/*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 i10931316492 = new FrameBuilder("10931316492", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2434\" 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:white;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:0px;\n width:690px;\n background:white;\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?3.0.2434\" 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(\"114\");\n JotForm.setCalendar(\"119\");\n JotForm.setCalendar(\"120\");\n JotForm.setCalendar(\"117\");\n JotForm.setCalendar(\"118\");\n JotForm.setCalendar(\"116\");\n JotForm.setCalendar(\"102\");\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_10931316492\" id=\"10931316492\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"10931316492\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li id=\"cid_46\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_46\" class=\"form-header\">\n LOFFMAN PROPERTY MANAGEMENT\n <\/h2>\n <\/div>\n <\/li>\n <li id=\"cid_99\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_99\" class=\"form-header\">\n Rental Application\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_136\">\n <div id=\"cid_136\" class=\"form-input-wide\">\n <div id=\"text_136\" class=\"form-html\">\n <p>\n Before filling out this application please call our leasing agent Michelle at 916-698-5060\n <\/p>\n <p>\n or Debbie at 916-580-1051 to check on the very latest status of this property.\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_47\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_47\" class=\"form-header\">\n Property Address Applying For\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_94\">\n <label class=\"form-label-left\" id=\"label_94\" for=\"input_94\">\n Property Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_94\" class=\"form-input\">\n <textarea id=\"input_94\" class=\"form-textarea validate[required]\" name=\"q94_propertyAddress94\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_114\">\n <label class=\"form-label-left\" id=\"label_114\" for=\"input_114\"> Desired Move In Date <\/label>\n <div id=\"cid_114\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_114\" name=\"q114_desiredMove[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_114\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_114\" name=\"q114_desiredMove[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_114\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_114\" name=\"q114_desiredMove[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_114\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_114\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_114\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_114\" name=\"q114_desiredMove[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"00\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_114\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_114\" name=\"q114_desiredMove[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"44\" \/>\n <label class=\"form-sub-label\" for=\"min_114\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_114\" name=\"q114_desiredMove[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_114\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_114_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_114_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li id=\"cid_95\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_95\" class=\"form-header\">\n Your Information\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_15\">\n <label class=\"form-label-left\" id=\"label_15\" for=\"input_15\">\n First Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_15\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_15\" name=\"q15_firstName\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_16\">\n <label class=\"form-label-left\" id=\"label_16\" for=\"input_16\"> Middle Name <\/label>\n <div id=\"cid_16\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_16\" name=\"q16_middleName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_14\">\n <label class=\"form-label-left\" id=\"label_14\" for=\"input_14\">\n Last Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_14\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_14\" name=\"q14_lastName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_17\">\n <label class=\"form-label-left\" id=\"label_17\" for=\"input_17\">\n Social Security Number<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_17\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_17\" name=\"q17_socialSecurity\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_143\">\n <label class=\"form-label-left\" id=\"label_143\" for=\"input_143\">\n Date of Birth<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_143\" class=\"form-input\"><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q143_dateOf[month]\" id=\"input_143_month\">\n <option> <\/option>\n <option value=\"January\"> January <\/option>\n <option value=\"February\"> February <\/option>\n <option value=\"March\"> March <\/option>\n <option value=\"April\"> April <\/option>\n <option value=\"May\"> May <\/option>\n <option value=\"June\"> June <\/option>\n <option value=\"July\"> July <\/option>\n <option value=\"August\"> August <\/option>\n <option value=\"September\"> September <\/option>\n <option value=\"October\"> October <\/option>\n <option value=\"November\"> November <\/option>\n <option value=\"December\"> December <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_143_month\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q143_dateOf[day]\" id=\"input_143_day\">\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 <option value=\"5\"> 5 <\/option>\n <option value=\"6\"> 6 <\/option>\n <option value=\"7\"> 7 <\/option>\n <option value=\"8\"> 8 <\/option>\n <option value=\"9\"> 9 <\/option>\n <option value=\"10\"> 10 <\/option>\n <option value=\"11\"> 11 <\/option>\n <option value=\"12\"> 12 <\/option>\n <option value=\"13\"> 13 <\/option>\n <option value=\"14\"> 14 <\/option>\n <option value=\"15\"> 15 <\/option>\n <option value=\"16\"> 16 <\/option>\n <option value=\"17\"> 17 <\/option>\n <option value=\"18\"> 18 <\/option>\n <option value=\"19\"> 19 <\/option>\n <option value=\"20\"> 20 <\/option>\n <option value=\"21\"> 21 <\/option>\n <option value=\"22\"> 22 <\/option>\n <option value=\"23\"> 23 <\/option>\n <option value=\"24\"> 24 <\/option>\n <option value=\"25\"> 25 <\/option>\n <option value=\"26\"> 26 <\/option>\n <option value=\"27\"> 27 <\/option>\n <option value=\"28\"> 28 <\/option>\n <option value=\"29\"> 29 <\/option>\n <option value=\"30\"> 30 <\/option>\n <option value=\"31\"> 31 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_143_day\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q143_dateOf[year]\" id=\"input_143_year\">\n <option> <\/option>\n <option value=\"2016\"> 2016 <\/option>\n <option value=\"2015\"> 2015 <\/option>\n <option value=\"2014\"> 2014 <\/option>\n <option value=\"2013\"> 2013 <\/option>\n <option value=\"2012\"> 2012 <\/option>\n <option value=\"2011\"> 2011 <\/option>\n <option value=\"2010\"> 2010 <\/option>\n <option value=\"2009\"> 2009 <\/option>\n <option value=\"2008\"> 2008 <\/option>\n <option value=\"2007\"> 2007 <\/option>\n <option value=\"2006\"> 2006 <\/option>\n <option value=\"2005\"> 2005 <\/option>\n <option value=\"2004\"> 2004 <\/option>\n <option value=\"2003\"> 2003 <\/option>\n <option value=\"2002\"> 2002 <\/option>\n <option value=\"2001\"> 2001 <\/option>\n <option value=\"2000\"> 2000 <\/option>\n <option value=\"1999\"> 1999 <\/option>\n <option value=\"1998\"> 1998 <\/option>\n <option value=\"1997\"> 1997 <\/option>\n <option value=\"1996\"> 1996 <\/option>\n <option value=\"1995\"> 1995 <\/option>\n <option value=\"1994\"> 1994 <\/option>\n <option value=\"1993\"> 1993 <\/option>\n <option value=\"1992\"> 1992 <\/option>\n <option value=\"1991\"> 1991 <\/option>\n <option value=\"1990\"> 1990 <\/option>\n <option value=\"1989\"> 1989 <\/option>\n <option value=\"1988\"> 1988 <\/option>\n <option value=\"1987\"> 1987 <\/option>\n <option value=\"1986\"> 1986 <\/option>\n <option value=\"1985\"> 1985 <\/option>\n <option value=\"1984\"> 1984 <\/option>\n <option value=\"1983\"> 1983 <\/option>\n <option value=\"1982\"> 1982 <\/option>\n <option value=\"1981\"> 1981 <\/option>\n <option value=\"1980\"> 1980 <\/option>\n <option value=\"1979\"> 1979 <\/option>\n <option value=\"1978\"> 1978 <\/option>\n <option value=\"1977\"> 1977 <\/option>\n <option value=\"1976\"> 1976 <\/option>\n <option value=\"1975\"> 1975 <\/option>\n <option value=\"1974\"> 1974 <\/option>\n <option value=\"1973\"> 1973 <\/option>\n <option value=\"1972\"> 1972 <\/option>\n <option value=\"1971\"> 1971 <\/option>\n <option value=\"1970\"> 1970 <\/option>\n <option value=\"1969\"> 1969 <\/option>\n <option value=\"1968\"> 1968 <\/option>\n <option value=\"1967\"> 1967 <\/option>\n <option value=\"1966\"> 1966 <\/option>\n <option value=\"1965\"> 1965 <\/option>\n <option value=\"1964\"> 1964 <\/option>\n <option value=\"1963\"> 1963 <\/option>\n <option value=\"1962\"> 1962 <\/option>\n <option value=\"1961\"> 1961 <\/option>\n <option value=\"1960\"> 1960 <\/option>\n <option value=\"1959\"> 1959 <\/option>\n <option value=\"1958\"> 1958 <\/option>\n <option value=\"1957\"> 1957 <\/option>\n <option value=\"1956\"> 1956 <\/option>\n <option value=\"1955\"> 1955 <\/option>\n <option value=\"1954\"> 1954 <\/option>\n <option value=\"1953\"> 1953 <\/option>\n <option value=\"1952\"> 1952 <\/option>\n <option value=\"1951\"> 1951 <\/option>\n <option value=\"1950\"> 1950 <\/option>\n <option value=\"1949\"> 1949 <\/option>\n <option value=\"1948\"> 1948 <\/option>\n <option value=\"1947\"> 1947 <\/option>\n <option value=\"1946\"> 1946 <\/option>\n <option value=\"1945\"> 1945 <\/option>\n <option value=\"1944\"> 1944 <\/option>\n <option value=\"1943\"> 1943 <\/option>\n <option value=\"1942\"> 1942 <\/option>\n <option value=\"1941\"> 1941 <\/option>\n <option value=\"1940\"> 1940 <\/option>\n <option value=\"1939\"> 1939 <\/option>\n <option value=\"1938\"> 1938 <\/option>\n <option value=\"1937\"> 1937 <\/option>\n <option value=\"1936\"> 1936 <\/option>\n <option value=\"1935\"> 1935 <\/option>\n <option value=\"1934\"> 1934 <\/option>\n <option value=\"1933\"> 1933 <\/option>\n <option value=\"1932\"> 1932 <\/option>\n <option value=\"1931\"> 1931 <\/option>\n <option value=\"1930\"> 1930 <\/option>\n <option value=\"1929\"> 1929 <\/option>\n <option value=\"1928\"> 1928 <\/option>\n <option value=\"1927\"> 1927 <\/option>\n <option value=\"1926\"> 1926 <\/option>\n <option value=\"1925\"> 1925 <\/option>\n <option value=\"1924\"> 1924 <\/option>\n <option value=\"1923\"> 1923 <\/option>\n <option value=\"1922\"> 1922 <\/option>\n <option value=\"1921\"> 1921 <\/option>\n <option value=\"1920\"> 1920 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_143_year\" id=\"sublabel_year\"> Year <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_130\">\n <div id=\"cid_130\" class=\"form-input-wide\">\n <div id=\"text_130\" class=\"form-html\">\n <p>\n In order for us to process your application you must provide a Social Security Number, or, you may call us if you are not comfortable providing this online. Our office number is 916-580-1051 .\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_18\">\n <label class=\"form-label-left\" id=\"label_18\" for=\"input_18\"> Drivers License Number <\/label>\n <div id=\"cid_18\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_18\" name=\"q18_driversLicense\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_19\">\n <label class=\"form-label-left\" id=\"label_19\" for=\"input_19\"> Home Phone Number <\/label>\n <div id=\"cid_19\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_19\" name=\"q19_homePhone\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_20\">\n <label class=\"form-label-left\" id=\"label_20\" for=\"input_20\"> Cell Phone Number <\/label>\n <div id=\"cid_20\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_20\" name=\"q20_cellPhone\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_22\">\n <label class=\"form-label-left\" id=\"label_22\" for=\"input_22\"> Work\/Alternate Phone Number <\/label>\n <div id=\"cid_22\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_22\" name=\"q22_workalternatePhone\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_23\">\n <label class=\"form-label-left\" id=\"label_23\" for=\"input_23\">\n Your Email<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_23\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_23\" name=\"q23_yourEmail\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_25\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_25\" class=\"form-header\">\n Your Present Address\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_26\">\n <label class=\"form-label-left\" id=\"label_26\" for=\"input_26\">\n Present Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_26\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_26\" name=\"q26_presentAddress\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_27\">\n <label class=\"form-label-left\" id=\"label_27\" for=\"input_27\">\n City<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_27\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_27\" name=\"q27_city\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_28\">\n <label class=\"form-label-left\" id=\"label_28\" for=\"input_28\">\n State<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_28\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_28\" name=\"q28_state\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_29\">\n <label class=\"form-label-left\" id=\"label_29\" for=\"input_29\">\n Zip Code<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_29\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_29\" name=\"q29_zipCode\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_119\">\n <label class=\"form-label-left\" id=\"label_119\" for=\"input_119\"> Move In Date <\/label>\n <div id=\"cid_119\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_119\" name=\"q119_moveIn[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_119\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_119\" name=\"q119_moveIn[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_119\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_119\" name=\"q119_moveIn[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_119\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_119\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_119\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_119\" name=\"q119_moveIn[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"00\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_119\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_119\" name=\"q119_moveIn[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"44\" \/>\n <label class=\"form-sub-label\" for=\"min_119\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_119\" name=\"q119_moveIn[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_119\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_119_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_119_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_120\">\n <label class=\"form-label-left\" id=\"label_120\" for=\"input_120\"> Move Out Date <\/label>\n <div id=\"cid_120\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_120\" name=\"q120_moveOut[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_120\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_120\" name=\"q120_moveOut[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_120\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_120\" name=\"q120_moveOut[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_120\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_120\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_120\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_120\" name=\"q120_moveOut[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"00\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_120\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_120\" name=\"q120_moveOut[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"44\" \/>\n <label class=\"form-sub-label\" for=\"min_120\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_120\" name=\"q120_moveOut[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_120\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_120_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_120_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_32\">\n <label class=\"form-label-left\" id=\"label_32\" for=\"input_32\"> Owner\/Manager Name <\/label>\n <div id=\"cid_32\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_32\" name=\"q32_ownermanagerName32\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_33\">\n <label class=\"form-label-left\" id=\"label_33\" for=\"input_33\"> Owner\/Manager Phone <\/label>\n <div id=\"cid_33\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_33\" name=\"q33_ownermanagerPhone\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_34\">\n <label class=\"form-label-left\" id=\"label_34\" for=\"input_34\"> Reason For Moving <\/label>\n <div id=\"cid_34\" class=\"form-input\">\n <textarea id=\"input_34\" class=\"form-textarea\" name=\"q34_reasonFor\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_35\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_35\" class=\"form-header\">\n Your Previous Address\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_36\">\n <label class=\"form-label-left\" id=\"label_36\" for=\"input_36\"> Previous Address <\/label>\n <div id=\"cid_36\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_36\" name=\"q36_previousAddress\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_37\">\n <label class=\"form-label-left\" id=\"label_37\" for=\"input_37\"> City <\/label>\n <div id=\"cid_37\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_37\" name=\"q37_city37\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_38\">\n <label class=\"form-label-left\" id=\"label_38\" for=\"input_38\"> State <\/label>\n <div id=\"cid_38\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_38\" name=\"q38_state38\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_39\">\n <label class=\"form-label-left\" id=\"label_39\" for=\"input_39\"> Zip code <\/label>\n <div id=\"cid_39\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_39\" name=\"q39_zipCode39\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_117\">\n <label class=\"form-label-left\" id=\"label_117\" for=\"input_117\"> Move In Date <\/label>\n <div id=\"cid_117\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_117\" name=\"q117_moveIn117[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_117\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_117\" name=\"q117_moveIn117[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_117\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_117\" name=\"q117_moveIn117[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_117\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_117\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_117\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_117\" name=\"q117_moveIn117[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"00\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_117\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_117\" name=\"q117_moveIn117[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"44\" \/>\n <label class=\"form-sub-label\" for=\"min_117\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_117\" name=\"q117_moveIn117[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_117\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_117_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_117_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_118\">\n <label class=\"form-label-left\" id=\"label_118\" for=\"input_118\"> Move Out Date <\/label>\n <div id=\"cid_118\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_118\" name=\"q118_moveOut118[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_118\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_118\" name=\"q118_moveOut118[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_118\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_118\" name=\"q118_moveOut118[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_118\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_118\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_118\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_118\" name=\"q118_moveOut118[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"00\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_118\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_118\" name=\"q118_moveOut118[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"44\" \/>\n <label class=\"form-sub-label\" for=\"min_118\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_118\" name=\"q118_moveOut118[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_118\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_118_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_118_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_42\">\n <label class=\"form-label-left\" id=\"label_42\" for=\"input_42\"> Owner\/Manager Name <\/label>\n <div id=\"cid_42\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_42\" name=\"q42_ownermanagerName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_43\">\n <label class=\"form-label-left\" id=\"label_43\" for=\"input_43\"> Owner\/Manager Phone <\/label>\n <div id=\"cid_43\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_43\" name=\"q43_ownermanagerPhone43\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_44\">\n <label class=\"form-label-left\" id=\"label_44\" for=\"input_44\"> Reason For Moving <\/label>\n <div id=\"cid_44\" class=\"form-input\">\n <textarea id=\"input_44\" class=\"form-textarea\" name=\"q44_reasonFor44\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_48\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_48\" class=\"form-header\">\n Number and Names of Proposed Occupants\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_50\">\n <label class=\"form-label-left\" id=\"label_50\" for=\"input_50\"> 1. Name and Birth Date <\/label>\n <div id=\"cid_50\" class=\"form-input\">\n <textarea id=\"input_50\" class=\"form-textarea\" name=\"q50_1Name\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_51\">\n <label class=\"form-label-left\" id=\"label_51\" for=\"input_51\"> 2. Name and Birth Date <\/label>\n <div id=\"cid_51\" class=\"form-input\">\n <textarea id=\"input_51\" class=\"form-textarea\" name=\"q51_2Name\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_52\">\n <label class=\"form-label-left\" id=\"label_52\" for=\"input_52\"> 3. Name and Birth Date <\/label>\n <div id=\"cid_52\" class=\"form-input\">\n <textarea id=\"input_52\" class=\"form-textarea\" name=\"q52_3Name\" 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\"> 4. Name and Birth Date <\/label>\n <div id=\"cid_53\" class=\"form-input\">\n <textarea id=\"input_53\" class=\"form-textarea\" name=\"q53_4Name\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_55\">\n <label class=\"form-label-left\" id=\"label_55\" for=\"input_55\"> Pets? If Yes, describe <\/label>\n <div id=\"cid_55\" class=\"form-input\">\n <textarea id=\"input_55\" class=\"form-textarea\" name=\"q55_petsIf\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_56\">\n <label class=\"form-label-left\" id=\"label_56\" for=\"input_56\"> Liquid Filled Furniture? <\/label>\n <div id=\"cid_56\" class=\"form-input\">\n <textarea id=\"input_56\" class=\"form-textarea\" name=\"q56_liquidFilled\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_58\">\n <label class=\"form-label-left\" id=\"label_58\" for=\"input_58\"> Do You Smoke? <\/label>\n <div id=\"cid_58\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_58\" name=\"q58_doYou\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_59\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_59\" class=\"form-header\">\n Present Employment\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_61\">\n <label class=\"form-label-left\" id=\"label_61\" for=\"input_61\"> Present Employer <\/label>\n <div id=\"cid_61\" class=\"form-input\">\n <textarea id=\"input_61\" class=\"form-textarea\" name=\"q61_presentEmployer\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_62\">\n <label class=\"form-label-left\" id=\"label_62\" for=\"input_62\"> Address <\/label>\n <div id=\"cid_62\" class=\"form-input\">\n <textarea id=\"input_62\" class=\"form-textarea\" name=\"q62_address\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_116\">\n <label class=\"form-label-left\" id=\"label_116\" for=\"input_116\"> Start Date <\/label>\n <div id=\"cid_116\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_116\" name=\"q116_startDate[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_116\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_116\" name=\"q116_startDate[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_116\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_116\" name=\"q116_startDate[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_116\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_116\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_116\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_116\" name=\"q116_startDate[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"00\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_116\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_116\" name=\"q116_startDate[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"44\" \/>\n <label class=\"form-sub-label\" for=\"min_116\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_116\" name=\"q116_startDate[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_116\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_116_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_116_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_107\">\n <label class=\"form-label-left\" id=\"label_107\" for=\"input_107\"> Position <\/label>\n <div id=\"cid_107\" class=\"form-input\">\n <textarea id=\"input_107\" class=\"form-textarea\" name=\"q107_position\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_65\">\n <label class=\"form-label-left\" id=\"label_65\" for=\"input_65\"> Supervisor's Name <\/label>\n <div id=\"cid_65\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_65\" name=\"q65_supervisorsName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_66\">\n <label class=\"form-label-left\" id=\"label_66\" for=\"input_66\"> Supervisor's Phone <\/label>\n <div id=\"cid_66\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_66\" name=\"q66_supervisorsPhone\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_106\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_106\" class=\"form-header\">\n Income\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_67\">\n <label class=\"form-label-left\" id=\"label_67\" for=\"input_67\"> Current Gross Income $ <\/label>\n <div id=\"cid_67\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_67\" name=\"q67_currentGross\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_70\">\n <label class=\"form-label-left\" id=\"label_70\" for=\"input_70\"> Weekly, Monthly, Yearly? <\/label>\n <div id=\"cid_70\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_70\" name=\"q70_weeklyMonthly\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_71\">\n <label class=\"form-label-left\" id=\"label_71\" for=\"input_71\"> Other Sources of Income <\/label>\n <div id=\"cid_71\" class=\"form-input\">\n <textarea id=\"input_71\" class=\"form-textarea\" name=\"q71_otherSources\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_73\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_73\" class=\"form-header\">\n Your Bank\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_74\">\n <label class=\"form-label-left\" id=\"label_74\" for=\"input_74\"> Bank Name <\/label>\n <div id=\"cid_74\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_74\" name=\"q74_bankName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_75\">\n <label class=\"form-label-left\" id=\"label_75\" for=\"input_75\"> Branch or Address <\/label>\n <div id=\"cid_75\" class=\"form-input\">\n <textarea id=\"input_75\" class=\"form-textarea\" name=\"q75_branchOr\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_76\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_76\" class=\"form-header\">\n Your Automobiles\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_104\">\n <div id=\"cid_104\" class=\"form-input-wide\">\n <div id=\"text_104\" class=\"form-html\">\n Automobile Number 1\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_77\">\n <label class=\"form-label-left\" id=\"label_77\" for=\"input_77\"> 1. Year, Make, Model <\/label>\n <div id=\"cid_77\" class=\"form-input\">\n <textarea id=\"input_77\" class=\"form-textarea\" name=\"q77_1Year\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_78\">\n <label class=\"form-label-left\" id=\"label_78\" for=\"input_78\"> 1. Color <\/label>\n <div id=\"cid_78\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_78\" name=\"q78_1Color\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_79\">\n <label class=\"form-label-left\" id=\"label_79\" for=\"input_79\"> 1. License Plate # <\/label>\n <div id=\"cid_79\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_79\" name=\"q79_1License\" size=\"20\" maxlength=\"100\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_105\">\n <div id=\"cid_105\" class=\"form-input-wide\">\n <div id=\"text_105\" class=\"form-html\">\n Automobile Number 2\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_80\">\n <label class=\"form-label-left\" id=\"label_80\" for=\"input_80\"> 2. Year, Make, Model <\/label>\n <div id=\"cid_80\" class=\"form-input\">\n <textarea id=\"input_80\" class=\"form-textarea\" name=\"q80_2Year\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_81\">\n <label class=\"form-label-left\" id=\"label_81\" for=\"input_81\"> 2. Color <\/label>\n <div id=\"cid_81\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_81\" name=\"q81_2Color\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_82\">\n <label class=\"form-label-left\" id=\"label_82\" for=\"input_82\"> 2. License Plate # <\/label>\n <div id=\"cid_82\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_82\" name=\"q82_2License\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li id=\"cid_83\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_83\" class=\"form-header\">\n Personal References\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_84\">\n <label class=\"form-label-left\" id=\"label_84\" for=\"input_84\"> 1. Name, Address, Phone, Relationship <\/label>\n <div id=\"cid_84\" class=\"form-input\">\n <textarea id=\"input_84\" class=\"form-textarea\" name=\"q84_1Name84\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_85\">\n <label class=\"form-label-left\" id=\"label_85\" for=\"input_85\"> 2. Name, Address, Phone, Relationship <\/label>\n <div id=\"cid_85\" class=\"form-input\">\n <textarea id=\"input_85\" class=\"form-textarea\" name=\"q85_2Name85\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_86\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_86\" class=\"form-header\">\n In Case of Emergency\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_87\">\n <label class=\"form-label-left\" id=\"label_87\" for=\"input_87\"> 1. Name, Address, Phone, Relationship <\/label>\n <div id=\"cid_87\" class=\"form-input\">\n <textarea id=\"input_87\" class=\"form-textarea\" name=\"q87_1Name87\" cols=\"30\" rows=\"2\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_88\">\n <label class=\"form-label-left\" id=\"label_88\" for=\"input_88\"> 2. Name, Address, Phone, Relationship <\/label>\n <div id=\"cid_88\" class=\"form-input\">\n <textarea id=\"input_88\" class=\"form-textarea\" name=\"q88_2Name88\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_89\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_89\" class=\"form-header\">\n Have You.....\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_90\">\n <label class=\"form-label-left\" id=\"label_90\" for=\"input_90\"> Have you ever been evicted or asked to move? <\/label>\n <div id=\"cid_90\" class=\"form-input\">\n <textarea id=\"input_90\" class=\"form-textarea\" name=\"q90_haveYou90\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_91\">\n <label class=\"form-label-left\" id=\"label_91\" for=\"input_91\"> Have you ever filed for bankruptcy? <\/label>\n <div id=\"cid_91\" class=\"form-input\">\n <textarea id=\"input_91\" class=\"form-textarea\" name=\"q91_haveYou91\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_103\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_103\" class=\"form-header\">\n Declaration and Signature\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_100\">\n <div id=\"cid_100\" class=\"form-input-wide\">\n <div id=\"text_100\" class=\"form-html\">\n I declare that the foregoing information is true and correct. I authorize Loffman Property Management to verify the information on this application including, but not limited to, obtaining credit reports, employment verification, previous landlord reports and\/or character reports as necessary. I agree that Landlord may terminate any agreement entered into in reliance on any misstatements made above.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_101\">\n <label class=\"form-label-left\" id=\"label_101\" for=\"input_101\"> Applicant Name (Your Signature) <\/label>\n <div id=\"cid_101\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_101\" name=\"q101_applicantName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_102\">\n <label class=\"form-label-left\" id=\"label_102\" for=\"input_102\"> Date Signed <\/label>\n <div id=\"cid_102\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"month_102\" name=\"q102_dateSigned[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_102\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"day_102\" name=\"q102_dateSigned[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_102\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"year_102\" name=\"q102_dateSigned[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_102\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><div id=\"at_102\">\n at\n <\/div>\n <label class=\"form-sub-label\" for=\"at_102\"> <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"hour_102\" name=\"q102_dateSigned[hour]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"00\" \/><span class=\"date-separate\"> \/<\/span>\n <label class=\"form-sub-label\" for=\"hour_102\" id=\"sublabel_hour\"> Hour <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" id=\"min_102\" name=\"q102_dateSigned[min]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"44\" \/>\n <label class=\"form-sub-label\" for=\"min_102\" id=\"sublabel_minutes\"> Minutes <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" id=\"ampm_102\" name=\"q102_dateSigned[ampm]\">\n <option value=\"AM\"> AM <\/option>\n <option value=\"PM\"> PM <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"ampm_102\"> <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_102_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_102_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_108\">\n <div id=\"cid_108\" class=\"form-input-wide\">\n <div id=\"text_108\" class=\"form-html\">\n A credit application fee of $30.00 FOR EACH ADULT APPLICANT must be mailed or delivered to Loffman Property Management in order to process your application. This fee will be used to verify the information you submitted on this application.\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_131\">\n <div id=\"cid_131\" class=\"form-input-wide\">\n <div id=\"text_131\" class=\"form-html\">\n <p>\n WE ARE NOT ABLE TO PROCESS YOUR APPLICATION UNLESS WE RECEIVE THIS FEE. Please call us (916-580-1051 ) and let us know how you intend to send this. You may also send email to: debbie@loffmanproperties.com\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_138\">\n <div id=\"cid_138\" class=\"form-input-wide\">\n <div id=\"text_138\" class=\"form-html\">\n <P>\n An email confirming receipt of this application will be sent to you from us. IF YOU DO NOT RECEIVE THIS CONFIRMATION WITHIN 24 HOURS PLEASE CALL OUR OFFICE.\n <\/P>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_140\">\n <div id=\"cid_140\" class=\"form-input-wide\">\n <div id=\"text_140\" class=\"form-html\">\n <p><span style=\"font-family: tahoma,arial,helvetica,sans-serif; font-size: small;\">If applicant is approved and wishes to hold the property and have it taken off the market, they will need to submit a non-refundable\n <strong>\n Holding Deposit\n <\/strong>\n equal to the\n <strong>\n Security Deposit\n <\/strong>\n amount, which will become the\n <strong>\n Security Deposit\n <\/strong>\n upon signing the\n <strong>\n Rental Agreement\n <\/strong>\n . Applicant understands, acknowledges, and agrees that if he\/she fails to rent the above stated property, the non-refundable\n <strong>\n Holding Deposit\n <\/strong>\n shall be forfeited.<\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_142\">\n <div id=\"cid_142\" class=\"form-input-wide\">\n <div id=\"text_142\" class=\"form-html\">\n <p>\n Our office phone number is: 916-580-1051\n <\/p>\n <p>\n Our office fax number is: 916-580-1052\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_132\">\n <div id=\"cid_132\" class=\"form-input-wide\">\n <div id=\"text_132\" class=\"form-html\">\n <p>\n Our mailing address is:\n <\/p>\n <p>\n Loffman Property Management\n <\/p>\n <p>\n 5701 Lonetree Blvd., Suite 125\n <\/p>\n <p>\n Rocklin, CA 95765\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_123\">\n <div id=\"cid_123\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_123\" type=\"submit\" class=\"form-submit-button\">\n Submit\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=\"10931316492\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"10931316492-10931316492\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");