{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 submit_button(form_name)
	{ldelim}	
		var form=document.outboundForm;
		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 moving_from_empty=validate("moving_from", "moving_from_error", "moving_from_style");
		var moving_to_empty=validate("moving_to", "moving_to_error", "moving_to_style");
		var current_address_empty=validate("current_address", "current_address_error", "current_address_style");
		var expected_survey_date_empty=validate("expected_survey_date", "expected_survey_date_error", "expected_survey_date_style");
		var time_of_survey_empty=validate("time_of_survey", "time_of_survey_error", "time_of_survey_style");
		var expected_moving_date_empty=validate("expected_moving_date", "expected_moving_date_error", "expected_moving_date_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 (form.move[0].checked==false && form.move[1].checked==false ) 
		{ldelim}
			var move_empty=validate_option("move", "move_error", "private_move_style");
			error_arr=error_arr.concat(move_empty);
		{rdelim}
		else
		{ldelim}
			document.getElementById("private_move_style").style.color = '#333333';
		{rdelim}
		
		
		if (moving_from_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(moving_from_empty);
		{rdelim}//end if
		
		if (moving_to_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(moving_to_empty);
		{rdelim}//end if
		
		if (current_address_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(current_address_empty);
		{rdelim}//end if
		
		if (expected_survey_date_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(expected_survey_date_empty);
		{rdelim}//end if
		else 
		{ldelim}
			var expected_survey_date_incorrect=validate_date("expected_survey_date", "expected_survey_date_error", "expected_survey_date_style");
			if (expected_survey_date_incorrect!=true)
			{ldelim}
				error_arr=error_arr.concat(expected_survey_date_incorrect);
			{rdelim}//end if
		{rdelim}
		
		if (time_of_survey_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(time_of_survey_empty);
		{rdelim}//end if
		
		if (expected_moving_date_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(expected_moving_date_empty);
		{rdelim}//end if
		else
		{ldelim}
			var expected_moving_date_incorrect=validate_date("expected_moving_date", "expected_moving_date_error", "expected_moving_date_style");
			if (expected_moving_date_incorrect!=true)
			{ldelim}
				error_arr=error_arr.concat(expected_moving_date_incorrect);
			{rdelim}//end if
		{rdelim}
		
		if (form.allowance[0].checked==false && form.allowance[1].checked==false ) 
		{ldelim}
			var allowance_empty=validate_option("allowance", "allowance_error", "allowance_style");
			error_arr=error_arr.concat(allowance_empty);
		{rdelim}
		else
		{ldelim}
			document.getElementById("allowance_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="outboundForm" id="outboundForm" method="post" action="?module=request.form&form=outbound">
		  <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 width="55%" id="private_move_style">{#lbl_move#}  <span class="required">*</span></td>
            <td width="45%">&nbsp;&nbsp;{#lbl_term_of_payment#}</td>
          </tr>
          <tr>
            <td id="move_style"><input name="move" type="radio" value="0"  />
{#lbl_private_move#}<input name="move" type="radio" value="1" />{#lbl_corporate_move#} 
			  <input name="move_error" type="hidden" id="move_error" value="{#str_move_empty#}">			  </td>
            <td align="right">
			<input name="term_of_payment" type="radio" value="TT">{#lbl_tt#}
			  <input name="term_of_payment" type="radio" value="Cash">{#lbl_cash#}
			  <input name="term_of_payment" type="radio" value="Check">{#lbl_check#}</td>
          </tr>
        </table></td>
	  </tr>
	  
	  <tr>
	    <td valign="bottom">
			  </td>
	    </tr>
	  <tr>
	    <td id="moving_from_style">{#lbl_moving_from#} <span class="required">*</span><br />
	      <input name="moving_from" type="text" id="moving_from" size="75" class="inputbox">
	      <input name="moving_from_error" type="hidden" id="moving_from_error" value="{#str_moving_from_empty#}"></td>
	    </tr>
	  <tr>
	    <td id="moving_to_style">{#lbl_moving_to#} <span class="required">*</span><br />
	      <input name="moving_to" type="text" id="moving_to" size="75" class="inputbox">
	      <input name="moving_to_error" type="hidden" id="moving_to_error" value="{#str_moving_to_empty#}"></td>
	    </tr>
	  <tr>
	    <td id="current_address_style">{#lbl_current_address#} <span class="required">*</span><br />
	      <input name="current_address" type="text" id="current_address" size="75" class="inputbox">
	      <input name="current_address_error" type="hidden" id="current_address_error" value="{#str_current_address_empty#}"></td>
	    </tr>
	  <tr>
	    <td>{#lbl_destination_address#}<br />
	      <input name="destination_address" type="text" id="destination_address" size="75" class="inputbox"></td>
	  </tr>
	  <tr>
	    <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td width="50%" valign="top" ><span  id="expected_survey_date_style">{#lbl_expected_survey_date#} </span><span class="required">*</span><br>
			<input name="expected_survey_date" type="text" id="expected_survey_date" value="" readonly class="inputbox" size="7" /> 
			<input type="button" name="choose_expected_survey_date" value=" &middot;&middot;&middot; " class="button_icon" onclick="if(self.gfPop)gfPop.fPopCalendar(expected_survey_date);return false;">
			<input name="expected_survey_date_error" type="hidden" id="expected_survey_date_error" value="{#str_expected_survey_date_empty#}">
			({#lbl_mdy#})</td>
            <td rowspan="6" valign="bottom">{#lbl_other_infomation#}<br>
              <textarea name="other_infomation" cols="37" rows="8" id="other_infomation" class="textarea"></textarea></td>
          </tr>
          <tr>
            <td valign="bottom" ><span id="time_of_survey_style">
{#lbl_time_of_survey#} </span><span class="required">*</span><br>
			<input name="time_of_survey" type="text" id="time_of_survey" size="12" maxlength="8" class="inputbox">
			<input name="time_of_survey_error" type="hidden" id="time_of_survey_error" value="{#str_time_of_survey_empty#}"></td>
          </tr>
          <tr>
            <td valign="bottom" ><span id="expected_moving_date_style">{#lbl_expected_moving_date#}</span><span class="required">*</span><br />
			<input name="expected_moving_date" type="text" id="expected_moving_date" value="" readonly class="inputbox" size="7" /> 
			<input type="button" name="choose_expected_moving_date" value=" &middot;&middot;&middot; " class="button_icon" onclick="if(self.gfPop)gfPop.fPopCalendar(expected_moving_date);return false;">
			<input name="expected_moving_date_error" type="hidden" id="expected_moving_date_error" value="{#str_expected_moving_date_empty#}">						({#lbl_mdy#})</td>
            </tr>
          <tr>
            <td valign="bottom" ><span id="allowance_style">{#lbl_allowance#}</span> <span class="required">*</span>
              <input name="allowance" type="radio" value="1"> 
              {#lbl_sea#}
              <input name="allowance" type="radio" value="2"> 
              {#lbl_air#}
			  <input name="allowance_error" type="hidden" id="allowance_error" value="{#str_allowance_empty#}">
			  </td>
          </tr>
          <tr>
            <td valign="bottom"><input name="allowance_value" type="text" id="allowance_value" size="25" class="inputbox"></td>
          </tr>
        </table></td>
	    </tr>
	  <tr>
	    <td align="center"><br /><br /><input type="button" name="send" value="{#lbl_send#}" class="button" onClick="submit_button('outboundForm');" /> <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>