{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.pet_relocationForm;
		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 name_empty=validate("name", "name_error", "name_style");
		var age_empty=validate("age", "age_error", "age_style");
		var breed_empty=validate("breed", "breed_error", "breed_style");
		var weight_empty=validate("weight", "weight_error", "weight_style");
		var vaccination_empty=validate("vaccination", "vaccination_error", "vaccination_style");
		var country_of_origin_empty=validate("country_of_origin", "country_of_origin_error", "country_of_origin_style");
		var country_of_destination_empty=validate("country_of_destination", "country_of_destination_error", "country_of_destination_style");
		
		var date_of_travel_empty=validate("date_of_travel", "date_of_travel_error", "date_of_travel_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 (name_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(name_empty);
		{rdelim}//end if
		
		if (age_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(age_empty);
		{rdelim}//end if
		
		if (breed_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(breed_empty);
		{rdelim}//end if
		
		if (weight_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(weight_empty);
		{rdelim}//end if
		
		if (vaccination_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(vaccination_empty);
		{rdelim}//end if
		
		if (country_of_origin_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(country_of_origin_empty);
		{rdelim}//end if
		
		if (country_of_destination_empty!=true)
		{ldelim}
			error_arr=error_arr.concat(country_of_destination_empty);
		{rdelim}//end if
		
		if (date_of_travel_empty !=false)
		{ldelim}	
			var date_of_travel_incorrect=validate_date("date_of_travel", "date_of_travel_error", "date_of_travel_style");
			if (date_of_travel_incorrect!=true)
			{ldelim}
				error_arr=error_arr.concat(date_of_travel_incorrect);
			{rdelim}//end if
		{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="pet_relocationForm" id="pet_relocationForm" method="post" action="?module=request.form&form=pet.relocation">
		    <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 style="padding-top:5px" 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 style="padding-top:5px">{#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 class="bold" style="padding-top:5px"><u>{#lbl_details_your_pet#}</u></td>
	  </tr>
	  <tr>
	    <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td width="90%" id="name_style">{#lbl_name#} <span class="required">*</span><br />
              <input name="name" type="text" id="name" size="48" class="inputbox">
              <input name="name_error" type="hidden" id="name_error" value="{#str_pet_name_empty#}"></td>
            <td id="age_style">{#lbl_age#} <span class="required">*</span><br />
			
		      <input name="age" type="text" class="inputbox" id="age"  size="10" >
		      <input name="age_error" type="hidden" id="age_error" value="{#str_pet_age_empty#}"></td>
          </tr>
        </table></td>
	  </tr>
	  <tr>
	    <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td width="90%" id="breed_style">{#lbl_breed#} <span class="required">*</span><br>
              <input name="breed" type="text" id="breed" size="48" class="inputbox">
              <input name="breed_error" type="hidden" id="breed_error" value="{#str_pet_breed_empty#}"></td>
            <td id="weight_style">{#lbl_weight#} <span class="required">*</span><br>
              <input name="weight" type="text" id="weight" size="10" class="inputbox">
              <input name="weight_error" type="hidden" id="weight_error" value="{#str_pet_weight_empty#}"></td>
          </tr>
        </table></td>
	  </tr>
	  <tr>
	    <td id="vaccination_style">{#lbl_vaccination#} <span class="required">*</span><br>
	      <input name="vaccination" type="text" id="vaccination" size="75" class="inputbox">
	      <input name="vaccination_error" type="hidden" id="vaccination_error" value="{#str_pet_vaccination_empty#}"></td>
	  </tr>
	  <tr>
	    <td><table width="100%" border="0" cellspacing="0" cellpadding="0">
          <tr>
            <td id="country_of_origin_style">{#lbl_country_of_origin#} <span class="required">*</span><br>
			{$country_of_origin}			  
			  <input name="country_of_origin_error" type="hidden" id="country_of_origin_error" value="{#str_country_of_origin_empty#}"></td>
            <td rowspan="3" valign="top">{#lbl_other_infomation#}<br>
              <textarea name="other_infomation" cols="25" rows="7" wrap="virtual" id="other_infomation" class="textarea"></textarea></td>
          </tr>
          <tr>
            <td id="country_of_destination_style">{#lbl_country_of_destination#} <span class="required">*</span><br>
			{$country_of_destination}
              <input name="country_of_destination_error" type="hidden" id="country_of_destination_error" value="{#str_country_of_destination_empty#}"></td>
          </tr>
          <tr>
            <td style="padding-top:5px;">{#lbl_travel_plan#}<br>
              <input name="travel_plan" type="text" id="travel_plan" size="45" class="inputbox"></td>
          </tr>
		  <tr>
                <td height="60" id="date_of_travel_style">{#lbl_date_of_travel#}<br />
					  <input name="date_of_travel" type="text" id="date_of_travel" size="20" readonly class="inputbox"><input type="button" name="choose_date_of_travel" value=" &middot;&middot;&middot; " class="button_icon" onclick="if(self.gfPop)gfPop.fPopCalendar(date_of_travel);return false;">
					  <input name="date_of_travel_error" type="hidden" id="date_of_travel_error" value="{#str_date_of_travel_empty#}">
					  <br />
({#lbl_mdy#})</td>
              </tr>
        </table></td>
	  </tr>
	  <tr>
	    <td align="center"><br /><br /><input type="button" name="send" value="{#lbl_send#}" class="button" onClick="submit_button('pet_relocationForm');" /> <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>