/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
* Includes a Form with javascript
* @param {Object} formId
* @param {Object} initialHeight
* @param {Object} iframeCode
*/
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
this.formId = formId;
this.initialHeight = initialHeight;
this.iframeCode = iframeCode;
this.frame = null;
this.timeInterval= 200;
this.appendTo = appendTo || false;
// initialize function for object
this.init = function(){
this.createFrame();
this.addFrameContent(this.iframeCode);
};
// Create the frame
this.createFrame = function(){
var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\">";
if(this.appendTo === false){
document.write(htmlCode);
}else{
var tmp = document.createElement('div');
tmp.innerHTML = htmlCode;
var a = this.appendTo;
document.getElementById(a).appendChild(tmp.firstChild);
}
// also get the frame for future use.
this.frame = document.getElementById(this.formId);
// set the time on the on load event of the frame
this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
};
// add event function for different browsers
this.addEvent = function( obj, type, fn ) {
if ( obj.attachEvent ) {
obj["e"+type+fn] = fn;
obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
obj.attachEvent( "on"+type, obj[type+fn] );
}
else{
obj.addEventListener( type, fn, false );
}
};
this.addFrameContent = function (string){
string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"><'+'div id="recaptcha_div"><'+'/div>'+
'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
' }<'+'/script>');
string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
frameDocument.document.open();
frameDocument.document.write(string);
setTimeout( function(){
frameDocument.document.close();
try{
if('JotFormFrameLoaded' in window){
JotFormFrameLoaded();
}
}catch(e){}
},200);
};
this.setTimer = function(){
var self = this;
this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
};
this.changeHeight = function (){
var actualHeight = this.getBodyHeight();
var currentHeight = this.getViewPortHeight();
if(actualHeight === undefined){
this.frame.style.height = "100%";
if(!this.frame.style.minHeight){
this.frame.style.minHeight = "300px";
}
}else if (Math.abs(actualHeight - currentHeight) > 18){
this.frame.style.height = (actualHeight)+"px";
}
this.setTimer();
};
this.bindMethod = function(method, scope) {
return function() {
method.apply(scope,arguments);
};
};
this.getBodyHeight = function (){
var height;
var scrollHeight;
var offsetHeight;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.document.height){
height = this.frame.contentWindow.document.height;
//Emre: to prevent "iframe height" problem (61059)
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
} else if (this.frame.contentWindow.document.body){
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
if (scrollHeight && offsetHeight){
height = Math.max(scrollHeight, offsetHeight);
}
}
}catch(e){ }
return height;
};
this.getViewPortHeight = function(){
var height = 0;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.window.innerHeight)
{
height = this.frame.contentWindow.window.innerHeight - 18;
}
else if ((this.frame.contentWindow.document.documentElement) &&
(this.frame.contentWindow.document.documentElement.clientHeight))
{
height = this.frame.contentWindow.document.documentElement.clientHeight;
}
else if ((this.frame.contentWindow.document.body) &&
(this.frame.contentWindow.document.body.clientHeight))
{
height = this.frame.contentWindow.document.body.clientHeight;
}
}catch(e){ }
return height;
};
this.init();
}
FrameBuilder.get = [];
var i10860951507 = new FrameBuilder("10860951507", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2435\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">\n .form-label{\n width:150px !important;\n }\n .form-label-left{\n width:150px !important;\n }\n .form-line{\n padding:5px;\n }\n .form-label-right{\n width:150px !important;\n }\n body, html{\n margin:0;\n padding:0;\n background:#dddddd;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:20px;\n width:470px;\n background:#dddddd;\n color:black !important;\n font-family:Verdana;\n font-size:12px;\n }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2435\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n JotForm.jsForm = true;\n\n JotForm.init(function(){\n JotForm.setCalendar(\"9\");\n JotForm.setCalendar(\"69\");\n });\n\n clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" name=\"form_10860951507\" id=\"10860951507\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"10860951507\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li class=\"form-line\" id=\"id_71\">\n <div id=\"cid_71\" class=\"form-input-wide\">\n <div id=\"text_71\" class=\"form-html\">\n <p>\n <strong><span style=\"font-size: medium; font-family: verdana,geneva;\">Exinda Evaluation Equipment<\/span>\n <\/strong>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_9\">\n <label class=\"form-label-left\" id=\"label_9\" for=\"input_9\">\n Requested Install Date (allow 2 weeks shipping)<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_9\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"month_9\" name=\"q9_requestedInstall[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_9\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"day_9\" name=\"q9_requestedInstall[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_9\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"year_9\" name=\"q9_requestedInstall[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_9\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_9_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_9_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <label class=\"form-label-left\" id=\"label_10\" for=\"input_10\">\n Product 1:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_10\" class=\"form-input\">\n <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_10\" name=\"q10_product1\">\n <option> <\/option>\n <option value=\"EX-1760\"> EX-1760 <\/option>\n <option value=\"EX-1860\"> EX-1860 <\/option>\n <option value=\"EX-2760\"> EX-2760 <\/option>\n <option value=\"EX-2860\"> EX-2860 <\/option>\n <option value=\"EX-4761\"> EX-4761 <\/option>\n <option value=\"EX-4861\"> EX-4861 <\/option>\n <option value=\"EX-6760\"> EX-6760 <\/option>\n <option value=\"EX-6860\"> EX-6860 <\/option>\n <option value=\"EX-8760\"> EX-8760 <\/option>\n <option value=\"EX-8860\"> EX-8860 <\/option>\n <option value=\"EX-10760\"> EX-10760 <\/option>\n <option value=\"EX-10860\"> EX-10860 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_11\">\n <label class=\"form-label-left\" id=\"label_11\" for=\"input_11\"> Qty: <\/label>\n <div id=\"cid_11\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:50px\" id=\"input_11\" name=\"q11_qty11\">\n <option> <\/option>\n <option value=\"1\"> 1 <\/option>\n <option value=\"2\"> 2 <\/option>\n <option value=\"3\"> 3 <\/option>\n <option value=\"4\"> 4 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_81\">\n <label class=\"form-label-left\" id=\"label_81\" for=\"input_81\"> Internet Link Size: <\/label>\n <div id=\"cid_81\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_81\" name=\"q81_internetLink81\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_13\">\n <label class=\"form-label-left\" id=\"label_13\" for=\"input_13\"> Product 2: <\/label>\n <div id=\"cid_13\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_13\" name=\"q13_product2\">\n <option> <\/option>\n <option value=\"EX-1760\"> EX-1760 <\/option>\n <option value=\"EX-1860\"> EX-1860 <\/option>\n <option value=\"EX-2760\"> EX-2760 <\/option>\n <option value=\"EX-2860\"> EX-2860 <\/option>\n <option value=\"EX-4761\"> EX-4761 <\/option>\n <option value=\"EX-4861\"> EX-4861 <\/option>\n <option value=\"EX-6760\"> EX-6760 <\/option>\n <option value=\"EX-6860\"> EX-6860 <\/option>\n <option value=\"EX-8760\"> EX-8760 <\/option>\n <option value=\"EX-8860\"> EX-8860 <\/option>\n <option value=\"EX-10760\"> EX-10760 <\/option>\n <option value=\"EX-10860\"> EX-10860 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_14\">\n <label class=\"form-label-left\" id=\"label_14\" for=\"input_14\"> Qty: <\/label>\n <div id=\"cid_14\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:50px\" id=\"input_14\" name=\"q14_qty14\">\n <option> <\/option>\n <option value=\"1 \"> 1 <\/option>\n <option value=\"2 \"> 2 <\/option>\n <option value=\"3 \"> 3 <\/option>\n <option value=\"4\"> 4 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_82\">\n <label class=\"form-label-left\" id=\"label_82\" for=\"input_82\"> Internet Link Size: <\/label>\n <div id=\"cid_82\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_82\" name=\"q82_internetLink82\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_16\">\n <label class=\"form-label-left\" id=\"label_16\" for=\"input_16\"> Product 3: <\/label>\n <div id=\"cid_16\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_16\" name=\"q16_product3\">\n <option> <\/option>\n <option value=\"EX-1760\"> EX-1760 <\/option>\n <option value=\"EX-1860\"> EX-1860 <\/option>\n <option value=\"EX-2760\"> EX-2760 <\/option>\n <option value=\"EX-2860\"> EX-2860 <\/option>\n <option value=\"EX-4761\"> EX-4761 <\/option>\n <option value=\"EX-4861\"> EX-4861 <\/option>\n <option value=\"EX-6760\"> EX-6760 <\/option>\n <option value=\"EX-6860\"> EX-6860 <\/option>\n <option value=\"EX-8760\"> EX-8760 <\/option>\n <option value=\"EX-8860\"> EX-8860 <\/option>\n <option value=\"EX-10760\"> EX-10760 <\/option>\n <option value=\"EX-10860\"> EX-10860 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_17\">\n <label class=\"form-label-left\" id=\"label_17\" for=\"input_17\"> Qty: <\/label>\n <div id=\"cid_17\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:50px\" id=\"input_17\" name=\"q17_qty17\">\n <option> <\/option>\n <option value=\"1\"> 1 <\/option>\n <option value=\"2\"> 2 <\/option>\n <option value=\"3\"> 3 <\/option>\n <option value=\"4\"> 4 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_84\">\n <label class=\"form-label-left\" id=\"label_84\" for=\"input_84\"> Internet Link Size: <\/label>\n <div id=\"cid_84\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_84\" name=\"q84_internetLink\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_32\">\n <div id=\"cid_32\" class=\"form-input-wide\">\n <div id=\"text_32\" class=\"form-html\">\n <p>\n <strong>\n Primary Shipping Address\n <\/strong>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_33\">\n <label class=\"form-label-left\" id=\"label_33\" for=\"input_33\">\n Street Address:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_33\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_33\" name=\"q33_streetAddress\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_35\">\n <label class=\"form-label-left\" id=\"label_35\" for=\"input_35\"> Address Line 2: <\/label>\n <div id=\"cid_35\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_35\" name=\"q35_addressLine\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_36\">\n <label class=\"form-label-left\" id=\"label_36\" for=\"input_36\">\n City:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_36\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_36\" name=\"q36_city\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_76\">\n <label class=\"form-label-left\" id=\"label_76\" for=\"input_76\">\n State:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_76\" class=\"form-input\">\n <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_76\" name=\"q76_state76\">\n <option> <\/option>\n <option value=\"Alabama \"> Alabama <\/option>\n <option value=\"Alaska \"> Alaska <\/option>\n <option value=\"Arizona \"> Arizona <\/option>\n <option value=\"Arkansas \"> Arkansas <\/option>\n <option value=\"California \"> California <\/option>\n <option value=\"Colorado \"> Colorado <\/option>\n <option value=\"Connecticut \"> Connecticut <\/option>\n <option value=\"Delaware \"> Delaware <\/option>\n <option value=\"District of Columbia \"> District of Columbia <\/option>\n <option value=\"Florida \"> Florida <\/option>\n <option value=\"Georgia \"> Georgia <\/option>\n <option value=\"Hawaii \"> Hawaii <\/option>\n <option value=\"Idaho \"> Idaho <\/option>\n <option value=\"Illinois \"> Illinois <\/option>\n <option value=\"Indiana \"> Indiana <\/option>\n <option value=\"Iowa \"> Iowa <\/option>\n <option value=\"Kansas \"> Kansas <\/option>\n <option value=\"Kentucky \"> Kentucky <\/option>\n <option value=\"Louisiana \"> Louisiana <\/option>\n <option value=\"Maine \"> Maine <\/option>\n <option value=\"Maryland \"> Maryland <\/option>\n <option value=\"Massachusetts \"> Massachusetts <\/option>\n <option value=\"Michigan \"> Michigan <\/option>\n <option value=\"Minnesota \"> Minnesota <\/option>\n <option value=\"Mississippi \"> Mississippi <\/option>\n <option value=\"Missouri \"> Missouri <\/option>\n <option value=\"Montana \"> Montana <\/option>\n <option value=\"Nebraska \"> Nebraska <\/option>\n <option value=\"Nevada \"> Nevada <\/option>\n <option value=\"New Hampshire \"> New Hampshire <\/option>\n <option value=\"New Jersey \"> New Jersey <\/option>\n <option value=\"New Mexico \"> New Mexico <\/option>\n <option value=\"New York \"> New York <\/option>\n <option value=\"North Carolina \"> North Carolina <\/option>\n <option value=\"North Dakota \"> North Dakota <\/option>\n <option value=\"Ohio \"> Ohio <\/option>\n <option value=\"Oklahoma \"> Oklahoma <\/option>\n <option value=\"Oregon \"> Oregon <\/option>\n <option value=\"Pennsylvania \"> Pennsylvania <\/option>\n <option value=\"Rhode Island \"> Rhode Island <\/option>\n <option value=\"South Carolina \"> South Carolina <\/option>\n <option value=\"South Dakota \"> South Dakota <\/option>\n <option value=\"Tennessee \"> Tennessee <\/option>\n <option value=\"Texas \"> Texas <\/option>\n <option value=\"Utah \"> Utah <\/option>\n <option value=\"Vermont \"> Vermont <\/option>\n <option value=\"Virginia \"> Virginia <\/option>\n <option value=\"Washington \"> Washington <\/option>\n <option value=\"West Virginia \"> West Virginia <\/option>\n <option value=\"Wisconsin \"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_38\">\n <label class=\"form-label-left\" id=\"label_38\" for=\"input_38\">\n Zip:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_38\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_38\" name=\"q38_zip\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_39\">\n <div id=\"cid_39\" class=\"form-input-wide\">\n <div id=\"text_39\" class=\"form-html\">\n <p>\n <strong>\n Shipping Address Two\n <\/strong>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_40\">\n <label class=\"form-label-left\" id=\"label_40\" for=\"input_40\"> Street Address: <\/label>\n <div id=\"cid_40\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_40\" name=\"q40_streetAddress40\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_41\">\n <label class=\"form-label-left\" id=\"label_41\" for=\"input_41\"> Address Line 2: <\/label>\n <div id=\"cid_41\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_41\" name=\"q41_addressLine41\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_42\">\n <label class=\"form-label-left\" id=\"label_42\" for=\"input_42\"> City: <\/label>\n <div id=\"cid_42\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_42\" name=\"q42_city42\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_77\">\n <label class=\"form-label-left\" id=\"label_77\" for=\"input_77\"> State: <\/label>\n <div id=\"cid_77\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_77\" name=\"q77_state77\">\n <option> <\/option>\n <option value=\"Alabama \"> Alabama <\/option>\n <option value=\"Alaska \"> Alaska <\/option>\n <option value=\"Arizona \"> Arizona <\/option>\n <option value=\"Arkansas \"> Arkansas <\/option>\n <option value=\"California \"> California <\/option>\n <option value=\"Colorado \"> Colorado <\/option>\n <option value=\"Connecticut \"> Connecticut <\/option>\n <option value=\"Delaware \"> Delaware <\/option>\n <option value=\"District of Columbia \"> District of Columbia <\/option>\n <option value=\"Florida \"> Florida <\/option>\n <option value=\"Georgia \"> Georgia <\/option>\n <option value=\"Hawaii \"> Hawaii <\/option>\n <option value=\"Idaho \"> Idaho <\/option>\n <option value=\"Illinois \"> Illinois <\/option>\n <option value=\"Indiana \"> Indiana <\/option>\n <option value=\"Iowa \"> Iowa <\/option>\n <option value=\"Kansas \"> Kansas <\/option>\n <option value=\"Kentucky \"> Kentucky <\/option>\n <option value=\"Louisiana \"> Louisiana <\/option>\n <option value=\"Maine \"> Maine <\/option>\n <option value=\"Maryland \"> Maryland <\/option>\n <option value=\"Massachusetts \"> Massachusetts <\/option>\n <option value=\"Michigan \"> Michigan <\/option>\n <option value=\"Minnesota \"> Minnesota <\/option>\n <option value=\"Mississippi \"> Mississippi <\/option>\n <option value=\"Missouri \"> Missouri <\/option>\n <option value=\"Montana \"> Montana <\/option>\n <option value=\"Nebraska \"> Nebraska <\/option>\n <option value=\"Nevada \"> Nevada <\/option>\n <option value=\"New Hampshire \"> New Hampshire <\/option>\n <option value=\"New Jersey \"> New Jersey <\/option>\n <option value=\"New Mexico \"> New Mexico <\/option>\n <option value=\"New York \"> New York <\/option>\n <option value=\"North Carolina \"> North Carolina <\/option>\n <option value=\"North Dakota \"> North Dakota <\/option>\n <option value=\"Ohio \"> Ohio <\/option>\n <option value=\"Oklahoma \"> Oklahoma <\/option>\n <option value=\"Oregon \"> Oregon <\/option>\n <option value=\"Pennsylvania \"> Pennsylvania <\/option>\n <option value=\"Rhode Island \"> Rhode Island <\/option>\n <option value=\"South Carolina \"> South Carolina <\/option>\n <option value=\"South Dakota \"> South Dakota <\/option>\n <option value=\"Tennessee \"> Tennessee <\/option>\n <option value=\"Texas \"> Texas <\/option>\n <option value=\"Utah \"> Utah <\/option>\n <option value=\"Vermont \"> Vermont <\/option>\n <option value=\"Virginia \"> Virginia <\/option>\n <option value=\"Washington \"> Washington <\/option>\n <option value=\"West Virginia \"> West Virginia <\/option>\n <option value=\"Wisconsin \"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_44\">\n <label class=\"form-label-left\" id=\"label_44\" for=\"input_44\"> Zip: <\/label>\n <div id=\"cid_44\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_44\" name=\"q44_zip44\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_45\">\n <div id=\"cid_45\" class=\"form-input-wide\">\n <div id=\"text_45\" class=\"form-html\">\n <p>\n <strong>\n Shipping Address Three\n <\/strong>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_46\">\n <label class=\"form-label-left\" id=\"label_46\" for=\"input_46\"> Street Address: <\/label>\n <div id=\"cid_46\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_46\" name=\"q46_streetAddress46\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_47\">\n <label class=\"form-label-left\" id=\"label_47\" for=\"input_47\"> Address Line 2: <\/label>\n <div id=\"cid_47\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_47\" name=\"q47_addressLine47\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_48\">\n <label class=\"form-label-left\" id=\"label_48\" for=\"input_48\"> City: <\/label>\n <div id=\"cid_48\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_48\" name=\"q48_city48\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_78\">\n <label class=\"form-label-left\" id=\"label_78\" for=\"input_78\"> State: <\/label>\n <div id=\"cid_78\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_78\" name=\"q78_state\">\n <option> <\/option>\n <option value=\"Alabama \"> Alabama <\/option>\n <option value=\"Alaska \"> Alaska <\/option>\n <option value=\"Arizona \"> Arizona <\/option>\n <option value=\"Arkansas \"> Arkansas <\/option>\n <option value=\"California \"> California <\/option>\n <option value=\"Colorado \"> Colorado <\/option>\n <option value=\"Connecticut \"> Connecticut <\/option>\n <option value=\"Delaware \"> Delaware <\/option>\n <option value=\"District of Columbia \"> District of Columbia <\/option>\n <option value=\"Florida \"> Florida <\/option>\n <option value=\"Georgia \"> Georgia <\/option>\n <option value=\"Hawaii \"> Hawaii <\/option>\n <option value=\"Idaho \"> Idaho <\/option>\n <option value=\"Illinois \"> Illinois <\/option>\n <option value=\"Indiana \"> Indiana <\/option>\n <option value=\"Iowa \"> Iowa <\/option>\n <option value=\"Kansas \"> Kansas <\/option>\n <option value=\"Kentucky \"> Kentucky <\/option>\n <option value=\"Louisiana \"> Louisiana <\/option>\n <option value=\"Maine \"> Maine <\/option>\n <option value=\"Maryland \"> Maryland <\/option>\n <option value=\"Massachusetts \"> Massachusetts <\/option>\n <option value=\"Michigan \"> Michigan <\/option>\n <option value=\"Minnesota \"> Minnesota <\/option>\n <option value=\"Mississippi \"> Mississippi <\/option>\n <option value=\"Missouri \"> Missouri <\/option>\n <option value=\"Montana \"> Montana <\/option>\n <option value=\"Nebraska \"> Nebraska <\/option>\n <option value=\"Nevada \"> Nevada <\/option>\n <option value=\"New Hampshire \"> New Hampshire <\/option>\n <option value=\"New Jersey \"> New Jersey <\/option>\n <option value=\"New Mexico \"> New Mexico <\/option>\n <option value=\"New York \"> New York <\/option>\n <option value=\"North Carolina \"> North Carolina <\/option>\n <option value=\"North Dakota \"> North Dakota <\/option>\n <option value=\"Ohio \"> Ohio <\/option>\n <option value=\"Oklahoma \"> Oklahoma <\/option>\n <option value=\"Oregon \"> Oregon <\/option>\n <option value=\"Pennsylvania \"> Pennsylvania <\/option>\n <option value=\"Rhode Island \"> Rhode Island <\/option>\n <option value=\"South Carolina \"> South Carolina <\/option>\n <option value=\"South Dakota \"> South Dakota <\/option>\n <option value=\"Tennessee \"> Tennessee <\/option>\n <option value=\"Texas \"> Texas <\/option>\n <option value=\"Utah \"> Utah <\/option>\n <option value=\"Vermont \"> Vermont <\/option>\n <option value=\"Virginia \"> Virginia <\/option>\n <option value=\"Washington \"> Washington <\/option>\n <option value=\"West Virginia \"> West Virginia <\/option>\n <option value=\"Wisconsin \"> Wisconsin <\/option>\n <option value=\"Wyoming\"> Wyoming <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_50\">\n <label class=\"form-label-left\" id=\"label_50\" for=\"input_50\"> Zip: <\/label>\n <div id=\"cid_50\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_50\" name=\"q50_zip50\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_51\">\n <div id=\"cid_51\" class=\"form-input-wide\">\n <div id=\"text_51\" class=\"form-html\">\n <p>\n <strong><span style=\"font-size: medium; font-family: verdana,geneva;\">Objective<\/span>\n <\/strong>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_52\">\n <label class=\"form-label-left\" id=\"label_52\" for=\"input_52\">\n Performance problems you're trying to solve:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_52\" class=\"form-input\">\n <textarea id=\"input_52\" class=\"form-textarea validate[required]\" name=\"q52_performanceProblems\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_53\">\n <label class=\"form-label-left\" id=\"label_53\" for=\"input_53\"> Applications you want to prioritize: <\/label>\n <div id=\"cid_53\" class=\"form-input\">\n <textarea id=\"input_53\" class=\"form-textarea\" name=\"q53_applicationsYou\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_54\">\n <div id=\"cid_54\" class=\"form-input-wide\">\n <div id=\"text_54\" class=\"form-html\">\n <p>\n <strong><span style=\"font-size: medium; font-family: verdana,geneva;\">Customer Information<\/span>\n <\/strong>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_55\">\n <label class=\"form-label-left\" id=\"label_55\" for=\"input_55\">\n First Name:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_55\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_55\" name=\"q55_firstName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_56\">\n <label class=\"form-label-left\" id=\"label_56\" for=\"input_56\">\n Last Name:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_56\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_56\" name=\"q56_lastName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_57\">\n <label class=\"form-label-left\" id=\"label_57\" for=\"input_57\">\n Organization:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_57\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_57\" name=\"q57_organization\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_58\">\n <label class=\"form-label-left\" id=\"label_58\" for=\"input_58\">\n Email:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_58\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_58\" name=\"q58_email\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_80\">\n <label class=\"form-label-left\" id=\"label_80\" for=\"input_80\">\n Phone:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_80\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q80_phone80[area]\" id=\"input_80_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_80_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q80_phone80[phone]\" id=\"input_80_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_80_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_60\">\n <div id=\"cid_60\" class=\"form-input-wide\">\n <div id=\"text_60\" class=\"form-html\">\n <p>\n <strong><span style=\"font-size: medium; font-family: verdana,geneva;\">Terms<\/span>\n <\/strong>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_69\">\n <label class=\"form-label-left\" id=\"label_69\" for=\"input_69\">\n Agreement Date<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_69\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"month_69\" name=\"q69_agreementDate[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_69\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"day_69\" name=\"q69_agreementDate[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_69\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"year_69\" name=\"q69_agreementDate[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_69\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_69_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_69_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_63\">\n <label class=\"form-label-left\" id=\"label_63\" for=\"input_63\">\n I understand and agree to abide by the terms of this evaluation.<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_63\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox validate[required]\" id=\"input_63_0\" name=\"q63_iUnderstand63[]\" value=\"Agree\" \/>\n <label for=\"input_63_0\"> Agree <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_86\">\n <div id=\"cid_86\" class=\"form-input-wide\">\n <div id=\"text_86\" class=\"form-html\">\n <p>\n See Terms and Conditions to the left of this form.\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_85\">\n <div id=\"cid_85\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_85\" type=\"submit\" class=\"form-submit-button\">\n Submit Agreement\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <li style=\"display:none\">\n Should be Empty:\n <input type=\"text\" name=\"website\" value=\"\" \/>\n <\/li>\n <\/ul>\n <\/div>\n <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"10860951507\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"10860951507-10860951507\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");