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/lib/jquery-validate/demo/multipart/index.html

#
HTML | 412 lines | 394 code | 18 blank | 0 comment | 0 complexity | 6de3adc97ce8567e2a8f43bbc641212d MD5 | raw file
Possible License(s): LGPL-2.1, Apache-2.0, BSD-3-Clause 
    

  1. <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
    2. 

  2. <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
    3. 

  3. <head>
    4. 

  4. 

  5. <title>jQuery accordion form with validation</title>
    6. 

  6. 

  7. <link rel="stylesheet" href="../assets/demo_blue.css" type="text/css" />
    8. 

  8. 

  9. <script type="text/javascript" src="../../lib/jquery.js"></script>
    10. 

  10. <script type="text/javascript" src="../../jquery.validate.js"></script>
    11. 

  11. <script type="text/javascript" src="js/jquery.maskedinput-1.0.js"></script>
    12. 

  12. <script type="text/javascript" src="js/ui.core.js"></script>
    13. 

  13. <script type="text/javascript" src="js/ui.accordion.js"></script>
    14. 

  14. 

  15. <script type="text/javascript">
    16. 

  16. $(document).ready(function(){
    17. 

  17. 

  18. 	$("#recordClientPhone").mask("(999) 999-9999");
    19. 

  19. 	$("#recordClientPhoneAlt").mask("(999) 999-9999");
    20. 

  20. 	$("#recordClientZip").mask("99999");
    21. 

  21. 	$("#recordPropertyZip").mask("99999");	
    22. 

  22. 	$("#recordPurchaseZip").mask("99999");	
    23. 

  23. 

  24. 	// add * to required field labels
    25. 

  25. 	$('label.required').append('&nbsp;<strong>*</strong>&nbsp;');
    26. 

  26. 

  27. 	// accordion functions
    28. 

  28. 	var accordion = $("#stepForm").accordion(); 
    29. 

  29. 	var current = 0;

    30. 

  30. 	

    31. 

  31. 	$.validator.addMethod("pageRequired", function(value, element) {

    32. 

  32. 		var $element = $(element)

    33. 

  33. 		function match(index) {

    34. 

  34. 			return current == index && $(element).parents("#sf" + (index + 1)).length;

    35. 

  35. 		}

    36. 

  36. 		if (match(0) || match(1) || match(2)) {

    37. 

  37. 			return !this.optional(element);

    38. 

  38. 		}

    39. 

  39. 		return "dependency-mismatch";

    40. 

  40. 	}, $.validator.messages.required)

    41. 

  41. 	
    42. 

  42. 	var v = $("#cmaForm").validate({
    43. 

  43. 		errorClass: "warning",
    44. 

  44. 		onkeyup: false,
    45. 

  45. 		onblur: false,

    46. 

  46. 		submitHandler: function() {

    47. 

  47. 			alert("Submitted, thanks!");

    48. 

  48. 		}
    49. 

  49. 	});
    50. 

  50. 	
    51. 

  51. 	// back buttons do not need to run validation
    52. 

  52. 	$("#sf2 .prevbutton").click(function(){
    53. 

  53. 		accordion.accordion("activate", 0);
    54. 

  54. 		current = 0;
    55. 

  55. 	}); 
    56. 

  56. 	$("#sf3 .prevbutton").click(function(){
    57. 

  57. 		accordion.accordion("activate", 1);
    58. 

  58. 		current = 1;
    59. 

  59. 	}); 
    60. 

  60. 	// these buttons all run the validation, overridden by specific targets above
    61. 

  61. 	$(".open2").click(function() {
    62. 

  62. 	  if (v.form()) {
    63. 

  63. 	    accordion.accordion("activate", 2);
    64. 

  64. 	    current = 2;
    65. 

  65. 	  }
    66. 

  66. 	});
    67. 

  67. 	$(".open1").click(function() {
    68. 

  68. 	  if (v.form()) {
    69. 

  69. 	    accordion.accordion("activate", 1);
    70. 

  70. 	    current = 1;
    71. 

  71. 	  }
    72. 

  72. 	});
    73. 

  73. 	$(".open0").click(function() {
    74. 

  74. 	  if (v.form()) {
    75. 

  75. 	    accordion.accordion("activate", 0);
    76. 

  76. 	    current = 0;
    77. 

  77. 	  }
    78. 

  78. 	});
    79. 

  79.  
    80. 

  80. });
    81. 

  81. </script>
    82. 

  82. 

  83. <link rel="stylesheet" type="text/css" media="screen" href="style.css" />
    84. 

  84. </head>
    85. 

  85. <body>
    86. 

  86. 

  87. <div id="wrap">
    88. 

  88. <div id="main">
    89. 

  89. 

  90. <h1 class="top bottom"><span>Help me</span> Buy and Sell a House</h1>
    91. 

  91. <h2>This form is quick &amp; easy to complete - in only 3 steps!</h2>
    92. 

  92. <form name="cmaForm" id="cmaForm" method="post">
    93. 

  93. <input type="hidden" name="recordRequestPrimaryServiceID" id="recordRequestPrimaryServiceID" value="100" />
    94. 

  94. <input type="hidden" name="recordClientServices" id="recordClientServices" value="1,3" />
    95. 

  95. <ul id="stepForm" class="ui-accordion-container">
    96. 

  96. 	<li id="sf1"><a href='#' class="ui-accordion-link"> </a>
    97. 

  97. 	<div>
    98. 

  98. 	<fieldset><legend> Step 1 of 3 </legend>
    99. 

  99. 	<div class="requiredNotice">*Required Field</div>
    100. 

  100. 	<h3 class="stepHeader">Tell us about the property you're buying</h3>
    101. 

  101. 	<label for="recordPurchaseMetRealtor" class="input required">Are you currently working with a<br />
    102. 

  102. 	real estate agent? </label> &nbsp;&nbsp;No: <input name="recordPurchaseMetRealtor" type="radio" checked="checked" class="inputclass" value="0" /> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Yes: <input name="recordPurchaseMetRealtor" type="radio" class="inputclass pageRequired" value="1" title="Please choose Yes or No" />
    103. 

  103. 	<div class="formspacer"></div>
    104. 

  104. 	<label for="recordPurchaseTimeFrameID" class="input required">When would you like to move?</label> <select name="recordPurchaseTimeFrameID" id="recordPurchaseTimeFrameID" class="inputclass pageRequired" title="Select a Time Frame">
    105. 

  105. 		<option value="">-Select-</option>
    106. 

  106. 		<option value="1">Less than 3 months</option>
    107. 

  107. 		<option value="2">3-6 months</option>
    108. 

  108. 		<option value="3">6-9 months</option>
    109. 

  109. 		<option value="4">9-12 months</option>
    110. 

  110. 		<option value="5">Over 12 months</option>
    111. 

  111. 	</select> <br />
    112. 

  112. 	<label for="recordPurchasePriceRangeID" class="input required">Purchase price range:</label> <select name="recordPurchasePriceRangeID" id="recordPurchasePriceRangeID" class="inputclass pageRequired" title="Select a Price Range">
    113. 

  113. 		<option value="">-Select-</option>
    114. 

  114. 		<option value="1"></option>
    115. 

  115. 		<option value="2">$75,000 - $100,000</option>
    116. 

  116. 		<option value="3">$100,000 - $125,000</option>
    117. 

  117. 		<option value="4">$125,000 - $150,000</option>
    118. 

  118. 		<option value="5">$150,000 - $200,000</option>
    119. 

  119. 		<option value="6">$200,000 - $250,000</option>
    120. 

  120. 		<option value="7">$250,000 - $300,000</option>
    121. 

  121. 		<option value="8">$300,000 - $350,000</option>
    122. 

  122. 		<option value="9">$350,000 - $400,000</option>
    123. 

  123. 		<option value="10">$400,000 - $500,000</option>
    124. 

  124. 		<option value="11">$500,000 - $700,000</option>
    125. 

  125. 		<option value="12">$700,000 - $900,000</option>
    126. 

  126. 		<option value="13">> $900,000</option>
    127. 

  127. 	</select> <br />
    128. 

  128. 	<label for="recordPurchaseState" class="input required">State:</label> <select name="recordPurchaseState" id="recordPurchaseState" class="inputclass pageRequired" title="Select a State">
    129. 

  129. 		<option value="">-Select-</option>
    130. 

  130. 		<option value="AL">Alabama</option>
    131. 

  131. 		<option value="AK">Alaska</option>
    132. 

  132. 		<option value="AZ">Arizona</option>
    133. 

  133. 		<option value="AR">Arkansas</option>
    134. 

  134. 		<option value="CA">California</option>
    135. 

  135. 		<option value="CO">Colorado</option>
    136. 

  136. 		<option value="CT">Connecticut</option>
    137. 

  137. 		<option value="DE">Delaware</option>
    138. 

  138. 		<option value="DC">Dist of Columbia</option>
    139. 

  139. 		<option value="FL">Florida</option>
    140. 

  140. 		<option value="GA">Georgia</option>
    141. 

  141. 		<option value="HI">Hawaii</option>
    142. 

  142. 		<option value="ID">Idaho</option>
    143. 

  143. 		<option value="IL">Illinois</option>
    144. 

  144. 		<option value="IN">Indiana</option>
    145. 

  145. 		<option value="IA">Iowa</option>
    146. 

  146. 		<option value="KS">Kansas</option>
    147. 

  147. 		<option value="KY">Kentucky</option>
    148. 

  148. 		<option value="LA">Louisiana</option>
    149. 

  149. 		<option value="ME">Maine</option>
    150. 

  150. 		<option value="MD">Maryland</option>
    151. 

  151. 		<option value="MA">Massachusetts</option>
    152. 

  152. 		<option value="MI">Michigan</option>
    153. 

  153. 		<option value="MN">Minnesota</option>
    154. 

  154. 		<option value="MS">Mississippi</option>
    155. 

  155. 		<option value="MO">Missouri</option>
    156. 

  156. 		<option value="MT">Montana</option>
    157. 

  157. 		<option value="NE">Nebraska</option>
    158. 

  158. 		<option value="NV">Nevada</option>
    159. 

  159. 		<option value="NH">New Hampshire</option>
    160. 

  160. 		<option value="NJ">New Jersey</option>
    161. 

  161. 		<option value="NM">New Mexico</option>
    162. 

  162. 		<option value="NY">New York</option>
    163. 

  163. 		<option value="NC">North Carolina</option>
    164. 

  164. 		<option value="ND">North Dakota</option>
    165. 

  165. 		<option value="OH">Ohio</option>
    166. 

  166. 		<option value="OK">Oklahoma</option>
    167. 

  167. 		<option value="OR">Oregon</option>
    168. 

  168. 		<option value="PA" selected="selected">Pennsylvania</option>
    169. 

  169. 		<option value="RI">Rhode Island</option>
    170. 

  170. 		<option value="SC">South Carolina</option>
    171. 

  171. 		<option value="SD">South Dakota</option>
    172. 

  172. 		<option value="TN">Tennessee</option>
    173. 

  173. 		<option value="TX">Texas</option>
    174. 

  174. 		<option value="UT">Utah</option>
    175. 

  175. 		<option value="VT">Vermont</option>
    176. 

  176. 		<option value="VA">Virginia</option>
    177. 

  177. 		<option value="WA">Washington</option>
    178. 

  178. 		<option value="WV">West Virginia</option>
    179. 

  179. 		<option value="WI">Wisconsin</option>
    180. 

  180. 		<option value="WY">Wyoming</option>
    181. 

  181. 	</select> <br />
    182. 

  182. 

  183. 	<label for="recordPurchasePropertyTypeID" class="input">Desired property type:</label> <select name="recordPurchasePropertyTypeID" id="recordPurchasePropertyTypeID" class="inputclass" title="Select a Property Type">
    184. 

  184. 		<option value="">-Select-</option>
    185. 

  185. 		<option value="1">Single Family Detached</option>
    186. 

  186. 		<option value="2">Condo</option>
    187. 

  187. 		<option value="3">Townhouse</option>
    188. 

  188. 		<option value="4">Rental</option>
    189. 

  189. 		<option value="5">Multi-Family</option>
    190. 

  190. 		<option value="6">Vacation Home</option>
    191. 

  191. 		<option value="7">Other</option>
    192. 

  192. 	</select> <br />
    193. 

  193. 	<div class="buttonWrapper"><input name="formNext1" type="button" class="open1 nextbutton" value="Next" alt="Next" title="Next" /></div>
    194. 

  194. 	</fieldset>
    195. 

  195. 	</div>
    196. 

  196. 	</li>
    197. 

  197. 	<li id="sf2">
    198. 

  198. 	<a href='#' class="ui-accordion-link">
    199. 

  199. 	</a>
    200. 

  200. 	<div>
    201. 

  201. 	<fieldset><legend> Step 2 of 3 </legend>
    202. 

  202. 	<div class="requiredNotice">*Required Field</div>
    203. 

  203. 	<h3 class="stepHeader">Tell us about the property you're selling</h3>
    204. 

  204. 	<label for="recordClientTimeFrameID" class="input required">When would you like to sell?</label> <select name="recordClientTimeFrameID" id="recordClientTimeFrameID" class="inputclass pageRequired" title="Select a Time Frame">
    205. 

  205. 		<option value="">-Select-</option>
    206. 

  206. 		<option value="1">Less than 3 months</option>
    207. 

  207. 		<option value="2">3-6 months</option>
    208. 

  208. 		<option value="3">6-9 months</option>
    209. 

  209. 		<option value="4">9-12 months</option>
    210. 

  210. 		<option value="5">Over 12 months</option>
    211. 

  211. 	</select> <br />
    212. 

  212. 	<label for="recordClientHomeTypeID" class="input required">Type of property you are selling:</label> <select name="recordClientHomeTypeID" id="recordClientHomeTypeID" class="inputclass pageRequired" title="Select a Property Type">
    213. 

  213. 		<option value="">-Select-</option>
    214. 

  214. 		<option value="1">Single Family Detached</option>
    215. 

  215. 		<option value="2">Condo</option>
    216. 

  216. 		<option value="3">Townhouse</option>
    217. 

  217. 		<option value="4">Rental</option>
    218. 

  218. 		<option value="5">Multi-Family</option>
    219. 

  219. 		<option value="6">Vacation Home</option>
    220. 

  220. 		<option value="7">Other</option>
    221. 

  221. 	</select> <br />
    222. 

  222. 	<label for="recordPropertyAddress1" class="input required">Property Street Address:</label> <input name="recordPropertyAddress1" id="recordPropertyAddress1" class="inputclass pageRequired" title="Street Address is required" maxlength="254" onblur="recordClientAddress1.value = this.value" /><br />
    223. 

  223. 	<label for="recordPropertyAddress2" class="input">Address (2):</label> <input name="recordPropertyAddress2" id="recordPropertyAddress2" class="inputclass" maxlength="254" onblur="recordClientAddress2.value = this.value" /><br />
    224. 

  224. 	<label for="recordPropertyCity" class="input required">City:</label> <input name="recordPropertyCity" id="recordPropertyCity" class="inputclass pageRequired" title="City is required" maxlength="254" onblur="recordClientCity.value = this.value" /><br />
    225. 

  225. 	<label for="recordPropertyState" class="input required">State:</label> <select name="recordPropertyState" id="recordPropertyState" class="inputclass pageRequired" title="Select a State" onchange="recordClientState.value = this.value">
    226. 

  226. 		<option value="">-Select-</option>
    227. 

  227. 		<option value="AL">Alabama</option>
    228. 

  228. 		<option value="AK">Alaska</option>
    229. 

  229. 		<option value="AZ">Arizona</option>
    230. 

  230. 		<option value="AR">Arkansas</option>
    231. 

  231. 		<option value="CA">California</option>
    232. 

  232. 		<option value="CO">Colorado</option>
    233. 

  233. 		<option value="CT">Connecticut</option>
    234. 

  234. 		<option value="DE">Delaware</option>
    235. 

  235. 		<option value="DC">Dist of Columbia</option>
    236. 

  236. 		<option value="FL">Florida</option>
    237. 

  237. 		<option value="GA">Georgia</option>
    238. 

  238. 		<option value="HI">Hawaii</option>
    239. 

  239. 		<option value="ID">Idaho</option>
    240. 

  240. 		<option value="IL">Illinois</option>
    241. 

  241. 		<option value="IN">Indiana</option>
    242. 

  242. 		<option value="IA">Iowa</option>
    243. 

  243. 		<option value="KS">Kansas</option>
    244. 

  244. 		<option value="KY">Kentucky</option>
    245. 

  245. 		<option value="LA">Louisiana</option>
    246. 

  246. 		<option value="ME">Maine</option>
    247. 

  247. 		<option value="MD">Maryland</option>
    248. 

  248. 		<option value="MA">Massachusetts</option>
    249. 

  249. 		<option value="MI">Michigan</option>
    250. 

  250. 		<option value="MN">Minnesota</option>
    251. 

  251. 		<option value="MS">Mississippi</option>
    252. 

  252. 		<option value="MO">Missouri</option>
    253. 

  253. 		<option value="MT">Montana</option>
    254. 

  254. 		<option value="NE">Nebraska</option>
    255. 

  255. 		<option value="NV">Nevada</option>
    256. 

  256. 		<option value="NH">New Hampshire</option>
    257. 

  257. 		<option value="NJ">New Jersey</option>
    258. 

  258. 		<option value="NM">New Mexico</option>
    259. 

  259. 		<option value="NY">New York</option>
    260. 

  260. 		<option value="NC">North Carolina</option>
    261. 

  261. 		<option value="ND">North Dakota</option>
    262. 

  262. 		<option value="OH">Ohio</option>
    263. 

  263. 		<option value="OK">Oklahoma</option>
    264. 

  264. 		<option value="OR">Oregon</option>
    265. 

  265. 		<option value="PA" selected="selected">Pennsylvania</option>
    266. 

  266. 		<option value="RI">Rhode Island</option>
    267. 

  267. 		<option value="SC">South Carolina</option>
    268. 

  268. 		<option value="SD">South Dakota</option>
    269. 

  269. 		<option value="TN">Tennessee</option>
    270. 

  270. 		<option value="TX">Texas</option>
    271. 

  271. 		<option value="UT">Utah</option>
    272. 

  272. 		<option value="VT">Vermont</option>
    273. 

  273. 		<option value="VA">Virginia</option>
    274. 

  274. 		<option value="WA">Washington</option>
    275. 

  275. 		<option value="WV">West Virginia</option>
    276. 

  276. 		<option value="WI">Wisconsin</option>
    277. 

  277. 		<option value="WY">Wyoming</option>
    278. 

  278. 	</select> <br />
    279. 

  279. 	<label for="recordPropertyZip" class="input required">Zip:</label> <input name="recordPropertyZip" id="recordPropertyZip" class="inputclass pageRequired" title="Zip Code is required" maxlength="254" onblur="recordClientZip.value = this.value" /><br />
    280. 

  280. 

  281. 	<label for="recordClientPropertyValueID" class="input required">Estimated Market Value:</label> <select name="recordClientPropertyValueID" id="recordClientPropertyValueID" class="inputclass pageRequired" title="Select a Price Range">
    282. 

  282. 		<option value="">-Select-</option>
    283. 

  283. 		<option value="1">Less Than $75K</option>
    284. 

  284. 		<option value="2">$75-$100K</option>
    285. 

  285. 		<option value="3">$100-$125K</option>
    286. 

  286. 		<option value="4">$125-$150K</option>
    287. 

  287. 		<option value="5">$150-$200K</option>
    288. 

  288. 		<option value="6">$200-$250K</option>
    289. 

  289. 		<option value="7">$250-$300K</option>
    290. 

  290. 		<option value="8">$300-$350K</option>
    291. 

  291. 		<option value="9">$350-$400K</option>
    292. 

  292. 		<option value="10">$400-$500K</option>
    293. 

  293. 		<option value="11">$500-$700K</option>
    294. 

  294. 		<option value="12">$700-$900K</option>
    295. 

  295. 		<option value="13">Over $900K</option>
    296. 

  296. 	</select> <br />
    297. 

  297. 	<label for="recordPropertyBedroomsID" class="input">Bedrooms:</label> <select name="recordPropertyBedroomsID" id="recordPropertyBedroomsID" class="inputclass">
    298. 

  298. 		<option value="">-Select-</option>
    299. 

  299. 		<option value="1">1</option>
    300. 

  300. 		<option value="2">2</option>
    301. 

  301. 		<option value="3">3</option>
    302. 

  302. 		<option value="4">4</option>
    303. 

  303. 		<option value="5">5+</option>
    304. 

  304. 	</select> <br />
    305. 

  305. 	<label for="recordPropertyBathroomsId" class="input">Bathrooms:</label> <select name="recordPropertyBathroomsId" id="recordPropertyBathroomsId" class="inputclass">
    306. 

  306. 		<option value="">-Select-</option>
    307. 

  307. 		<option value="1">1</option>
    308. 

  308. 		<option value="2">1.5</option>
    309. 

  309. 		<option value="3">2</option>
    310. 

  310. 		<option value="4">2.5</option>
    311. 

  311. 		<option value="5">3</option>
    312. 

  312. 		<option value="6">3.5</option>
    313. 

  313. 		<option value="7">4+</option>
    314. 

  314. 	</select> <br />
    315. 

  315. 	<label for="recordPropertyAgeId" class="input">Approx. Age of Home:</label> <select name="recordPropertyAgeId" id="recordPropertyAgeId" class="inputclass">
    316. 

  316. 		<option value="">-Select-</option>
    317. 

  317. 		<option value="1">Less Than 1 year</option>
    318. 

  318. 		<option value="2">1-5 years</option>
    319. 

  319. 		<option value="3">6-10 years</option>
    320. 

  320. 		<option value="4">11-15 years</option>
    321. 

  321. 		<option value="5">More than 15 years</option>
    322. 

  322. 	</select> <br />
    323. 

  323. 	<label for="recordPropertySqFt" class="input">Approx. Square Footage:</label> <input name="recordPropertySqFt" id="recordPropertySqFt" class="inputclass" maxlength="254" /><br />
    324. 

  324. 	<div class="buttonWrapper"><input name="formBack0" type="button" class="open0 prevbutton" value="Back" alt="Back" title="Back" /> <input name="formNext2" type="button" class="open2 nextbutton" value="Next" alt="Next" title="Next" /></div>
    325. 

  325. 	</fieldset>
    326. 

  326. 	</div>
    327. 

  327. 	</li>
    328. 

  328. 	<li id="sf3">
    329. 

  329. 	<a href='#' class="ui-accordion-link">
    330. 

  330. 	</a>
    331. 

  331. 	<div>
    332. 

  332. 	<fieldset><legend> Step 3 of 3 </legend>
    333. 

  333. 	<div class="requiredNotice">*Required Field</div>
    334. 

  334. 	<h3 class="stepHeader">Tell us about yourself</h3>
    335. 

  335. 	<label for="recordClientNameFirst" class="input required">First Name:</label> <input name="recordClientNameFirst" id="recordClientNameFirst" class="inputclass pageRequired" title="First Name is required" maxlength="254" /> <br />
    336. 

  336. 	<label for="recordClientNameLast" class="input required">Last Name:</label> <input name="recordClientNameLast" id="recordClientNameLast" class="inputclass pageRequired" maxlength="254" title="Last Name is required" /> <br />
    337. 

  337. 	<label for="recordClientAddress1" class="input required">Current Address:</label> <input name="recordClientAddress1" id="recordClientAddress1" class="inputclass pageRequired" maxlength="254" title="Address is required" /> <br />
    338. 

  338. 	<label for="recordClientAddress2" class="input">Address (2):</label> <input name="recordClientAddress2" id="recordClientAddress2" class="inputclass" maxlength="254" /> <br />
    339. 

  339. 	<label for="recordClientCity" class="input required">City:</label> <input name="recordClientCity" id="recordClientCity" class="inputclass pageRequired" maxlength="254" title="City is required" /> <br />
    340. 

  340. 	<label for="recordClientState" class="input required">State:</label> <select name="recordClientState" id="recordClientState" class="inputclass pageRequired" title="Select a State">
    341. 

  341. 		<option value="">-Select-</option>
    342. 

  342. 		<option value="AL">Alabama</option>
    343. 

  343. 		<option value="AK">Alaska</option>
    344. 

  344. 		<option value="AZ">Arizona</option>
    345. 

  345. 		<option value="AR">Arkansas</option>
    346. 

  346. 		<option value="CA">California</option>
    347. 

  347. 		<option value="CO">Colorado</option>
    348. 

  348. 		<option value="CT">Connecticut</option>
    349. 

  349. 		<option value="DE">Delaware</option>
    350. 

  350. 		<option value="DC">Dist of Columbia</option>
    351. 

  351. 		<option value="FL">Florida</option>
    352. 

  352. 		<option value="GA">Georgia</option>
    353. 

  353. 		<option value="HI">Hawaii</option>
    354. 

  354. 		<option value="ID">Idaho</option>
    355. 

  355. 		<option value="IL">Illinois</option>
    356. 

  356. 		<option value="IN">Indiana</option>
    357. 

  357. 		<option value="IA">Iowa</option>
    358. 

  358. 		<option value="KS">Kansas</option>
    359. 

  359. 		<option value="KY">Kentucky</option>
    360. 

  360. 		<option value="LA">Louisiana</option>
    361. 

  361. 		<option value="ME">Maine</option>
    362. 

  362. 		<option value="MD">Maryland</option>
    363. 

  363. 		<option value="MA">Massachusetts</option>
    364. 

  364. 		<option value="MI">Michigan</option>
    365. 

  365. 		<option value="MN">Minnesota</option>
    366. 

  366. 		<option value="MS">Mississippi</option>
    367. 

  367. 		<option value="MO">Missouri</option>
    368. 

  368. 		<option value="MT">Montana</option>
    369. 

  369. 		<option value="NE">Nebraska</option>
    370. 

  370. 		<option value="NV">Nevada</option>
    371. 

  371. 		<option value="NH">New Hampshire</option>
    372. 

  372. 		<option value="NJ">New Jersey</option>
    373. 

  373. 		<option value="NM">New Mexico</option>
    374. 

  374. 		<option value="NY">New York</option>
    375. 

  375. 		<option value="NC">North Carolina</option>
    376. 

  376. 		<option value="ND">North Dakota</option>
    377. 

  377. 		<option value="OH">Ohio</option>
    378. 

  378. 		<option value="OK">Oklahoma</option>
    379. 

  379. 		<option value="OR">Oregon</option>
    380. 

  380. 		<option value="PA" selected="selected">Pennsylvania</option>
    381. 

  381. 		<option value="RI">Rhode Island</option>
    382. 

  382. 		<option value="SC">South Carolina</option>
    383. 

  383. 		<option value="SD">South Dakota</option>
    384. 

  384. 		<option value="TN">Tennessee</option>
    385. 

  385. 		<option value="TX">Texas</option>
    386. 

  386. 		<option value="UT">Utah</option>
    387. 

  387. 		<option value="VT">Vermont</option>
    388. 

  388. 		<option value="VA">Virginia</option>
    389. 

  389. 		<option value="WA">Washington</option>
    390. 

  390. 		<option value="WV">West Virginia</option>
    391. 

  391. 		<option value="WI">Wisconsin</option>
    392. 

  392. 		<option value="WY">Wyoming</option>
    393. 

  393. 	</select> <br />
    394. 

  394. 	<label for="recordClientZip" class="input required">Zip:</label> <input name="recordClientZip" id="recordClientZip" class="inputclass pageRequired" maxlength="12" title="Zip Code is required" /> <br />
    395. 

  395. 	<label for="recordClientPhone" class="input required">Phone Number:</label> <input name="recordClientPhone" id="recordClientPhone" class="inputclass pageRequired" maxlength="254" title="Phone Number is required" /> <br />
    396. 

  396. 	<label for="recordClientPhoneAlt" class="input">Alternate Number:</label> <input name="recordClientPhoneAlt" id="recordClientPhoneAlt" class="inputclass" maxlength="254" /> <br />
    397. 

  397. 	<label for="recordClientEmail" class="input required">Email Address:</label> <input name="recordClientEmail" id="recordClientEmail" class="inputclass pageRequired email" maxlength="254" title="Email address is required" /> <br />
    398. 

  398. 	<label for="recordClientEmail1" class="input required">Confirm Email:</label> <input name="recordClientEmail1" id="recordClientEmail1" class="inputclass pageRequired" equalTo:"'#recordClientEmail" maxlength="254" title="Please confirm your email address" /> <br />
    399. 

  399. 	<br />
    400. 

  400. 	<p class="formDisclaimer">This is a sample form, no information is sent anywhere.</p>
    401. 

  401. 	<div class="buttonWrapper"><input name="formBack1" type="button" class="open1 prevbutton" value="Back" alt="Back" title="Back" /> <input name="submit" type="submit" id="submit" value="Submit" class="submitbutton" alt="Submit" title="Submit"></div>
    402. 

  402. 	</fieldset>
    403. 

  403. 	</div>
    404. 

  404. 	</li>
    405. 

  405. </ul>
    406. 

  406. </form>
    407. 

  407. 

  408. </div>
    409. 

  409. </div>
    410. 

  410. 

  411. </body>
    412. 

  412. </html>
    413. 

  413.