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Please help me fix this code problem.

kilerb

By kilerb
in PHP Coding Help

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kilerb

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Posted

Hi guys...  I am attempting to make a page on our site that has a tenant application.  I used an online wizard.  It had the ability to make certain fields required and it marks them with a red star.  As soon as I generate the code, it turns EVERY field into a required field.  The submit form doesn't seem to be working properly either, even though I filled in the blanks they asked for...  but the wizard changes those back to generic answers when I generate the code... 

 

Here's the code, if anyone can help, I'd really appreciate it!  Thanks....

 

<script language='javascript'>
function verifyMe(){
var msg='';

if(document.getElementById('applicant').value==''){
msg+='- Applicant is completing application as a\n\n';}

if(document.getElementById('numberofapplicants').value==''){
msg+='- Total number of applicants\n\n';}

if(document.getElementById('propertyaddress').value==''){
msg+='- Application to rent property at: (address)\n\n';}

if(document.getElementById('monthlyrent').value==''){
msg+='- Monthly rent\n\n';}

if(document.getElementById('moveindate').value==''){
msg+='- Proposed move-in date\n\n';}

if(document.getElementById('fullname').value==''){
msg+='- Full name\n\n';}

if(document.getElementById('socialsecurtyno').value==''){
msg+='- Social security no.\n\n';}

if(document.getElementById('driverslicense').value==''){
msg+='- Drivers License No.\n\n';}

if(document.getElementById('state').value==''){
msg+='- State\n\n';}

if(document.getElementById('expires').value==''){
msg+='- Expires\n\n';}

var email=document.getElementById('emailaddress').value;
if(!(/^\w+([\.-]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,3})+$/.test(email))){
msg+='- Invalid Email Address: '+email+'\n\n';}

if(document.getElementById('emailaddress').value==''){
msg+='- Email Address\n\n';}

if(document.getElementById('homephone').value==''){
msg+='- Home Phone\n\n';}

if(document.getElementById('workphone').value==''){
msg+='- Work Phone\n\n';}

if(document.getElementById('celphone').value==''){
msg+='- Cel Phone\n\n';}

if(document.getElementById('allproposedoccupants').value==''){
msg+='- Name(s) of all proposed occupant(s) and relationship to applicant\n\n';}

if(document.getElementById('pets').value==''){
msg+='- Pets or service animals (number and type)\n\n';}

if(document.getElementById('automake').value==''){
msg+='- Auto Make\n\n';}

if(document.getElementById('model').value==''){
msg+='- Model\n\n';}

if(document.getElementById('autoyear').value==''){
msg+='- Year\n\n';}

if(document.getElementById('licenseno').value==''){
msg+='- License No.\n\n';}

if(document.getElementById('autostate').value==''){
msg+='- State\n\n';}

if(document.getElementById('autocolor').value==''){
msg+='- Color\n\n';}

if(document.getElementById('othervehicles').value==''){
msg+='- Other Vehicles\n\n';}

if(document.getElementById('emergencycontact').value==''){
msg+='- In Case of Emergency, Notify\n\n';}

if(document.getElementById('emergencycontactrelationship').value==''){
msg+='- Relationship\n\n';}

if(document.getElementById('emergencyphone').value==''){
msg+='- Phone\n\n';}

if(document.getElementById('emergencycontactphone2').value==''){
msg+='- Phone 2\n\n';}

if(document.getElementById('emergencycontactaddress').value==''){
msg+='- Address\n\n';}

if(!document.getElementById('liquidfilledfurniture[0]').checked && !document.getElementById('liquidfilledfurniture[1]').checked){
msg+='- Does the applicant or any proposed occupant plan to use liquid filled furniture?\n\n';}

if(document.getElementById('waterfurnituretype').value==''){
msg+='- If so, what type?\n\n';}

if(!document.getElementById('bankruptcy[0]').checked && !document.getElementById('bankruptcy[1]').checked){
msg+='- Has the applicant been a party to an unlawful detainer action or file bankruptcy within the last seven years?\n\n';}

if(document.getElementById('explainbk').value==''){
msg+='- If yes, explain\n\n';}

if(!document.getElementById('felony[0]').checked && !document.getElementById('felony[1]').checked){
msg+='- Has the applicant or any proposed occupant ever been convicted of or pleaded no contest to a felony?\n\n';}

if(document.getElementById('explainfelony').value==''){
msg+='- If yes, explain\n\n';}

if(!document.getElementById('askedtomoveoutofaresidence[0]').checked && !document.getElementById('askedtomoveoutofaresidence[1]').checked){
msg+='- Has the applicant or any proposed occupant ever been asked to move out of a residence?\n\n';}

if(document.getElementById('explainwhyaskedtoleave').value==''){
msg+='- If yes, explain\n\n';}

if(document.getElementById('currentaddress').value==''){
msg+='- Current Address\n\n';}

if(document.getElementById('datesoftenancy').value==''){
msg+='- Dates of Tenancy\n\n';}

if(document.getElementById('nameoflandlordcurrentaddress').value==''){
msg+='- Name of Landlord\n\n';}

if(document.getElementById('currentlandlordphone').value==''){
msg+='- Phone\n\n';}

if(!document.getElementById('currentaddressown[0]').checked && !document.getElementById('currentaddressown[1]').checked){
msg+='- Did you own this property?\n\n';}

if(document.getElementById('previousaddress').value==''){
msg+='- Previous Address (Up to 10 years of residence history)\n\n';}

if(document.getElementById('previousaddressdatesoftenancy').value==''){
msg+='- Dates of Tenancy\n\n';}

if(document.getElementById('previousaddresslandlord').value==''){
msg+='- Name of Landlord\n\n';}

if(document.getElementById('previousaddresslandlordphone').value==''){
msg+='- Phone\n\n';}

if(!document.getElementById('ownpreviousaddress[0]').checked && !document.getElementById('ownpreviousaddress[1]').checked){
msg+='- Did you own this property?\n\n';}

if(document.getElementById('previousaddress2').value==''){
msg+='- Previous Address (Up to 10 years of residence history)\n\n';}

if(document.getElementById('tenancydatesaddress3').value==''){
msg+='- Dates of Tenancy\n\n';}

if(document.getElementById('landlordaddress3').value==''){
msg+='- Name of Landlord\n\n';}

if(document.getElementById('landlordaddress3phone').value==''){
msg+='- Phone\n\n';}

if(!document.getElementById('ownproperty3[0]').checked && !document.getElementById('ownproperty3[1]').checked){
msg+='- Did you own this property\n\n';}

if(document.getElementById('currentemployer').value==''){
msg+='- Current Employer\n\n';}

if(document.getElementById('supervisorcurrentjob').value==''){
msg+='- Supervisor\n\n';}

if(document.getElementById('currentsupervisorsphone').value==''){
msg+='- Supervisor Phone No.\n\n';}

if(document.getElementById('currentjobaddress').value==''){
msg+='- Complete Address\n\n';}

if(document.getElementById('currentjobphone').value==''){
msg+='- Phone\n\n';}

if(document.getElementById('annualgrosscurrentjob').value==''){
msg+='- Annual Gross Income\n\n';}

if(document.getElementById('currentjobtitle').value==''){
msg+='- Job Title\n\n';}

if(document.getElementById('lengthofemploymentcurrentjob').value==''){
msg+='- Length of Employment\n\n';}

if(document.getElementById('previousemployer').value==''){
msg+='- Previous Employer (Up to 10 years of residence history)\n\n';}

if(document.getElementById('previoussupervisor').value==''){
msg+='- Supervisor\n\n';}

if(document.getElementById('previoussupervisorphone').value==''){
msg+='- Supervisor Phone No.\n\n';}

if(document.getElementById('previousjobaddress').value==''){
msg+='- Complete Address\n\n';}

if(document.getElementById('previousjobphone').value==''){
msg+='- Phone\n\n';}

if(document.getElementById('previousjobannualgrossincome').value==''){
msg+='- Annual Gross Income\n\n';}

if(document.getElementById('previousjobtitle').value==''){
msg+='- Job Title\n\n';}

if(document.getElementById('previousjoblengthofemployment').value==''){
msg+='- Length of Employment\n\n';}

if(document.getElementById('employer3').value==''){
msg+='- Previous Employer (Up to 10 years of residence history) \n\n';}

if(document.getElementById('job3supervisor').value==''){
msg+='- Supervisor\n\n';}

if(document.getElementById('supervisorphonejob3').value==''){
msg+='- Supervisor Phone No.\n\n';}

if(document.getElementById('job3address').value==''){
msg+='- Complete Address\n\n';}

if(document.getElementById('job3phone').value==''){
msg+='- Phone\n\n';}

if(document.getElementById('job3annualgrossincome').value==''){
msg+='- Annual Gross Income\n\n';}

if(document.getElementById('job3title').value==''){
msg+='- Job Title\n\n';}

if(document.getElementById('job3lengthofemployment').value==''){
msg+='- Length of Employment\n\n';}

if(document.getElementById('creditor1').value==''){
msg+='- Name of Creditor\n\n';}

if(document.getElementById('creditor1acctnumber').value==''){
msg+='- Account Number\n\n';}

if(document.getElementById('creditor1monthlypayment').value==''){
msg+='- Monthly Payment\n\n';}

if(document.getElementById('creditor1balance').value==''){
msg+='- Balance\n\n';}

if(document.getElementById('nameofcreditor2').value==''){
msg+='- Name of Creditor\n\n';}

if(document.getElementById('accountnumbercreditor2').value==''){
msg+='- Account Number\n\n';}

if(document.getElementById('creditor2monthlypayment').value==''){
msg+='- Monthly Payment\n\n';}

if(document.getElementById('creditor2acctbalance').value==''){
msg+='- Account Balance\n\n';}

if(document.getElementById('personalreference1').value==''){
msg+='- Personal Reference\n\n';}

if(document.getElementById('personalreferenceaddress').value==''){
msg+='- Address\n\n';}

if(document.getElementById('personalreferencephone').value==''){
msg+='- Phone\n\n';}

if(document.getElementById('lengthofacquainance').value==''){
msg+='- Length of Acquaintance\n\n';}

if(document.getElementById('personalreference2').value==''){
msg+='- Personal Reference\n\n';}

if(document.getElementById('reference2address').value==''){
msg+='- Address\n\n';}

if(document.getElementById('reference2phone').value==''){
msg+='- Phone\n\n';}

if(document.getElementById('reference2lengthofacquaintance').value==''){
msg+='- Length of Acquaintance\n\n';}

if(document.getElementById('nearestrelative').value==''){
msg+='- Nearest Relative\n\n';}

if(document.getElementById('nearestrelativeaddress').value==''){
msg+='- Address\n\n';}

if(document.getElementById('nearestrelativephone').value==''){
msg+='- Phone\n\n';}

if(document.getElementById('nearestrelativerelationship').value==''){
msg+='- Relationship\n\n';}

if(document.getElementById('nearestrelative2').value==''){
msg+='- Nearest Relative 2\n\n';}

if(document.getElementById('relative2address').value==''){
msg+='- Address\n\n';}

if(document.getElementById('relative2phone').value==''){
msg+='- Phone\n\n';}

if(document.getElementById('relative2relationship').value==''){
msg+='- Relationship\n\n';}

if(document.getElementById('qualifications').value==''){
msg+='- Use this space to add any additional information necessary to describe your full qualifications for the position which you are applying:\n\n';}

if(msg!=''){
alert('The following fields are empty or invalid:\n\n'+msg);
return false
}else{
return true }

}
</script>
<form name='tenantapplication' action='action=\"http://www.yourwebsite.com/yourprocessscript.php\".' method='POST' enctype='application/x-www-form-urlencoded' onsubmit='return verifyMe();'>
<table class='table_form_1' id='table_form_1' cellspacing='0'>
<tr>
	<td class='ftbl_row_1' ><LABEL for='applicant' ACCESSKEY='none' ><b style='color:red'>*</b>Applicant is completing application as a
	</td>
	<td class='ftbl_row_1a' ><select name='applicant' id='applicant'>
		<option value='tenant'>tenant</option>
		<option value=' tenant with co-tenant(s)'> tenant with co-tenant(s)</option>
		<option value=' guarantor/co-signor'> guarantor/co-signor</option>
	</select>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='numberofapplicants' ACCESSKEY='none' ><b style='color:red'>*</b>Total number of applicants
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='numberofapplicants' id='numberofapplicants' size='2' maxlength='2'  value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='propertyaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Application to rent property at: (address)
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='propertyaddress' id='propertyaddress' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='monthlyrent' ACCESSKEY='none' ><b style='color:red'>*</b>Monthly rent
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='monthlyrent' id='monthlyrent' size='6' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='moveindate' ACCESSKEY='none' ><b style='color:red'>*</b>Proposed move-in date
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='moveindate' id='moveindate' size='8' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='fullname' ACCESSKEY='none' ><b style='color:red'>*</b>Full name
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='fullname' id='fullname' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='socialsecurtyno' ACCESSKEY='none' ><b style='color:red'>*</b>Social security no.
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='socialsecurtyno' id='socialsecurtyno' size='11' maxlength='11'  value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='driverslicense' ACCESSKEY='none' ><b style='color:red'>*</b>Drivers License No.
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='driverslicense' id='driverslicense' size='12' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='state' ACCESSKEY='none' ><b style='color:red'>*</b>State
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='state' id='state' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='expires' ACCESSKEY='none' ><b style='color:red'>*</b>Expires
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='expires' id='expires' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='emailaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Email Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='emailaddress' id='emailaddress' size='30' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='homephone' ACCESSKEY='none' ><b style='color:red'>*</b>Home Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='homephone' id='homephone' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='workphone' ACCESSKEY='none' ><b style='color:red'>*</b>Work Phone
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='workphone' id='workphone' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='celphone' ACCESSKEY='none' ><b style='color:red'>*</b>Cel Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='celphone' id='celphone' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='allproposedoccupants' ACCESSKEY='none' ><b style='color:red'>*</b>Name(s) of all proposed occupant(s) and relationship to applicant
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='allproposedoccupants' id='allproposedoccupants' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='pets' ACCESSKEY='none' ><b style='color:red'>*</b>Pets or service animals (number and type)
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='pets' id='pets' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='automake' ACCESSKEY='none' ><b style='color:red'>*</b>Auto Make
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='automake' id='automake' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='model' ACCESSKEY='none' ><b style='color:red'>*</b>Model
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='model' id='model' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='autoyear' ACCESSKEY='none' ><b style='color:red'>*</b>Year
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='autoyear' id='autoyear' size='4' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='licenseno' ACCESSKEY='none' ><b style='color:red'>*</b>License No.
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='licenseno' id='licenseno' size='9' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='autostate' ACCESSKEY='none' ><b style='color:red'>*</b>State
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='autostate' id='autostate' size='2' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='autocolor' ACCESSKEY='none' ><b style='color:red'>*</b>Color
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='autocolor' id='autocolor' size='9' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='othervehicles' ACCESSKEY='none' ><b style='color:red'>*</b>Other Vehicles
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='othervehicles' id='othervehicles' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='emergencycontact' ACCESSKEY='none' ><b style='color:red'>*</b>In Case of Emergency, Notify
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='emergencycontact' id='emergencycontact' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='emergencycontactrelationship' ACCESSKEY='none' ><b style='color:red'>*</b>Relationship
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='emergencycontactrelationship' id='emergencycontactrelationship' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='emergencyphone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='emergencyphone' id='emergencyphone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='emergencycontactphone2' ACCESSKEY='none' ><b style='color:red'>*</b>Phone 2
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='emergencycontactphone2' id='emergencycontactphone2' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='emergencycontactaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Address
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='emergencycontactaddress' id='emergencycontactaddress' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><b style='color:red'>*</b>Does the applicant or any proposed occupant plan to use liquid filled furniture?
	</td>
	<td class='ftbl_row_1a' >
		<LABEL ACCESSKEY=''><input type='radio' name='liquidfilledfurniture' id='liquidfilledfurniture[0]' value=''></LABEL> 
		<LABEL ACCESSKEY=''><input type='radio' name='liquidfilledfurniture' id='liquidfilledfurniture[1]' value=''></LABEL> 
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='waterfurnituretype' ACCESSKEY='none' ><b style='color:red'>*</b>If so, what type?
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='waterfurnituretype' id='waterfurnituretype' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><b style='color:red'>*</b>Has the applicant been a party to an unlawful detainer action or file bankruptcy within the last seven years?
	</td>
	<td class='ftbl_row_1a' >
		<LABEL ACCESSKEY=''><input type='radio' name='bankruptcy' id='bankruptcy[0]' value=''></LABEL> 
		<LABEL ACCESSKEY=''><input type='radio' name='bankruptcy' id='bankruptcy[1]' value=''></LABEL> 
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='explainbk' ACCESSKEY='none' ><b style='color:red'>*</b>If yes, explain
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='explainbk' id='explainbk' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><b style='color:red'>*</b>Has the applicant or any proposed occupant ever been convicted of or pleaded no contest to a felony?
	</td>
	<td class='ftbl_row_1a' >
		<LABEL ACCESSKEY=''><input type='radio' name='felony' id='felony[0]' value=''></LABEL> 
		<LABEL ACCESSKEY=''><input type='radio' name='felony' id='felony[1]' value=''></LABEL> 
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='explainfelony' ACCESSKEY='none' ><b style='color:red'>*</b>If yes, explain
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='explainfelony' id='explainfelony' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><b style='color:red'>*</b>Has the applicant or any proposed occupant ever been asked to move out of a residence?
	</td>
	<td class='ftbl_row_1a' >
		<LABEL ACCESSKEY=''><input type='radio' name='askedtomoveoutofaresidence' id='askedtomoveoutofaresidence[0]' value=''></LABEL> 
		<LABEL ACCESSKEY=''><input type='radio' name='askedtomoveoutofaresidence' id='askedtomoveoutofaresidence[1]' value=''></LABEL> 
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='explainwhyaskedtoleave' ACCESSKEY='none' ><b style='color:red'>*</b>If yes, explain
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='explainwhyaskedtoleave' id='explainwhyaskedtoleave' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='currentaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Current Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='currentaddress' id='currentaddress' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='datesoftenancy' ACCESSKEY='none' ><b style='color:red'>*</b>Dates of Tenancy
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='datesoftenancy' id='datesoftenancy' size='23' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='nameoflandlordcurrentaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Name of Landlord
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='nameoflandlordcurrentaddress' id='nameoflandlordcurrentaddress' size='23' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='currentlandlordphone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='currentlandlordphone' id='currentlandlordphone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><b style='color:red'>*</b>Did you own this property?
	</td>
	<td class='ftbl_row_1a' >
		<LABEL ACCESSKEY=''><input type='radio' name='currentaddressown' id='currentaddressown[0]' value=''></LABEL> 
		<LABEL ACCESSKEY=''><input type='radio' name='currentaddressown' id='currentaddressown[1]' value=''></LABEL> 
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='previousaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Previous Address (Up to 10 years of residence history)
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='previousaddress' id='previousaddress' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='previousaddressdatesoftenancy' ACCESSKEY='none' ><b style='color:red'>*</b>Dates of Tenancy
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='previousaddressdatesoftenancy' id='previousaddressdatesoftenancy' size='23' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='previousaddresslandlord' ACCESSKEY='none' ><b style='color:red'>*</b>Name of Landlord
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='previousaddresslandlord' id='previousaddresslandlord' size='23' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='previousaddresslandlordphone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='previousaddresslandlordphone' id='previousaddresslandlordphone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><b style='color:red'>*</b>Did you own this property?
	</td>
	<td class='ftbl_row_2a' >
		<LABEL ACCESSKEY=''><input type='radio' name='ownpreviousaddress' id='ownpreviousaddress[0]' value=''></LABEL> 
		<LABEL ACCESSKEY=''><input type='radio' name='ownpreviousaddress' id='ownpreviousaddress[1]' value=''></LABEL> 
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='previousaddress2' ACCESSKEY='none' ><b style='color:red'>*</b>Previous Address (Up to 10 years of residence history)
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='previousaddress2' id='previousaddress2' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='tenancydatesaddress3' ACCESSKEY='none' ><b style='color:red'>*</b>Dates of Tenancy
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='tenancydatesaddress3' id='tenancydatesaddress3' size='23' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='landlordaddress3' ACCESSKEY='none' ><b style='color:red'>*</b>Name of Landlord
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='landlordaddress3' id='landlordaddress3' size='23' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='landlordaddress3phone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='landlordaddress3phone' id='landlordaddress3phone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><b style='color:red'>*</b>Did you own this property
	</td>
	<td class='ftbl_row_1a' >
		<LABEL ACCESSKEY=''><input type='radio' name='ownproperty3' id='ownproperty3[0]' value=''></LABEL> 
		<LABEL ACCESSKEY=''><input type='radio' name='ownproperty3' id='ownproperty3[1]' value=''></LABEL> 
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='currentemployer' ACCESSKEY='none' ><b style='color:red'>*</b>Current Employer
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='currentemployer' id='currentemployer' size='25' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='supervisorcurrentjob' ACCESSKEY='none' ><b style='color:red'>*</b>Supervisor
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='supervisorcurrentjob' id='supervisorcurrentjob' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='currentsupervisorsphone' ACCESSKEY='none' ><b style='color:red'>*</b>Supervisor Phone No.
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='currentsupervisorsphone' id='currentsupervisorsphone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='currentjobaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Complete Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='currentjobaddress' id='currentjobaddress' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='currentjobphone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='currentjobphone' id='currentjobphone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='annualgrosscurrentjob' ACCESSKEY='none' ><b style='color:red'>*</b>Annual Gross Income
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='annualgrosscurrentjob' id='annualgrosscurrentjob' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='currentjobtitle' ACCESSKEY='none' ><b style='color:red'>*</b>Job Title
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='currentjobtitle' id='currentjobtitle' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='lengthofemploymentcurrentjob' ACCESSKEY='none' ><b style='color:red'>*</b>Length of Employment
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='lengthofemploymentcurrentjob' id='lengthofemploymentcurrentjob' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='previousemployer' ACCESSKEY='none' ><b style='color:red'>*</b>Previous Employer (Up to 10 years of residence history)
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='previousemployer' id='previousemployer' size='25' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='previoussupervisor' ACCESSKEY='none' ><b style='color:red'>*</b>Supervisor
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='previoussupervisor' id='previoussupervisor' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='previoussupervisorphone' ACCESSKEY='none' ><b style='color:red'>*</b>Supervisor Phone No.
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='previoussupervisorphone' id='previoussupervisorphone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='previousjobaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Complete Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='previousjobaddress' id='previousjobaddress' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='previousjobphone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='previousjobphone' id='previousjobphone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='previousjobannualgrossincome' ACCESSKEY='none' ><b style='color:red'>*</b>Annual Gross Income
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='previousjobannualgrossincome' id='previousjobannualgrossincome' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='previousjobtitle' ACCESSKEY='none' ><b style='color:red'>*</b>Job Title
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='previousjobtitle' id='previousjobtitle' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='previousjoblengthofemployment' ACCESSKEY='none' ><b style='color:red'>*</b>Length of Employment
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='previousjoblengthofemployment' id='previousjoblengthofemployment' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='employer3' ACCESSKEY='none' ><b style='color:red'>*</b>Previous Employer (Up to 10 years of residence history) 
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='employer3' id='employer3' size='25' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='job3supervisor' ACCESSKEY='none' ><b style='color:red'>*</b>Supervisor
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='job3supervisor' id='job3supervisor' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='supervisorphonejob3' ACCESSKEY='none' ><b style='color:red'>*</b>Supervisor Phone No.
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='supervisorphonejob3' id='supervisorphonejob3' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='job3address' ACCESSKEY='none' ><b style='color:red'>*</b>Complete Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='job3address' id='job3address' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='job3phone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='job3phone' id='job3phone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='job3annualgrossincome' ACCESSKEY='none' ><b style='color:red'>*</b>Annual Gross Income
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='job3annualgrossincome' id='job3annualgrossincome' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='job3title' ACCESSKEY='none' ><b style='color:red'>*</b>Job Title
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='job3title' id='job3title' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='job3lengthofemployment' ACCESSKEY='none' ><b style='color:red'>*</b>Length of Employment
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='job3lengthofemployment' id='job3lengthofemployment' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='creditor1' ACCESSKEY='none' ><b style='color:red'>*</b>Name of Creditor
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='creditor1' id='creditor1' size='25' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='creditor1acctnumber' ACCESSKEY='none' ><b style='color:red'>*</b>Account Number
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='creditor1acctnumber' id='creditor1acctnumber' size='25' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='creditor1monthlypayment' ACCESSKEY='none' ><b style='color:red'>*</b>Monthly Payment
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='creditor1monthlypayment' id='creditor1monthlypayment' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='creditor1balance' ACCESSKEY='none' ><b style='color:red'>*</b>Balance
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='creditor1balance' id='creditor1balance' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='nameofcreditor2' ACCESSKEY='none' ><b style='color:red'>*</b>Name of Creditor
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='nameofcreditor2' id='nameofcreditor2' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='accountnumbercreditor2' ACCESSKEY='none' ><b style='color:red'>*</b>Account Number
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='accountnumbercreditor2' id='accountnumbercreditor2' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='creditor2monthlypayment' ACCESSKEY='none' ><b style='color:red'>*</b>Monthly Payment
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='creditor2monthlypayment' id='creditor2monthlypayment' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='creditor2acctbalance' ACCESSKEY='none' ><b style='color:red'>*</b>Account Balance
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='creditor2acctbalance' id='creditor2acctbalance' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='personalreference1' ACCESSKEY='none' ><b style='color:red'>*</b>Personal Reference
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='personalreference1' id='personalreference1' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='personalreferenceaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='personalreferenceaddress' id='personalreferenceaddress' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='personalreferencephone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='personalreferencephone' id='personalreferencephone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='lengthofacquainance' ACCESSKEY='none' ><b style='color:red'>*</b>Length of Acquaintance
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='lengthofacquainance' id='lengthofacquainance' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='personalreference2' ACCESSKEY='none' ><b style='color:red'>*</b>Personal Reference
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='personalreference2' id='personalreference2' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='reference2address' ACCESSKEY='none' ><b style='color:red'>*</b>Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='reference2address' id='reference2address' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='reference2phone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='reference2phone' id='reference2phone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='reference2lengthofacquaintance' ACCESSKEY='none' ><b style='color:red'>*</b>Length of Acquaintance
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='reference2lengthofacquaintance' id='reference2lengthofacquaintance' size='10' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='nearestrelative' ACCESSKEY='none' ><b style='color:red'>*</b>Nearest Relative
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='nearestrelative' id='nearestrelative' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='nearestrelativeaddress' ACCESSKEY='none' ><b style='color:red'>*</b>Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='nearestrelativeaddress' id='nearestrelativeaddress' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='nearestrelativephone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='nearestrelativephone' id='nearestrelativephone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='nearestrelativerelationship' ACCESSKEY='none' ><b style='color:red'>*</b>Relationship
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='nearestrelativerelationship' id='nearestrelativerelationship' size='15' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='nearestrelative2' ACCESSKEY='none' ><b style='color:red'>*</b>Nearest Relative 2
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='nearestrelative2' id='nearestrelative2' size='20' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='relative2address' ACCESSKEY='none' ><b style='color:red'>*</b>Address
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='relative2address' id='relative2address' size='45' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_2' ><LABEL for='relative2phone' ACCESSKEY='none' ><b style='color:red'>*</b>Phone
	</td>
	<td class='ftbl_row_2a' ><input type='text' name='relative2phone' id='relative2phone' size='14' value=''>
	</td>
</tr>
<tr>
	<td class='ftbl_row_1' ><LABEL for='relative2relationship' ACCESSKEY='none' ><b style='color:red'>*</b>Relationship
	</td>
	<td class='ftbl_row_1a' ><input type='text' name='relative2relationship' id='relative2relationship' size='15' value=''>
	</td>
</tr>
<tr>
	<td valign='top' class='ftbl_row_2' ><LABEL for='qualifications' ACCESSKEY='none' ><b style='color:red'>*</b>Use this space to add any additional information necessary to describe your full qualifications for the position which you are applying:
	</td>
	<td class='ftbl_row_2a' ><textarea name='qualifications' id='qualifications' cols='35' rows='6' value=''></textarea>
	</td>
</tr>
<tr>
	<td colspan='2' align='right'><input type='submit' name='submit' value='Submit'> <input type='reset' name='reset' value='Reset'><br /><a href='http://www.formgenics.com' style='font-family:arial;font-size:10px;color:#C0C0C0;text-decoration:none'>powered by FormGenics.com</a>
	</td>
</tr>
</table>
</form>

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RussellReal Member

RussellReal

Posted
Posted

I could just remake the script for you for like.. $50 and then you can have it professionally made, as I doubt anybody will help you with this, unless they're really bored, this forum is mostly to HELP ppl learn php and that code isn't even php :)

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kilerb Newbie

kilerb

Posted
  • Author
Posted

I could just remake the script for you for like.. $50 and then you can have it professionally made, as I doubt anybody will help you with this, unless they're really bored, this forum is mostly to HELP ppl learn php and that code isn't even php :)

 

Hi Russell, I emailed you at your hotmail address.  Not sure if you got it or not.  Let me know!

 

Thanks!

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