Untitled

<!DOCTYPE html PUBLIC '-//W3C//DTD XHTML 1.0 Transitional//EN'
'http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd'>
<html>
<head>
<style type='text/css'>
 .headline {
  border: none;
  }
 .ctr {
  border: solid 1px black;
  border-collapse: collapse;
  }
 th {
  text-align: left;
  font-family: Cambria,'Times New Roman',Serif;
  font-size: 220%;
  color: #62194b;
  }
 hr {
  width: 800px;
  height: 4px;
  color: #679146;
  }
 td {
  text-align: left;
  font-family: Calibri,Arial,sans-serif;
  border: none;
  }
 tr {
  border: none
  }
 #names {
  float: right;
  position: relative;
  right: 40px;
  }
 .inputbox {
   position: absolute;
   left: 275px;
  }
 p {
  font-family: Calibri,Arial,Sans-serif;
  font-size: 0.9em;
  }
 label {
  font-family: Calibri,Arial,Sans-serif;
  font-size: 0.9em;
  }
 body {
  margin-left: 150px;
  margin-right: 150px;
  border: solid 1px black;
  padding: 5px;
  }
 h2 {
  font-family: Calibri,Arial,Sans-serif;
  font-size: 1.4em;
  color: #62194b;
  }
</style>
<script type='text/javascript' src='jquery.js'></script>
<script type='text/javascript'>
$(document).ready(function() {
var lastNames = new Array("Lil Harry's Closet","Lil Harry's Closet","Name","Name");
var firstNames = new Array("","","Name","Name");
var middleIs = new Array("","","C","C");
var ssns = new Array("xxxxxxxxx","xxxxxxxxx","xxxxxxxxx","xxxxxxxxx");
var streets = new Array("23123 Hazelwood Ave","P O Box 46633","City","City");
var cities = new Array("Hazel Park","Mt Clemens","City","City");
var states = new Array("MI","MI","MI","MI");
var zipCodes = new Array("48030","48046","48030","48030");
var birthDates = new Array("09/16/1989","--/--/----","--/--/----","--/--/----");
var occupations = new Array("","","","");
var idTypes = new Array("0","0","0","0");
var issuers = new Array("","","","");
var idNumbers = new Array("","","X 123 456 789 012","X 123 456 789 012");
$('.conductor').click(function() {
var selector = $(this).val();
$('#lname').val(lastNames.splice(selector,1));
$('#fname').val(firstNames.splice(selector,1));
$('#mi').val(middleIs.splice(selector,1));
$('#ssn').val(ssns.splice(selector,1));
$('#addr').val(streets.splice(selector,1));
$('#city').val(cities.splice(selector,1));
$('#state').val(states.splice(selector,1));
$('#zip').val(zipCodes.splice(selector,1));
$('#dob').val(birthDates.splice(selector,1));
$('#occu').val(occupations.splice(selector,1));
if (idTypes[selector] == 2)
{
$('#idtype1').attr('checked','checked');
}
else if (idTypes[selector] == 4 || idTypes[selector] == 5 )
{
$('#idtype2').attr('checked','checked');
}
else if (idTypes[selector] == 8 )
{
$('#idtype3').attr('checked','checked');
}
$('#iss').val(issuers.splice(selector,1));
$('#dlnumber').val(idNumbers.splice(selector,1));
for (i=0; i<lastNames.length; i++)
{
var titlestring = '<h2>Other name(s) on Account</h2>';
var lname = '<p>Last name: <input type=\'text\' class=\'inputbox\' value=\'' + lastNames[i] + '\' /></p>';
var fname = '<p>First name: <input type=\'text\' class=\'inputbox\' value=\'' + firstNames[i] + '\' /></p>';
var midi = '<p>Middle initial: <input type=\'text\' class=\'inputbox\' value=\'' + middleIs[i] + '\' /></p>';
var nssn = '<p>SSN: <input type=\'text\' class=\'inputbox\' value=\'' + ssns[i] + '\' /></p>';
var nstreet = '<p>Street Address: <input type=\'text\' class=\'inputbox\' value=\'' + streets[i]+ '\' /></p>';
var ncity = '<p>City: <input type=\'text\' class=\'inputbox\' value=\'' + cities[i] + '\' /></p>';
var nstate = '<p>State: <input type=\'text\' class=\'inputbox\' value=\'' + states[i] + '\' /></p>';
var nzip = '<p>ZIP Code: <input type=\'text\' class=\'inputbox\' value=\'' + zipCodes[i] + '\' /></p>';
var ndob = '<p>Date of Birth: <input type=\'text\' class=\'inputbox\' value=\'' + birthDates[i] + '\' /></p>';
var noccu = '<p>Occupation: <input type=\'text\' class=\'inputbox\' value=\'' + occupations[i] + '\' /></p>';
$('#chosen').after('<div class=\'others\'></div>');
$('.others').append(titlestring,lname,fname,midi,nssn,nstreet,ncity,nstate,nzip,ndob,noccu);
}
});
$('#reload').click( function() {
 location.reload(true);
 });
});
</script>
</head>
<body>
<div>
<h2>
Business Detail
</h2>
<p>Entity's Name: <input type='text' class='inputbox' size='40' id='detailName' value="Lil Harry's Closet" /></p>
<p>Tax ID Number: <input type='text' class='inputbox' size='40' id='detailTID' value='454688067' /></p>
<p>Address: <input type='text' class='inputbox' size='40' id='detailAddr' value='23123 Hazelwood Ave' /></p>
<p>City: <input type='text' class='inputbox' size='40' id='detailCity' value='Hazel Park' /></p>
<p>State: <input type='text' class='inputbox' size='40' id='detailState' value='MI' /></p>
<p>Zip Code: <input type='text' class='inputbox' size='40' id='detailZIP' value='48030' /></p>
<p>Type of Business: <input type='text' class='inputbox' size='40' value='Screen Printing Business' /></p>
</div>
<div id='names'>
<p>Select the name of the person conducting the transaction:</p>
<label for='name1'>Lil Harry's Closet</label>
<input type='radio' name='conductor' class='conductor' id='name1' value=0 />
<br />
<label for='name2'>Lil Harry's Closet</label>
<input type='radio' name='conductor' class='conductor' id='name2' value=1 />
<br />
<label for='name3'>Julie C Baumer</label>
<input type='radio' name='conductor' class='conductor' id='name3' value=2 />
<br />
<br />
<p>If you chose the wrong name, <input type='button' id='reload' value='Click Here'></p>
</div>
<div id='chosen'>
<h2>Person conducting transaction detail</h2>
<p>Last name: <input type='text' class='inputbox' id='lname'></p>
<p>First name: <input type='text' class='inputbox' id='fname'></p>
<p>Middle Initial: <input type='text' class='inputbox' id='mi'></p>
<p>SSN: <input type='text' class='inputbox' id='ssn'></p>
<p>Street Address: <input type='text' class='inputbox' id='addr'></p>
<p>City: <input type='text' class='inputbox' id='city'></p>
<p>State: <input type='text' class='inputbox' id='state'></p>
<p>ZIP Code: <input type='text' class='inputbox' id='zip'></p>
<p>Date of Birth: <input type='text' class='inputbox' id='dob'></p>
<p>Occupation: <input type='text' class='inputbox' id='occu'></p>
<p>ID Type:</p>
<label for='idtype1'>Driver's license</label>
<input type='radio' name='idtype' value='license' id='idtype1' />
<label for='idtype2'>Passport</label>
<input type='radio' name='idtype' value='passport' id='idtype2' />
<label for='idtype3'>Alien Registration</label>
<input type='radio' name='idtype' value='alien_registration' id='idtype3' />
<p>Issued by: <input type='text' class='inputbox' id='iss'></p>
<p>Number: <input type='text' class='inputbox' id='dlnumber'></p>
</div>
</body>
</html>