function ValidateForm()	{

		var isFormValid = 1;
		var errorMessage = '';
		var firstName = document.getElementById('FirstName');
		var lastName = document.getElementById('LastName');
		var emailAddress = document.getElementById('EmailAddress');
		var homePhone = document.getElementById('HomePhone');
		var State = document.getElementById('State');
		
		if(firstName.value.length < 1) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- First Name is required.\n';
		}
		if(lastName.value.length < 1) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Last Name is required.\n';
		}
		if(homePhone.value.length < 9) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Phone Number is required.\n';
		}
		if(State.value == '-1')
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Select a State from the drop down.\n';
		}
		if(emailAddress.value.length < 4) 
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Email Address is required.\n';
		}
		if(IsEmailValid(emailAddress.value) == false)
		{
			isFormValid = 0;
			errorMessage = errorMessage + '- Email Address is not valid.\n';
		}
	
		if(isFormValid == 0)
		{
			alert(errorMessage);
		}
		else
		{
			// Send the data and user to next step
			 //window.location = 'http://www.delraycc.com/transfer.asp?FirstName=' + escape(document.getElementById('FirstName').value) + '&LastName=' + escape(document.getElementById('LastName').value) + '&HomePhone=' + escape(document.getElementById('HomePhone').value) + '&EmailAddress=' + escape(document.getElementById('EmailAddress').value) + '&ContactTime=' + escape(document.getElementById('ContactTime').options[document.getElementById('ContactTime').selectedIndex].value) + '&State=' + escape(document.getElementById('State').options[document.getElementById('State').selectedIndex].value) + '&TotalDebt=' + escape(document.getElementById('TotalDebt').options[document.getElementById('TotalDebt').selectedIndex].value) + '&ReferURL=' + escape(document.referrer);
			window.location = 'http://www.delraycc.com/indexdccnew.asp?FirstName=' + escape(document.getElementById('FirstName').value) + '&LastName=' + escape(document.getElementById('LastName').value) + '&HomePhone=' + escape(document.getElementById('HomePhone').value) + '&EmailAddress=' + escape(document.getElementById('EmailAddress').value) + '&ContactTime=' + escape(document.getElementById('ContactTime').options[document.getElementById('ContactTime').selectedIndex].value) + '&State=' + escape(document.getElementById('State').options[document.getElementById('State').selectedIndex].value) + '&TotalDebt=' + escape(document.getElementById('TotalDebt').options[document.getElementById('TotalDebt').selectedIndex].value) + '&ReferURL=' + escape(document.referrer); 
		}
		
		return false;
	}
	
	function IsEmailValid(emailAddress) {
		var emailReg = "^[\\w-_\.]*[\\w-_\.]\@[\\w]\.+[\\w]+[\\w]$";
		var regex = new RegExp(emailReg);
		return regex.test(emailAddress);
	}

document.write('<table width="225" border="0" cellspacing="0" cellpadding="3" align="center" class="newform">');
document.write('<tr>');
document.write('<td height="50" width="60"></td>');
document.write('<td height="50" width="140"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="28" align="right" nowrap="nowrap" style="font-size: 14px; color: #ffffff;">First Name</td>');
document.write('<td><input name="FirstName" id="FirstName" type="text" size="20"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="28" align="right" nowrap="nowrap" style="font-size: 14px; color: #ffffff;">Last Name</td>');
document.write('<td><input name="LastName" id="LastName" type="text" size="20"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="28" align="right" style="font-size: 14px; color: #ffffff;">Email</td>');
document.write('<td><input name="EmailAddress" id="EmailAddress" type="text" size="20" ></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="28" align="right" style="font-size: 14px; color: #ffffff;">Phone</td>');
document.write('<td><input name="HomePhone" id="HomePhone" type="text" size="20"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="28" align="right" style="font-size: 14px; color: #ffffff;">State</td>');
document.write('<td>');
document.write('<select name="State" id="State">');
document.write('<option value="---" selected>Please Select</option>');
document.write('<option value="al">Alabama</option>');
document.write('<option value="ak">Alaska</option>');
document.write('<option value="az">Arizona</option>');
document.write('<option value="ar">Arkansas</option>');
document.write('<option value="ca">California</option>');
document.write('<option value="co">Colorado</option>');
document.write('<option value="ct">Connecticut</option>');
document.write('<option value="de">Delaware</option>');
document.write('<option value="dc">DC</option>');
document.write('<option value="fl">Florida</option>');
document.write('<option value="ga">Georgia</option>');
document.write('<option value="hi">Hawaii</option>');
document.write('<option value="id">Idaho</option>');
document.write('<option value="il">Illinois</option>');
document.write('<option value="in">Indiana</option>');
document.write('<option value="ia">Iowa</option>');
document.write('<option value="ky">Kentucky</option>');
document.write('<option value="la">Louisiana</option>');
document.write('<option value="me">Maine</option>');
document.write('<option value="md">Maryland</option>');
document.write('<option value="ma">Massachusetts</option>');
document.write('<option value="mi">Michigan</option>');
document.write('<option value="fm">Micronesia</option>');
document.write('<option value="mn">Minnesota</option>');
document.write('<option value="ms">Mississippi</option>');
document.write('<option value="mo">Missouri</option>');
document.write('<option value="mt">Montana</option>');
document.write('<option value="ne">Nebraska</option>');
document.write('<option value="nv">Nevada</option>');
document.write('<option value="nh">New Hampshire</option>');
document.write('<option value="nj">New Jersey</option>');
document.write('<option value="nm">New Mexico</option>');
document.write('<option value="ny">New York</option>');
document.write('<option value="nf">Newfoundland</option>');
document.write('<option value="nc">North Carolina</option>');
document.write('<option value="nd">North Dakota</option>');
document.write('<option value="oh">Ohio</option>');
document.write('<option value="ok">Oklahoma</option>');
document.write('<option value="or">Oregon</option>');
document.write('<option value="pa">Pennsylvania</option>');
document.write('<option value="ri">Rhode Island</option>');
document.write('<option value="sc">South Carolina</option>');
document.write('<option value="sd">South Dakota</option>');
document.write('<option value="tn">Tennessee</option>');
document.write('<option value="tx">Texas</option>');
document.write('<option value="ut">Utah</option>');
document.write('<option value="vt">Vermont</option>');
document.write('<option value="va">Virginia</option>');
document.write('<option value="wa">Washington</option>');
document.write('<option value="wv">West Virginia</option>');
document.write('<option value="wy">Wyoming</option>');
document.write('</select>');			
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="28" align="right" style="font-size: 14px; color: #ffffff;">Contact</td>');
document.write('<td><select name="ContactTime" id="ContactTime">');
document.write('<option value="Morning">Morning</option>');
document.write('<option value="Afternoon">Afternoon</option>');
document.write('<option value="Evening">Evening</option>');
document.write('</select>');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="28" nowrap="nowrap" align="right" style="font-size: 14px; color: #ffffff;">Total Debt</td>');
document.write('<td>');
document.write('<select name="TotalDebt" id="TotalDebt">');
document.write('<option value="2000-20000">$2,000-$20,000</option>');
document.write('<option value="20001-100000">$20,001-$100,000</option>');
document.write('<option value="Over 100000">Over $100,000</option>');
document.write('<option value="Budgeting">Budgeting</option>');
document.write('<option value="Credit Report">Credit Report</option>');
document.write('<option value="Tax Assistance">Tax Assistance</option>');
document.write('</select>');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td></td>');
document.write('<td align="center"><input name="SubmitButton" id="SubmitButton" type="image" onClick="return ValidateForm();" value="submit" src="http://www.delraycc.com/images/newbutton.gif">');
document.write('<br><a class="landdisclaimer" href="http://www.delraycc.com/privacy-popup.htm" target="blank")">Privacy Policy</a>');
document.write('</td>');
document.write('</tr>');
document.write('</table>');
document.all('FirstName').focus();