/home/sprechma/public_html/form364924/tmp/persistent/form364924/install.php


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    <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
    <html>
    <head>
        <title>Claim Forwarding Form - created by phpFormGenerator</title>
        <meta http-equiv="content-type" content="text/html; charset=UTF-8"><link href="style.css" rel="stylesheet" type="text/css">
        <!-- calendar stuff -->
              <link rel="stylesheet" type="text/css" href="calendar/calendar-blue2.css" />
              <script type="text/javascript" src="calendar/calendar.js"></script>
              <script type="text/javascript" src="calendar/calendar-en.js"></script>
              <script type="text/javascript" src="calendar/calendar-setup.js"></script>
        <!-- END calendar stuff -->

        <!-- expand/collapse function -->
        <SCRIPT type=text/javascript>
        <!--
        function collapseElem(obj)
        {
            var el = document.getElementById(obj);
            el.style.display = 'none';
        }


        function expandElem(obj)
        {
            var el = document.getElementById(obj);
            el.style.display = '';
        }


        //-->
        </SCRIPT>
        <!-- expand/collapse function -->


        <!-- expand/collapse function -->
            <SCRIPT type=text/javascript>
            <!--

            // collapse all elements, except the first one
            function collapseAll()
            {
                var numFormPages = 1;

                for(i=2; i <= numFormPages; i++)
                {
                    currPageId = ('mainForm_' + i);
                    collapseElem(currPageId);
                }
            }


            //-->
            </SCRIPT>
        <!-- expand/collapse function -->


         <!-- validate -->
        <SCRIPT type=text/javascript>
        <!--
            function validateField(fieldId, fieldBoxId, fieldType, required)
            {
                fieldBox = document.getElementById(fieldBoxId);
                fieldObj = document.getElementById(fieldId);

                if(fieldType == 'text'  ||  fieldType == 'textarea'  ||  fieldType == 'password'  ||  fieldType == 'file'  ||  fieldType == 'phone'  || fieldType == 'website')
                {    
                    if(required == 1 && fieldObj.value == '')
                    {
                        fieldObj.setAttribute("class","mainFormError");
                        fieldObj.setAttribute("className","mainFormError");
                        fieldObj.focus();
                        return false;                    
                    }

                }


                else if(fieldType == 'menu'  || fieldType == 'country'  || fieldType == 'state')
                {    
                    if(required == 1 && fieldObj.selectedIndex == 0)
                    {                
                        fieldObj.setAttribute("class","mainFormError");
                        fieldObj.setAttribute("className","mainFormError");
                        fieldObj.focus();
                        return false;                    
                    }

                }


                else if(fieldType == 'email')
                {    
                    if((required == 1 && fieldObj.value=='')  ||  (fieldObj.value!=''  && !validate_email(fieldObj.value)))
                    {                
                        fieldObj.setAttribute("class","mainFormError");
                        fieldObj.setAttribute("className","mainFormError");
                        fieldObj.focus();
                        return false;                    
                    }

                }



            }

            function validate_email(emailStr)
            {        
                apos=emailStr.indexOf("@");
                dotpos=emailStr.lastIndexOf(".");

                if (apos<1||dotpos-apos<2) 
                {
                    return false;
                }
                else
                {
                    return true;
                }
            }


            function validateDate(fieldId, fieldBoxId, fieldType, required,  minDateStr, maxDateStr)
            {
                retValue = true;

                fieldBox = document.getElementById(fieldBoxId);
                fieldObj = document.getElementById(fieldId);    
                dateStr = fieldObj.value;


                if(required == 0  && dateStr == '')
                {
                    return true;
                }


                if(dateStr.charAt(2) != '/'  || dateStr.charAt(5) != '/' || dateStr.length != 10)
                {
                    retValue = false;
                }    

                else    // format's okay; check max, min
                {
                    currDays = parseInt(dateStr.substr(0,2),10) + parseInt(dateStr.substr(3,2),10)*30  + parseInt(dateStr.substr(6,4),10)*365;
                    //alert(currDays);

                    if(maxDateStr != '')
                    {
                        maxDays = parseInt(maxDateStr.substr(0,2),10) + parseInt(maxDateStr.substr(3,2),10)*30  + parseInt(maxDateStr.substr(6,4),10)*365;
                        //alert(maxDays);
                        if(currDays > maxDays)
                            retValue = false;
                    }

                    if(minDateStr != '')
                    {
                        minDays = parseInt(minDateStr.substr(0,2),10) + parseInt(minDateStr.substr(3,2),10)*30  + parseInt(minDateStr.substr(6,4),10)*365;
                        //alert(minDays);
                        if(currDays < minDays)
                            retValue = false;
                    }
                }

                if(retValue == false)
                {
                    fieldObj.setAttribute("class","mainFormError");
                    fieldObj.setAttribute("className","mainFormError");
                    fieldObj.focus();
                    return false;
                }
            }
        //-->
        </SCRIPT>
        <!-- end validate -->




    </head>

    <body onLoad="collapseAll()">

    <div id="mainForm">




        <div id="formHeader">
                <h2 class="formInfo">Claim Forwarding Form</h2>
                <p class="formInfo">By filling out this claim forwarding form you hereby agree to the fees, terms and conditions for representation in this matter by Sprechman & Fisher, P.A.  Please complete the form in its entirety.</p>
        </div>


        <BR/><div id="footer"><p class="footer"><a class=footer href=http://phpformgen.sourceforge.net>Generated by phpFormGenerator</a></p></div>

    </body>
    </html>