document.write('<link href="http://clients.jatxt.com/API/WebCapture/style.css" rel="stylesheet" type="text/css" /> ');document.write('<script>');document.write('function WC_3474_IsNumericField(){ '); document.write('var fromfield = document.getElementById("WC_3474_Mobile"); '); document.write('		mobilelength = String(fromfield.value).substring(0,2) == "07" ? 11 : 10; '); document.write('	if (isNumeric(fromfield.value)) { '); document.write('		if(fromfield.value.length > mobilelength) { '); document.write('          fromfield.value = fromfield.value.substring(0, mobilelength); '); document.write('		  fromfield.focus(); '); document.write(' 		}  '); document.write('	} else { '); document.write('		fromfield.value = fromfield.value.substring(0, String(fromfield.value).length-1); '); document.write('		fromfield.focus(); '); document.write('	} '); document.write('} '); document.write('function isNumeric(inputStr){ '); document.write('	for (var i = 0; i < inputStr.length; i++) { '); document.write('		var oneChar = inputStr.charAt(i); '); document.write('		if (oneChar < "0" || oneChar > "9") { return false; } '); document.write('	} '); document.write('	return true; '); document.write('} '); document.write('function clearText(field){ '); document.write('	if (field.defaultValue == field.value) { field.value = ""; '); document.write('	} else if (field.value == "") { field.value = field.defaultValue; } '); document.write(' } '); document.write('function isEmail(inputStr){ '); document.write('if(!inputStr.match(/^([0-9a-zA-Z]|[-]|[.]|[_])+[@]([0-9a-zA-Z]|[-]|[_]|[.])+[.]([0-9a-zA-Z])+$/)) return false; '); document.write('  return true; '); document.write('} '); document.write('function isEmptyStr(inputStr){ '); document.write('  if(inputStr == null || inputStr == "undefined" || inputStr == "" || inputStr == "null") return true; '); document.write('  return false; '); document.write('} '); document.write(' function isDateFormat(inputStr) { '); document.write(' 	var reDate = /^(1[0-2]|0?[1-9])[/](0?[1-9]|[12][0-9]|3[01])[/]((19|20)[0-9][0-9])$/; '); document.write(' 	var matchArrayDate = reDate.exec(inputStr); '); document.write('     if (!matchArrayDate) { '); document.write(' 	  return false; '); document.write(' 	} '); document.write('     return true; '); document.write(' } '); document.write('function WC_ChkForm_3474() { '); document.write('	var ErrorMSG = ""; '); document.write(' 	document.getElementById("WC_3474_Firstname").className  = "WC_TextField"; '); document.write(' if (isEmptyStr(document.getElementById("WC_3474_Firstname").value)) { document.getElementById("WC_3474_Firstname").className  = "WC_Error"; ErrorMSG += "|WC_3474_Firstname|"; } '); document.write(' 	document.getElementById("WC_3474_Surname").className  = "WC_TextField"; '); document.write(' if (isEmptyStr(document.getElementById("WC_3474_Surname").value)) { document.getElementById("WC_3474_Surname").className  = "WC_Error"; ErrorMSG += "|WC_3474_Surname|"; } '); document.write(' 	document.getElementById("WC_3474_ZIP").className  = "WC_TextField"; '); document.write(' if (isEmptyStr(document.getElementById("WC_3474_ZIP").value)) { document.getElementById("WC_3474_ZIP").className  = "WC_Error"; ErrorMSG += "|WC_3474_ZIP|"; } '); document.write(' 	document.getElementById("WC_3474_Mobile").className  = "WC_TextField"; '); document.write(' if (isEmptyStr(document.getElementById("WC_3474_Mobile").value)) { document.getElementById("WC_3474_Mobile").className  = "WC_Error"; ErrorMSG += "|WC_3474_Mobile|"; } '); document.write(' if ((!isEmptyStr(document.getElementById("WC_3474_Mobile").value)) && ((!isNumeric(document.getElementById("WC_3474_Mobile").value)) || (String(document.getElementById("WC_3474_Mobile").value).length < 10))) { document.getElementById("WC_3474_Mobile").className  = "WC_Error"; ErrorMSG += "|WC_3474_Mobile|"; } '); document.write(' 	document.getElementById("WC_3474_Email").className  = "WC_TextField"; '); document.write(' if ((!isEmptyStr(document.getElementById("WC_3474_Email").value)) && (!isEmail(document.getElementById("WC_3474_Email").value))) { document.getElementById("WC_3474_Email").className  = "WC_Error"; ErrorMSG += "|WC_3474_Email|"; } '); document.write(' 	document.getElementById("WC_3474_Address1").className  = "WC_TextField"; '); document.write(' 	document.getElementById("WC_3474_Address2").className  = "WC_TextField"; '); document.write(' 	document.getElementById("WC_3474_City").className  = "WC_TextField"; '); document.write(' 	document.getElementById("WC_3474_State").className  = "WC_TextField"; '); document.write(' if (ErrorMSG != "") { '); document.write(' alert("Please fix the errors and try again!"); '); document.write(' return false; '); document.write(' } else { '); document.write(' return true; '); document.write(' } '); document.write(' } '); document.write('</script>');document.write('<form action="http://clients.jatxt.com/api/webcapture/Process.asp" method="POST" name="WC_FRM_3474" style="margin: 0px" onsubmit="return WC_ChkForm_3474()">');document.write('<table border="0" cellspacing="0" cellpadding="0" class="WC_Table">');	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">Firstname*</td>'); 	document.write('		<td class="WC_Middle"><input name="Firstname" id="WC_3474_Firstname" type="text" class="WC_TextField" undefined maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right">&nbsp;</td>'); 	document.write('  	</tr>'); 	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">Lastname*</td>'); 	document.write('		<td class="WC_Middle"><input name="Surname" id="WC_3474_Surname" type="text" class="WC_TextField" undefined maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right">&nbsp;</td>'); 	document.write('  	</tr>'); 	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">Your Zip Code*</td>'); 	document.write('		<td class="WC_Middle"><input name="ZIP" id="WC_3474_ZIP" type="text" class="WC_TextField" undefined maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right">&nbsp;</td>'); 	document.write('  	</tr>'); 	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">Mobile*</td>'); 	document.write('		<td class="WC_Middle"><input name="Mobile" id="WC_3474_Mobile" type="text" class="WC_TextField" onkeyup="WC_3474_IsNumericField()" maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right">&nbsp;</td>'); 	document.write('  	</tr>'); 	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">E-Mail (optional)</td>'); 	document.write('		<td class="WC_Middle"><input name="Email" id="WC_3474_Email" type="text" class="WC_TextField" undefined maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right">&nbsp;</td>'); 	document.write('  	</tr>'); 	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">Address Line 1 (optional)</td>'); 	document.write('		<td class="WC_Middle"><input name="Address1" id="WC_3474_Address1" type="text" class="WC_TextField" undefined maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right">&nbsp;</td>'); 	document.write('  	</tr>'); 	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">Address Line 2  (optional)</td>'); 	document.write('		<td class="WC_Middle"><input name="Address2" id="WC_3474_Address2" type="text" class="WC_TextField" undefined maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right">&nbsp;</td>'); 	document.write('  	</tr>'); 	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">City  (optional)</td>'); 	document.write('		<td class="WC_Middle"><input name="City" id="WC_3474_City" type="text" class="WC_TextField" undefined maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right">&nbsp;</td>'); 	document.write('  	</tr>'); 	document.write('	<tr>'); 	document.write('		<td nowrap class="WC_Left">State  (optional)</td>'); 	document.write('		<td class="WC_Middle"><input name="State" id="WC_3474_State" type="text" class="WC_TextField" undefined maxlength="75"></td>'); 	document.write('		<td nowrap class="WC_Right"><input type="submit" class="WC_Submit" value="Join"></td>'); 	document.write('  	</tr>'); document.write('</table>');document.write('<p class="WC_Required">* Required</p>');document.write('<p class="WC_Legal"></p>');document.write('<input name="AccountID" type="hidden" value="3535">');document.write('<input name="Source" type="hidden" value="Mobile Alerts">');document.write('<input name="RTNURL" type="hidden" value="http://www.martinomalley.com">');document.write('<input name="SendAlert" type="hidden" value="null">');document.write('<input name="ConfirmOption" type="hidden" value="null">');document.write('<input name="PageURL" type="hidden" value="'+window.location.href+'">');document.write('</form>');