<html>
<body><div id='crmWebToEntityForm' align=center><META HTTP-EQUIV ='content-type' CONTENT='text/html;charset = UTF-8'> <form action='https://crm.zoho.com/crm/WebToContactForm' name="contactForm" method='POST' onsubmit="return validateForm()"><table border=0 cellspacing=0 cellpadding=5 width=480 style='border-top:2px solid #999999;border-bottom:1px solid #999999;background-color:#ffffff;'> <input type='hidden' name='xnQsjsdp' value=42Ox4h0d34c$/> <input type='hidden' name='xmIwtLD' value=ksCSnRONGHQnv1lj3wF972-*B6-MHnNR/> <input type='hidden' name='actionType' value=Q29udGFjdHM=/> <input type='hidden' name='returnURL' value='http://lovelycutsgrooming.com' /> <br><tr><td colspan='2' align='left' style='background-color:#f5f5f5;border-bottom:2px dotted #dadada; color:#000000;font-family:sans-serif;font-size:14px;'><strong>Web Form</strong></td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>First Name :</td><td width='75%'><input type='text' maxlength='40' id='fname' name='fname' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Last Name :</td><td width='75%'><input type='text' maxlength='80' name='lname' id='lname' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Email :</td><td width='75%'><input type='text' maxlength='100' name='email' id'email' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Phone :</td><td width='75%'><input type='text' maxlength='50' name='phone' id='phone' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Mobile :</td><td width='75%'><input type='text' maxlength='30' name='mobile' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Date of Birth :</td><td width='75%'><input type='text' maxlength='20' name='Date of Birth' />MM/dd/yyyy </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Mailing Street :</td><td width='75%'><input type='text' maxlength='250' name='mailingstreet' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Mailing City :</td><td width='75%'><input type='text' maxlength='30' name='mailingcity' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Mailing State :</td><td width='75%'><input type='text' maxlength='30' name='mailingstate' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Mailing Zip :</td><td width='75%'><input type='text' maxlength='30' name='mailingzip' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>First Visit :</td><td width='75%'><input type='text' maxlength='20' name='firstvisit' />MM/dd/yyyy </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Shot's up to Date? :</td><td width='75%'><input type='checkbox' name='CONTACTCF110' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Breed :</td><td width='75%'><input type='text' maxlength='50' name='CONTACTCF2' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Pet Age :</td><td width='75%'><input type='text' maxlength='20' name='CONTACTCF3' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Pet Name :</td><td width='75%'><input type='text' maxlength='20' name='CONTACTCF1' /> </td></tr><tr><td nowrap style='font-family:sans-serif;font-size:12px;font-weight:bold' align='right' width='25%'>Allergies/Health Problems :</td><td width='75%'> <textarea name='CONTACTCF4' maxlength='1000' width='250' height='250'></textarea></td></tr><tr>
<td style="font-family: sans-serif; font-size: 12px;" class="feature-border" align="right" nowrap="nowrap" width="29%">Verification Code:</td>
<td class="feature-border" align="left" valign="middle" width="66%"><input name="varifyNumHidden" id="varifyNumHidden" value="701469" type="hidden">
<input name="enterVerify" id="enterVerify" type="text"> <div id="varifyNum" style="font-size: 14px; font-family: Arial,Helvetica,sans-serif; font-weight: bold;"></div></td>
</tr><tr><td colspan=2 align=center style='background-color:#eaeaea'> <input type='submit' name='save' value=Save /> <input type='reset' name='reset' value=Reset /> </td></tr></table> </form>
<script>
function randomgen()
{
var rannumber='';
for(ranNum=1; ranNum<=6; ranNum++){
rannumber+=Math.floor(Math.random()*10).toString();
}
document.getElementById('varifyNum').innerHTML=rannumber;
document.getElementById('varifyNumHidden').value=rannumber;
}
randomgen();
//Varification number genarate code End here
//Validation Start Here
function validateForm()
{
var thefrm=document.contactForm;
if(thefrm.enterVerify.value=="")
{
alert("Enter your Verification Code");
thefrm.enterVerify.focus();
return false;
}
else if(thefrm.enterVerify.value!="")
{
if(thefrm.enterVerify.value!=thefrm.varifyNumHidden.value)
{
alert("please Enter Currect Verification Number");
randomgen();
thefrm.enterVerify.select();
thefrm.enterVerify.focus();
return false;
}
else
{
return true;
}
}
else
{
return true;
}
}
</script>
</div>
</body>
</html>