{config_load file="$path_language/$access.html" section="request_form"}
<script language="JavaScript" src="{$dir_ws_js}sendform.js"></script>
<script language="JavaScript" type="text/javascript">
	
	function draw_form_radio(obj, from_div)
		{ldelim}
			var a = obj.value.slice(0, -1);
			if (a=='No'||a=='いいえ') document.getElementById(from_div).style.display="";
			else document.getElementById(from_div).style.display="none";
		{rdelim}
		
	function submit_button(form_name)
	{ldelim}	
		var form=document.orientationForm;
		var error_arr=new Array();
		var fullname_empty=validate("customer", "customer_error", "customer_style");
		var country_empty=validate("country_id", "country_error", "country_style");
		var tel_work_empty=validate("tel_work", "tel_work_error", "tel_work_style");
		var email_empty=validate("email", "email_error", "email_style");
		var current_residence_empty=validate("current_residence", "current_residence_error", "current_residence_style");
		
		
		
		if (fullname_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(fullname_empty);
		{rdelim}//end if
		
		if (country_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(country_empty);
		{rdelim}//end if
		
		if (tel_work_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(tel_work_empty);
		{rdelim}else{ldelim}
			var tel_work_invalid=validate_phone("tel_work", "tel_work_invalid", "tel_work_style");
			if (tel_work_invalid!=true)
			{ldelim}
				error_arr=error_arr.concat(tel_work_invalid);
			{rdelim}//end if
		{rdelim}//end if
		
		if (form.tel_home.value!="")
		{ldelim}
			var tel_home_invalid=validate_phone("tel_home", "tel_home_invalid", "tel_home_style");
			if (tel_home_invalid!=true)
			{ldelim}
				error_arr=error_arr.concat(tel_home_invalid);
			{rdelim}//end if
		{rdelim}//end if
		else
		{ldelim}
			document.getElementById("tel_home_style").style.color = '#333333';
			document.getElementById("tel_home").style.background = '#FFFFFF';
		{rdelim}//end if
		
		
		if (form.mobile.value!="")
		{ldelim}
			var mobile_invalid=validate_phone("mobile", "mobile_invalid", "mobile_style");
			if (mobile_invalid!=true)
			{ldelim}
				error_arr=error_arr.concat(mobile_invalid);
			{rdelim}//end if
		{rdelim}//end if
		else
		{ldelim}
			document.getElementById("mobile_style").style.color = '#333333';
			document.getElementById("mobile").style.background = '#FFFFFF';
		{rdelim}//end if
		
		
		if (email_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(email_empty);
		{rdelim}else{ldelim}
			var email_invalid=validate_email("email", "email_invalid", "email_style");
			if (email_invalid!=true)
			{ldelim}
				error_arr=error_arr.concat(email_invalid);
			{rdelim}//end if
		{rdelim}//end if
		
		if (current_residence_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(current_residence_empty);
		{rdelim}//end if
		
		if (form.first_visit_to_vietnam[0].checked==false && form.first_visit_to_vietnam[1].checked==false ) 
		{ldelim}
			var first_visit_to_vietnam_empty=validate_option("first_visit_to_vietnam", "first_visit_to_vietnam_error", "first_visit_to_vietnam_style");
			error_arr=error_arr.concat(first_visit_to_vietnam_empty);
		{rdelim}
		else
		{ldelim}
			if(form.first_visit_to_vietnam[1].checked==true)
				{ldelim}
					var date_of_last_visit_empty=validate("date_of_last_visit", "date_of_last_visit_error", "when_was_your_last_visit_style");
					if (date_of_last_visit_empty!=true)
					{ldelim}
						error_arr=error_arr.concat(date_of_last_visit_empty);
					{rdelim}//end if
					else
					{ldelim}			
						var date_of_last_visit_empty=validate_dated("date_of_last_visit", "date_of_last_visit_error", "when_was_your_last_visit_style");
						if (date_of_last_visit_empty!=true)
						{ldelim}
							error_arr=error_arr.concat(date_of_last_visit_empty);
						{rdelim}//end if
					{rdelim}//end if
			{rdelim}
		{rdelim}
		
		if(form.children[0].checked==false && form.children[1].checked==false && form.children[2].checked==false && form.children[3].checked==false)
		{ldelim}
			var children_empty=validate_option("children", "children_error", "children_style");
			error_arr=error_arr.concat(children_empty);
		{rdelim}
		else
		{ldelim}
			document.getElementById("children_style").style.color = '#333333';
		{rdelim}
		
		
		if(form.city_orientation_package[0].checked==false && form.city_orientation_package[1].checked==false && form.city_orientation_package[2].checked==false)
		{ldelim}
			var city_orientation_package_empty=validate_option("city_orientation_package", "city_orientation_package_error", "city_orientation_package_style");
			
			error_arr=error_arr.concat(city_orientation_package_empty);
		{rdelim}
		else
		{ldelim}
			document.getElementById("city_orientation_package_style").style.color = '#333333';
		{rdelim}
		
		if(form.settling_in_package[0].checked==false && form.settling_in_package[1].checked==false)
		{ldelim}
			var settling_in_package_empty=validate_option("settling_in_package", "settling_in_package_error", "settling_in_package_style");
			error_arr=error_arr.concat(settling_in_package_empty);
		{rdelim}
		else
		{ldelim}
			document.getElementById("settling_in_package_style").style.color = '#333333';
		{rdelim}
		
		if (error_arr.length>0)
		{ldelim}
			show_erros(error_arr, '{#lbl_warning#}', '90%', '{$dir_ws_theme}');
		{rdelim}else{ldelim}
			submit_action_form(form_name);
		{rdelim}//end if
	{rdelim}
	
	
</script>

<table width="780" border="0" cellspacing="0" cellpadding="0">
  <tr>
    <td width="210" valign="top" align="right">
	<table width="100%" border="0" cellspacing="0" cellpadding="0">
	  <tr>
		<td align="right" class="title_left">{$request_from}</td>
	  </tr>
	  <tr>
		<td align="right" class="title_request_form">{$form_name}</td>
	  </tr>
	</table>
	</td>
    <td width="1" valign="top" class="bg_grey2"><img src="{$dir_ws_theme}images/trans.gif" width="1" height="1"></td>
    <td valign="top" class="space10px_left">
	
	  <table width="90%" border="0" align="center" cellpadding="0" cellspacing="0" bgcolor="#F2F2F2">
        <tr>
          <td width="10" height="10"><img src="{$dir_ws_theme}images/box1.gif" width="10" height="11"></td>
          <td height="10" background="{$dir_ws_theme}images/box2.gif"><img src="{$dir_ws_theme}images/trans.gif" width="1" height="1"></td>
          <td width="10" height="10"><img src="{$dir_ws_theme}images/box3.gif" width="10" height="11"></td>
        </tr>
        <tr>
          <td width="10" background="{$dir_ws_theme}images/box4.gif"><img src="{$dir_ws_theme}images/trans.gif" width="1" height="1"></td>
          <td>
		  <div id="errors"></div>
		  <form name="orientationForm" id="orientationForm" method="post" action="?module=request.form&form=orientation">
		  <table width="70%" border="0" align="center" cellpadding="0" cellspacing="1">
	  <tr>
        <td align="right"  class="bold">{#lbl_required#}</td>
      </tr>
	 <tr>
		<td><table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td width="60%" id="customer_style">
			{#lbl_your_name#} <span class="required">*</span><br />
			<input name="customer" type="text" class="inputbox" id="customer" value="{$customer.customer}" size="20">
            <input name="customer_error" type="hidden" id="customer_error" value="{#str_fullname_empty#}">			</td>
            <td id="country_style">{#lbl_country#} <span class="required">*</span><br />
			{$country}
          <input name="country_error" type="hidden" id="country_error" value="{#str_country_empty#}">
			</td>
          </tr>
        </table></td>
	  </tr>
	  <tr>
	    <td id="company_style">{#lbl_company#} <br />
		<input name="company" type="text" id="company" size="75" class="inputbox">
          <input name="company_error" type="hidden" id="company_error" value="{#str_company_empty#}">
		</td>
	    </tr>
	  <tr>
	    <td>{#lbl_address#}<br />
		<input name="address" type="text" id="address" size="75" class="inputbox">
		</td>
	    </tr>
	  <tr>
	    <td><input name="address2" type="text" id="address2" size="75" class="inputbox"></td>
	    </tr>
	  <tr>
	    <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td width="34%" valign="bottom" id="tel_work_style">{#lbl_tel_work#} <span class="required">*</span><br />
			<input name="tel_work" type="text" id="tel_work" size="20" class="inputbox">
            <input name="tel_work_error" type="hidden" id="tel_work_error" value="{#str_tel_work_empty#}">
            <input name="tel_work_invalid" type="hidden" id="tel_work_invalid" value="{#str_tel_work_invalid#}">
			</td>
            <td width="34%" valign="bottom" id="tel_home_style">{#lbl_tel_home#}<br />
			<input name="tel_home" type="text" id="tel_home" size="20" class="inputbox">
			<input name="tel_home_invalid" type="hidden" id="tel_home_invalid" value="{#str_tel_home_invalid#}">			</td>
			<td valign="bottom" id="mobile_style">{#lbl_mobile#}<br />
			<input name="mobile" type="text" id="mobile" size="20" class="inputbox">
			<input name="mobile_invalid" type="hidden" id="mobile_invalid" value="{#str_mobile_invalid#}">
			</td>
          </tr>
        </table></td>
	    </tr>
	  <tr>
	    <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td width="40%" valign="bottom">{#lbl_vat#}<br />
              <input name="vat" type="text" id="vat" size="20" class="inputbox"></td>
            <td valign="bottom" id="email_style">{#lbl_email#} <span class="required">*</span><br />
              <input name="email" type="text" class="inputbox" id="email" size="48">
              <input name="email_error" type="hidden" id="email_error" value="{#str_email_empty#}">
              <input name="email_invalid" type="hidden" id="email_invalid" value="{#str_email_invalid#}"></td>
          </tr>
        </table></td>
	    </tr>
	  <tr>
	    <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td colspan="2" valign="top"><table width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td id="current_residence_style">{#lbl_current_residence#} <span class="required">*</span><br>
                  <input name="current_residence" type="text" id="current_residence" size="35" class="inputbox">
                  <input name="current_residence_error" type="hidden" id="current_residence_error" value="{#str_current_residence_empty#}"></td>
              </tr>
              <tr>
                <td>{#lbl_schedule_of_travel_to_vietnam#}:<br>
                  <input name="schedule_of_travel_to_vietnam" type="text" id="schedule_of_travel_to_vietnam" size="35" class="inputbox"></td>
              </tr>
              <tr>
                <td height="28" ><span id="first_visit_to_vietnam_style">{#lbl_first_visit_to_vietnam#}</span><span class="required">*</span><input name="first_visit_to_vietnam" type="radio" value="{#lbl_yes#}" onclick="JavaScript:draw_form_radio(this, 'first_visit_to_vietnam_no');" >
                   {#lbl_yes#}
                   <input name="first_visit_to_vietnam" type="radio" value="{#lbl_no#}"  onclick="JavaScript:draw_form_radio(this, 'first_visit_to_vietnam_no');" >
                   {#lbl_no#}
				   <input name="first_visit_to_vietnam_error" type="hidden" id="first_visit_to_vietnam_error" value="{#str_first_visit_to_vietnam_empty#}">
					</div>				</td>
              </tr>
			  <tr>
                <td height="72" id="first_visit_to_vietnam_no" style="display:none"><span  id="when_was_your_last_visit_style">{#lbl_when_was_your_last_visit#} </span><span class="required">*</span><br />
                	 <input name="date_of_last_visit" type="text" id="date_of_last_visit" size="20" readonly class="inputbox">&nbsp;<input type="button" name="choose_date_of_last_visit" value=" &middot;&middot;&middot; " class="button_icon" onclick="if(self.gfPop)gfPop.fPopCalendar(date_of_last_visit);return false;">({#lbl_mdy#})
<input name="date_of_last_visit_error" type="hidden" id="date_of_last_visit_error" value="{#str_date_of_last_visit_empty#}">				</td>
              </tr>
			  
            </table></td>
            </tr>
          
          <tr>
            <td width="56%" valign="top"><span id="children_style"> {#lbl_children#}</span><span class="required">*</span><br />
 <input name="children" type="radio" value="{#lbl_no#}"  >
  {#lbl_no#}
  <input name="children" type="radio" value="1" > {#lbl_1#} <input name="children" type="radio" value="2" >{#lbl_2#} <input name="children" type="radio" value="{#lbl_more#}" >{#lbl_more#}
				<input name="children_error" type="hidden" id="children_error" value="{#str_children_empty#}"></td>
            <td width="44%" rowspan="3" valign="bottom" class="space10px_left">{#lbl_other_infomation#}<br>
              <textarea name="other_infomation" cols="30" rows="8" wrap="virtual" id="other_infomation" class="textarea"></textarea></td>
          </tr>
          <tr>
            <td valign="top" height="52" ><span id="city_orientation_package_style"> {#lbl_city_orientation_package#}</span><span class="required">*</span><br>
					<div align="right">
					   <input name="city_orientation_package" type="radio" value="{#lbl_halfday#}"> {#lbl_halfday#}
					  <input name="city_orientation_package" type="radio" value="{#lbl_1day#}"> {#lbl_1day#}
					  <input name="city_orientation_package"  type="radio" value="{#lbl_2days#}"> {#lbl_2days#}
					  <input name="city_orientation_package_error" type="hidden" id="city_orientation_package_error" value="{#str_city_orientation_package_empty#}">
					</div>				</td>
            </tr>
          <tr>
           <td height="28" ><span id="settling_in_package_style"> {#lbl_settling_in_package#}</span><span class="required">*</span><input name="settling_in_package" type="radio" value="{#lbl_yes#}">
           {#lbl_yes#}
<input name="settling_in_package" type="radio" value="{#lbl_no#}"> 
           {#lbl_no#}
				<input name="settling_in_package_error" type="hidden" id="settling_in_package_error" value="{#str_settling_in_package_empty#}">                  </td>
            </tr>
		  
        </table></td>
	  </tr>
	  <tr>
                <td valign="bottom">
                  <table width="100%" border="0" cellspacing="0" cellpadding="0">
                    <tr>
						<td colspan="2"><p><br />
						  {#lbl_other_service#}</p></td>
					</tr>
					<tr>
                      <td width="49%">
                        <input type="checkbox" name="service_home_search" id="service_home_search" value="1" />{#lbl_home_search#}
                        </td>
                      <td width="51%"><input type="checkbox" name="service_schooling" id="service_schooling" value="1" />{#lbl_schooling#}</td>
                    </tr>
                    <tr>
                      <td><input type="checkbox" name="service_culture" id="service_culture" value="1" />{#lbl_culture_training#}</td>
                      <td><input type="checkbox" name="service_cleaning" id="service_cleaning" value="1" />{#lbl_cleaning#}</td>
                    </tr>
                    <tr>
                      <td><input type="checkbox" name="service_handyman" id="service_handyman" value="1" />{#lbl_handyman#}</td>
                      <td><input type="checkbox" name="service_maid"  id="service_maid" value="1" />{#lbl_maid_helper#}</td>
                    </tr>
                    <tr>
                      <td><input type="checkbox" name="service_banking" id="service_banking" value="1" />{#lbl_banking#}</td>
                      <td><input type="checkbox" name="service_internet"  id="service_internet" value="1" />{#lbl_internet#}</td>
                    </tr>
                  </table>                  <p><br>
                    
                    
                  </p></td>
              </tr>
	  <tr>
	    <td align="center"><br /><br /><input type="button" name="send" value="{#lbl_send#}" class="button" onClick="submit_button('orientationForm');" /> <input type="reset" name="Reset" value="{#lbl_reset#}" class="button" />
	      <input name="action" type="hidden" id="action" value="save"></td>
	    </tr>
	</table>
		  </form>
		  </td>
          <td width="10" background="{$dir_ws_theme}images/box5.gif"><img src="./images/trans.gif" width="1" height="1"></td>
        </tr>
        <tr>
          <td width="10" height="10"><img src="{$dir_ws_theme}images/box6.gif" width="10" height="10"></td>
          <td height="10" background="{$dir_ws_theme}images/box7.gif"><img src="./images/trans.gif" width="1" height="1"></td>
          <td width="10" height="10"><img src="{$dir_ws_theme}images/box8.gif" width="10" height="10"></td>
        </tr>
</table>
<iframe width=174 height=189 name="gToday:normal:agenda.js" id="gToday:normal:agenda.js" src="./languages/{$access}/javascript/calendar/ipopeng.htm" scrolling="no" frameborder="0" style="visibility:visible; z-index:999; position:absolute; left:-500px; top:0px;">
	</iframe>
	</td>
  </tr>
</table>