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<form action="//submit.form" id="SignUp100" method="post" onsubmit="return ValidateForm(this);">
< script type="text/javascript">
function ValidateForm(frm) {
if (frm.FirstName.value == "") { alert('First Name is required.'); frm.FirstName.focus(); return false; }
if (frm.LastName.value == "") { alert('Last Name is required.'); frm.LastName.focus(); return false; }
if (frm.FromEmailAddress.value == "") { alert('Email address is required.'); frm.FromEmailAddress.focus(); return false; }
if (frm.FromEmailAddress.value.indexOf("@") < 1 || frm.FromEmailAddress.value.indexOf(".") < 1) { alert('Please enter a valid email address.'); frm.FromEmailAddress.focus(); return false; }
if (frm.StreetAddress1.value == "") { alert('Address is required.'); frm.StreetAddress1.focus(); return false; }
if (frm.City.value == "") { alert('City is required.'); frm.City.focus(); return false; }
if (frm.Country.value == "") { alert('Country is required.'); frm.Country.focus(); return false; }
return true; }
< /script>
< table border="0" cellpadding="5" cellspacing="0" width="600">
<tr> <td>
<label for="FirstName">First</label>, <label for="LastName">Last Name*:</label>
</td> <td>
<input name="FirstName" type="text" maxlength="60" style="width: 146px;" />
<input name="LastName" type="text" maxlength="60" style="width: 146px;" />
</td> </tr> <tr> <td>
<label for="Organization">Organization:</label>
</td> <td>
<input name="Organization" type="text" maxlength="60" style="width: 300px;" />
</td> </tr> <tr> <td>
<label for="FromEmailAddress">Email address*:</label>
</td> <td>
<input name="FromEmailAddress" type="text" maxlength="60" style="width: 300px;" />
</td> </tr> <tr> <td>
<label for="WorkPhone">Work Phone:</label>
</td> <td>
<input name="WorkPhone" type="text" maxlength="43" style="width: 250px;" />
</td> </tr> <tr> <td>
<label for="HomePhone">Home Phone:</label>
</td> <td>
<input name="HomePhone" type="text" maxlength="43" style="width: 250px;" />
</td> </tr> <tr> <td>
<label for="CellPhone">Cell Phone:</label>
</td> <td>
<input name="CellPhone" type="text" maxlength="43" style="width: 250px;" />
</td> </tr> <tr> <td>
<label for="Fax">Fax:</label>
</td> <td>
<input name="Fax" type="text" maxlength="43" style="width: 250px;" />
</td> </tr> <tr> <td>
<label for="StreetAddress1">Address 1*:</label>
</td> <td>
<input name="StreetAddress1" type="text" maxlength="120" style="width: 350px;" />
</td> </tr> <tr> <td>
<label for="StreetAddress2">Address 2:</label>
</td> <td>
<input name="StreetAddress2" type="text" maxlength="120" style="width: 350px;" />
</td> </tr> <tr> <td>
<label for="City">City*:</label>
</td> <td>
<input name="City" type="text" maxlength="120" style="width: 300px;" />
</td> </tr> <tr> <td>
<label for="State">State/Province:</label>
</td> <td>
<input name="State" type="text" maxlength="120" style="width: 300px;" />
</td> </tr> <tr> <td>
<label for="Zip">Zip/Postal Code:</label>
</td> <td>
<input name="Zip" type="text" maxlength="30" style="width: 100px;" />
</td> </tr> <tr> <td>
<label for="Country">Country*:</label>
</td> <td>
<input name="Country" type="text" maxlength="120" style="width: 300px;" />
</td> </tr> <tr> <td>
* - required fields
</td> <td>
<div style="float: right">
<a href="https://www.100forms.com" id="lnk100" title="web forms">forms</a></div>
<script src="https://www.100forms.com/js/FORMKEY:NLYTPW7RQJY8/SEND:
" type="text/javascript"></script>
<input name="skip_Submit" type="submit" value="Submit" />
</td> </tr>
< /table>
< /form>