function ValidateForm()	{
		var isFormValid = 1;
		var errorMessage = '';
		var firstName = document.getElementById('FirstName');
		var lastName = document.getElementById('LastName');
		var emailAddress = document.getElementById('EmailAddress');
		var homePhone = document.getElementById('HomePhone');
		
		if(firstName.value.length < 1) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- First Name is required.\n';
		}
		if(lastName.value.length < 1) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Last Name is required.\n';
		}
		if(homePhone.value.length < 9) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Phone Number is required.\n';
		}
        if (document.getElementById('State').options[document.getElementById('State').selectedIndex].value == '-1')
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Select a State from the drop down.\n';
		}
		if(emailAddress.value.length < 4) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Email Address is required.\n';
		}
		if(IsEmailValid(emailAddress.value) == false)
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Email Address is not valid.\n';
		}
		
		if(isFormValid == 0)
		{
			alert(errorMessage);
		}
		else
		{
		    // Send the data and user to next step
		    //window.location = 'http://www.aftermarketsites.com/DataStream-DCU-2010-04-30.aspx?FirstName=' + escape(document.getElementById('FirstName').value) + '&LastName=' + escape(document.getElementById('LastName').value) + '&HomePhone=' + escape(document.getElementById('HomePhone').value) + '&EmailAddress=' + escape(document.getElementById('EmailAddress').value) + '&ContactTime=' + escape(document.getElementById('ContactTime').options[document.getElementById('ContactTime').selectedIndex].value) + '&State=' + escape(document.getElementById('State').options[document.getElementById('State').selectedIndex].value) + '&TotalDebt=' + escape(document.getElementById('TotalDebt').options[document.getElementById('TotalDebt').selectedIndex].value) + '&ReferURL=' + escape(document.referrer);
		    window.location = 'http://www.aftermarketsites.com/DataStream-LJL-2008-07-22.aspx?FirstName=' + escape(document.getElementById('FirstName').value) + '&LastName=' + escape(document.getElementById('LastName').value) + '&HomePhone=' + escape(document.getElementById('HomePhone').value) + '&EmailAddress=' + escape(document.getElementById('EmailAddress').value) + '&ContactTime=' + escape(document.getElementById('ContactTime').options[document.getElementById('ContactTime').selectedIndex].value) + '&State=' + escape(document.getElementById('State').options[document.getElementById('State').selectedIndex].value) + '&TotalDebt=' + escape(document.getElementById('TotalDebt').options[document.getElementById('TotalDebt').selectedIndex].value) + '&ReferURL=' + escape(document.referrer);
		}
	}
	
	function IsEmailValid(emailAddress) {
		var emailReg = "^[\\w-_\.]*[\\w-_\.]\@[\\w]\.+[\\w]+[\\w]$";
		var regex = new RegExp(emailReg);
		return regex.test(emailAddress);
	}



document.write('<p class="text-label">First Name<input class="text-input" type="text" name="FirstName" id="FirstName" maxlength=25 tabindex=1></p>');

document.write('<p class="text-label2">Last Name<input class="text-input" type="text" name="LastName" id="LastName" maxlength=30 tabindex=2></p>');

document.write('<br class="clearfloat" />');

document.write('<p class="text-label">Phone<input class="text-input" type="text" name="HomePhone" id="HomePhone" maxlength=50 tabindex=3></p>');

document.write('<p class="text-label2">State<select class="state-list" name="State" id="State" tabindex=4>');
document.write('<option value="-1">Select a State</option>');
document.write('<option value="al">Alabama</option>');
document.write('<option value="ak">Alaska</option>');
document.write('<option value="az">Arizona</option>');
document.write('<option value="ar">Arkansas</option>');
document.write('<option value="ca">California</option>');
document.write('<option value="co">Colorado</option>');
document.write('<option value="ct">Connecticut</option>');
document.write('<option value="de">Delaware</option>');
document.write('<option value="dc">DC</option>');
document.write('<option value="fl">Florida</option>');
document.write('<option value="ga">Georgia</option>');
document.write('<option value="hi">Hawaii</option>');
document.write('<option value="id">Idaho</option>');
document.write('<option value="il">Illinois</option>');
document.write('<option value="in">Indiana</option>');
document.write('<option value="ia">Iowa</option>');
document.write('<option value="ks">Kansas</option>');
document.write('<option value="ky">Kentucky</option>');
document.write('<option value="la">Louisiana</option>');
document.write('<option value="me">Maine</option>');
document.write('<option value="md">Maryland</option>');
document.write('<option value="ma">Massachusetts</option>');
document.write('<option value="mi">Michigan</option>');
document.write('<option value="fm">Micronesia</option>');
document.write('<option value="mn">Minnesota</option>');
document.write('<option value="ms">Mississippi</option>');
document.write('<option value="mo">Missouri</option>');
document.write('<option value="mt">Montana</option>');
document.write('<option value="ne">Nebraska</option>');
document.write('<option value="nv">Nevada</option>');
document.write('<option value="nh">New Hampshire</option>');
document.write('<option value="nj">New Jersey</option>');
document.write('<option value="nm">New Mexico</option>');
document.write('<option value="ny">New York</option>');
document.write('<option value="nf">Newfoundland</option>');
document.write('<option value="nc">North Carolina</option>');
document.write('<option value="nd">North Dakota</option>');
document.write('<option value="oh">Ohio</option>');
document.write('<option value="ok">Oklahoma</option>');
document.write('<option value="or">Oregon</option>');
document.write('<option value="pa">Pennsylvania</option>');
document.write('<option value="ri">Rhode Island</option>');
document.write('<option value="sc">South Carolina</option>');
document.write('<option value="sd">South Dakota</option>');
document.write('<option value="tn">Tennessee</option>');
document.write('<option value="tx">Texas</option>');
document.write('<option value="ut">Utah</option>');
document.write('<option value="vt">Vermont</option>');
document.write('<option value="va">Virginia</option>');
document.write('<option value="wa">Washington</option>');
document.write('<option value="wi">Wisconsin</option>');
document.write('<option value="wv">West Virginia</option>');
document.write('<option value="wy">Wyoming</option>');
document.write('</select><p>');
document.write('<br class="clearfloat"/>');

document.write('<p class="text-label">Email<input class="text-input" type="text" name="EmailAddress" id="EmailAddress" maxlength=50 tabindex=5></p>');

document.write('<p class="text-label2">Total Unsecured Debt<select class="state-list" name="TotalDebt" id="TotalDebt" tabindex=6>');
document.write('<option value="2000-5000">$2,000-$5,000</option>');
document.write('<option value="5001-10000">$5,001-$10,000</option>');
document.write('<option selected value="10000-20000">$10,001-$20,000</option>');
document.write('<option value="20000-50000">$20,000-$50,000</option>');
document.write('<option value="Over 50000">Over $50,000</option>');
document.write('</select></p>');

document.write('<br class="clearfloat"/>');

document.write('<p class="text-label">Best Time To Contact<select class="best-time-list" name="ContactTime" id="ContactTime" tabindex=7>');
document.write('<option value="Morning">Morning</option>');
document.write('<option selected value="Afternoon">Afternoon</option>');
document.write('<option value="Evening">Evening</option>');
document.write('</select></p>');

document.write('<a href="#"><input name="SubmitButton" id="SubmitButton" type="image" onClick="return ValidateForm();" value="submit" class="start-btn" src="http://www.debtconsolidationunion.com/wp-content/themes/DCU-theme/images/start-btn.png" width="166" height="42"></a>');

document.write('<br class="clearfloat"/>');
document.all('FirstName').focus();