Phiên bản đầy đủ: jsB@nk » Email » Mẫu liên hệ chi tiết
URL: https://www.javascriptbank.com/submission-form.html
Hiệu ứng tạo một mẫu liên hệ chi tiết với rất nhiều thông số yêu cầu bạn nhập vào như họ tên, địa chỉ, nghề nghiệp, ngôn ngữ,... và biểu mẫu sẽ kiểm tra nếu bạn chưa nhập hoặc nhập sai dữ liệu nào đó.
Phiên bản đầy đủ: jsB@nk » Email » Mẫu liên hệ chi tiết
URL: https://www.javascriptbank.com/submission-form.html
<SCRIPT language=JavaScript><!--Script By Danny C's Free Web Ring And Site Linking--!><!-- Begin function resetform() {document.forms[0].elements[0]=="";}function submitForms() {if ( isClass() && isFname() && isLname() && isEmail() && isConfirmemail() && isAddress1() && isAddress2() && isCity() && isUsstate() && isAustate() && isZip() && isCountry() && isPhone() && isOccupation() && isEmploy() && isIncome() && isLanguage() && isGender() && isMonth() && isDay() && isYear() && isHowfind() && isMailinglist() && isTerms())if (confirm("\n You are about to e-mail your submission. \n\nYES to submit. NO to abort.")){alert("\nYour submission will now be sent. \n\n Use the Return Button once the submission is complete to return to my home page.\n\n\n Thank you for joining my mailing list!");return true;}else{alert("\n You have chosen to abort the submission.");return false}else return false;}function isClass() {if (document.forms[0].elements[0].value == "") {alert ("\n What Do You Like To Be Called.\n\n Mr, Mrs, Miss, Ms, Master,\n\n Please Select Your Title")document.forms[0].elements[0].focus();return false;}return true;}function isFname() {if (document.forms[0].elements[1].value == "") {alert ("\n The First Name field is blank. \n\n Please enter your first name.")document.forms[0].elements[1].focus();return false;}return true;}function isLname() {if (document.forms[0].elements[2].value == "") {alert ("\n The Last Name field is blank. \n\nPlease enter your last name.")document.forms[0].elements[2].focus();return false;}return true;}function isEmail() {if (document.forms[0].elements[3].value == "") {alert ("\n The E-Mail field is blank. \n\n Please enter your E-Mail address.")document.forms[0].elements[3].focus();return false;}if (document.forms[0].elements[3].value.indexOf ('@',0) == -1 ||document.forms[0].elements[3].value.indexOf ('.',0) == -1) {alert ("\n The E-Mail field requires a \"@\" and a \".\"be used. \n\nPlease re-enter your E-Mail address.")document.forms[0].elements[3].select();document.forms[0].elements[3].focus();return false;}return true;}function isConfirmemail() {if (document.forms[0].elements[4].value == "") {alert ("\n The Confirm E-Mail field is blank. \n\n Please Confirm your E-Mail address.")document.forms[0].elements[4].focus();return false;}if (document.forms[0].elements[4].value.indexOf ('@',0) == -1 ||document.forms[0].elements[4].value.indexOf ('.',0) == -1) {alert ("\n The E-Mail field requires a \"@\" and a \".\"be used. \n\nPlease re-confirm your E-Mail address.")document.forms[0].elements[4].select();document.forms[0].elements[4].focus();return false;}return true;}function isAddress1() {if (document.forms[0].elements[5].value == "") {alert ("\n The Address field is blank. \n\nPlease enter your address.")document.forms[0].elements[5].focus();return false;}return true;}function isAddress2() {if (document.forms[0].elements[6].value == "") {alert ("\n The Address 2 field is blank. \n\nPlease Select A Street Name.")document.forms[0].elements[6].focus();return false;}return true;}function isCity() {if (document.forms[0].elements[7].value == "") {alert ("\n The City field is blank. \n\nPlease enter your City.")document.forms[0].elements[7].focus();return false;}return true;}function isUsstate() {if (document.forms[0].elements[8].value == "") {alert ("\n The US State field is blank. \n\nPlease Select Other If Not US state.")document.forms[0].elements[8].focus();return false;}return true;}function isAustate() {if (document.forms[0].elements[9].value == "") {alert ("\n The AUS state field is blank.\n\nPlease Select Other If Not AUS state.")document.forms[0].elements[9].focus();return false;}return true;}function isZip() {if (document.forms[0].elements[10].value == "") {alert ("\n The Zip code field is blank. \n\nPlease enter your Zip code.")document.forms[0].elements[10].focus();return false;}return true;}function isCountry() {if (document.forms[0].elements[11].value == "") {alert ("\n The Country field is blank. \n\nPlease enter your Country.")document.forms[0].elements[11].focus();return false;}return true;}function isPhone() {if (document.forms[0].elements[12].value == "") {alert ("\n The Phone field is blank. \n\nPlease enter your Phone Number.")document.forms[0].elements[12].focus();return false;}return true;}function isOccupation() {if (document.forms[0].elements[13].value == "") {alert ("\n The Occupation field is blank. \n\nPlease enter your Occupation.")document.forms[0].elements[13].focus();return false;}return true;}function isEmploy() {if (document.forms[0].elements[14].value == "") {alert ("\n The Employment field is blank. \n\nPlease enter your Employment.")document.forms[0].elements[14].focus();return false;}return true;}function isIncome() {if (document.forms[0].elements[15].value == "") {alert ("\n The Income field is blank. \n\nPlease enter your Income.")document.forms[0].elements[15].focus();return false;}return true;}function isLanguage() {if (document.forms[0].elements[16].value == "") {alert ("\n The Language field is blank. \n\nPlease enter your Language.")document.forms[0].elements[16].focus();return false;}return true;}function isGender() {if (document.forms[0].elements[17].value == "") {alert ("\n The Gender field is blank. \n\nPlease enter your Sex.")document.forms[0].elements[17].focus();return false;}return true;}function isMonth() {if (document.forms[0].elements[18].value == "") {alert ("\n The Month field is blank. \n\nPlease enter your Month Of Birth.")document.forms[0].elements[18].focus();return false;}return true;}function isDay() {if (document.forms[0].elements[19].value == "") {alert ("\n The Day field is blank. \n\nPlease enter your Day Of Birth.")document.forms[0].elements[19].focus();return false;}return true;}function isYear() {if (document.forms[0].elements[20].value == "") {alert ("\n The Year field is blank. \n\nPlease enter your Year Of Birth.")document.forms[0].elements[20].focus();return false;}return true;}function isHowfind() {if (document.forms[0].elements[21].value == "") {alert ("\n The How You Found Us field is blank. \n\nPlease Tell Us How You Found Our Site.")document.forms[0].elements[21].focus();return false;}return true;}function isMailinglist() {if (document.forms[0].elements[22].value == "") {alert ("\n The Mailing List field is blank. \n\nPlease Select Your Option.")document.forms[0].elements[22].focus();return false;}return true;}function isTerms() {if (document.forms[0].elements[23].value == "") {alert ("\n Read The Terms & Conditions. \n\nThen Please Select.")document.forms[0].elements[23].focus();return false;}return true;}// End --></SCRIPT><!-- This script downloaded from www.JavaScriptBank.com Come to view and download over 2000+ free javascript at www.JavaScriptBank.com--><TABLE height=400 cellSpacing=2 cellPadding=5 width=500 align=center bgColor=#cccccc border=5> <TBODY> <TR> <TD> <FORM name=addform onsubmit="return submitForms()" action="mailto:dsjcullen@bigpond.com?subject=Subscribe To Mailing List" method=post encType=text/plain> <TABLE align=center> <TBODY> <TR> <TD align=left><B>Title</B></TD> <TD align=left><SELECT size=1 name=Class> <OPTION value="" selected></OPTION> <OPTION value=Mr>Mr</OPTION> <OPTION value=Miss>Miss</OPTION> <OPTION value=Mrs>Mrs</OPTION> <OPTION value=Ms>Ms</OPTION> <OPTION value=Mast>Master</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>First Name</B></TD> <TD align=left><INPUT maxLength=30 size=25 name=Fname></TD></TR> <TR> <TD align=left><B>Last Name</B></TD> <TD align=left><INPUT maxLength=30 size=25 name=Lname></TD></TR> <TR> <TD align=left><B>Email Address</B></TD> <TD align=left><INPUT maxLength=30 size=25 name=Email></TD></TR> <TR> <TD align=left><B>Confirm Email</B></TD> <TD align=left><INPUT maxLength=30 size=25 name=Confirmemail></TD></TR> <TR> <TD align=left><B>Street No` & Name</B></TD> <TD align=left><INPUT maxLength=30 size=25 name=Address1></TD></TR> <TR> <TD align=left><B>Street Type</B></TD> <TD align=left><SELECT size=1 name=Address2> <OPTION value="" selected></OPTION> <OPTION value=Ave>Avenue</OPTION> <OPTION value=Drv>Drive</OPTION> <OPTION value=Rd>Road</OPTION> <OPTION value=St>Street</OPTION> <OPTION value=Blv>Boulevard</OPTION> <OPTION value=Crcle>Circle</OPTION> <OPTION value=Cl>Close</OPTION> <OPTION value=Crt>Court</OPTION> <OPTION value=Crs>Crescent</OPTION> <OPTION value=Esp>Esplanade</OPTION> <OPTION value=Gr>Grove</OPTION> <OPTION value=Hwy>Highway</OPTION> <OPTION value=La>Lane</OPTION> <OPTION value=Pde>Parade</OPTION> <OPTION value=Pl>Place</OPTION> <OPTION value=Sq>Square</OPTION> <OPTION value=Tce>Terrace</OPTION> <OPTION value=Wlk>Walk</OPTION> <OPTION value=Way>Way</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>City</B></TD> <TD align=left><INPUT maxLength=30 size=25 name=City></TD></TR> <TR> <TD align=left><B>US State</B></TD> <TD align=left><SELECT size=1 name=Usstate> <OPTION value="" selected></OPTION> <OPTION value=Other>Other</OPTION> <OPTION value=Alabama>Alabama</OPTION> <OPTION value=Alaska>Alaska</OPTION> <OPTION value=Arizona>Arizona</OPTION> <OPTION value=Arkansas>Arkansas</OPTION> <OPTION value=California>California</OPTION> <OPTION value=Colorado>Colorado</OPTION> <OPTION value=Connecticut>Connecticut</OPTION> <OPTION value=Delaware>Delaware</OPTION> <OPTION value=Florida>Florida</OPTION> <OPTION value=Georgia>Georgia</OPTION> <OPTION value=Hawaii>Hawaii</OPTION> <OPTION value=Idaho>Idaho</OPTION> <OPTION value=Illinois>Illinois</OPTION> <OPTION value=Indiana>Indiana</OPTION> <OPTION value=Iowa>Iowa</OPTION> <OPTION value=Kansas>Kansas</OPTION> <OPTION value=Kentucky>Kentucky</OPTION> <OPTION value=Louisiana>Louisiana</OPTION> <OPTION value=Maine>Maine</OPTION> <OPTION value=Maryland>Maryland</OPTION> <OPTION value=Massachusetts>Massachusetts</OPTION> <OPTION value=Michigan>Michigan</OPTION> <OPTION value=Minnesota>Minnesota</OPTION> <OPTION value=Mississippi>Mississippi</OPTION> <OPTION value=Missouri>Missouri</OPTION> <OPTION value=Montana>Montana</OPTION> <OPTION value=Nebraska>Nebraska</OPTION> <OPTION value=Nevada>Nevada</OPTION> <OPTION value="New Hampshire">New Hampshire</OPTION> <OPTION value="New Jersey">New Jersey</OPTION> <OPTION value="New Mexico">New Mexico</OPTION> <OPTION value="New York">New York</OPTION> <OPTION value="North Carolina">North Carolina</OPTION> <OPTION value="North Dakota">North Dakota</OPTION> <OPTION value=Ohio>Ohio</OPTION> <OPTION value=Oklahoma>Oklahoma</OPTION> <OPTION value=Oregon>Oregon</OPTION> <OPTION value=Pennsylvania>Pennsylvania</OPTION> <OPTION value="Rhode Island">Rhode Island</OPTION> <OPTION value="South Carolina">South Carolina</OPTION> <OPTION value="South Dakota">South Dakota</OPTION> <OPTION value=Tennessee>Tennessee</OPTION> <OPTION value=Texas>Texas</OPTION> <OPTION value=Utah>Utah</OPTION> <OPTION value=Vermont>Vermont</OPTION> <OPTION value=Virginia>Virginia</OPTION> <OPTION value=Washington>Washington</OPTION> <OPTION value="Washington D.C.">Washington D.C.</OPTION> <OPTION value="West Virginia">West Virginia</OPTION> <OPTION value=Wisconsin>Wisconsin</OPTION> <OPTION value=Wyoming>Wyoming</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Australian State</B></TD> <TD align=left><SELECT size=1 name=Austate> <OPTION value="" selected></OPTION> <OPTION value=Other>Other</OPTION> <OPTION value=NSW>NSW</OPTION> <OPTION value=QLD>QLD</OPTION> <OPTION value=VIC>VIC</OPTION> <OPTION value=ACT>ACT</OPTION> <OPTION value=SA>SA</OPTION> <OPTION value=WA>WA</OPTION> <OPTION value=TAS>TAS</OPTION> <OPTION value=NT>NT</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Zip-Postal Code</B></TD> <TD align=left><INPUT maxLength=6 size=6 name=Postal></TD></TR> <TR> <TD align=left><B>Country</B></TD> <TD align=left><SELECT size=1 name=Country> <OPTION value="" selected></OPTION> <OPTION value=Afghanistan>Afghanistan<OPTION value=Albania>Albania<OPTION value=Algeria>Algeria<OPTION value="American Samoa">American Samoa<OPTION value=Angola>Angola<OPTION value=Anguilla>Anguilla<OPTION value=Antartica>Antartica<OPTION value=Antigua>Antigua<OPTION value=Argentina>Argentina<OPTION value=Armenia>Armenia<OPTION value=Aruba>Aruba<OPTION value="Ascension Island">Ascension Island<OPTION value=Australia>Australia<OPTION value=Austria>Austria<OPTION value=Azerbaijan>Azerbaijan<OPTION value=Bahamas>Bahamas<OPTION value=Bahrain>Bahrain<OPTION value=Bangladesh>Bangladesh<OPTION value=Barbados>Barbados<OPTION value=Belarus>Belarus<OPTION value=Belgium>Belgium<OPTION value=Belize>Belize<OPTION value=Benin>Benin<OPTION value=Bermuda>Bermuda<OPTION value=Bhutan>Bhutan<OPTION value=Bolivia>Bolivia<OPTION value=Bosnia-Herzegovina>Bosnia-Herzegovina<OPTION value=Botswana>Botswana<OPTION value=Brazil>Brazil<OPTION value="British Virgin Islands">British Virgin Islands<OPTION value=Brunei>Brunei<OPTION value=Bulgaria>Bulgaria<OPTION value="Barkinoa Faso">Barkinoa Faso<OPTION value=Burundi>Burundi<OPTION value=Camaroon>Camaroon<OPTION value=Cambodia>Cambodia<OPTION value=Canada>Canada<OPTION value="Cape Verde Islands">Cape Verde Islands<OPTION value="Cayman Islands">Cayman Islands<OPTION value="Central African Rep.">Central African Rep.<OPTION value="Chad Republic">Chad Republic<OPTION value=Chile>Chile<OPTION value=China>China<OPTION value=Colombia>Colombia<OPTION value=Comoros>Comoros<OPTION value=Congo>Congo<OPTION value="Cook Islands">Cook Islands<OPTION value="Costa Rica">Costa Rica<OPTION value=Croatia>Croatia<OPTION value=Cyprus>Cyprus<OPTION value="Czech Republic">Czech Republic<OPTION value=Denmark>Denmark<OPTION value="Diego Garcia">Diego Garcia<OPTION value=Djibouti>Djibouti<OPTION value=Dominica>Dominica<OPTION value="Dominican Republic">Dominican Republic<OPTION value=Ecuador>Ecuador<OPTION value=Egypt>Egypt<OPTION value="El Salvador">El Salvador<OPTION value="Eqitorial Guinea">Eqitorial Guinea<OPTION value=Eritrea>Eritrea<OPTION value=Estonia>Estonia<OPTION value=Ethiopia>Ethiopia<OPTION value="Faeroe Islands">Faeroe Islands<OPTION value="Falkland Islands">Falkland Islands<OPTION value="Fiji Islands">Fiji Islands<OPTION value=Finland>Finland<OPTION value="French Guiana">French Guiana<OPTION value="French Polynesia">French Polynesia<OPTION value=France>France<OPTION value="French Antilles">French Antilles<OPTION value=Gabon>Gabon<OPTION value=Gambia>Gambia<OPTION value=Georgia>Georgia<OPTION value=Germany>Germany<OPTION value=Ghana>Ghana<OPTION value=Gibralter>Gibralter<OPTION value=Greece>Greece<OPTION value=Greenland>Greenland<OPTION value=Grenada>Grenada<OPTION value=Guadeloupe>Guadeloupe<OPTION value=Guam>Guam<OPTION value="Guantanemo Bay">Guantanemo Bay<OPTION value=Guatemala>Guatemala<OPTION value=Guinea>Guinea<OPTION value="Guinea Bissau">Guinea Bissau<OPTION value=Guyana>Guyana<OPTION value=Haiti>Haiti<OPTION value=Honduras>Honduras<OPTION value="Hong Kong">Hong Kong<OPTION value=Hungary>Hungary<OPTION value=Iceland>Iceland<OPTION value=India>India<OPTION value=Indonesia>Indonesia<OPTION value=Iran>Iran<OPTION value=Iraq>Iraq<OPTION value="Ireland ">Ireland<OPTION value=Isreal>Isreal<OPTION value=Italy>Italy<OPTION value="Ivory Coast">Ivory Coast<OPTION value=Jamaica>Jamaica<OPTION value=Japan>Japan<OPTION value=Jordan>Jordan<OPTION value=Kazakhstan>Kazakhstan<OPTION value=Kenya>Kenya<OPTION value=Kiribati>Kiribati<OPTION value="Korea (South)">Korea (South)<OPTION value="Korea (North)">Korea (North)<OPTION value=Kuwait>Kuwait<OPTION value=Kyrgyzstan>Kyrgyzstan<OPTION value=Laos>Laos<OPTION value=Latvia>Latvia<OPTION value=Lebanon>Lebanon<OPTION value=Lesotho>Lesotho<OPTION value=Liberia>Liberia<OPTION value=Libya>Libya<OPTION value=Lithuania>Lithuania<OPTION value=Luxembourg>Luxembourg<OPTION value=Macao>Macao<OPTION value=Macedonia>Macedonia<OPTION value=Madagascar>Madagascar<OPTION value=Malawi>Malawi<OPTION value=Malaysia>Malaysia<OPTION value=Maldives>Maldives<OPTION value="Mali Republic">Mali Republic<OPTION value=Malta>Malta<OPTION value="Marshall Islands">Marshall Islands<OPTION value=Mauritania>Mauritania<OPTION value=Mauritius>Mauritius<OPTION value=Mexico>Mexico<OPTION value=Micronesia>Micronesia<OPTION value="Moldiva (CIS)">Moldiva (CIS)<OPTION value=Mongolia>Mongolia<OPTION value=Montserrat>Montserrat<OPTION value=Morocco>Morocco<OPTION value=Mozambique>Mozambique<OPTION value=Namibia>Namibia<OPTION value=Nauru>Nauru<OPTION value=Nepal>Nepal<OPTION value="Netherland Antilles">Netherland Antilles<OPTION value=Netherlands>Netherlands<OPTION value=Nevis>Nevis<OPTION value="New Calidonia">New Calidonia<OPTION value="New Zealand">New Zealand<OPTION value=Nicaragua>Nicaragua<OPTION value=Niger>Niger<OPTION value=Nigeria>Nigeria<OPTION value="Niue Island">Niue Island<OPTION value="Norfork Island">Norfork Island<OPTION value=Norway>Norway<OPTION value=Oman>Oman<OPTION value=Pakistan>Pakistan<OPTION value=Palau>Palau<OPTION value=Panama>Panama<OPTION value="Papua New Guinia">Papua New Guinia<OPTION value=Paraguay>Paraguay<OPTION value=Peru>Peru<OPTION value=Philipines>Philipines<OPTION value=Poland>Poland<OPTION value=Portugal>Portugal<OPTION value=Qatar>Qatar<OPTION value="Reunion Island">Reunion Island<OPTION value=Romania>Romania<OPTION value=Russia>Russia<OPTION value=Rwanda>Rwanda<OPTION value=Saipan>Saipan<OPTION value="Sao Tome">Sao Tome<OPTION value="Saudi Arabia">Saudi Arabia<OPTION value="Senegal Republic">Senegal Republic<OPTION value="Seychelles Island">Seychelles Island<OPTION value="Sierrra Leone">Sierrra Leone<OPTION value=Singapore>Singapore<OPTION value=Slovenia>Slovenia<OPTION value="Soloman Island">Soloman Island<OPTION value=Somalia>Somalia<OPTION value="South Africa">South Africa<OPTION value=Spain>Spain<OPTION value="Sri Lanka">Sri Lanka<OPTION value="St Helen">St Helen<OPTION value="St Kitts">St Kitts<OPTION value="St Lucia">St Lucia<OPTION value="St Pierre">St Pierre<OPTION value="St Vincent">St Vincent<OPTION value=Sudan>Sudan<OPTION value=Suriname>Suriname<OPTION value=Swaziland>Swaziland<OPTION value=Sweden>Sweden<OPTION value=Switzerland>Switzerland<OPTION value=Syria>Syria<OPTION value=Taiwan>Taiwan<OPTION value=Tanzania>Tanzania<OPTION value=Thailand>Thailand<OPTION value=Togo>Togo<OPTION value=Tonga>Tonga<OPTION value="Trinidad & Tobago">Trinidad & Tobago<OPTION value=Tunisia>Tunisia<OPTION value=Turkey>Turkey<OPTION value=Turks/Caicos>Turks/Caicos<OPTION value=Tuvalu>Tuvalu<OPTION value=Uganda>Uganda<OPTION value=Ukraine>Ukraine<OPTION value="United Arab Emirates">United Arab Emirates<OPTION value="United Kingdom">United Kingdom<OPTION value="United States">United States<OPTION value=Canada>Canada<OPTION value=Uruguay>Uruguay<OPTION value=Vanuatu>Vanuatu<OPTION value=Venezuela>Venezuela<OPTION value="Viet Nam">Viet Nam<OPTION value="Wallis / Futuna">Wallis / Futuna<OPTION value="West Samoa">West Samoa<OPTION value="Yemen Republic">Yemen Republic<OPTION value=Yugoslavia>Yugoslavia<OPTION value=Zaire>Zaire<OPTION value=Zambia>Zambia<OPTION value=Zimbabwe>Zimbabwe</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Phone Number</B></TD> <TD align=left><INPUT maxLength=25 size=25 name=Phone></TD></TR> <TR> <TD align=left><B>Occupation</B></TD> <TD align=left><SELECT size=1 name=Occupation> <OPTION value="" selected></OPTION> <OPTION value=Accounting/Finance>Accounting/Finance</OPTION> <OPTION value=Agriculture>Agriculture</OPTION> <OPTION value=Architecture/Design>Architecture/Design</OPTION> <OPTION value=Communications>Communications</OPTION> <OPTION value=Construction>Construction</OPTION> <OPTION value=Education>Education</OPTION> <OPTION value=Engineering>Engineering</OPTION> <OPTION value=Entertainment>Entertainment</OPTION> <OPTION value=Fashion>Fashion</OPTION> <OPTION value="Food & Wine">Food & Wine</OPTION> <OPTION value=Health>Health</OPTION> <OPTION value=Homemaker>Homemaker</OPTION> <OPTION value=Hospitality>Hospitality</OPTION> <OPTION value="Information Technology">Information Technology</OPTION> <OPTION value=Law>Law</OPTION> <OPTION value=Manufacturing>Manufacturing</OPTION> <OPTION value=Marketing>Marketing</OPTION> <OPTION value=Mining>Mining</OPTION> <OPTION value="Property Services">Property Services</OPTION> <OPTION value=Retail>Retail</OPTION> <OPTION value=Retired>Retired</OPTION> <OPTION value=Student>Student</OPTION> <OPTION value=Travel>Travel</OPTION> <OPTION value=Unemployed>Unemployed</OPTION> <OPTION value=Other>Other</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Job Title</B></TD> <TD align=left><SELECT size=1 name=Employ> <OPTION value="" selected></OPTION> <OPTION value=N>None</OPTION> <OPTION value=CEO>CEO / Chairman</OPTION> <OPTION value=GMD>General Manager / Director</OPTION> <OPTION value=PurM>Purchasing Manager</OPTION> <OPTION value=BDM>Business Development Manager</OPTION> <OPTION value=MktD)>Marketing Director (inc. Sales, PR & Adv)</OPTION> <OPTION value=TITMr>Technical / IT Manager</OPTION> <OPTION value=MSE>Marketing / Sales Executive</OPTION> <OPTION value=FC>Finance Controller / Finance Director</OPTION> <OPTION value=HRDM>Human Resources Decision Maker</OPTION> <OPTION value=ENG>Engineer</OPTION> <OPTION value=EJW>Editor / Journalist / Writer</OPTION> <OPTION value=OA>Office Assistant</OPTION> <OPTION value=CS>Company Secretary</OPTION> <OPTION value=WDP>Web Designer / Programmer</OPTION> <OPTION value=AC>Analyst / Consultant</OPTION> <OPTION value=TT>Technician / Tradesman</OPTION> <OPTION value=ML>Manual Labourer</OPTION> <OPTION value=ST>Student</OPTION> <OPTION value=O>Other</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Annual Income</B></TD> <TD align=left><SELECT size=1 name=Income> <OPTION value="" selected></OPTION> <OPTION value=U10K>Less Than $10,000</OPTION> <OPTION value=10/19K>$10,000 - $19,999</OPTION> <OPTION value=20/39K>$20,000 - $39,999</OPTION> <OPTION value=40/59K>$40,000 - $59,999</OPTION> <OPTION value=60/79K>$60,000 - $79,999</OPTION> <OPTION value=80/99K>$80,000 - $99,999</OPTION> <OPTION value=100KUP>More than $100,000</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Spoken Language</B></TD> <TD align=left><SELECT size=1 name=Language> <OPTION value="" selected></OPTION> <OPTION value=English>English/American</OPTION> <OPTION value=Arabic>Arabic</OPTION> <OPTION value=Chinese>Chinese</OPTION> <OPTION value=French>French</OPTION> <OPTION value=German>German</OPTION> <OPTION value=Greek>Greek</OPTION> <OPTION value=Indonesian>Indonesian</OPTION> <OPTION value=Italian>Italian</OPTION> <OPTION value=Japanese>Japanese</OPTION> <OPTION value=Korean>Korean</OPTION> <OPTION value=Portuguese>Portuguese</OPTION> <OPTION value=Russian>Russian</OPTION> <OPTION value=Spanish>Spanish</OPTION> <OPTION value=Swedish>Swedish</OPTION> <OPTION value=Vietnamese>Vietnamese</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Your Gender</B></TD> <TD align=left><SELECT size=1 name=Gender> <OPTION value="" selected></OPTION> <OPTION value=M>MALE</OPTION> <OPTION value=F>FEMALE</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Date Of Birth</B></TD> <TD align=left><SELECT size=1 name=Month> <OPTION value="" selected></OPTION> <OPTION value=Jan>January</OPTION> <OPTION value=Feb>Febuary</OPTION> <OPTION value=Mar>March</OPTION> <OPTION value=Apr>April</OPTION> <OPTION value=May>May</OPTION> <OPTION value=Jun>June</OPTION> <OPTION value=Jul>July</OPTION> <OPTION value=Aug>August</OPTION> <OPTION value=Sep>September</OPTION> <OPTION value=Oct>October</OPTION> <OPTION value=Nov>November</OPTION> <OPTION value=Dec>December</OPTION></SELECT> <SELECT name=Day> <OPTION value="" selected></OPTION> <OPTION value=1>1</OPTION> <OPTION value=2>2</OPTION> <OPTION value=3>3</OPTION> <OPTION value=4>4</OPTION> <OPTION value=5>5</OPTION> <OPTION value=6>6</OPTION> <OPTION value=7>7</OPTION> <OPTION value=8>8</OPTION> <OPTION value=9>9</OPTION> <OPTION value=10>10</OPTION> <OPTION value=11>11</OPTION> <OPTION value=12>12</OPTION> <OPTION value=13>13</OPTION> <OPTION value=14>14</OPTION> <OPTION value=15>15</OPTION> <OPTION value=16>16</OPTION> <OPTION value=17>17</OPTION> <OPTION value=18>18</OPTION> <OPTION value=19>19</OPTION> <OPTION value=20>20</OPTION> <OPTION value=21>21</OPTION> <OPTION value=22>22</OPTION> <OPTION value=23>23</OPTION> <OPTION value=24>24</OPTION> <OPTION value=25>25</OPTION> <OPTION value=26>26</OPTION> <OPTION value=27>27</OPTION> <OPTION value=28>28</OPTION> <OPTION value=29>29</OPTION> <OPTION value=30>30</OPTION> <OPTION value=31>31</OPTION></SELECT> <SELECT name=Year> <OPTION value="" selected></OPTION> <OPTION value=2001>2001</OPTION> <OPTION value=2000>2000</OPTION> <OPTION value=1999>1999</OPTION> <OPTION value=1998>1998</OPTION> <OPTION value=1997>1997</OPTION> <OPTION value=1996>1996</OPTION> <OPTION value=1995>1995</OPTION> <OPTION value=1994>1994</OPTION> <OPTION value=1993>1993</OPTION> <OPTION value=1992>1992</OPTION> <OPTION value=1991>1991</OPTION> <OPTION value=1990>1990</OPTION> <OPTION value=1989>1989</OPTION> <OPTION value=1988>1988</OPTION> <OPTION value=1987>1987</OPTION> <OPTION value=1986>1986</OPTION> <OPTION value=1985>1985</OPTION> <OPTION value=1984>1984</OPTION> <OPTION value=1983>1983</OPTION> <OPTION value=1982>1982</OPTION> <OPTION value=1981>1981</OPTION> <OPTION value=1980>1980</OPTION> <OPTION value=1979>1979</OPTION> <OPTION value=1978>1978</OPTION> <OPTION value=1977>1977</OPTION> <OPTION value=1976>1976</OPTION> <OPTION value=1975>1975</OPTION> <OPTION value=1974>1974</OPTION> <OPTION value=1973>1973</OPTION> <OPTION value=1972>1972</OPTION> <OPTION value=1971>1971</OPTION> <OPTION value=1970>1970</OPTION> <OPTION value=1969>1969</OPTION> <OPTION value=1968>1968</OPTION> <OPTION value=1967>1967</OPTION> <OPTION value=1966>1966</OPTION> <OPTION value=1965>1965</OPTION> <OPTION value=1964>1964</OPTION> <OPTION value=1963>1963</OPTION> <OPTION value=1962>1962</OPTION> <OPTION value=1961>1961</OPTION> <OPTION value=1960>1960</OPTION> <OPTION value=1959>1959</OPTION> <OPTION value=1958>1958</OPTION> <OPTION value=1957>1957</OPTION> <OPTION value=1956>1956</OPTION> <OPTION value=1955>1955</OPTION> <OPTION value=1954>1954</OPTION> <OPTION value=1953>1953</OPTION> <OPTION value=1952>1952</OPTION> <OPTION value=1951>1951</OPTION> <OPTION value=1950>1950</OPTION> <OPTION value=1949>1949</OPTION> <OPTION value=1948>1948</OPTION> <OPTION value=1947>1947</OPTION> <OPTION value=1946>1946</OPTION> <OPTION value=1945>1945</OPTION> <OPTION value=1943>1943</OPTION> <OPTION value=1942>1942</OPTION> <OPTION value=1941>1941</OPTION> <OPTION value=1940>1940</OPTION> <OPTION value=1939>1939</OPTION> <OPTION value=1938>1938</OPTION> <OPTION value=1937>1937</OPTION> <OPTION value=1936>1936</OPTION> <OPTION value=1935>1935</OPTION> <OPTION value=1934>1934</OPTION> <OPTION value=1933>1933</OPTION> <OPTION value=1932>1932</OPTION> <OPTION value=1931>1931</OPTION> <OPTION value=1930>1930</OPTION> <OPTION value=1929>1929</OPTION> <OPTION value=1928>1928</OPTION> <OPTION value=1927>1927</OPTION> <OPTION value=1926>1926</OPTION> <OPTION value=1925>1925</OPTION> <OPTION value=1924>1924</OPTION> <OPTION value=1923>1923</OPTION> <OPTION value=1922>1922</OPTION> <OPTION value=1921>1921</OPTION> <OPTION value=1920>1920</OPTION> <OPTION value=1919>1919</OPTION> <OPTION value=1918>1918</OPTION> <OPTION value=1917>1917</OPTION> <OPTION value=1916>1916</OPTION> <OPTION value=1915>1915</OPTION> <OPTION value=1914>1914</OPTION> <OPTION value=1913>1913</OPTION> <OPTION value=1912>1912</OPTION> <OPTION value=1911>1911</OPTION> <OPTION value=1910>1910</OPTION> <OPTION value=1909>1909</OPTION> <OPTION value=1908>1908</OPTION> <OPTION value=1907>1907</OPTION> <OPTION value=1906>1906</OPTION> <OPTION value=1905>1905</OPTION> <OPTION value=1904>1904</OPTION> <OPTION value=1903>1903</OPTION> <OPTION value=1902>1902</OPTION> <OPTION value=1901>1901</OPTION> <OPTION value=1900>1900</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>How Did You Find Us?</B></TD> <TD align=left><SELECT size=1 name=Howfind> <OPTION value="" selected></OPTION> <OPTION value=Brochure>Brochure</OPTION> <OPTION value="Friend/Family Referral">Friend/Family Referral</OPTION> <OPTION value="Internet Email">Internet Email</OPTION> <OPTION value="Link ">Web Site Link</OPTION> <OPTION value=Banner>Web Site Link - Banner Ads</OPTION> <OPTION value=TV>Television</OPTION> <OPTION value=SEY>Search Engine - Yahoo</OPTION> <OPTION value=SEL>Search Engine - Looksmart</OPTION> <OPTION value=SEG>Search Engine - Google</OPTION> <OPTION value=SEAV>Search Engine - Alta Vista</OPTION> <OPTION value=SEO>Search Engine - Others</OPTION> <OPTION value=Mag>Magazine</OPTION> <OPTION value=News>Newspaper</OPTION> <OPTION value=Radio>Radio Stations</OPTION> <OPTION value=Other>Others</OPTION></SELECT></TD></TR> <TR> <TD align=left><B>Join Mailing List</B></TD> <TD align=left><SELECT size=1 name=Mailinglist> <OPTION value="" selected></OPTION> <OPTION value=YES>YES</OPTION> <OPTION value=NO>NO</OPTION></SELECT></TD></TR> <TR> <TD align=left><B><FONT size=2>Agree To Terms & Conditions</FONT></B></TD> <TD align=left><SELECT size=1 name=Terms> <OPTION value="" selected></OPTION> <OPTION value=YES>YES</OPTION> <OPTION value=NO>NO</OPTION></SELECT></A></TD></TR></TBODY></TABLE><BR> <CENTER><INPUT type=submit value="SEND IT"> <INPUT onclick="window.location='http://jsbank.topcities.com'" type=button value=HOME> <INPUT type=reset value=CLEAR></FORM> </TD></TR></TBODY></TABLE><!-- This script downloaded from www.JavaScriptBank.com Come to view and download over 2000+ free javascript at www.JavaScriptBank.com-->