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(homePhone.value.length < 9) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Phone Number is required.\n';
		}
		if(document.getElementById('State').value == '-1')
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Select a State from the drop down.\n';
		}
		if(emailAddress.value.length < 4) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Email Address 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 and user to next step
			window.location = 'http://www.aftermarketsites.com/DataStream-DMG-2009-08-25.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);
		}
	}
	
	function IsEmailValid(emailAddress) {
		var emailReg = "^[\\w-_\.]*[\\w-_\.]\@[\\w]\.+[\\w]+[\\w]$";
		var regex = new RegExp(emailReg);
		return regex.test(emailAddress);
	}


document.write('<div id="header">');
document.write('<!-- #end header--></div>');
document.write('<div id="banner">');
document.write('<div id="form-holder">');

document.write('<div class="btn-hldr"><a href="#"><input name="SubmitButton" id="SubmitButton" type="image" width="146" height="47" border="0" onClick="return ValidateForm();" value="submit" class="submit-button" src="images/button.jpg"></a></div>');
document.write('<div class="input-left">');
document.write('<span class="text-label">First Name:</span><br />');
document.write('<input type="text" name="FirstName" id="FirstName" class="input-01" size="25" maxlength="25" />');
document.write('<span class="text-label">Last Name:</span><br />');
document.write('<input type="text" name="LastName" id="LastName" class="input-01" size="25" maxlength="30" />');
document.write('<span class="text-label">Email:</span><br />');
document.write('<input type="text" name="EmailAddress" id="EmailAddress" class="input-01" size="25" maxlength="50" />');
document.write('<span class="text-label">Phone:</span><br />');
document.write('<input type="text" name="HomePhone" id="HomePhone" class="input-01" size="25" maxlength="50" />');
document.write('</div>');
document.write('<div class="input-right">');
document.write('<span class="text-label">State: </span><br />');
document.write('<select name="State" id="State" class="input-02" tabindex=5>');
document.write('<option value="-1">Select a State</option>');
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="ks">Kansas</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>');
document.write('<span class="text-label">Best Time to Call: </span><br />');
document.write('<select name="ContactTime" id="ContactTime" class="input-02" 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>');
document.write('<span class="text-label">Total Unsecured Debt: </span><br />');
document.write('<select name="TotalDebt" id="TotalDebt" class="input-02" 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>');
document.write('</div>');

document.write('<!-- #end form-holder--></div>');
document.write('<!-- #end banner--></div>');

document.getElementById('FirstName').focus();