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bobcatou

original email form

bobcatou
May 17th, 2011
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  1. <!-- BEGIN: Signup Form Manual Code from Benchmark Email Ver 2.0 ------>
  2.  
  3. <script type="text/javascript">
  4. function CheckField91269(fldName, frm){ if ( frm[fldName].length ) { for ( var i = 0, l = frm[fldName].length; i < l; i++ ) { if ( frm[fldName].type =='select-one' ) { if ( frm[fldName][i].selected ) { return true; } } else { if ( frm[fldName][i].checked ) { return true; } }; } return false; } else { frm[fldName].focus(); return (frm[fldName].value.length > 0);}}
  5. function rmspaces(x) {var leftx = 0;var rightx = x.length -1;while ( x.charAt(leftx) == ' ') { leftx++; }while ( x.charAt(rightx) == ' ') { --rightx; }var q = x.substr(leftx,rightx-leftx + 1);if ( (leftx == x.length) && (rightx == -1) ) { q =''; } return(q); }
  6. function checkfield(data) {if (rmspaces(data) == ""){return false;}else {return true;}}
  7. function isemail(data) {var flag = false;if ( data.indexOf("@",0) == -1 || data.indexOf("\\",0) != -1 ||data.indexOf("/",0) != -1 ||!checkfield(data) || data.indexOf(".",0) == -1 || data.indexOf("@") == 0 ||data.lastIndexOf(".") < data.lastIndexOf("@") ||data.lastIndexOf(".") == (data.length - 1) ||data.lastIndexOf("@") != data.indexOf("@") ||data.indexOf(",",0) != -1 ||data.indexOf(":",0) != -1 ||data.indexOf(";",0) != -1 ) {return flag;} else {var temp = rmspaces(data);if (temp.indexOf(' ',0) != -1) { flag = true; }var d3 = temp.lastIndexOf('.') + 4;var d4 = temp.substring(0,d3);var e2 = temp.length - temp.lastIndexOf('.') - 1;var i1 = temp.indexOf('@');if ( (temp.charAt(i1+1) == '.') || ( e2 > 4 ) || ( e2 < 2 ) ) { flag = true; }return !flag;}}
  8. function CheckFieldD91269(fldH, chkDD, chkMM, chkYY, reqd, frm){ var retVal = true; var dt = validDate91269(chkDD, chkMM, chkYY, frm); var nDate = frm[chkDD].value + " " + frm[chkMM].value + " " + frm[chkYY].value; if ( dt == null && reqd == 1 ) { nDate = ""; retVal = false; } else if ( (frm[chkDD].value != "" || frm[chkMM].value != "" || frm[chkYY].value != "") && dt == null) { retVal = false; nDate = "";} if ( retVal ) {frm[fldH].value = nDate;} return retVal; }
  9. function validDate91269(chkDD, chkMM, chkYY, frm) {var objDate = null; if ( frm[chkDD].value != "" && frm[chkMM].value != "" && frm[chkYY].value != "" ) {var mSeconds = (new Date(frm[chkYY].value - 0, frm[chkMM].selectedIndex - 1, frm[chkDD].value - 0)).getTime();var objDate = new Date();objDate.setTime(mSeconds);if (objDate.getFullYear() != frm[chkYY].value - 0 || objDate.getMonth() != frm[chkMM].selectedIndex - 1 || objDate.getDate() != frm[chkDD].value - 0){objDate = null;}}return objDate;}
  10. function _checkSubmit91269(frm){
  11. if ( !isemail(frm["fldEmail"].value) ) {
  12. alert("Please enter the Email");
  13. return false;
  14. }
  15. return true; }
  16. </script>
  17. <div align="center"><form style="display:inline;" action="http://lb.benchmarkemail.com//code/lbform" method=post name="frmLB91269" accept-charset="UTF-8" onsubmit="return _checkSubmit91269(this);" >
  18. <input type=hidden name=successurl value="http://www.benchmarkemail.com/Code/ThankYouOptin?" /><input type=hidden name=errorurl value="http://lb.benchmarkemail.com//Code/Error" /><input type=hidden name=token value="mFcQnoBFKMTU7FyJNPddH%2BoNbCMyivkXZmDy%2BOeCGTQ3Ih4P1WxctQ%3D%3D" />
  19. <input type=hidden name=doubleoptin value="" /><table id=tblFormData91269 width="220" border="0" cellspacing="0" cellpadding="0" style="border: 1px solid #DEDEDE;background: #DEDEDE;color: #000000; font-family:Georgia; font-size:10px"><tr><td valign=top id=tblForm91269 bgcolor="#DEDEDE" >
  20. <table width='100%' border=0 cellspacing=0 cellpadding=0><tr><td id=tdHeader91269 align=left valign=top bgcolor="#DEDEDE" style="color:#000000;font-family:Georgia;font-size:12px;padding:5px 5px 5px 10px;"><b>Stay Informed with Action Alerts</b></td></tr></table>
  21. <div style="padding:20px;"><table border=0 cellspacing=0 cellpadding=0><tr><td valign=top id=tdIntro91269 align=left style="font-family:Georgia;font-size:10px;color:#000000;"></td></tr></table><br /><table id=tblFieldData91269 border=0 cellpadding=0 cellspacing=0 style="background: #DEDEDE;color: #000000; font-family:Georgia; font-size:10px"><tr><td valign=top align=left style='padding:0px 0px 10px 0px'>
  22. <div style='width:120px;float:left;padding-top:5px;font-size:10px;'><b>First Name</b></div>
  23. <br clear=all />
  24. <div style='float:left;padding-top:3px;'><input type=text style='width:180px' name=fldfirstname maxlength=100 /></div>
  25. </td>
  26. </tr>
  27. <tr>
  28. <td valign=top align=left style='padding:0px 0px 10px 0px'>
  29. <div style='width:120px;float:left;padding-top:5px;font-size:10px;'><b>Last Name</b></div>
  30. <br clear=all />
  31. <div style='float:left;padding-top:3px;'><input type=text style='width:180px' name=fldlastname maxlength=100 /></div>
  32. </td>
  33. </tr>
  34. <tr>
  35. <td valign=top align=left style='padding:0px 0px 10px 0px'>
  36. <div style='width:120px;float:left;padding-top:5px;font-size:10px;'><b>Email <span style='color:#CC0000;font-size:125%;'> *</span> </b></div>
  37. <br clear=all />
  38. <div style='float:left;padding-top:3px;'><input type=text style='width:180px' name=fldEmail maxlength=100 /></div>
  39. </td>
  40. </tr>
  41. <tr>
  42. <td valign=top align=left style='padding:0px 0px 10px 0px'><div style='width:120px;float:left;padding-top:5px;font-size:10px;'><b>State</b></div>
  43. <br clear=all />
  44. <div style='float:left;padding-top:3px;'><select style='width:180px' name=fldfield3><option value="" ></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="District of Columbia" >District of Columbia</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="West Virginia" >West Virginia</option><option value="Wisconsin" >Wisconsin</option><option value="Wyoming" >Wyoming</option><option value="Outside US" >Outside US</option></select></div>
  45. </td>
  46. </tr>
  47. </table>
  48. </div>
  49. </td>
  50. </tr>
  51. <tr>
  52. <td valign=top id='tdSep91269' style='background-color:#DEDEDE;padding:0px;' ><img src='http://lb.benchmarkemail.com//images/blank.gif' height=1 width=1 />
  53. </td>
  54. </tr>
  55. <tr>
  56. <td valign=top style='padding-top:10px;padding-bottom:10px;' align=center><input type="submit" id="btnSubmit" value="Submit" style='font-size:10px;font-family:Arial;padding-left:10px;padding-right:10px;color:#000000;' />
  57. </td>
  58. </tr>
  59. </table>
  60. <table id="tblRequiredField91269" width="220" border="0" cellspacing="0" cellpadding="0" ><tr><td align=right style='font-size:10px;'>* Required Field</td>
  61. </tr>
  62. </table>
  63. </form>
  64. </div>
  65. <!-- BEGIN: Email Marketing By Benchmark Email ------>
  66. <div align="center" style="padding-top:5px;font-family:Arial,Helvetica,sans-serif;font-size:10px;color:#999999;"><a href="http://www.benchmarkemail.com" target=_new style="text-decoration:none;font-family:Arial,Helvetica,sans-serif;font-size:10px;color:#999999;">Email Marketing</a> by Benchmark Email</div>
  67. <!-- END: Email Marketing By Benchmark Email ---------->
  68. <!-- END: Signup Form Manual Code from Benchmark Email Ver 2.0 ------>
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