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Name* Phone* Email* Question/Comments* </td> </tr> <tr> <td> </td> <td ><table width="100%" border="0" cellspacing="0" cellpadding="0"> <tr> <td width="74%"><img id="button_div3" src="http://www.solomonfacialplastic.com/button.php?20120205034656" width="124" height="30" /></td> <td width="26%"><img onClick="captcha_refresh3();return false;" title="Refresh the code" style="cursor:pointer;" src="http://www.solomonfacialplastic.com/images/refresh.jpg" width="28" height="27" alt="" /></td> </tr> </table></td> </tr> <tr> <td style="padding-left:5px;">Verification Code<span style="color:#F00;">*</span></td> <td height="30"> <input type="text" class="form_input" style="background:url(http://www.solomonfacialplastic.com/images/contact_input_bg.jpg) left bottom no-repeat; border:1px solid #CCC; width:157px; height:21px;font-size:12px; padding:2px 3px 0px 3px;" name="userdigit3" id="userdigit3" onkeypress="if(event.keyCode=='13')return popvalidate(document.popcontact)"/></td> </tr> <tr> <td colspan="2" ><table width="100%" border="0" cellspacing="0" cellpadding="0"> <tr> <td height="5" colspan="3"></td> </tr> <tr> <td align="left"> </td> <td align="left"><input name="requestinfo" type="checkbox" id="requestinfo" checked="checked" /></td> <td height="28" align="left" style="font-size:12px;">Request Free Information</td> </tr> <tr> <td width="45%" align="left"> </td> <td width="7%" align="left"><input name="newsletter" type="checkbox" id="newsletter" checked="checked" /></td> <td width="48%" height="28" align="left" style="font-size:12px;">Newsletter Signup</td> </tr> </table></td> </tr> <tr> <td height="10" colspan="2"></td> </tr> <tr> <td> </td> <td><div id="submit_pop"><a href="#" style="width:84px; height:20px; display:block; text-align:center; text-decoration:none; color:#FFF; padding:1px 0px 0px 0px; background:url(http://www.solomonfacialplastic.com/images/inner-readmore-bg.jpg) left top no-repeat;" onClick="return popvalidate(document.popcontact);">Submit</a></div> <div id="wait_pop" align="center"></div> </td> </tr> <tr> <td height="10" colspan="2"></td> </tr> </table> </td> </tr> </table> </form> </body> </html> <script> function popvalidate(thisform) { with (thisform) { if (emptyvalidation(pname,"Please fill in your Name.")==false) { pname.select(); pname.focus(); return false; } if (emptyvalidation(pphone,"Please fill in your Phone.")==false) { pphone.select(); pphone.focus(); return false; } if (emptyvalidation(pemail,"Please fill in your Email Address.")==false) { pemail.select(); pemail.focus(); return false; } if(emailvalidation(pemail)==false) { alert("Sorry, You have entered an invalid Email Address."); pemail.select(); pemail.focus(); return false; } var desc_val=document.popcontact.pcomments.value; var string = desc_val.replace(new RegExp(/(<p> \;<\/p>)/g),""); if((desc_val=='')||(string==0)) { alert("Please fill in your Question/Comments."); pcomments.focus(); return false; } if(userdigit3.value=="verification code as shown above")userdigit3.value=""; if(emptyvalidation(userdigit3,"Please fill in Verification Code.")==false) { userdigit3.focus(); return false; } document.getElementById('submit_pop').style.display='none'; document.getElementById('wait_pop').style.display='block'; document.getElementById('wait_pop').innerHTML='<img src="http://www.solomonfacialplastic.com/images/send.gif" alt="" /><font color=#71a2d0> Please wait...</font>'; runAjax3('check_captcha3','http://www.solomonfacialplastic.com/process_mail_pop.php',document.popcontact.userdigit3.value); } return false; } function captcha_refresh3() { document.getElementById("button_div3").src='http://www.solomonfacialplastic.com/button.php?'+Math.random(); return false; } var xmlHttp function runAjax3(field,argurl,argVal) { xmlHttp=GetXmlHttpObject() if (xmlHttp==null) { alert ("Browser does not support HTTP Request") return } var url=argurl url=url+"?userdigit3="+argVal url=url+"&sid="+Math.random() if(field=='check_captcha3') xmlHttp.onreadystatechange=check_captcha3; xmlHttp.open("GET",url,true) xmlHttp.send(null) } function check_captcha3() { if (xmlHttp.readyState==4 || xmlHttp.readyState=="complete") { if(xmlHttp.responseText=="yes") { document.popcontact.submit(); } else { captcha_refresh3(); document.popcontact.userdigit3.value="Verification Code Mismatch."; document.getElementById('submit_pop').style.display='block'; document.getElementById('wait_pop').style.display='none'; document.popcontact.userdigit3.focus(); document.popcontact.userdigit3.select(); return false; } } } function GetXmlHttpObject() { var objXMLHttp=null if (window.XMLHttpRequest) { objXMLHttp=new XMLHttpRequest() } else if (window.ActiveXObject) { objXMLHttp=new ActiveXObject("Microsoft.XMLHTTP") } return objXMLHttp } function emailvalidation(thisform) { var reg = /^([A-Za-z0-9_\-\.])+\@([A-Za-z0-9_\-\.])+\.([A-Za-z]{2,4})$/; var address = thisform.value; var email = address.split(','); for (var i = 0; i < email.length; i++) { if(reg.test(email[i]) == false) { // alert('Invalid Email Address'); return false; } } } function emptyvalidation(entered, alertbox) { with (entered) { while (value.charAt(0) == ' ') value = value.substring(1); while (value.charAt(value.length - 1) == ' ') value = value.substring(0, value.length - 1); if (value==null || value=="") { if (alertbox!="") alert(alertbox); return false; } else return true; } } </script>