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Auto populate CITY, COUNTY when ZIP is entered, struts

Posted on 2005-05-13
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Last Modified: 2010-04-01
I have acheived this before without struts. When I simply used JSP, servlet, onblur event of ZIP textfield, after validation I submitted the form and I was able to get CITY, COUNTY from the database and populate it to the JSP. But with Struts I cannot do the same, form won't submit onblur event...
Does anyone acheived this in Struts (I am positive on this, someone must have done it) ?

Please help...
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Question by:raj3060
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22 Comments
 
LVL 16

Expert Comment

by:suprapto45
ID: 14001071
Hi,

Can you show me the example on how do you do it without Struts? I will replace it with how Struts do it.

Regards
Dave
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LVL 16

Expert Comment

by:suprapto45
ID: 14001094
Hi,

Maybe this help.

http://www.coreservlets.com/Apache-Struts-Tutorial/Struts-Forms.html
http://struts.apache.org/userGuide/struts-html.html#text

However I see that <html:text onblur="" /> thus it should not be a problem for you, shouldn't it

Regards
Dave
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LVL 29

Expert Comment

by:bloodredsun
ID: 14001760
you should be able to submit the form in the normal manner, Struts or not, as this is controlled by javascript which is a client side script. This means that it doesn't matter what you use at the back end, the HTML that is outputted is what counts.

e.g.
<html:text name="zipcode" onblur="javascript: document.myform.submit();"/>

I think that you are having issues witht he action form. The values in the <html:text> elements are directly related to the ActionForm, so as long as you put the values in there they will be populating the form.
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LVL 11

Author Comment

by:raj3060
ID: 14003280
This is not working:

onblur="javascript: document.form[0].submit();"

I can not define name to <html:form>

This works if I have a link:

<a href="action.do">Click</a>

I was thinking that this wud have worked:
onblur="action.do"

but unfortunately it doesn't..

Suggestions.....
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LVL 29

Expert Comment

by:bloodredsun
ID: 14003774
look at the HTML that is created and get the form name from that. Then put it in the javascript I suggested..

javascript: document.THEFORMNAME.submit();
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LVL 16

Expert Comment

by:suprapto45
ID: 14004573
Hi,

If you do not mind, can you post your JSP page?

Regards
Dave
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LVL 14

Expert Comment

by:boonleng
ID: 14004836
You dont need to specify the form name unless you want to submit another form. Just use 'this.form' to refer back to the form that the field resided on.

e.g.
<html:text property="zipcode"  onblur="this.form.submit()"/>

Regards,
Boon Leng
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LVL 11

Author Comment

by:raj3060
ID: 14007074
>>You dont need to specify the form name unless you want to submit another form. Just use 'this.form' to refer back to the form that the field resided on.

Did you ever try to assign name to <html:form>....

>><html:text property="zipcode"  onblur="this.form.submit()"/>

I was thinking the same that it wud work but it is not....
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LVL 14

Expert Comment

by:boonleng
ID: 14007766
hmm... strange..
You cant assign name to <html:form>. However, struts will use the form bean name declared in struts-config.xml as the form name.

Example.
struts-config.xml
-------------------------------------
<action path="/sample_add" name="sampleForm"  ...>

Struts will render <html:form> to become <form name="sampleForm" method="post" ..>
You probably can try the below codes:
<html:text property="zipcode"  onblur="document.sampleForm.submit()"/>
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LVL 11

Author Comment

by:raj3060
ID: 14010084
Nope not working.....
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LVL 19

Expert Comment

by:Kuldeepchaturvedi
ID: 14010893
>>>
This is not working:

onblur="javascript: document.form[0].submit();"

this needs to be

onblur="javascript: document.forms[0].submit();"

as Bloodred is saying, it does not matter what you used on the server side. It the HTML that counts when it comes to javascript.
If my above suggestion does not work, can you do a view source on generated HTML and post the HTML here so we can look at it.
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LVL 11

Author Comment

by:raj3060
ID: 14011813
Same error:

Object doesn't support this property or method...

This is where I am trying to use:

<html:text property="CL_R_ZIP" size="32"
                                                            styleClass="textbox"
                                                            onkeyup="this.value=formatZip(this.value);copyR();"
                                                            onblur="javascript: document.forms[0].submit();" title="Enter consumer residence zip" />

and it's not working....
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LVL 19

Expert Comment

by:Kuldeepchaturvedi
ID: 14011969
Can you post your generated HTML??
0
 
LVL 11

Author Comment

by:raj3060
ID: 14013398
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">



<html>
<head>


<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<meta name="GENERATOR" content="IBM WebSphere Studio">

<meta http-equiv="Content-Style-Type" content="text/css">
<link href="theme/mainstyle.css" rel="stylesheet" type="text/css">
<title>LCD Online System</title>
<script src="theme/validate.js"></script>

</head>

<body bgcolor="081830" topmargin=0>

<table width="755" bgcolor="#081830" align="center" CELLSPACING="0"
      bgcolor="white" style="vertical-align: top;">
      <tr>
            <td>
            <table CELLSPACING=0 cellpadding=1>
                  <tr>
                        <td colspan=2 class="header" title="Louisiana Department of Social Services"><a href="#main" class="myclass2" title="Click to Skip Navigation. 508 Compliance.">Skip Navigation</a></td>
                  </tr>
                  <tr>
                        <td colspan=2 height="2"></td>
                  </tr>
                  <tr bgcolor="white">
                        <td align="left"><font color="#7f98b7">[USER:&nbsp;RAJ SINGH,&nbsp;REGION:&nbsp;BATON ROUGE]</font></td>
                        <td align="right"><font color="#7f98b7">[Date:Monday, May 16, 2005]</font></td>
                  </tr>
            </table>
            </td>
      </tr>
      <!-- HEADER ENDS HERE -->
      <tr>
            <td valign="top">
            <table width="100%" bgcolor="white" border="0" align="center" style="vertical-align: top;">
                  <!-- NAV BEGINS HERE -->
                  <tr>

                        <td valign="top" style="border-right: #771100 2px solid"
                              align="center">

<table width="110" align="center" cellspacing="0" cellpadding="0">

      
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="LCD_main.jsp?screentype=home" title="Home Link">Home</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="menu.do?screen=manage" title="Search Link">Administrator</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="LCD_main.jsp?screentype=newcase" title="New Case Link">New Application</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="LCD_main.jsp?screentype=search" title="Search Link">Search</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="LCD_main.jsp?screentype=help" title="Help Link">Help</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="LCD_main.jsp?screentype=report" title="Reports Link">Reports</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>

      <TR>
            <TD  class="class1" ><A class="myclass"      href="logout.do" title="Logoff Link">&nbsp; Logoff</A></TD>
      </TR>
      
      
      <TR>
      <TD>&nbsp;</TD>
      </TR>
      <TR>
      <TD class="backtop" valign="top"><B><U>Case Summary</U></B><BR><td></TR>
      <TR><TD class="backmid" valign="top">
            <B>PRIORITY:</B>&nbsp;1<BR>
            <B>NAME:</B><br>CHECKIN CHECKOUT<B><BR>
            SSN:&nbsp;</B>111-11-1111<B><BR>
            REGION:</B><br>BATON ROUGE
            </TD></TR>
      <TR><TD class="backbot" valign="top"></td>
      </TR>
      
</table></td>

                        <!-- NAV ENDS HERE -->

                        <!-- Body begins here-->
                        <td valign="top"><a name="main" id="main"></a>
                        <table align="center" CELLSPACING="0" bgcolor="white" style="vertical-align: top;">
                              
                              <tr>

                                    
                                    <td valign="top" align="center" width="635">
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">








<html lang="en">
<head>
<SCRIPT>
function doSubmit1() {
  document.getElementById("case").style.display = "none";
  document.getElementById("loading").style.display = "inline";  
}

</SCRIPT>



<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<meta name="GENERATOR" content="IBM WebSphere Studio">

<meta http-equiv="Content-Style-Type" content="text/css">
<link href="theme/mainstyle.css" rel="stylesheet" type="text/css">
<title>LCD-Application Page</title>


</head>
<body>
<form name="app" method="post" action="/LCD/app.do" onsubmit="doSubmit1();">
      <TABLE width="631" cellpadding="0" align="center"
            style="vertical-align: top">
            <TBODY>
                  <TR>
                        <TD class="table5"><FONT style="font-size: 14"><b>&nbsp;Louisiana
                        Commission for the Deaf (LCD) - Case
                        Management</b></FONT></TD>
                  </TR>
                  <TR>
                        <td>
                        <table width="100%" cellspacing="0" cellpadding="0"
                              style="border-collapse: collapse">
                              <tr>
                                    <td class="table2" width="15%" align="center"><a href="#" class="button4" title="Consumer Information Link">Personal Info</a></td>
                                    
                                    <td class="table3" width="15%" align="center"><a href="LCD_main.jsp?screentype=eligibility" class="button5" title="Eligibility Plan Link" onclick="doSubmit1();" onmouseover="this.style.color='red'" onmouseout="this.style.color='blue'">Eligibility Plan</a></td>
                                    
                                    
                                    <td class="table3" width="15%" align="center"><a href="LCD_main.jsp?screentype=service" class="button5" title="Service Plan Link" onclick="doSubmit1();" onmouseover="this.style.color='red'" onmouseout="this.style.color='blue'">Service Plan</a></td>
                                    
                                    <td style="border-bottom: 1px solid highlight">&nbsp;</td>
                              </tr>
                        </table>
                        </td>
                  </TR>
            </TBODY>
            <tbody id="loading" style="display: none">
                  <tr>
                        <td>
                        <table width="100%">
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td width="25%">&nbsp;</td>
                                    <td width="50%" align="center" style="border: 1px solid highlight"><br />
                                    <br />
                                    <b>Processing request, please wait...</b><br />
                                    <br />
                                    <br />
                                    </td>
                                    <td width="25%">&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                        </table>
                        </td>
                  </tr>
            </tbody>
            <TBODY id="case" style="display: block">
                  <TR>
                        <td align="center">
                        <table width="100%" cellpadding="0" cellspacing="0">
                              <tr>
                                    <td width="20%"></td>
                                    <TD width="60%" align="center"><input type="submit" name="submit" value="Update" onclick="return validate1(1)" class="button" title="Click to update">&nbsp;&nbsp;<input type="reset" name="reset" value="Clear" class="button" title="Click to reset"></TD>
                                    <td width="20%" align="right">
                                    <table cellpadding="0" cellspacing="0">
                                          <tr>
                                                <td class="class2" onmouseover="this.className='class3'"
                                                      onmouseout="this.className='class2'"><a href="#" class="myclass1" title="Click to print application" onclick="window.open('printApp.jsp','Printable','location=no, menubar=yes, status=no, toolbar=no, scrollbars=yes, resizable=yes');">Print Application</a>
                                                </td>
                                          </tr>
                                    </table>
                                    
                                    <td>
                              </tr>
                        </table>
                        </td>
                  </TR>
                  <tr>
                        <td style="align: left; color: red">
                        </td>
                  </tr>
                  <TR>
                        <TD>
                        <FIELDSET class="fieldset"><LEGEND><B><FONT face="Arial"
                              color="Navy" size="2">Basic Information</FONT></B></LEGEND>
                        <TABLE width="100%" cellspacing="1" cellpadding="0">

                              <TBODY>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* SSN:</TD>
                                          <TD><input type="text" name="CL_SSN" maxlength="11" size="32" value="111-11-1111" onkeyup="this.value=formatSSN(this.value);" onblur="validSSN(this);" readonly="readonly" class="textbox" title="Enter consumer SSN"></TD>
                                          <td bgcolor="#EEEEFF" align="right">*SSN Verification</td>
                                          <TD><select name="CL_SSNV" style="width: 208px" class="textbox" title="Select SSN verification"><option value="0"></option>
<option value="1">SSA RECORDS</option>
<option value="2">HOSPITAL ENUMERATION</option>
<option value="3" selected="selected">SOCIAL SECURITY CARD</option>
<option value="4">DRIVERS LICENSE</option>
<option value="5">PENDING</option>
<option value="6">OTHER</option></select></TD>
                                    </TR>

                                    <TR>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">* First Name:</TD>
                                          <TD width="33%"><input type="text" name="CL_FNAME" size="23" value="CHECKIN" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter consumer first name">&nbsp;&nbsp;MI:&nbsp;&nbsp;<input type="text" name="CL_MI" maxlength="1" size="1" value="" onkeyup="if(this.value.match(/[^a-zA-Z]/))this.value=this.value.replace(/[^a-zA-Z]/g,'')" class="textbox" title="Enter consumer middle initial">
                                          </TD>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">* Last Name:</TD>
                                          <TD width="33%"><input type="text" name="CL_LNAME" size="20" value="CHECKOUT" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter consumer last name">&nbsp;&nbsp;SFX:<select name="CL_SFX" style="width: 40px" class="textbox" title="Select consumer suffix"><option value="" selected="selected"></option>
<option value="JR">JR</option>
<option value="SR">SR</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* DOB:</TD>
                                          <TD><input type="text" name="CL_DOB" maxlength="10" size="32" value="01-02-1981" onkeyup="this.value=formatDate(this.value);" onblur="validDate(this);" class="textbox" title="Enter consumer date of birth"></TD>
                                          <td bgcolor="#EEEEFF" align="right">*DOBVerification</td>
                                          <TD><select name="CL_DOBV" style="width: 208px" class="textbox" title="Select DOB verification"><option value="0"></option>
<option value="1">BIRTH/BAPTISMAL CERTIFICATE</option>
<option value="2" selected="selected">DRIVERS LICENSE</option>
<option value="3">HOSP/DOCTOR/HEALTH UNIT RCDS</option>
<option value="4">SCHOOL RECORDS</option>
<option value="5">INSURANCE RECORDS</option>
<option value="6">PASSPORT</option>
<option value="7">FEDERAL/STATE/LOCAL AGENCIES</option>
<option value="8">PENDING</option>
<option value="9">OTHER</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Race:</TD>
                                          <TD><select name="CL_RAC" style="width: 208px" class="textbox" title="Select consumer race"><option value="0"></option>
<option value="A">ASIAN</option>
<option value="B">AFRICAN AMERICAN</option>
<option value="C" selected="selected">CAUCASIAN</option>
<option value="D">AMERICAN INDIAN</option>
<option value="E">NATIVE HAWAIIAN/OTH PAC ISLNDR</option>
<option value="F">UNKNOWN/UNABLE TO DETERMINE</option></select></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Ethnicity:</TD>
                                          <TD><select name="CL_ETH" style="width: 208px" class="textbox" title="Select consumer ethnicity"><option value="0"></option>
<option value="Y">HISPANIC</option>
<option value="N" selected="selected">NON-HISPANIC</option>
<option value="U">UNKNOWN</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Sex:</TD>
                                          <TD><select name="CL_SEX" style="width: 208px" class="textbox" title="Select consumer sex"><option value="0"></option>
<option value="M" selected="selected">MALE</option>
<option value="F">FEMALE</option>
<option value="U">UNKNOWN</option></select></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Prime Lang:</TD>
                                          <TD><select name="CL_P_LANG" style="width: 208px" class="textbox" title="Select consumer primary language"><option value="0"></option>
<option value="1">AMERICAN SIGN LANGUAGE (ASL)</option>
<option value="2">SIGNED ENGLISH (A CODE OF ENGLISH)</option>
<option value="3" selected="selected">SPOKEN ENGLISH</option>
<option value="4">OTHER</option></select></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Second Lang:</TD>
                                          <TD><select name="CL_S_LANG" style="width: 208px" class="textbox" title="Select consumer secondary language"><option value="0" selected="selected"></option>
<option value="1">AMERICAN SIGN LANGUAGE (ASL)</option>
<option value="2">SIGNED ENGLISH (A CODE OF ENGLISH)</option>
<option value="3">SPOKEN ENGLISH</option>
<option value="4">OTHER</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#BBBBFF" colspan="2"><b>Residence Address:</b><font style="font-size: 7pt">(if PO Box, list street address also)</font></TD>
                                          <TD bgcolor="#BBBBFF" colspan="2"><b>Mailing Address:</b>&nbsp;<input type="checkbox" name="m_CHECK" value="on" onclick="copyR()" class="checkbox" title="Check if mailing address is same as residential address">&nbsp;<font style="font-size: 7pt">Check if same as Residence.</font></TD>
                                    </TR>
                                    <tr>
                                          <td colspan="2">
                                          <table cellpadding="0" cellspacing="0" width="100%">
                                                <TR>
                                                      <TD width="17%" bgcolor="#EEEEFF" align="right">* Address1:</TD>
                                                      <TD width="33%"><input type="text" name="CL_R_ADD1" size="32" value="123 CARTER" onkeyup="copyR()" class="textbox" title="Enter consumer residence street address"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1" src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">Address2:</TD>
                                                      <TD><input type="text" name="CL_R_ADD2" size="32" value="23" onkeyup="copyR()" class="textbox" title="Enter consumer residence address line 2"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* City:</TD>
                                                      <TD><input type="text" name="CL_R_CITY" size="32" value="BATON ROUGE" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'');copyR()" class="textbox" title="Enter consumer residence city"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* Parish:</TD>
                                                      <TD><select name="CL_R_PAR" onchange="copyR()" style="width: 208px" class="textbox" title="Select consumer residence parish"><option value="0"></option>
<option value="1">ACADIA</option>
<option value="2">ALLEN</option>
<option value="3">ASCENSION</option>
<option value="4">ASSUMPTION</option>
<option value="5">AVOYELLES</option>
<option value="6">BEAUREGARD</option>
<option value="7">BIENVILLE</option>
<option value="8">BOSSIER</option>
<option value="9">CADDO</option>
<option value="10">CALCASIEU</option>
<option value="11">CALDWELL</option>
<option value="12">CAMERON</option>
<option value="13">CATAHOULA</option>
<option value="14">CLAIBORNE</option>
<option value="15">CONCORDIA</option>
<option value="16">DESOTO</option>
<option value="17" selected="selected">EAST BATON ROUGE</option>
<option value="18">EAST CARROLL</option>
<option value="19">EAST FELICIANA</option>
<option value="20">EVANGELINE</option>
<option value="21">FRANKLIN</option>
<option value="22">GRANT</option>
<option value="23">IBERIA</option>
<option value="24">IBERVILLE</option>
<option value="25">JACKSON</option>
<option value="26">JEFFERSON</option>
<option value="27">JEFFERSON DAVIS</option>
<option value="28">LAFAYETTE</option>
<option value="29">LAFOURCHE</option>
<option value="30">LASALLE</option>
<option value="31">LINCOLN</option>
<option value="32">LIVINGSTON</option>
<option value="33">MADISON</option>
<option value="34">MOREHOUSE</option>
<option value="35">NATCHITOCHES</option>
<option value="36">ORLEANS</option>
<option value="37">OUACHITA</option>
<option value="38">PLAQUEMINES</option>
<option value="39">POINTE COUPEE</option>
<option value="40">RAPIDES</option>
<option value="41">RED RIVER</option>
<option value="42">RICHLAND</option>
<option value="43">SABINE</option>
<option value="44">ST. BERNARD</option>
<option value="45">ST. CHARLES</option>
<option value="46">ST. HELENA</option>
<option value="47">ST. JAMES</option>
<option value="48">ST. JOHN</option>
<option value="49">ST. LANDRY</option>
<option value="50">ST. MARTIN</option>
<option value="51">ST. MARY</option>
<option value="52">ST. TAMMANY</option>
<option value="53">TANGIPAHOA</option>
<option value="54">TENSAS</option>
<option value="55">TERREBONNE</option>
<option value="56">UNION</option>
<option value="57">VERMILION</option>
<option value="58">VERNON</option>
<option value="59">WASHINGTON</option>
<option value="60">WEBSTER</option>
<option value="61">WEST BATON ROUGE</option>
<option value="62">WEST CARROLL</option>
<option value="63">WEST FELICIANA</option>
<option value="64">WINN</option></select></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* State:</TD>
                                                      <TD><select name="CL_R_ST" onchange="copyR()" style="width: 208px" class="textbox" title="Select consumer residence state"><option value=""></option>
<option value="AR">ARKANSAS</option>
<option value="AK">ALASKA</option>
<option value="AZ">ARIZONA</option>
<option value="AL">ALABAMA</option>
<option value="CA">CALIFORNIA</option>
<option value="CO">COLORADO</option>
<option value="CT">CONNECTICUT</option>
<option value="DE">DELAWARE</option>
<option value="FL">FLORIDA</option>
<option value="GA">GEORGIA</option>
<option value="HI">HAWAII</option>
<option value="IN">INDIANA</option>
<option value="IA">IOWA</option>
<option value="ID">IDAHO</option>
<option value="IL">ILLINOIS</option>
<option value="IS">ISS OFFICE--MARYLAND</option>
<option value="KS">KANSAS</option>
<option value="KY">KENTUCKY</option>
<option value="LA" selected="selected">LOUISIANA</option>
<option value="MD">MARYLAND</option>
<option value="ME">MAINE</option>
<option value="MA">MASSACHUSETTS</option>
<option value="MI">MICHIGAN</option>
<option value="MN">MINNESOTA</option>
<option value="MO">MISSOURI</option>
<option value="MS">MISSISSIPPI</option>
<option value="MT">MONTANA</option>
<option value="NC">NORTH CAROLINA</option>
<option value="ND">NORTH DAKOTA</option>
<option value="NE">NEBRASKA</option>
<option value="NH">NEW HAMPSHIRE</option>
<option value="NJ">NEW JERSEY</option>
<option value="NM">NEW MEXICO</option>
<option value="NV">NEVADA</option>
<option value="NY">NEW YORK</option>
<option value="OH">OHIO</option>
<option value="OK">OKLAHOMA</option>
<option value="OR">OREGON</option>
<option value="PA">PENNSYLVANIA</option>
<option value="RI">RHODE ISLAND</option>
<option value="SC">SOUTH CAROLINA</option>
<option value="SD">SOUTH DAKOTA</option>
<option value="TN">TENNESSEE</option>
<option value="TX">TEXAS</option>
<option value="UT">UTAH</option>
<option value="VA">VIRGINIA</option>
<option value="VT">VERMONT</option>
<option value="WA">WASHINGTON</option>
<option value="WI">WISCONSIN</option>
<option value="WV">WEST VIRGINIA</option>
<option value="WY">WYOMING</option>
<option value="DC">DISTRICT OF COLUMBIA</option>
<option value="AS">AMERICAN SAMOA</option>
<option value="FM">FED STS MICRONESIA</option>
<option value="GU">GUAM</option>
<option value="MH">MARSHALL ISLANDS</option>
<option value="MP">NORTHERN MARIANA ISL</option>
<option value="PR">PUERTO RICO</option>
<option value="PW">PALAU</option>
<option value="UM">U.S. MINOR OUTLY ISL</option>
<option value="VI">VIRGIN ISLANDS</option></select></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* Zip:</TD>
                                                      <TD><input type="text" name="CL_R_ZIP" size="32" value="70809-0000" onkeyup="this.value=formatZip(this.value);copyR();" onblur="javascript: document.forms[0].submit();" class="textbox" title="Enter consumer residence zip"></TD>
                                                </TR>                                                
                                          </table>
                                          </td>
                                          <td colspan="2">
                                          <table cellpadding="0" cellspacing="0" width="100%">
                                                <TR>
                                                      <TD width="17%" bgcolor="#EEEEFF" align="right">* Address1:</TD>
                                                      <TD width="33%"><input type="text" name="CL_M_ADD1" size="32" value="123 CARTER" class="textbox" title="Enter consumer mailing street address"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1" src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">Address2:</TD>
                                                      <TD><input type="text" name="CL_M_ADD2" size="32" value="23" class="textbox" title="Enter consumer mailing address line 2"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* City:</TD>
                                                      <TD><input type="text" name="CL_M_CITY" size="32" value="BATON ROUGE" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter consumer mailing city"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* Parish:</TD>
                                                      <TD><select name="CL_M_PAR" style="width: 208px" class="textbox" title="Select consumer mailing parish"><option value="0"></option>
<option value="1">ACADIA</option>
<option value="2">ALLEN</option>
<option value="3">ASCENSION</option>
<option value="4">ASSUMPTION</option>
<option value="5">AVOYELLES</option>
<option value="6">BEAUREGARD</option>
<option value="7">BIENVILLE</option>
<option value="8">BOSSIER</option>
<option value="9">CADDO</option>
<option value="10">CALCASIEU</option>
<option value="11">CALDWELL</option>
<option value="12">CAMERON</option>
<option value="13">CATAHOULA</option>
<option value="14">CLAIBORNE</option>
<option value="15">CONCORDIA</option>
<option value="16">DESOTO</option>
<option value="17" selected="selected">EAST BATON ROUGE</option>
<option value="18">EAST CARROLL</option>
<option value="19">EAST FELICIANA</option>
<option value="20">EVANGELINE</option>
<option value="21">FRANKLIN</option>
<option value="22">GRANT</option>
<option value="23">IBERIA</option>
<option value="24">IBERVILLE</option>
<option value="25">JACKSON</option>
<option value="26">JEFFERSON</option>
<option value="27">JEFFERSON DAVIS</option>
<option value="28">LAFAYETTE</option>
<option value="29">LAFOURCHE</option>
<option value="30">LASALLE</option>
<option value="31">LINCOLN</option>
<option value="32">LIVINGSTON</option>
<option value="33">MADISON</option>
<option value="34">MOREHOUSE</option>
<option value="35">NATCHITOCHES</option>
<option value="36">ORLEANS</option>
<option value="37">OUACHITA</option>
<option value="38">PLAQUEMINES</option>
<option value="39">POINTE COUPEE</option>
<option value="40">RAPIDES</option>
<option value="41">RED RIVER</option>
<option value="42">RICHLAND</option>
<option value="43">SABINE</option>
<option value="44">ST. BERNARD</option>
<option value="45">ST. CHARLES</option>
<option value="46">ST. HELENA</option>
<option value="47">ST. JAMES</option>
<option value="48">ST. JOHN</option>
<option value="49">ST. LANDRY</option>
<option value="50">ST. MARTIN</option>
<option value="51">ST. MARY</option>
<option value="52">ST. TAMMANY</option>
<option value="53">TANGIPAHOA</option>
<option value="54">TENSAS</option>
<option value="55">TERREBONNE</option>
<option value="56">UNION</option>
<option value="57">VERMILION</option>
<option value="58">VERNON</option>
<option value="59">WASHINGTON</option>
<option value="60">WEBSTER</option>
<option value="61">WEST BATON ROUGE</option>
<option value="62">WEST CARROLL</option>
<option value="63">WEST FELICIANA</option>
<option value="64">WINN</option></select></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* State:</TD>
                                                      <TD><select name="CL_M_ST" style="width: 208px" class="textbox" title="Select consumer mailing state"><option value=""></option>
<option value="AR">ARKANSAS</option>
<option value="AK">ALASKA</option>
<option value="AZ">ARIZONA</option>
<option value="AL">ALABAMA</option>
<option value="CA">CALIFORNIA</option>
<option value="CO">COLORADO</option>
<option value="CT">CONNECTICUT</option>
<option value="DE">DELAWARE</option>
<option value="FL">FLORIDA</option>
<option value="GA">GEORGIA</option>
<option value="HI">HAWAII</option>
<option value="IN">INDIANA</option>
<option value="IA">IOWA</option>
<option value="ID">IDAHO</option>
<option value="IL">ILLINOIS</option>
<option value="IS">ISS OFFICE--MARYLAND</option>
<option value="KS">KANSAS</option>
<option value="KY">KENTUCKY</option>
<option value="LA" selected="selected">LOUISIANA</option>
<option value="MD">MARYLAND</option>
<option value="ME">MAINE</option>
<option value="MA">MASSACHUSETTS</option>
<option value="MI">MICHIGAN</option>
<option value="MN">MINNESOTA</option>
<option value="MO">MISSOURI</option>
<option value="MS">MISSISSIPPI</option>
<option value="MT">MONTANA</option>
<option value="NC">NORTH CAROLINA</option>
<option value="ND">NORTH DAKOTA</option>
<option value="NE">NEBRASKA</option>
<option value="NH">NEW HAMPSHIRE</option>
<option value="NJ">NEW JERSEY</option>
<option value="NM">NEW MEXICO</option>
<option value="NV">NEVADA</option>
<option value="NY">NEW YORK</option>
<option value="OH">OHIO</option>
<option value="OK">OKLAHOMA</option>
<option value="OR">OREGON</option>
<option value="PA">PENNSYLVANIA</option>
<option value="RI">RHODE ISLAND</option>
<option value="SC">SOUTH CAROLINA</option>
<option value="SD">SOUTH DAKOTA</option>
<option value="TN">TENNESSEE</option>
<option value="TX">TEXAS</option>
<option value="UT">UTAH</option>
<option value="VA">VIRGINIA</option>
<option value="VT">VERMONT</option>
<option value="WA">WASHINGTON</option>
<option value="WI">WISCONSIN</option>
<option value="WV">WEST VIRGINIA</option>
<option value="WY">WYOMING</option>
<option value="DC">DISTRICT OF COLUMBIA</option>
<option value="AS">AMERICAN SAMOA</option>
<option value="FM">FED STS MICRONESIA</option>
<option value="GU">GUAM</option>
<option value="MH">MARSHALL ISLANDS</option>
<option value="MP">NORTHERN MARIANA ISL</option>
<option value="PR">PUERTO RICO</option>
<option value="PW">PALAU</option>
<option value="UM">U.S. MINOR OUTLY ISL</option>
<option value="VI">VIRGIN ISLANDS</option></select></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* Zip:</TD>
                                                      <TD><input type="text" name="CL_M_ZIP" size="32" value="70809-0000" onkeyup="this.value=formatZip(this.value)" onblur="validZip(this);" class="textbox" title="Enter consumer mailing zip"></TD>
                                                </TR>
                                                
                                          </table>
                                          </td>
                                    </tr>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Home Phone:</TD>
                                          <TD><input type="text" name="CL_H_PH" maxlength="13" size="32" value="(225)237-3060" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer home phone number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Work Phone:</TD>
                                          <TD><input type="text" name="CL_W_PH" maxlength="13" size="20" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer home work number">&nbsp;&nbsp;EXT:<input type="text" name="CL_W_PH_EXT" maxlength="4" size="4" value="" class="textbox" title="Enter consumer work extension"></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">TDD:</TD>
                                          <TD><input type="text" name="CL_TDD" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer TDD number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Text Message:</TD>
                                          <TD><input type="text" name="CL_TEXT" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer text message number"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Voice:</TD>
                                          <TD><input type="text" name="CL_VOICE" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer voice number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Visual Phone:</TD>
                                          <TD><input type="text" name="CL_V_PH" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer visual phone number"></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Email:</TD>
                                          <TD><input type="text" name="CL_EMAIL" size="32" value="" class="textbox" title="Enter consumer email address"></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>
                              </TBODY>
                        </TABLE>
                        </FIELDSET>
                        </TD>
                  </TR>
                  <TR>
                        <TD>
                        <FIELDSET class="fieldset"><LEGEND><B><FONT face="Arial"
                              color="Navy" size="2">Contact Information</FONT></B></LEGEND>
                        <TABLE width="100%" cellpadding="0" cellspacing="1">

                              <TBODY>
                                    <tr>
                                          <td colspan="4" class="tdcell1">Emergency (Relative not living
                                          with you) Contact Information</td>
                                    </tr>
                                    <TR>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">* First Name:</TD>
                                          <TD width="33%"><input type="text" name="RL_FNAME" size="23" value="ABC" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter relative first name">&nbsp;&nbsp;MI:&nbsp;&nbsp;<input type="text" name="RL_MI" maxlength="1" size="1" value="" onkeyup="if(this.value.match(/[^a-zA-Z]/))this.value=this.value.replace(/[^a-zA-Z]/g,'')" class="textbox" title="Enter relative middle initial"></TD>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">* Last Name:</TD>
                                          <TD width="33%"><input type="text" name="RL_LNAME" size="20" value="DEF" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter relative last name">&nbsp;&nbsp;SFX:<select name="RL_SFX" style="width: 40px" class="textbox" title="Select relative name suffix"><option value="" selected="selected"></option>
<option value="JR">JR</option>
<option value="SR">SR</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option></select></TD>

                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Address1:</TD>
                                          <TD><input type="text" name="RL_ADD1" size="32" value="123 LOYOLLA" class="textbox" title="Enter relative street address"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Address2:</TD>
                                          <TD><input type="text" name="RL_ADD2" size="32" value="" class="textbox" title="Enter relative address line 2 if any"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* City:</TD>
                                          <TD><input type="text" name="RL_CITY" size="32" value="BATON ROUGE" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter relative city"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">* State:</TD>
                                          <TD><select name="RL_ST" style="width: 208px" class="textbox" title="Select relative state"><option value=""></option>
<option value="AR">ARKANSAS</option>
<option value="AK">ALASKA</option>
<option value="AZ">ARIZONA</option>
<option value="AL">ALABAMA</option>
<option value="CA">CALIFORNIA</option>
<option value="CO">COLORADO</option>
<option value="CT">CONNECTICUT</option>
<option value="DE">DELAWARE</option>
<option value="FL">FLORIDA</option>
<option value="GA">GEORGIA</option>
<option value="HI">HAWAII</option>
<option value="IN">INDIANA</option>
<option value="IA">IOWA</option>
<option value="ID">IDAHO</option>
<option value="IL">ILLINOIS</option>
<option value="IS">ISS OFFICE--MARYLAND</option>
<option value="KS">KANSAS</option>
<option value="KY">KENTUCKY</option>
<option value="LA" selected="selected">LOUISIANA</option>
<option value="MD">MARYLAND</option>
<option value="ME">MAINE</option>
<option value="MA">MASSACHUSETTS</option>
<option value="MI">MICHIGAN</option>
<option value="MN">MINNESOTA</option>
<option value="MO">MISSOURI</option>
<option value="MS">MISSISSIPPI</option>
<option value="MT">MONTANA</option>
<option value="NC">NORTH CAROLINA</option>
<option value="ND">NORTH DAKOTA</option>
<option value="NE">NEBRASKA</option>
<option value="NH">NEW HAMPSHIRE</option>
<option value="NJ">NEW JERSEY</option>
<option value="NM">NEW MEXICO</option>
<option value="NV">NEVADA</option>
<option value="NY">NEW YORK</option>
<option value="OH">OHIO</option>
<option value="OK">OKLAHOMA</option>
<option value="OR">OREGON</option>
<option value="PA">PENNSYLVANIA</option>
<option value="RI">RHODE ISLAND</option>
<option value="SC">SOUTH CAROLINA</option>
<option value="SD">SOUTH DAKOTA</option>
<option value="TN">TENNESSEE</option>
<option value="TX">TEXAS</option>
<option value="UT">UTAH</option>
<option value="VA">VIRGINIA</option>
<option value="VT">VERMONT</option>
<option value="WA">WASHINGTON</option>
<option value="WI">WISCONSIN</option>
<option value="WV">WEST VIRGINIA</option>
<option value="WY">WYOMING</option>
<option value="DC">DISTRICT OF COLUMBIA</option>
<option value="AS">AMERICAN SAMOA</option>
<option value="FM">FED STS MICRONESIA</option>
<option value="GU">GUAM</option>
<option value="MH">MARSHALL ISLANDS</option>
<option value="MP">NORTHERN MARIANA ISL</option>
<option value="PR">PUERTO RICO</option>
<option value="PW">PALAU</option>
<option value="UM">U.S. MINOR OUTLY ISL</option>
<option value="VI">VIRGIN ISLANDS</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Zip:</TD>
                                          <TD><input type="text" name="RL_ZIP" maxlength="10" size="32" value="70809-0000" onkeyup="this.value=formatZip(this.value)" onblur="validZip(this);" class="textbox" title="Enter relative zip"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">* Phone:</TD>
                                          <TD><input type="text" name="RL_PH" maxlength="13" size="20" value="(225)237-3000" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative phone number">&nbsp;&nbsp;EXT:<input type="text" name="RL_PH_EXT" maxlength="4" size="4" value="" class="textbox" title="Enter relative extension number if any"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">TDD:</TD>
                                          <TD><input type="text" name="RL_TDD" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative TDD number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Text Message:</TD>
                                          <TD><input type="text" name="RL_TEXT" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative text message number"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Voice:</TD>
                                          <TD><input type="text" name="RL_VOICE" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative voice number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Visual Phone:</TD>
                                          <TD><input type="text" name="RL_V_PH" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative visual phone number"></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Email:</TD>
                                          <TD><input type="text" name="RL_EMAIL" size="32" value="" class="textbox" title="Enter relative email address"></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>
                              </TBODY>

                              <TBODY>
                                    <tr>
                                          <td colspan="4" class="tdcell1">Advocate/Guardian Contact
                                          Information</td>
                                    </tr>
                                    <TR>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">First Name:</TD>
                                          <TD width="33%"><input type="text" name="g_FNAME" size="23" value="HELLO" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter guardian first name">&nbsp;&nbsp;MI:&nbsp; <input type="text" name="g_MI" maxlength="1" size="1" value="" onkeyup="if(this.value.match(/[^a-zA-Z]/))this.value=this.value.replace(/[^a-zA-Z]/g,'')" class="textbox" title="Enter guardian middle initial"></TD>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">Last Name:</TD>
                                          <TD width="33%"><input type="text" name="g_LNAME" size="20" value="DSDSDSD" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter guardian last name">&nbsp;&nbsp;SFX:<select name="g_SFX" style="width: 40px" class="textbox" title="Select guardian name suffix"><option value="" selected="selected"></option>
<option value="JR">JR</option>
<option value="SR">SR</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Phone:</TD>
                                          <TD><input type="text" name="g_PH" maxlength="13" size="20" value="(225)236-6666" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian phone number">&nbsp;&nbsp;EXT:<input type="text" name="g_PH_EXT" maxlength="4" size="4" value="" class="textbox" title="Enter guardian phone extension if any"></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">TDD:</TD>
                                          <TD><input type="text" name="g_TDD" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian TDD number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Text Message:</TD>
                                          <TD><input type="text" name="g_TEXT" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian text message number"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Voice:</TD>
                                          <TD><input type="text" name="g_VOICE" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian voice number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Visual Phone:</TD>
                                          <TD><input type="text" name="g_V_PH" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian visual phone number"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Email:</TD>
                                          <TD><input type="text" name="g_EMAIL" size="32" value="" class="textbox" title="Enter guardian email address"></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>
                              </TBODY>
                        </TABLE>
                        </FIELDSET>
                        </TD>
                  </TR>
                  <TR>
                        <TD align="center"><input type="submit" name="submit" value="Update" onclick="return validate1(1)" class="button" title="Click to update">&nbsp;&nbsp;<input type="reset" name="reset" value="Clear" class="button" title="Click to reset"></TD>
                  </TR>
                  
                  <TR>
                        <TD id="hhm">
                        <FIELDSET class="fieldset"><LEGEND><B><FONT face="Arial"
                              color="Navy" size="2">Other Household Members</FONT></B></LEGEND>
                        <TABLE width="100%" cellpadding="0" cellspacing="1">
                              <TBODY>
                                    <TR>
                                          <TD colspan="4"></TD>
                                    </TR>
                                    <TR>
                                          <TD colspan="4">
                                          <table width="100%">
                                                <tr>
                                                      <td colspan="7" align="center"><input type="button" name="button" value="Add New Member" onclick="hhSEL(1)" style="width:110px;" class="button" title="Click to add new household member">&nbsp;&nbsp;<input type="button" name="button" value="Update Member" onclick="hhSEL(2)" style="width:110px;" class="button" title="Click to update member">&nbsp;&nbsp;<input type="submit" name="submit" value="Delete Member" onclick="return hhSEL(3)" style="width:110px;" class="button" title="Click to delete member"></td>
                                                </tr>
                                                
                                          </table>
                                          </TD>
                                    </TR>
                              </TBODY>
                        </TABLE>
                        </FIELDSET>
                        </TD>
                  </TR>
                  
            </TBODY>
            <TBODY id="hh" style="display: none">
                  <TR>
                        <TD>
                        <FIELDSET class="fieldset"><LEGEND><B><FONT face="Arial"
                              color="Navy" size="2">Add / Update Household Member</FONT></B></LEGEND>
                        <TABLE width="50%" cellpadding="0" cellspacing="1">
                              <TBODY style="display: block">
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* SSN:</TD>
                                          <TD><input type="text" name="HH_SSN" maxlength="11" size="32" value="" onkeyup="this.value=formatSSN(this.value);" onblur="validSSN(this);" class="textbox" title="Enter household SSN"></TD>
                                    </TR>
                                    <TR>
                                          <TD width="15%" bgcolor="#EEEEFF" align="right">* First Name:</TD>
                                          <TD width="35%"><input type="text" name="HH_FNAME" size="23" value="" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter household first name">&nbsp;&nbsp;MI:&nbsp;&nbsp;<input type="text" name="HH_MI" maxlength="1" size="1" value="" onkeyup="if(this.value.match(/[^a-zA-Z]/))this.value=this.value.replace(/[^a-zA-Z]/g,'')" class="textbox" title="Enter household middle initial">
                                          </TD>
                                    </TR>
                                    <TR>
                                          <TD width="15%" bgcolor="#EEEEFF" align="right">* Last Name:</TD>
                                          <TD width="35%"><input type="text" name="HH_LNAME" size="20" value="" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter household last name">&nbsp;&nbsp;SFX:<select name="HH_SFX" style="width: 40px" class="textbox" title="Select household name suffix"><option value="" selected="selected"></option>
<option value="JR">JR</option>
<option value="SR">SR</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option></select></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* DOB:</TD>
                                          <TD><input type="text" name="HH_DOB" maxlength="10" size="32" value="" onkeyup="this.value=formatDate(this.value);" onblur="validDate(this);" class="textbox" title="Enter household DOB"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Sex:</TD>
                                          <TD><select name="HH_SEX" style="width: 208px" class="textbox" title="Select household sex"><option value="0"></option>
<option value="M">MALE</option>
<option value="F">FEMALE</option>
<option value="U">UNKNOWN</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Relationship:</TD>
                                          <TD><select name="HH_REL" style="width: 208px" class="textbox" title="Enter household relationship to consumer"><option value="0"></option>
<option value="1">ADOPTED CHILD</option>
<option value="2">AUNT</option>
<option value="3">BROTHER</option>
<option value="4">BROTHER-IN-LAW</option>
<option value="5">COUSIN</option>
<option value="6">DAUGHTER</option>
<option value="7">DAUGHTER-IN-LAW</option>
<option value="8">FATHER</option>
<option value="9">FATHER-IN-LAW</option>
<option value="10">FOSTER CHILD</option>
<option value="11">FRIEND</option>
<option value="12">GRANDCHILD</option>
<option value="13">GRANDPARENT</option>
<option value="14">HALF-SIBLING</option>
<option value="15">HUSBAND</option>
<option value="16">MOTHER</option>
<option value="17">MOTHER-IN-LAW</option>
<option value="18">NEPHEW</option>
<option value="19">NIECE</option>
<option value="20">PARAMOUR</option>
<option value="21">SELF</option>
<option value="22">SISTER</option>
<option value="23">SISTER-IN-LAW</option>
<option value="24">SON</option>
<option value="25">SON-IN-LAW</option>
<option value="26">STEPCHILD</option>
<option value="27">STEP-GRANDPARENT</option>
<option value="28">STEP-PARENT</option>
<option value="29">STEP-SIBLING</option>
<option value="30">UNCLE</option>
<option value="31">WIFE</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Disabled:</TD>
                                          <TD><select name="HH_DIS" style="width: 208px" class="textbox" title="Select household disability status"><option value="" selected="selected"></option>
                                                <option value="Y">YES</option>
                                                <option value="N">NO</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD align="center" colspan="2"><span id="addhh"><input type="submit" name="submit" value="Add Member" onclick="return hhSEL(4);" style="width:110px;" class="button" title="Click to add household"></span>&nbsp;&nbsp;<span
                                                id="uphh"><input type="submit" name="submit" value="Update Member" onclick="return hhSEL(4);" style="width:110px;" class="button" title="Click to update household"></span>&nbsp;&nbsp;<input type="button" name="reset" value="Cancel" onclick="hh(2)" class="button" title="Click to cancel"></TD>
                                    </TR>
                              </TBODY>
                        </TABLE>
                        </FIELDSET>
                        </TD>
                  </TR>
            </TBODY>
      </TABLE>
</form>
<script type="text/javascript" language="JavaScript">
  <!--
  var focusControl = document.forms["app"].elements["CL_FNAME"];

  if (focusControl.type != "hidden") {
     focusControl.focus();
  }
  // -->
</script>

</body>
</html>
</td>
                                    
                              </tr>
                        </table>
                        </td>
                  </tr>
            </table>
            </td>
      </tr>

      <tr>
            <td><!-- FOOTER BEGINS HERE -->
<table width="100%" bgcolor="white"><tr><td align="left" width="50%">
<font color= "#7f98b7" face = "verdana" size="1">All contents copyright &copy; DSS-IS
</font></td><td align="right"><a href="mailto:usc@dss.state.la.us?subject=Assistance needed, LCD online system" title="Click to email help desk"><font color= "#7f98b7" face = "verdana" size="1">Help Desk
</font></a></td></tr></table>
<!-- FOOTER ENDS HERE --></td>
      </tr>

      <!-- FOOTER ENDS HERE --></table></html>
0
 
LVL 19

Expert Comment

by:Kuldeepchaturvedi
ID: 14013716
Are you including your header & footer in your jsp????

this HTML has got more that one HTML tags More than one Head tag and more than one Body tag!!! i.e. document.fomrs[0] will get confused and will not work...
in short this is not a proper HTML....

you have to do it in following manner...
have your starting <HTML> <HEAD> tags in header..
have body in the main page
and have ending <HTML> in the footer
0
 
LVL 11

Author Comment

by:raj3060
ID: 14018196
>>Are you including your header & footer in your jsp????
Header is one JSP, Footer is one JSP, MAIN in one JSP, all body ELEMENTS are also JSP, those change based on WHAT link is selected....

>>this HTML has got more that one HTML tags More than one Head tag and more than one Body tag!!! i.e. document.fomrs[0] will get confused and will not work.

You might be right.. but my question was not to give me HTML setup. Did you try to submit form from onblur event in struts? If you have done it then let me know how you did it, and if you have not then try it.

I have tried it every way but it just don't work. Try it yourself..
0
 
LVL 19

Expert Comment

by:Kuldeepchaturvedi
ID: 14018925
>>>but my question was not to give me HTML setup. Did you try to submit form from onblur event in struts? If you have done it then let me know how you did it

submit on blur event has nothing to do with Struts or JSP for that matter. Its a simple HTML behaviour and will work no matter what was used on the server side, be it ASP or PHP or JSP or Struts...

Following code will work provided that the HTML that was generated is a well formed HTML... In your case its not working because your generated HTML is not well formed...

if you take out your header and footer.. ( I am assuming that main page has got a well formed HTML) it will work for you as well
<html:text property="CL_R_ZIP" size="32"
                                                  styleClass="textbox"
                                                  onkeyup="this.value=formatZip(this.value);copyR();"
                                                  onblur="javascript: document.forms[0].submit();" title="Enter consumer residence zip" />

0
 
LVL 29

Expert Comment

by:bloodredsun
ID: 14020312
Kuldeep is correct, your HTML is broken which means that your clientside scripting will not work. I suggest that you run your code through something like HTMLTidy to try and correct the errors and follow Kuldeeps excellent advice to prune your code into a functioning page.

>>You might be right.. but my question was not to give me HTML setup. Did you try to submit form from onblur event in struts? If you have done it then let me know how you did it, and if you have not then try it.

Yes, I've used JavaScript in Struts and HTML and it has worked fine.

>>I have tried it every way but it just don't work. Try it yourself..

As has been pointed out previously, your HTML is too badly formed for your JavaScript to work. I'm sure that it will fail for everyone else too if they tried.

I don't know whether you are using Tiles as well but if you are they need to be looked at also.
0
 
LVL 11

Author Comment

by:raj3060
ID: 14020504
ok

then what is the problem with this:


<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">








<html>
<HEAD>


<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<meta name="GENERATOR" content="IBM WebSphere Studio">

<meta http-equiv="Content-Style-Type" content="text/css">
<link href="theme/mainstyle.css" rel="stylesheet" type="text/css">
<title>LCD Online System</title>
<script src="theme/validate.js"></script>

</head>

<body bgcolor="081830" topmargin=0>

<table width="755" bgcolor="#081830" align="center" CELLSPACING="0"
      bgcolor="white" style="vertical-align: top;">
      <tr>
            <td>
            <table CELLSPACING=0 cellpadding=1>
                  <tr>
                        <td colspan=2 class="header" title="Louisiana Department of Social Services"><a href="#main" class="myclass2" title="Click to Skip Navigation. 508 Compliance.">Skip Navigation</a></td>
                  </tr>
                  <tr>
                        <td colspan=2 height="2"></td>
                  </tr>
                  <tr bgcolor="white">
                        <td align="left"><font color="#7f98b7">[USER:&nbsp;RAJ SINGH,&nbsp;REGION:&nbsp;BATON ROUGE]</font></td>
                        <td align="right"><font color="#7f98b7">[Date:Tuesday, May 17, 2005]</font></td>
                  </tr>
            </table>
            </td>
      </tr>
      <!-- HEADER ENDS HERE -->
      <tr>
            <td valign="top">
            <table width="100%" bgcolor="white" border="0" align="center"
                  style="vertical-align: top">
                  <!-- NAV BEGINS HERE -->
                  <tr>

                        <td valign="top" style="border-right: #771100 2px solid"
                              align="center">

<table width="110" align="center" cellspacing="0" cellpadding="0">

      
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="LCD_main.jsp?screentype=home" title="Home Link">Home</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="menu.do?screen=manage" title="Search Link">Administrator</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="menu.do?screen=newcase" title="New Case Link">New Application</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Link" src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="menu.do?screen=search" title="Search Link">Search</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="LCD_main.jsp?screentype=help" title="Help Link">Help</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>
      <TR>
            <TD  class="class1" ><A class="myclass"
                  href="LCD_main.jsp?screentype=report" title="Reports Link">Reports</A></TD>
      </TR>
      <tr>
            <td height="1"><img height="1" alt="New Case Link"
                  src="images/spacer.gif" width="1" border="0"></td>
      </tr>

      <TR>
            <TD  class="class1" ><A class="myclass"      href="logout.do" title="Logoff Link">&nbsp; Logoff</A></TD>
      </TR>
      
      
      <TR>
      <TD>&nbsp;</TD>
      </TR>
      <TR>
      <TD class="backtop" valign="top"><B><U>Case Summary</U></B><BR><td></TR>
      <TR><TD class="backmid" valign="top">
            <B>PRIORITY:</B>&nbsp;1<BR>
            <B>NAME:</B><br>CHECKIN CHECKOUT<B><BR>
            SSN:&nbsp;</B>111-11-1111<B><BR>
            REGION:</B><br>BATON ROUGE
            </TD></TR>
      <TR><TD class="backbot" valign="top"></td>
      </TR>
      
</table></td>

                        <!-- NAV ENDS HERE -->

                        <!-- Body begins here-->
                        <td valign="top"><a name="main" id="main"></a>
                        <table align="center" CELLSPACING="0" bgcolor="white"
                              style="vertical-align: top">

                              <tr>

                                    
                                    <td valign="top" align="center" width="635">








<form name="app" method="post" action="/LCD/app.do" onsubmit="doSubmit1();"><input type="hidden" name="org.apache.struts.taglib.html.TOKEN" value="b4ce0727525eddd3a26b6b1eb5b8a60e">
      <TABLE width="631" cellpadding="0" align="center"
            style="vertical-align: top">
            <TBODY>
                  <TR>
                        <TD class="table5"><FONT style="font-size: 14"><b>&nbsp;Louisiana
                        Commission for the Deaf (LCD) - Case
                        Management</b></FONT></TD>
                  </TR>
                  <TR>
                        <td>
                        <table width="100%" cellspacing="0" cellpadding="0"
                              style="border-collapse: collapse">
                              <tr>
                                    <td class="table2" width="15%" align="center"><a href="#" class="button4" title="Consumer Information Link">Personal Info</a></td>
                                    
                                    <td class="table3" width="15%" align="center"><a href="LCD_main.jsp?screentype=eligibility" class="button5" title="Eligibility Plan Link" onclick="doSubmit1();" onmouseover="this.style.color='red'" onmouseout="this.style.color='blue'">Eligibility Plan</a></td>
                                    
                                    
                                    <td class="table3" width="15%" align="center"><a href="LCD_main.jsp?screentype=service" class="button5" title="Service Plan Link" onclick="doSubmit1();" onmouseover="this.style.color='red'" onmouseout="this.style.color='blue'">Service Plan</a></td>
                                    
                                    <td style="border-bottom: 1px solid highlight">&nbsp;</td>
                              </tr>
                        </table>
                        </td>
                  </TR>
            </TBODY>
            <tbody id="loading" style="display: none">
                  <tr>
                        <td>
                        <table width="100%">
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td width="25%">&nbsp;</td>
                                    <td width="50%" align="center" style="border: 1px solid highlight"><br />
                                    <br />
                                    <b>Processing request, please wait...</b><br />
                                    <br />
                                    <br />
                                    </td>
                                    <td width="25%">&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                              <tr>
                                    <td>&nbsp;</td>
                              </tr>
                        </table>
                        </td>
                  </tr>
            </tbody>
            <TBODY id="case" style="display: block">
                  <TR>
                        <td align="center">
                        <table width="100%" cellpadding="0" cellspacing="0">
                              <tr>
                                    <td width="20%"></td>
                                    <TD width="60%" align="center"><input type="submit" name="submit" value="Update" onclick="return validate1(1)" class="button" title="Click to update">&nbsp;&nbsp;<input type="reset" name="reset" value="Clear" class="button" title="Click to reset"></TD>
                                    <td width="20%" align="right">
                                    <table cellpadding="0" cellspacing="0">
                                          <tr>
                                                <td class="class2" onmouseover="this.className='class3'"
                                                      onmouseout="this.className='class2'"><a href="#" class="myclass1" title="Click to print application" onclick="window.open('printApp.jsp','Printable','location=no, menubar=yes, status=no, toolbar=no, scrollbars=yes, resizable=yes');">Print Application</a>
                                                </td>
                                          </tr>
                                    </table>
                                    
                                    <td>
                              </tr>
                        </table>
                        </td>
                  </TR>
                  <tr>
                        <td style="align: left; color: red">
                        </td>
                  </tr>
                  <TR>
                        <TD>
                        <FIELDSET class="fieldset"><LEGEND><B><FONT face="Arial"
                              color="Navy" size="2">Basic Information</FONT></B></LEGEND>
                        <TABLE width="100%" cellspacing="1" cellpadding="0">

                              <TBODY>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* SSN:</TD>
                                          <TD><input type="text" name="CL_SSN" maxlength="11" size="32" value="111-11-1111" onkeyup="this.value=formatSSN(this.value);" onblur="validSSN(this);" readonly="readonly" class="textbox" title="Enter consumer SSN"></TD>
                                          <td bgcolor="#EEEEFF" align="right">*SSN Verification</td>
                                          <TD><select name="CL_SSNV" style="width: 208px" class="textbox" title="Select SSN verification"><option value="0"></option>
<option value="1">SSA RECORDS</option>
<option value="2">HOSPITAL ENUMERATION</option>
<option value="3" selected="selected">SOCIAL SECURITY CARD</option>
<option value="4">DRIVERS LICENSE</option>
<option value="5">PENDING</option>
<option value="6">OTHER</option></select></TD>
                                    </TR>

                                    <TR>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">* First Name:</TD>
                                          <TD width="33%"><input type="text" name="CL_FNAME" size="23" value="CHECKIN" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter consumer first name">&nbsp;&nbsp;MI:&nbsp;&nbsp;<input type="text" name="CL_MI" maxlength="1" size="1" value="" onkeyup="if(this.value.match(/[^a-zA-Z]/))this.value=this.value.replace(/[^a-zA-Z]/g,'')" class="textbox" title="Enter consumer middle initial">
                                          </TD>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">* Last Name:</TD>
                                          <TD width="33%"><input type="text" name="CL_LNAME" size="20" value="CHECKOUT" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter consumer last name">&nbsp;&nbsp;SFX:<select name="CL_SFX" style="width: 40px" class="textbox" title="Select consumer suffix"><option value="" selected="selected"></option>
<option value="JR">JR</option>
<option value="SR">SR</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* DOB:</TD>
                                          <TD><input type="text" name="CL_DOB" maxlength="10" size="32" value="01-02-1981" onkeyup="this.value=formatDate(this.value);" onblur="validDate(this);" class="textbox" title="Enter consumer date of birth"></TD>
                                          <td bgcolor="#EEEEFF" align="right">*DOBVerification</td>
                                          <TD><select name="CL_DOBV" style="width: 208px" class="textbox" title="Select DOB verification"><option value="0"></option>
<option value="1">BIRTH/BAPTISMAL CERTIFICATE</option>
<option value="2" selected="selected">DRIVERS LICENSE</option>
<option value="3">HOSP/DOCTOR/HEALTH UNIT RCDS</option>
<option value="4">SCHOOL RECORDS</option>
<option value="5">INSURANCE RECORDS</option>
<option value="6">PASSPORT</option>
<option value="7">FEDERAL/STATE/LOCAL AGENCIES</option>
<option value="8">PENDING</option>
<option value="9">OTHER</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Race:</TD>
                                          <TD><select name="CL_RAC" style="width: 208px" class="textbox" title="Select consumer race"><option value="0"></option>
<option value="A">ASIAN</option>
<option value="B">AFRICAN AMERICAN</option>
<option value="C" selected="selected">CAUCASIAN</option>
<option value="D">AMERICAN INDIAN</option>
<option value="E">NATIVE HAWAIIAN/OTH PAC ISLNDR</option>
<option value="F">UNKNOWN/UNABLE TO DETERMINE</option></select></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Ethnicity:</TD>
                                          <TD><select name="CL_ETH" style="width: 208px" class="textbox" title="Select consumer ethnicity"><option value="0"></option>
<option value="Y">HISPANIC</option>
<option value="N" selected="selected">NON-HISPANIC</option>
<option value="U">UNKNOWN</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Sex:</TD>
                                          <TD><select name="CL_SEX" style="width: 208px" class="textbox" title="Select consumer sex"><option value="0"></option>
<option value="M" selected="selected">MALE</option>
<option value="F">FEMALE</option>
<option value="U">UNKNOWN</option></select></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Prime Lang:</TD>
                                          <TD><select name="CL_P_LANG" style="width: 208px" class="textbox" title="Select consumer primary language"><option value="0"></option>
<option value="1">AMERICAN SIGN LANGUAGE (ASL)</option>
<option value="2">SIGNED ENGLISH (A CODE OF ENGLISH)</option>
<option value="3" selected="selected">SPOKEN ENGLISH</option>
<option value="4">OTHER</option></select></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Second Lang:</TD>
                                          <TD><select name="CL_S_LANG" style="width: 208px" class="textbox" title="Select consumer secondary language"><option value="0" selected="selected"></option>
<option value="1">AMERICAN SIGN LANGUAGE (ASL)</option>
<option value="2">SIGNED ENGLISH (A CODE OF ENGLISH)</option>
<option value="3">SPOKEN ENGLISH</option>
<option value="4">OTHER</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#BBBBFF" colspan="2"><b>Residence Address:</b><font style="font-size: 7pt">(if PO Box, list street address also)</font></TD>
                                          <TD bgcolor="#BBBBFF" colspan="2"><b>Mailing Address:</b>&nbsp;<input type="checkbox" name="m_CHECK" value="on" onclick="copyR()" class="checkbox" title="Check if mailing address is same as residential address">&nbsp;<font style="font-size: 7pt">Check if same as Residence.</font></TD>
                                    </TR>
                                    <tr>
                                          <td colspan="2">
                                          <table cellpadding="0" cellspacing="0" width="100%">
                                                <TR>
                                                      <TD width="17%" bgcolor="#EEEEFF" align="right">* Address1:</TD>
                                                      <TD width="33%"><input type="text" name="CL_R_ADD1" size="32" value="123 CARTER" onkeyup="copyR()" class="textbox" title="Enter consumer residence street address"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1" src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">Address2:</TD>
                                                      <TD><input type="text" name="CL_R_ADD2" size="32" value="23" onkeyup="copyR()" class="textbox" title="Enter consumer residence address line 2"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* City:</TD>
                                                      <TD><input type="text" name="CL_R_CITY" size="32" value="BATON ROUGE" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'');copyR()" class="textbox" title="Enter consumer residence city"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* Parish:</TD>
                                                      <TD><select name="CL_R_PAR" onchange="copyR()" style="width: 208px" class="textbox" title="Select consumer residence parish"><option value="0"></option>
<option value="1">ACADIA</option>
<option value="2">ALLEN</option>
<option value="3">ASCENSION</option>
<option value="4">ASSUMPTION</option>
<option value="5">AVOYELLES</option>
<option value="6">BEAUREGARD</option>
<option value="7">BIENVILLE</option>
<option value="8">BOSSIER</option>
<option value="9">CADDO</option>
<option value="10">CALCASIEU</option>
<option value="11">CALDWELL</option>
<option value="12">CAMERON</option>
<option value="13">CATAHOULA</option>
<option value="14">CLAIBORNE</option>
<option value="15">CONCORDIA</option>
<option value="16">DESOTO</option>
<option value="17" selected="selected">EAST BATON ROUGE</option>
<option value="18">EAST CARROLL</option>
<option value="19">EAST FELICIANA</option>
<option value="20">EVANGELINE</option>
<option value="21">FRANKLIN</option>
<option value="22">GRANT</option>
<option value="23">IBERIA</option>
<option value="24">IBERVILLE</option>
<option value="25">JACKSON</option>
<option value="26">JEFFERSON</option>
<option value="27">JEFFERSON DAVIS</option>
<option value="28">LAFAYETTE</option>
<option value="29">LAFOURCHE</option>
<option value="30">LASALLE</option>
<option value="31">LINCOLN</option>
<option value="32">LIVINGSTON</option>
<option value="33">MADISON</option>
<option value="34">MOREHOUSE</option>
<option value="35">NATCHITOCHES</option>
<option value="36">ORLEANS</option>
<option value="37">OUACHITA</option>
<option value="38">PLAQUEMINES</option>
<option value="39">POINTE COUPEE</option>
<option value="40">RAPIDES</option>
<option value="41">RED RIVER</option>
<option value="42">RICHLAND</option>
<option value="43">SABINE</option>
<option value="44">ST. BERNARD</option>
<option value="45">ST. CHARLES</option>
<option value="46">ST. HELENA</option>
<option value="47">ST. JAMES</option>
<option value="48">ST. JOHN</option>
<option value="49">ST. LANDRY</option>
<option value="50">ST. MARTIN</option>
<option value="51">ST. MARY</option>
<option value="52">ST. TAMMANY</option>
<option value="53">TANGIPAHOA</option>
<option value="54">TENSAS</option>
<option value="55">TERREBONNE</option>
<option value="56">UNION</option>
<option value="57">VERMILION</option>
<option value="58">VERNON</option>
<option value="59">WASHINGTON</option>
<option value="60">WEBSTER</option>
<option value="61">WEST BATON ROUGE</option>
<option value="62">WEST CARROLL</option>
<option value="63">WEST FELICIANA</option>
<option value="64">WINN</option></select></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* State:</TD>
                                                      <TD><select name="CL_R_ST" onchange="copyR()" style="width: 208px" class="textbox" title="Select consumer residence state"><option value=""></option>
<option value="AR">ARKANSAS</option>
<option value="AK">ALASKA</option>
<option value="AZ">ARIZONA</option>
<option value="AL">ALABAMA</option>
<option value="CA">CALIFORNIA</option>
<option value="CO">COLORADO</option>
<option value="CT">CONNECTICUT</option>
<option value="DE">DELAWARE</option>
<option value="FL">FLORIDA</option>
<option value="GA">GEORGIA</option>
<option value="HI">HAWAII</option>
<option value="IN">INDIANA</option>
<option value="IA">IOWA</option>
<option value="ID">IDAHO</option>
<option value="IL">ILLINOIS</option>
<option value="IS">ISS OFFICE--MARYLAND</option>
<option value="KS">KANSAS</option>
<option value="KY">KENTUCKY</option>
<option value="LA" selected="selected">LOUISIANA</option>
<option value="MD">MARYLAND</option>
<option value="ME">MAINE</option>
<option value="MA">MASSACHUSETTS</option>
<option value="MI">MICHIGAN</option>
<option value="MN">MINNESOTA</option>
<option value="MO">MISSOURI</option>
<option value="MS">MISSISSIPPI</option>
<option value="MT">MONTANA</option>
<option value="NC">NORTH CAROLINA</option>
<option value="ND">NORTH DAKOTA</option>
<option value="NE">NEBRASKA</option>
<option value="NH">NEW HAMPSHIRE</option>
<option value="NJ">NEW JERSEY</option>
<option value="NM">NEW MEXICO</option>
<option value="NV">NEVADA</option>
<option value="NY">NEW YORK</option>
<option value="OH">OHIO</option>
<option value="OK">OKLAHOMA</option>
<option value="OR">OREGON</option>
<option value="PA">PENNSYLVANIA</option>
<option value="RI">RHODE ISLAND</option>
<option value="SC">SOUTH CAROLINA</option>
<option value="SD">SOUTH DAKOTA</option>
<option value="TN">TENNESSEE</option>
<option value="TX">TEXAS</option>
<option value="UT">UTAH</option>
<option value="VA">VIRGINIA</option>
<option value="VT">VERMONT</option>
<option value="WA">WASHINGTON</option>
<option value="WI">WISCONSIN</option>
<option value="WV">WEST VIRGINIA</option>
<option value="WY">WYOMING</option>
<option value="DC">DISTRICT OF COLUMBIA</option>
<option value="AS">AMERICAN SAMOA</option>
<option value="FM">FED STS MICRONESIA</option>
<option value="GU">GUAM</option>
<option value="MH">MARSHALL ISLANDS</option>
<option value="MP">NORTHERN MARIANA ISL</option>
<option value="PR">PUERTO RICO</option>
<option value="PW">PALAU</option>
<option value="UM">U.S. MINOR OUTLY ISL</option>
<option value="VI">VIRGIN ISLANDS</option></select></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* Zip:</TD>
                                                      <TD><input type="text" name="CL_R_ZIP" size="32" value="70809-0000" onkeyup="this.value=formatZip(this.value);copyR();" onblur="document.forms['app'].submit();" class="textbox" title="Enter consumer residence zip"></TD>
                                                </TR>                                                
                                          </table>
                                          </td>
                                          <td colspan="2">
                                          <table cellpadding="0" cellspacing="0" width="100%">
                                                <TR>
                                                      <TD width="17%" bgcolor="#EEEEFF" align="right">* Address1:</TD>
                                                      <TD width="33%"><input type="text" name="CL_M_ADD1" size="32" value="123 CARTER" class="textbox" title="Enter consumer mailing street address"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1" src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">Address2:</TD>
                                                      <TD><input type="text" name="CL_M_ADD2" size="32" value="23" class="textbox" title="Enter consumer mailing address line 2"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* City:</TD>
                                                      <TD><input type="text" name="CL_M_CITY" size="32" value="BATON ROUGE" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter consumer mailing city"></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* Parish:</TD>
                                                      <TD><select name="CL_M_PAR" style="width: 208px" class="textbox" title="Select consumer mailing parish"><option value="0"></option>
<option value="1">ACADIA</option>
<option value="2">ALLEN</option>
<option value="3">ASCENSION</option>
<option value="4">ASSUMPTION</option>
<option value="5">AVOYELLES</option>
<option value="6">BEAUREGARD</option>
<option value="7">BIENVILLE</option>
<option value="8">BOSSIER</option>
<option value="9">CADDO</option>
<option value="10">CALCASIEU</option>
<option value="11">CALDWELL</option>
<option value="12">CAMERON</option>
<option value="13">CATAHOULA</option>
<option value="14">CLAIBORNE</option>
<option value="15">CONCORDIA</option>
<option value="16">DESOTO</option>
<option value="17" selected="selected">EAST BATON ROUGE</option>
<option value="18">EAST CARROLL</option>
<option value="19">EAST FELICIANA</option>
<option value="20">EVANGELINE</option>
<option value="21">FRANKLIN</option>
<option value="22">GRANT</option>
<option value="23">IBERIA</option>
<option value="24">IBERVILLE</option>
<option value="25">JACKSON</option>
<option value="26">JEFFERSON</option>
<option value="27">JEFFERSON DAVIS</option>
<option value="28">LAFAYETTE</option>
<option value="29">LAFOURCHE</option>
<option value="30">LASALLE</option>
<option value="31">LINCOLN</option>
<option value="32">LIVINGSTON</option>
<option value="33">MADISON</option>
<option value="34">MOREHOUSE</option>
<option value="35">NATCHITOCHES</option>
<option value="36">ORLEANS</option>
<option value="37">OUACHITA</option>
<option value="38">PLAQUEMINES</option>
<option value="39">POINTE COUPEE</option>
<option value="40">RAPIDES</option>
<option value="41">RED RIVER</option>
<option value="42">RICHLAND</option>
<option value="43">SABINE</option>
<option value="44">ST. BERNARD</option>
<option value="45">ST. CHARLES</option>
<option value="46">ST. HELENA</option>
<option value="47">ST. JAMES</option>
<option value="48">ST. JOHN</option>
<option value="49">ST. LANDRY</option>
<option value="50">ST. MARTIN</option>
<option value="51">ST. MARY</option>
<option value="52">ST. TAMMANY</option>
<option value="53">TANGIPAHOA</option>
<option value="54">TENSAS</option>
<option value="55">TERREBONNE</option>
<option value="56">UNION</option>
<option value="57">VERMILION</option>
<option value="58">VERNON</option>
<option value="59">WASHINGTON</option>
<option value="60">WEBSTER</option>
<option value="61">WEST BATON ROUGE</option>
<option value="62">WEST CARROLL</option>
<option value="63">WEST FELICIANA</option>
<option value="64">WINN</option></select></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* State:</TD>
                                                      <TD><select name="CL_M_ST" style="width: 208px" class="textbox" title="Select consumer mailing state"><option value=""></option>
<option value="AR">ARKANSAS</option>
<option value="AK">ALASKA</option>
<option value="AZ">ARIZONA</option>
<option value="AL">ALABAMA</option>
<option value="CA">CALIFORNIA</option>
<option value="CO">COLORADO</option>
<option value="CT">CONNECTICUT</option>
<option value="DE">DELAWARE</option>
<option value="FL">FLORIDA</option>
<option value="GA">GEORGIA</option>
<option value="HI">HAWAII</option>
<option value="IN">INDIANA</option>
<option value="IA">IOWA</option>
<option value="ID">IDAHO</option>
<option value="IL">ILLINOIS</option>
<option value="IS">ISS OFFICE--MARYLAND</option>
<option value="KS">KANSAS</option>
<option value="KY">KENTUCKY</option>
<option value="LA" selected="selected">LOUISIANA</option>
<option value="MD">MARYLAND</option>
<option value="ME">MAINE</option>
<option value="MA">MASSACHUSETTS</option>
<option value="MI">MICHIGAN</option>
<option value="MN">MINNESOTA</option>
<option value="MO">MISSOURI</option>
<option value="MS">MISSISSIPPI</option>
<option value="MT">MONTANA</option>
<option value="NC">NORTH CAROLINA</option>
<option value="ND">NORTH DAKOTA</option>
<option value="NE">NEBRASKA</option>
<option value="NH">NEW HAMPSHIRE</option>
<option value="NJ">NEW JERSEY</option>
<option value="NM">NEW MEXICO</option>
<option value="NV">NEVADA</option>
<option value="NY">NEW YORK</option>
<option value="OH">OHIO</option>
<option value="OK">OKLAHOMA</option>
<option value="OR">OREGON</option>
<option value="PA">PENNSYLVANIA</option>
<option value="RI">RHODE ISLAND</option>
<option value="SC">SOUTH CAROLINA</option>
<option value="SD">SOUTH DAKOTA</option>
<option value="TN">TENNESSEE</option>
<option value="TX">TEXAS</option>
<option value="UT">UTAH</option>
<option value="VA">VIRGINIA</option>
<option value="VT">VERMONT</option>
<option value="WA">WASHINGTON</option>
<option value="WI">WISCONSIN</option>
<option value="WV">WEST VIRGINIA</option>
<option value="WY">WYOMING</option>
<option value="DC">DISTRICT OF COLUMBIA</option>
<option value="AS">AMERICAN SAMOA</option>
<option value="FM">FED STS MICRONESIA</option>
<option value="GU">GUAM</option>
<option value="MH">MARSHALL ISLANDS</option>
<option value="MP">NORTHERN MARIANA ISL</option>
<option value="PR">PUERTO RICO</option>
<option value="PW">PALAU</option>
<option value="UM">U.S. MINOR OUTLY ISL</option>
<option value="VI">VIRGIN ISLANDS</option></select></TD>
                                                </TR>
                                                <tr>
                                                      <td height="1"><img height="1"
                                                            src="images/spacer.gif" width="1" border="0"></td>
                                                </tr>
                                                <TR>
                                                      <TD bgcolor="#EEEEFF" align="right">* Zip:</TD>
                                                      <TD><input type="text" name="CL_M_ZIP" size="32" value="70809-0000" onkeyup="this.value=formatZip(this.value)" onblur="validZip(this);" class="textbox" title="Enter consumer mailing zip"></TD>
                                                </TR>
                                                
                                          </table>
                                          </td>
                                    </tr>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Home Phone:</TD>
                                          <TD><input type="text" name="CL_H_PH" maxlength="13" size="32" value="(225)237-3060" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer home phone number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Work Phone:</TD>
                                          <TD><input type="text" name="CL_W_PH" maxlength="13" size="20" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer home work number">&nbsp;&nbsp;EXT:<input type="text" name="CL_W_PH_EXT" maxlength="4" size="4" value="" class="textbox" title="Enter consumer work extension"></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">TDD:</TD>
                                          <TD><input type="text" name="CL_TDD" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer TDD number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Text Message:</TD>
                                          <TD><input type="text" name="CL_TEXT" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer text message number"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Voice:</TD>
                                          <TD><input type="text" name="CL_VOICE" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer voice number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Visual Phone:</TD>
                                          <TD><input type="text" name="CL_V_PH" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter consumer visual phone number"></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Email:</TD>
                                          <TD><input type="text" name="CL_EMAIL" size="32" value="" class="textbox" title="Enter consumer email address"></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>
                              </TBODY>
                        </TABLE>
                        </FIELDSET>
                        </TD>
                  </TR>
                  <TR>
                        <TD>
                        <FIELDSET class="fieldset"><LEGEND><B><FONT face="Arial"
                              color="Navy" size="2">Contact Information</FONT></B></LEGEND>
                        <TABLE width="100%" cellpadding="0" cellspacing="1">

                              <TBODY>
                                    <tr>
                                          <td colspan="4" class="tdcell1">Emergency (Relative not living
                                          with you) Contact Information</td>
                                    </tr>
                                    <TR>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">* First Name:</TD>
                                          <TD width="33%"><input type="text" name="RL_FNAME" size="23" value="ABC" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter relative first name">&nbsp;&nbsp;MI:&nbsp;&nbsp;<input type="text" name="RL_MI" maxlength="1" size="1" value="" onkeyup="if(this.value.match(/[^a-zA-Z]/))this.value=this.value.replace(/[^a-zA-Z]/g,'')" class="textbox" title="Enter relative middle initial"></TD>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">* Last Name:</TD>
                                          <TD width="33%"><input type="text" name="RL_LNAME" size="20" value="DEF" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter relative last name">&nbsp;&nbsp;SFX:<select name="RL_SFX" style="width: 40px" class="textbox" title="Select relative name suffix"><option value="" selected="selected"></option>
<option value="JR">JR</option>
<option value="SR">SR</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option></select></TD>

                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Address1:</TD>
                                          <TD><input type="text" name="RL_ADD1" size="32" value="123 LOYOLLA" class="textbox" title="Enter relative street address"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Address2:</TD>
                                          <TD><input type="text" name="RL_ADD2" size="32" value="" class="textbox" title="Enter relative address line 2 if any"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* City:</TD>
                                          <TD><input type="text" name="RL_CITY" size="32" value="BATON ROUGE" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter relative city"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">* State:</TD>
                                          <TD><select name="RL_ST" style="width: 208px" class="textbox" title="Select relative state"><option value=""></option>
<option value="AR">ARKANSAS</option>
<option value="AK">ALASKA</option>
<option value="AZ">ARIZONA</option>
<option value="AL">ALABAMA</option>
<option value="CA">CALIFORNIA</option>
<option value="CO">COLORADO</option>
<option value="CT">CONNECTICUT</option>
<option value="DE">DELAWARE</option>
<option value="FL">FLORIDA</option>
<option value="GA">GEORGIA</option>
<option value="HI">HAWAII</option>
<option value="IN">INDIANA</option>
<option value="IA">IOWA</option>
<option value="ID">IDAHO</option>
<option value="IL">ILLINOIS</option>
<option value="IS">ISS OFFICE--MARYLAND</option>
<option value="KS">KANSAS</option>
<option value="KY">KENTUCKY</option>
<option value="LA" selected="selected">LOUISIANA</option>
<option value="MD">MARYLAND</option>
<option value="ME">MAINE</option>
<option value="MA">MASSACHUSETTS</option>
<option value="MI">MICHIGAN</option>
<option value="MN">MINNESOTA</option>
<option value="MO">MISSOURI</option>
<option value="MS">MISSISSIPPI</option>
<option value="MT">MONTANA</option>
<option value="NC">NORTH CAROLINA</option>
<option value="ND">NORTH DAKOTA</option>
<option value="NE">NEBRASKA</option>
<option value="NH">NEW HAMPSHIRE</option>
<option value="NJ">NEW JERSEY</option>
<option value="NM">NEW MEXICO</option>
<option value="NV">NEVADA</option>
<option value="NY">NEW YORK</option>
<option value="OH">OHIO</option>
<option value="OK">OKLAHOMA</option>
<option value="OR">OREGON</option>
<option value="PA">PENNSYLVANIA</option>
<option value="RI">RHODE ISLAND</option>
<option value="SC">SOUTH CAROLINA</option>
<option value="SD">SOUTH DAKOTA</option>
<option value="TN">TENNESSEE</option>
<option value="TX">TEXAS</option>
<option value="UT">UTAH</option>
<option value="VA">VIRGINIA</option>
<option value="VT">VERMONT</option>
<option value="WA">WASHINGTON</option>
<option value="WI">WISCONSIN</option>
<option value="WV">WEST VIRGINIA</option>
<option value="WY">WYOMING</option>
<option value="DC">DISTRICT OF COLUMBIA</option>
<option value="AS">AMERICAN SAMOA</option>
<option value="FM">FED STS MICRONESIA</option>
<option value="GU">GUAM</option>
<option value="MH">MARSHALL ISLANDS</option>
<option value="MP">NORTHERN MARIANA ISL</option>
<option value="PR">PUERTO RICO</option>
<option value="PW">PALAU</option>
<option value="UM">U.S. MINOR OUTLY ISL</option>
<option value="VI">VIRGIN ISLANDS</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Zip:</TD>
                                          <TD><input type="text" name="RL_ZIP" maxlength="10" size="32" value="70809-0000" onkeyup="this.value=formatZip(this.value)" onblur="validZip(this);" class="textbox" title="Enter relative zip"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">* Phone:</TD>
                                          <TD><input type="text" name="RL_PH" maxlength="13" size="20" value="(225)237-3000" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative phone number">&nbsp;&nbsp;EXT:<input type="text" name="RL_PH_EXT" maxlength="4" size="4" value="" class="textbox" title="Enter relative extension number if any"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">TDD:</TD>
                                          <TD><input type="text" name="RL_TDD" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative TDD number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Text Message:</TD>
                                          <TD><input type="text" name="RL_TEXT" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative text message number"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Voice:</TD>
                                          <TD><input type="text" name="RL_VOICE" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative voice number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Visual Phone:</TD>
                                          <TD><input type="text" name="RL_V_PH" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter relative visual phone number"></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Email:</TD>
                                          <TD><input type="text" name="RL_EMAIL" size="32" value="" class="textbox" title="Enter relative email address"></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>
                              </TBODY>

                              <TBODY>
                                    <tr>
                                          <td colspan="4" class="tdcell1">Advocate/Guardian Contact
                                          Information</td>
                                    </tr>
                                    <TR>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">First Name:</TD>
                                          <TD width="33%"><input type="text" name="g_FNAME" size="23" value="HELLO" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter guardian first name">&nbsp;&nbsp;MI:&nbsp; <input type="text" name="g_MI" maxlength="1" size="1" value="" onkeyup="if(this.value.match(/[^a-zA-Z]/))this.value=this.value.replace(/[^a-zA-Z]/g,'')" class="textbox" title="Enter guardian middle initial"></TD>
                                          <TD width="17%" bgcolor="#EEEEFF" align="right">Last Name:</TD>
                                          <TD width="33%"><input type="text" name="g_LNAME" size="20" value="DSDSDSD" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter guardian last name">&nbsp;&nbsp;SFX:<select name="g_SFX" style="width: 40px" class="textbox" title="Select guardian name suffix"><option value="" selected="selected"></option>
<option value="JR">JR</option>
<option value="SR">SR</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Phone:</TD>
                                          <TD><input type="text" name="g_PH" maxlength="13" size="20" value="(225)236-6666" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian phone number">&nbsp;&nbsp;EXT:<input type="text" name="g_PH_EXT" maxlength="4" size="4" value="" class="textbox" title="Enter guardian phone extension if any"></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">TDD:</TD>
                                          <TD><input type="text" name="g_TDD" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian TDD number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Text Message:</TD>
                                          <TD><input type="text" name="g_TEXT" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian text message number"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Voice:</TD>
                                          <TD><input type="text" name="g_VOICE" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian voice number"></TD>
                                          <TD bgcolor="#EEEEFF" align="right">Visual Phone:</TD>
                                          <TD><input type="text" name="g_V_PH" size="32" value="" onkeyup="this.value=formatTel(this.value);" onblur="validTel(this);" class="textbox" title="Enter guardian visual phone number"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">Email:</TD>
                                          <TD><input type="text" name="g_EMAIL" size="32" value="" class="textbox" title="Enter guardian email address"></TD>
                                          <TD bgcolor="#EEEEFF"></TD>
                                    </TR>
                              </TBODY>
                        </TABLE>
                        </FIELDSET>
                        </TD>
                  </TR>
                  <TR>
                        <TD align="center"><input type="submit" name="submit" value="Update" onclick="return validate1(1)" class="button" title="Click to update">&nbsp;&nbsp;<input type="reset" name="reset" value="Clear" class="button" title="Click to reset"></TD>
                  </TR>
                  
                  <TR>
                        <TD id="hhm">
                        <FIELDSET class="fieldset"><LEGEND><B><FONT face="Arial"
                              color="Navy" size="2">Other Household Members</FONT></B></LEGEND>
                        <TABLE width="100%" cellpadding="0" cellspacing="1">
                              <TBODY>
                                    <TR>
                                          <TD colspan="4"></TD>
                                    </TR>
                                    <TR>
                                          <TD colspan="4">
                                          <table width="100%">
                                                <tr>
                                                      <td colspan="7" align="center"><input type="button" name="button" value="Add New Member" onclick="hhSEL(1)" style="width:110px;" class="button" title="Click to add new household member">&nbsp;&nbsp;<input type="button" name="button" value="Update Member" onclick="hhSEL(2)" style="width:110px;" class="button" title="Click to update member">&nbsp;&nbsp;<input type="submit" name="submit" value="Delete Member" onclick="return hhSEL(3)" style="width:110px;" class="button" title="Click to delete member"></td>
                                                </tr>
                                                
                                          </table>
                                          </TD>
                                    </TR>
                              </TBODY>
                        </TABLE>
                        </FIELDSET>
                        </TD>
                  </TR>
                  
            </TBODY>
            <TBODY id="hh" style="display: none">
                  <TR>
                        <TD>
                        <FIELDSET class="fieldset"><LEGEND><B><FONT face="Arial"
                              color="Navy" size="2">Add / Update Household Member</FONT></B></LEGEND>
                        <TABLE width="50%" cellpadding="0" cellspacing="1">
                              <TBODY style="display: block">
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* SSN:</TD>
                                          <TD><input type="text" name="HH_SSN" maxlength="11" size="32" value="" onkeyup="this.value=formatSSN(this.value);" onblur="validSSN(this);" class="textbox" title="Enter household SSN"></TD>
                                    </TR>
                                    <TR>
                                          <TD width="15%" bgcolor="#EEEEFF" align="right">* First Name:</TD>
                                          <TD width="35%"><input type="text" name="HH_FNAME" size="23" value="" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter household first name">&nbsp;&nbsp;MI:&nbsp;&nbsp;<input type="text" name="HH_MI" maxlength="1" size="1" value="" onkeyup="if(this.value.match(/[^a-zA-Z]/))this.value=this.value.replace(/[^a-zA-Z]/g,'')" class="textbox" title="Enter household middle initial">
                                          </TD>
                                    </TR>
                                    <TR>
                                          <TD width="15%" bgcolor="#EEEEFF" align="right">* Last Name:</TD>
                                          <TD width="35%"><input type="text" name="HH_LNAME" size="20" value="" onkeyup="if(this.value.match(/[^a-z' 'A-Z]/))this.value=this.value.replace(/[^a-z' 'A-Z]/g,'')" class="textbox" title="Enter household last name">&nbsp;&nbsp;SFX:<select name="HH_SFX" style="width: 40px" class="textbox" title="Select household name suffix"><option value="" selected="selected"></option>
<option value="JR">JR</option>
<option value="SR">SR</option>
<option value="II">II</option>
<option value="III">III</option>
<option value="IV">IV</option></select></TD>
                                    </TR>

                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* DOB:</TD>
                                          <TD><input type="text" name="HH_DOB" maxlength="10" size="32" value="" onkeyup="this.value=formatDate(this.value);" onblur="validDate(this);" class="textbox" title="Enter household DOB"></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Sex:</TD>
                                          <TD><select name="HH_SEX" style="width: 208px" class="textbox" title="Select household sex"><option value="0"></option>
<option value="M">MALE</option>
<option value="F">FEMALE</option>
<option value="U">UNKNOWN</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Relationship:</TD>
                                          <TD><select name="HH_REL" style="width: 208px" class="textbox" title="Enter household relationship to consumer"><option value="0"></option>
<option value="1">ADOPTED CHILD</option>
<option value="2">AUNT</option>
<option value="3">BROTHER</option>
<option value="4">BROTHER-IN-LAW</option>
<option value="5">COUSIN</option>
<option value="6">DAUGHTER</option>
<option value="7">DAUGHTER-IN-LAW</option>
<option value="8">FATHER</option>
<option value="9">FATHER-IN-LAW</option>
<option value="10">FOSTER CHILD</option>
<option value="11">FRIEND</option>
<option value="12">GRANDCHILD</option>
<option value="13">GRANDPARENT</option>
<option value="14">HALF-SIBLING</option>
<option value="15">HUSBAND</option>
<option value="16">MOTHER</option>
<option value="17">MOTHER-IN-LAW</option>
<option value="18">NEPHEW</option>
<option value="19">NIECE</option>
<option value="20">PARAMOUR</option>
<option value="21">SELF</option>
<option value="22">SISTER</option>
<option value="23">SISTER-IN-LAW</option>
<option value="24">SON</option>
<option value="25">SON-IN-LAW</option>
<option value="26">STEPCHILD</option>
<option value="27">STEP-GRANDPARENT</option>
<option value="28">STEP-PARENT</option>
<option value="29">STEP-SIBLING</option>
<option value="30">UNCLE</option>
<option value="31">WIFE</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD bgcolor="#EEEEFF" align="right">* Disabled:</TD>
                                          <TD><select name="HH_DIS" style="width: 208px" class="textbox" title="Select household disability status"><option value="" selected="selected"></option>
                                                <option value="Y">YES</option>
                                                <option value="N">NO</option></select></TD>
                                    </TR>
                                    <TR>
                                          <TD align="center" colspan="2"><span id="addhh"><input type="submit" name="submit" value="Add Member" onclick="return hhSEL(4);" style="width:110px;" class="button" title="Click to add household"></span>&nbsp;&nbsp;<span
                                                id="uphh"><input type="submit" name="submit" value="Update Member" onclick="return hhSEL(4);" style="width:110px;" class="button" title="Click to update household"></span>&nbsp;&nbsp;<input type="button" name="reset" value="Cancel" onclick="hh(2)" class="button" title="Click to cancel"></TD>
                                    </TR>
                              </TBODY>
                        </TABLE>
                        </FIELDSET>
                        </TD>
                  </TR>
            </TBODY>
      </TABLE>
</form>
<script type="text/javascript" language="JavaScript">
  <!--
  var focusControl = document.forms["app"].elements["CL_FNAME"];

  if (focusControl.type != "hidden") {
     focusControl.focus();
  }
  // -->
</script>
</td>
                                    
                              </tr>
                        </table>
                        </td>
                  </tr>
            </table>
            </td>
      </tr>

      <tr>
            <td><!-- FOOTER BEGINS HERE -->
<table width="100%" bgcolor="white"><tr><td align="left" width="50%">
<font color= "#7f98b7" face = "verdana" size="1">All contents copyright &copy; DSS-IS
</font></td><td align="right"><a href="mailto:usc@dss.state.la.us?subject=Assistance needed, LCD online system" title="Click to email help desk"><font color= "#7f98b7" face = "verdana" size="1">Help Desk
</font></a></td></tr></table>
<!-- FOOTER ENDS HERE --></td>
      </tr>

      <!-- FOOTER ENDS HERE --></table>
</html>
0
 
LVL 19

Accepted Solution

by:
Kuldeepchaturvedi earned 2000 total points
ID: 14020964
:-)
Alright here is the deal...

in yur form you have three buttons of type submit and all three of them are names as submit too.............!!!

thats a problem right there....
when you do
document.forms[0].submit().. it starts referring to one of these buttons ( because of the name)... and as a result you get the msg that object doesn't support property or method...!!!

change all these buttons name to may be submit1 or something other than "submit"
and instead of having
document.forms['app'].submit() have it either document.forms[0].submit(); or document.app.submit();
if you make these changes correctly and your last posted HTML still wont work, I will take retirement from EE ( just kidding...:-))
0
 
LVL 11

Author Comment

by:raj3060
ID: 14021305
>>if you make these changes correctly and your last posted HTML still wont work, I will take retirement from EE

RETIRE................

Just kidding, it worked... I guess I was exhausted with other problem, and I was not seeing it...

document.forms['app'].submit() works.... Problem was submit.

Thankyou very much..
0
 
LVL 19

Expert Comment

by:Kuldeepchaturvedi
ID: 14021323
:-) glad to be of any help....
0

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