Version compl�te: jsB@nk » Email » Formulaire de soumission
URL: https://www.javascriptbank.com/submission-form.html
Cet JavaScript peut créer une enregistrées forme l'avance avec beaucoup de paramètres.
Version compl�te: jsB@nk » Email » Formulaire de soumission
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:[email protected]?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-->