function chk_frm() {
	if(!hasCharacter(frm.company.value)) { 
		alert("Company Name cannot be blank.")
		frm.company.focus()
		frm.company.select()
		return false;
	}
	if(!hasCharacter(frm.name1.value)) { 
		alert("Adjuster/Contractor First Name cannot be blank.")
		frm.name1.focus()
		frm.name1.select()
		return false;
	}
	if(!hasCharacter(frm.name2.value)) { 
		alert("Adjuster/Contractor Last Name cannot be blank.")
		frm.name2.focus()
		frm.name2.select()
		return false;
	}
	if(!isNumberNoDecimal(frm.mareacode.value) || frm.mareacode.value.length < 3) {
		alert("Main Phone Area Code must be 3 digits in length.")
		frm.mareacode.focus()
		frm.mareacode.select()
		return false;
	}
	if(!isNumberNoDecimal(frm.mphoneprefix.value) || frm.mphoneprefix.value.length < 3) {
		alert("Main Phone Prefix must be 3 digits in length.")
		frm.mphoneprefix.focus()
		frm.mphoneprefix.select()
		return false;
	}
	if(!isNumberNoDecimal(frm.mphonesuffix.value) || frm.mphonesuffix.value.length < 4) {
		alert("Main Phone Suffix must be 4 digits in length.")
		frm.mphonesuffix.focus()
		frm.mphonesuffix.select()
		return false;
	}
	if(!hasCharacter(frm.ownerfirstname.value)) {
		alert("Owner First Name cannot be blank.")
		frm.ownerfirstname.focus()
		frm.ownerfirstname.select()
		return false;
	}
	if(!hasCharacter(frm.ownerlastname.value)) {
		alert("Owner Last Name cannot be blank.")
		frm.ownerlastname.focus()
		frm.ownerlastname.select()
		return false;
	}
	if(!hasCharacter(frm.owneraddress.value)) {
		alert("Owner Address cannot be blank.")
		frm.owneraddress.focus()
		frm.owneraddress.select()
		return false;
	}
	if(!hasCharacter(frm.ownercity.value)) {
		alert("Owner City cannot be blank.")
		frm.ownercity.focus()
		frm.ownercity.select()
		return false;
	}
	if(!checkstate(frm.ownerstate.value)) {
		alert("Please enter a valid 2 letter state abbreviation.")
		frm.ownerstate.focus()
		frm.ownerstate.select()
		return false;
	}
	if(!isZipCode(frm.ownerzip.value)) {
		alert("Please enter a correctly formatted zip (xxxxx or xxxxx-yyyy).")
		frm.ownerzip.focus()
		frm.ownerzip.select()
		return false;
	}
	if(!isNumberNoDecimal(frm.oareacode1.value) || frm.oareacode1.value.length < 3) {
		alert("Owner Phone Area Code must be 3 digits in length.")
		frm.oareacode1.focus()
		frm.oareacode1.select()
		return false;
	}
	if(!isNumberNoDecimal(frm.ophoneprefix1.value) || frm.ophoneprefix1.value.length < 3) {
		alert("Owner Phone Prefix must be 3 digits in length.")
		frm.ophoneprefix1.focus()
		frm.ophoneprefix1.select()
		return false;
	}
	if(!isNumberNoDecimal(frm.ophonesuffix1.value) || frm.ophonesuffix1.value.length < 4) {
		alert("Owner Phone Suffix must be 4 digits in length.")
		frm.ophonesuffix1.focus()
		frm.ophonesuffix1.select()
		return false;
	}
	if(hascharacter(frm.oareacode2.value) || hascharacter(frm.ophoneprefix2.value) || hascharacter(frm.ophonesuffix2.value)) {
		if(!isNumberNoDecimal(frm.areacode2.value) || frm.areacode2.value.length < 3) {
			alert("If you are going to enter a work phone number for the owner then the Phone Area Code must be 3 digits in length.")
			frm.oareacode2.focus()
			frm.oareacode2.select()
			return false;
		}
		if(!isNumberNoDecimal(frm.phoneprefix2.value) || frm.phoneprefix2.value.length < 3) {
			alert("If you are going to enter a work phone number for the owner then the Phone Prefix must be 3 digits in length.")
			frm.ophoneprefix2.focus()
			frm.ophoneprefix2.select()
			return false;
		}
		if(!isNumberNoDecimal(frm.phonesuffix2.value) || frm.phonesuffix2.value.length < 4) {
			alert("If you are going to enter a work phone number for the owner then the Phone Suffix must be 4 digits in length.")
			frm.ophonesuffix2.focus()
			frm.ophonesuffix2.select()
			return false;
		}
	}

	if(hascharacter(frm.oareacode3.value) || hascharacter(frm.ophoneprefix3.value) || hascharacter(frm.ophoneprefix3.value)) {
		if(!isNumberNoDecimal(frm.oareacode3.value) || frm.oareacode3.value.length < 3) {
			alert("If you are going to enter an alternate phone number for the owner then the Phone Area Code must be 3 digits in length.")
			frm.oareacode3.focus()
			frm.oareacode3.select()
			return false;
		}
		if(!isNumberNoDecimal(frm.ophoneprefix3.value) || frm.ophoneprefix3.value.length < 3) {
			alert("If you are going to enter an alternate phone number for the owner then the Phone Prefix must be 3 digits in length.")
			frm.ophoneprefix3.focus()
			frm.ophoneprefix3.select()
			return false;
		}
		if(!isNumberNoDecimal(frm.ophonesuffix3.value) || frm.ophonesuffix3.value.length < 4) {
			alert("If you are going to enter an alternate phone number for the owner then the Phone Suffix must be 4 digits in length.")
			frm.ophonesuffix3.focus()
			frm.ophonesuffix3.select()
			return false;
		}
	}
	return false;
  
  
} // end function chk_frm()
document.write('\
<table width="510" border="0" cellspacing="0" cellpadding="3">\
<form action="restoration-submit2.asp" name="frm" onsubmit="return chk_frm()" method="post">\
  <tr bgcolor="#999999">\
    <td colspan="2"><p class="header2">Insurance Company or Contractor Information </p></td>\
    </tr>\
<tr>\
	<td width="222"><span class="header1">*</span> = Required Field</td>\
	<td>&nbsp;</td>\
</tr>\
  <tr>\
    <td width="222" class="body1"><span class="header1">*</span> Company Name </td>\
    <td width="276"><input name="company" type="text" class="body1" size="30"></td>\
  </tr>\
  <tr>\
    <td class="body1"> <span class="header1">*</span> Adjuster/Contractor Name (First /Last) </td>\
    <td><input name="name1" type="text" class="body1" size="12">\
      <input name="name2" type="text" class="body1" size="15"></td>\
  </tr>\
  <tr>\
    <td class="body1"> <span class="header1">*</span> Main Phone Number </td>\
    <td><input name="mareacode" type="text" class="body1" size="3" maxlength="3">\
      <input name="mphoneprefix" type="text" class="body1" size="3" maxlength="3">\
      <input name="mphonesuffix" type="text" class="body1" size="4" maxlength="4"></td>\
  </tr>\
  <tr>\
    <td class="body1">2nd Phone Number</td>\
    <td><input name="areacode2" type="text" class="body1" size="3" maxlength="3">\
      <input name="phoneprefix2" type="text" class="body1" size="3" maxlength="3">\
      <input name="phonesuffix2" type="text" class="body1" size="4" maxlength="4"></td>\
  </tr>\
  <tr>\
    <td class="body1">Fax Number </td>\
    <td><input name="faxareacode" type="text" class="body1" size="3" maxlength="3">\
      <input name="faxprefix" type="text" class="body1" size="3" maxlength="3">\
      <input name="faxsuffix" type="text" class="body1" size="4" maxlength="4"></td>\
  </tr>\
  <tr>\
    <td class="body1">Email</td>\
    <td><input name="email" type="text" class="body1" size="20"></td>\
  </tr>\
  <tr>\
    <td class="body1">Insurance Claim Number </td>\
    <td><input name="insuranceclaimnumber" type="text" class="body1" size="20"></td>\
  </tr>\
  <tr bgcolor="#999999">\
    <td colspan="2"><p class="header2">Home Owner  Information </p></td>\
  </tr>\
  <tr>\
    <td class="body1"><span class="header1">*</span> Owner Name (First /Last) </td>\
    <td><input name="ownerfirstname" type="text" class="body1" size="12">\
      <input name="ownerlastname" type="text" class="body1" size="15"></td>\
  </tr>\
  <tr>\
    <td class="body1"><span class="header1">*</span> Street Address </td>\
    <td><input name="owneraddress" type="text" class="body1" size="30"></td>\
  </tr>\
  <tr>\
    <td class="body1"><span class="header1">*</span> City&nbsp;</td>\
    <td><input value= "" name="ownercity" type="text" class="body1" size="30"> \
</tr>\
<tr>\
	<td width="222" align="right" class="body1"><span class="header1">*</span> State&nbsp;</td>\
	<td class="body1">\
		<table cellpadding="0" cellspacing="0" border="0">\
		<tr>\
	        <td><input name="ownerstate" type="text" class="body1" size="2" value="" maxlength="2"></td>\
			<td width="10">&nbsp;</td>\
	        <td class="body1"><span class="header1">*</span> Zip&nbsp;</td>\
	        <td><input name="ownerzip" type="text" class="body1" value="" size="5"></td>\
		</tr>\
		</table>\
	</td>\
  </tr>\
  <tr>\
    <td class="body1"><span class="header1">*</span> Main Phone Number </td>\
    <td><input name="oareacode1" type="text" class="body1" size="3" maxlength="3">\
      <input name="ophoneprefix1" type="text" class="body1" size="3" maxlength="3">\
      <input name="ophonesuffix1" type="text" class="body1" size="4" maxlength="4"></td>\
  </tr>\
  <tr>\
    <td class="body1">Work Phone Number </td>\
    <td><input name="oareacode2" type="text" class="body1" size="3" maxlength="3">\
      <input name="ophoneprefix2" type="text" class="body1" size="3" maxlength="3">\
      <input name="ophonesuffix2" type="text" class="body1" size="4" maxlength="4"></td>\
  </tr>\
  <tr>\
    <td class="body1">Alt Phone Number </td>\
    <td><input name="oareacode3" type="text" class="body1" size="3" maxlength="3">\
      <input name="ophoneprefix3" type="text" class="body1" size="3" maxlength="3">\
      <input name="ophonesuffix3" type="text" class="body1" size="4" maxlength="4"></td>\
  </tr>\
  <tr>\
    <td class="body1">Pick Up Instructions / Notes </td>\
    <td>&nbsp;</td>\
  </tr>\
  <tr>\
    <td colspan="2"><p>\
      <textarea name="pickupinstructions" cols="75" rows="7" class="body1"></textarea>\
    </p>\
      <p>\
        <input name="Submit" type="submit" class="body1" value="Submit">&nbsp;<input class="body1" type="button" value="cancel" onclick="javascript:window.location.href=\'restoration.html\'"  \
            </p></td>\
    </tr>\
	</form>\
</table>\
<br />\
');
