; return true; }

				Date of Birth 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 Gender Select.. Male Female Height/Weight Ft 3 4 5 6 7 / In 1 2 3 4 5 6 7 8 9 10 11 Lbs. Tobacco Usage Select.. Yes No Desired Coverage Please Select $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $525,000 $550,000 $575,000 $600,000 $650,000 $675,000 $700,000 $725,000 $750,000 $775,000 $800,000 $825,000 $850,000 $875,000 $900,000 $925,000 $950,000 $975,000 $1,000,000 $1,250,000 $1,500,000 $2,000,000 $2,250,000 $2,500,000 $2,750,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 $5,000,000 $5,500,000 $6,000,000 $7,000,000 $8,000,000 $9,000,000 $10,000,000 Name (First Last) E-mail Address Zip Code Best Phone (    ) - Time To Call Select... Morning Afternoon Evening