New Zenner
- Join Date:
- Oct 2006
- Posts:
- 21
- Plugin Contributions:
- 0
Help needed on Dealer Signup form contribution
Help needed on Dealer Signup form contribution. I'v made a dealer sign up form which I've placed in my EZPages. It dies on the processing of the data collected. I need help in getting the information collected either emailed to me or placed in the data base. Any help would be appreciated. The code is below. ```
<p> <link href="dealform_files/document.css" rel="stylesheet" type="text/css" /></p> <script language="javascript"> function validate(form){ if (form.txtBName.value == ""){ alert("Please enter value for Business Name"); form.txtBName.focus(); return(false); } if (form.txtAdd1.value == ""){ alert("Please enter value for Business Address"); form.txtAdd1.focus(); return(false); } if (form.txtCity.value == ""){ alert("Please enter value for Business City"); form.txtCity.focus(); return(false); } if (form.txtZip.value == ""){
alert("Please enter value for Business zip/pin code");
form.txtZip.focus();
return(false);
}
if (form.txtZip.value.length < 5){
alert("Please enter valid Business zip/pin code");
form.txtZip.focus();
return(false);
}
if (form.txtOFName.value == ""){
alert("Please enter value for Onwer first name");
form.txtOFName.focus();
return(false);
}
if (form.txtOAdd1.value == ""){
alert("Please enter value for Onwer Address");
form.txtOAdd1.focus();
return(false);
}
if (form.txtOZip.value == ""){
alert("Please enter value for Onwer zip/pic code");
form.txtOZip.focus();
return(false);
}
if (form.txtOZip.value.length < 5){
alert("Please enter valid Business zip/pin code");
form.txtOZip.focus();
return(false);
}
if (form.txtBphone.value == ""){
alert("Please enter value for Business Phone number");
form.txtBphone.focus();
return(false);
}
if (form.cred_txtBphone.value == ""){
alert("Please enter value for Business Phone number");
form.cred_txtBphone.focus();
return(false);
}
if (form.cred_txtemail.value == ""){
alert("Please enter value for Email address");
form.cred_txtemail.focus();
return(false);
}
return(true);
}
</script>
<table width="100%" valign="middle">
<tbody>
<tr>
<td class="tbltitle">Barrage Barrel Dealer Application</td>
</tr>
</tbody>
</table>
<div width="100%" style="text-align: center;">Please complete this form then click submit at the bottom of the page</div>
<form onsubmit="javascript:return validate(this);" method="post" action="process">
<table cellspacing="0" cellpadding="1" border="0" align="center" class="tblbody">
<tbody>
<tr>
<td class="tbltitle" colspan="3">Business Information</td>
</tr>
<tr>
<td class="coltitle">Business Name *</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtBName" name="txtBName" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Contact Name (First/Last)</td>
<td><input type="textbox" maxlength="50" value="" style="width: 200px;" id="txtCFName" name="txtCFName" class="textbox" /></td>
<td><input type="textbox" maxlength="50" value="" style="width: 194px;" id="txtCLName" name="txtCLName" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Business Street Address *</td>
<td colspan="2"><input type="textbox" maxlength="100" value="" id="txtAdd1" name="txtAdd1" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Business Street Address2</td>
<td colspan="2"><input type="textbox" maxlength="100" value="" id="txtAdd2" name="txtAdd2" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">City *</td>
<td colspan="2"><input type="textbox" maxlength="30" value="" id="txtCity" name="txtCity" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">State</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtState" name="txtState" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Zip/Pin Code *</td>
<td colspan="2"><input type="textbox" style="width: 50px;" maxlength="6" value="" id="txtZip" name="txtZip" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Country</td>
<td colspan="2"><select style="width: 400px;" id="cmbCountry" name="cmbCountry">
<option selected="selected" value="UNITED STATES">UNITED STATES</option>
<option value="ANDORRA">ANDORRA</option>
<option value="UNITED KINGDOM">UNITED KINGDOM</option>
<option value="UNITED STATES">UNITED STATES</option>
<option value="US MINOR OUTLYING ISLAND">US MINOR OUTLYING ISLAND</option>
</select></td>
</tr>
<tr>
<td class="coltitle">Business Phone *</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtBphone" name="txtBphone" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Business Fax</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtBFax" name="txtBFax" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Federal Tax ID (US Customers)</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtFTID" name="txtFTID" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Email Address</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtemail" name="txtemail" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Entity</td>
<td colspan="2"><select style="" id="cmbEntity" name="cmbEntity">
<option selected="selected" value="Sole Prop">Sole Prop</option>
<option value="Partnership">Partnership</option>
<option value="LLC">LLC</option>
<option value="Corporation">Corporation</option>
</select></td>
</tr>
<tr>
<td class="coltitle" rowspan="4">Business type <br />
(Check all that apply)</td>
<td class="coltitle">Field</td>
<td><input type="checkbox" id="txtFType" name="txtFType" /></td>
</tr>
<tr>
<td class="coltitle">Retail Store</td>
<td><input type="checkbox" id="txtRType" name="txtRType" /></td>
</tr>
<tr>
<td class="coltitle">Online Store</td>
<td><input type="checkbox" id="txtOType" name="txtOType" /></td>
</tr>
<tr>
<td class="coltitle">Distributor</td>
<td><input type="checkbox" id="txtDType" name="txtDType" /></td>
</tr>
</tbody>
</table>
<br />
<table cellspacing="0" cellpadding="1" border="0" align="center" class="tblbody">
<tbody>
<tr>
<td class="tbltitle" colspan="3">Credit / Billing Information</td>
</tr>
<tr>
<td class="coltitle">Business Name *</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="cred_txtBName" name="cred_txtBName" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Contact Name (First/Last)</td>
<td><input type="textbox" maxlength="50" value="" style="width: 200px;" id="cred_txtCFName" name="cred_txtCFName" class="textbox" /></td>
<td><input type="textbox" maxlength="50" value="" style="width: 194px;" id="cred_txtCLName" name="cred_txtCLName" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Business Billing Address *</td>
<td colspan="2"><input type="textbox" maxlength="100" value="" id="cred_txtAdd1" name="cred_txtAdd1" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Business Billing Address2</td>
<td colspan="2"><input type="textbox" maxlength="100" value="" id="cred_txtAdd2" name="cred_txtAdd2" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">City *</td>
<td colspan="2"><input type="textbox" maxlength="30" value="" id="cred_txtCity" name="cred_txtCity" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">State</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="cred_txtState" name="cred_txtState" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Zip/Pin Code *</td>
<td colspan="2"><input type="textbox" style="width: 50px;" maxlength="6" value="" id="cred_txtZip" name="cred_txtZip" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Country</td>
<td colspan="2"><select style="width: 400px;" id="cred_cmbCountry" name="cred_cmbCountry">
<option selected="selected" value="UNITED STATES">UNITED STATES</option>
<option value="ANDORRA">ANDORRA</option>
<option value="UNITED KINGDOM">UNITED KINGDOM</option>
<option value="UNITED STATES">UNITED STATES</option>
<option value="US MINOR OUTLYING ISLAND">US MINOR OUTLYING ISLAND</option>
</select></td>
</tr>
<tr>
<td class="coltitle">Business Phone *</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="cred_txtBphone" name="cred_txtBphone" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Business Fax</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="cred_txtBFax" name="cred_txtBFax" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Federal Tax ID (US Customers)</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtFTID" name="cred_txtFTID" class="cred_textbox" /></td>
</tr>
<tr>
<td class="coltitle">Email Address *</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="cred_txtemail" name="cred_txtemail" class="textbox" /></td>
</tr>
</tbody>
</table>
<br />
<table cellspacing="0" cellpadding="1" border="0" align="center" class="tblbody">
<tbody>
<tr>
<td class="tbltitle" colspan="3">Owner / Officer Information</td>
</tr>
<tr>
<td class="coltitle">Owner Name (First/Last) *</td>
<td><input type="textbox" maxlength="50" value="" style="width: 200px;" id="txtOFName" name="txtOFName" class="textbox" /></td>
<td><input type="textbox" maxlength="50" value="" style="width: 194px;" id="txtOLName" name="txtOLName" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Home Street Address *</td>
<td colspan="2"><input type="textbox" maxlength="100" value="" id="txtOAdd1" name="txtOAdd1" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Home Street Address2</td>
<td colspan="2"><input type="textbox" maxlength="100" value="" id="txtOAdd2" name="txtOAdd2" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">City</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtOCity" name="txtOCity" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">State</td>
<td style="border-bottom: 0px none; margin-left: 0px; padding-left: 0px;" class="textbox" colspan="2"><input type="textbox" style="width: 100px;" maxlength="2" value="" id="txtOState" name="txtOState" class="textbox" /> <font size="2">(2 Letters)</font></td>
</tr>
<tr>
<td class="coltitle">Zip *</td>
<td style="margin-left: 0px; padding-left: 0px;" class="coltitle" colspan="2"><input type="textbox" style="width: 100px;" maxlength="6" value="" id="txtOZip" name="txtOZip" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Country</td>
<td colspan="2"><select style="width: 400px;" id="cmbOCountry" name="cmbOCountry">
<option selected="selected" value="UNITED STATES">UNITED STATES</option>
<option value="UNITED KINGDOM">UNITED KINGDOM</option>
<option value="UNITED STATES">UNITED STATES</option>
<option value="US MINOR OUTLYING ISLAND">US MINOR OUTLYING ISLAND</option>
</select></td>
</tr>
<tr>
<td class="coltitle">Business Phone</td>
<td colspan="2"><input type="textbox" maxlength="50" value="" id="txtOBphone" name="txtOBphone" class="textbox" /></td>
</tr>
</tbody>
</table>
<br />
<!-- <%
Dim i
response.write "<input name="txtMax" id="txtMax" value="4" type="hidden">"
for i = 1 to 4
%>
<%
next
%> -->
<table cellspacing="0" cellpadding="1" border="0" align="center">
<tbody>
<tr>
<td class="tbltitle">Trade References</td>
</tr>
<tr>
<td style="height: 120px;">
<table cellspacing="0" cellpadding="1" border="0" align="center" class="tblbody">
<tbody>
<tr>
<td style="word-spacing: 0px; text-align: left; letter-spacing: 0px; font-family: verdana; font-style: normal; font-variant: normal; font-weight: normal; font-size: 12px; line-height: normal; font-size-adjust: none; font-stretch: normal;" class="tbltitle" colspan="3"> </td>
</tr>
<tr>
<td class="coltitle">Company Name</td>
<td colspan="2"><input type="textbox" maxlength="100" value="" id="txtCName<%=i%>" name="txtCName<%=i%>" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Contact Person</td>
<td colspan="2"><input type="textbox" maxlength="100" value="" id="txtCP<%=i%>" name="txtCP<%=i%>" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Account #</td>
<td colspan="2"><input type="textbox" maxlength="20" value="" id="txtCAccount<%=i%>" name="txtCAccount<%=i%>" class="textbox" /></td>
</tr>
<tr>
<td class="coltitle">Phone Number</td>
<td colspan="2"><input type="textbox" maxlength="50" style="width: 100px;" value="" id="txtCPhone<%=i%>" name="txtCPhone<%=i%>" class="textbox" /></td>
</tr>
</tbody>
</table>
</td>
</tr>
</tbody>
</table>
<br />
<div width="100%" style="text-align: center;">
<table cellspacing="0" cellpadding="1" border="0" align="center" class="tblbody">
<tbody>
<tr>
<td align="center" class="coltitle2"><font color="#ff0000">All lines with a '*' are required</font></td>
<td colspan="2"> </td>
</tr>
<tr>
<td align="center" class="coltitle2">Please send us a copy of your State Business License<br />
New York businesses must <font color="#ff0000">also</font> fill out an ST120 Resale Certificate which can<br />
be downloaded from http://www.tax.state.ny.us/pdf/1999/fillin/st/st120_699_fill_in.pdf <br />
You can email it to <a href="mailto:[email protected]">[email protected]</a></td>
<td colspan="2"> </td>
</tr>
</tbody>
</table>
<br />
<table align="center">
<tbody>
<tr>
<td><input type="submit" value="Submit" id="cmdSubmit" name="cmdSubmit" class="cmdButton" /></td>
</tr>
<tr>
</tr>
</tbody>
</table>
</div>
</form>
```