// Validate the lead form, then data to iframe
	function ValidateForm()	{
		var isFormValid = 1;
		var errorMessage = '';
		var firstName = document.getElementById('FirstName');
		var lastName = document.getElementById('LastName');
		var emailAddress = document.getElementById('EmailAddress');
		var homePhone = document.getElementById('HomePhone');
		
		if(firstName.value.length < 1) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- First Name is required.\n';
		}
		if(lastName.value.length < 1) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Last Name is required.\n';
		}
		if(emailAddress.value.length < 1) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Email Address is required.\n';
		}
		if(homePhone.value.length < 1) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Phone Number is required.\n';
		}
		if(IsEmailValid(emailAddress.value) == false)
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Email Address is not valid.\n';
		}

		if(isFormValid == 0)
		{
			alert(errorMessage);
		}
		else
		{
			// Send the data to the iframe
			document.getElementById('PassData').src = 'http://www.debthelp.net/PassData-ODH.aspx?FirstName=' + escape(document.getElementById('FirstName').value) + '&LastName=' + escape(document.getElementById('LastName').value) + '&HomePhone=' + escape(document.getElementById('HomePhone').value) + '&emailAddress=' + escape(document.getElementById('EmailAddress').value) + '&ContactTime=' + escape(document.getElementById('ContactTime').options[document.getElementById('ContactTime').selectedIndex].value) + '&State=' + escape(document.getElementById('State').options[document.getElementById('State').selectedIndex].value) + '&TotalDebt=' + escape(document.getElementById('TotalDebt').options[document.getElementById('TotalDebt').selectedIndex].value) + '&ReferURL=' + escape(document.referrer);
			
			// Let the user know everything was successful
			alert('Success!  We will be contacting you during our normal business hours.  \nExpect to be hearing from us shortly.');
			
			// Clear the lead form
			firstName.value = '';
			lastName.value = '';
			emailAddress.value = '';
			homePhone.value = '';
		}
	}
	
	function IsEmailValid(emailAddress) {
		var emailReg = "^[\\w-_\.]*[\\w-_\.]\@[\\w]\.+[\\w]+[\\w]$";
		var regex = new RegExp(emailReg);
		return regex.test(emailAddress);
	}


document.write('<div id="header2">');
document.write('<table width="100%" border="0" valign="top">');
document.write('<tr>');
document.write('<td width="375"> </td>');
document.write('<td height="30" class="blog_green_head">Get Help with your Debts, Fill Out Form Below</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td> </td>');
document.write('<td valign="top">');
document.write('<table>');
document.write('<tr>');
document.write('<td colspan="7" height="3"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>First Name</td>');
document.write('<td width="10"><b>:</b></td>');
document.write('<td><input name="FirstName" id="FirstName" type="text" style="width:120px;" maxlength=25 tabindex=1></td>');
document.write('<td width="10"></td>');
document.write('<td>Last Name</td>');
document.write('<td width="10"><b>:</b></td>');
document.write('<td><input name="LastName" id="LastName" type="text" style="width:120px;" maxlength=30 tabindex=2></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="7" height="3"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>Email</td>');
document.write('<td width="10"><b>:</b></td>');
document.write('<td><input name="EmailAddress" id="EmailAddress" type="text" style="width:120px;" maxlength=50 tabindex=3></td>');
document.write('<td width="10"></td>');
document.write('<td>Phone</td>');
document.write('<td width="10"><b>:</b></td>');
document.write('<td><input name="HomePhone" id="HomePhone" type="text" style="width:120px;" maxlength=50 tabindex=4></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="7" height="3"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>State</td>');
document.write('<td width="10"><b>:</b></td>');
document.write('<td><select name="State" id="State" style="font:8pt Arial;" tabindex=5>');
document.write('<option value="al">Alabama</option>');
document.write('<option value="ak">Alaska</option>');
document.write('<option value="az">Arizona</option>');
document.write('<option value="ar">Arkansas</option>');
document.write('<option value="ca">California</option>');
document.write('<option value="co">Colorado</option>');
document.write('<option value="ct">Connecticut</option>');
document.write('<option value="de">Delaware</option>');
document.write('<option value="dc">DC</option>');
document.write('<option value="fl">Florida</option>');
document.write('<option value="ga">Georgia</option>');
document.write('<option value="hi">Hawaii</option>');
document.write('<option value="id">Idaho</option>');
document.write('<option value="il">Illinois</option>');
document.write('<option value="in">Indiana</option>');
document.write('<option value="ia">Iowa</option>');
document.write('<option value="ky">Kentucky</option>');
document.write('<option value="la">Louisiana</option>');
document.write('<option value="me">Maine</option>');
document.write('<option value="md">Maryland</option>');
document.write('<option value="ma">Massachusetts</option>');
document.write('<option value="mi">Michigan</option>');
document.write('<option value="fm">Micronesia</option>');
document.write('<option value="mn">Minnesota</option>');
document.write('<option value="ms">Mississippi</option>');
document.write('<option value="mo">Missouri</option>');
document.write('<option value="mt">Montana</option>');
document.write('<option value="ne">Nebraska</option>');
document.write('<option value="nv">Nevada</option>');
document.write('<option value="nh">New Hampshire</option>');
document.write('<option value="nj">New Jersey</option>');
document.write('<option value="nm">New Mexico</option>');
document.write('<option value="ny">New York</option>');
document.write('<option value="nf">Newfoundland</option>');
document.write('<option value="nc">North Carolina</option>');
document.write('<option value="nd">North Dakota</option>');
document.write('<option value="oh">Ohio</option>');
document.write('<option value="ok">Oklahoma</option>');
document.write('<option value="or">Oregon</option>');
document.write('<option value="pa">Pennsylvania</option>');
document.write('<option value="ri">Rhode Island</option>');
document.write('<option value="sc">South Carolina</option>');
document.write('<option value="sd">South Dakota</option>');
document.write('<option value="tn">Tennessee</option>');
document.write('<option value="tx">Texas</option>');
document.write('<option value="ut">Utah</option>');
document.write('<option value="vt">Vermont</option>');
document.write('<option value="va">Virginia</option>');
document.write('<option value="wa">Washington</option>');
document.write('<option value="wi">Wisconsin</option>');
document.write('<option value="wv">West Virginia</option>');
document.write('<option value="wy">Wyoming</option>');
document.write('</select></td>');
document.write('<td width="10"></td>');
document.write('<td>Best Time to Contact</td>');
document.write('<td width="10"><b>:</b></td>');
document.write('<td><select name="ContactTime" id="ContactTime" style="font:8pt Arial;" tabindex=6>');
document.write('<option value="Morning">Morning</option>');
document.write('<option selected value="Afternoon">Afternoon</option>');
document.write('<option value="Evening">Evening</option>');
document.write('</select></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="7" height="3"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>Total Unsecured<br>Debt</td>');
document.write('<td width="10"><b>:</b></td>');
document.write('<td><select name="TotalDebt" id="TotalDebt" style="font:8pt Arial;" tabindex=7>');
document.write('<option value="2000-5000">$2,000-$5,000</option>');
document.write('<option value="5001-10000">$5,001-$10,000</option>');
document.write('<option selected value="10000-20000">$10,001-$20,000</option>');
document.write('<option value="20000-50000">$20,000-$50,000</option>');
document.write('<option value="Over 50000">Over $50,000</option>');
document.write('</select></td>');
document.write('<td width="10"></td>');
document.write('<td></td>');
document.write('<td></td>');
document.write('<td></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="7" height="3"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan=7><a href="#"><input name="SubmitButton" id="SubmitButton" type="image" onClick="return ValidateForm();" value="submit" border=0 class="no-border" src="http://www.onlinedebthelp.org/debt-form-submit.jpg"></a></td>');
document.write('</tr>');
document.write('</table>');
document.write('</td>');
document.write('</tr>');   
document.write('</table>');
document.write('</div>');
document.write('<iframe src="" style="display:none;" id="PassData" name="PassData"></iframe>');