?
Solved

All the radio Buttons on my Form are slected i dont know why

Posted on 2011-10-06
18
Medium Priority
?
338 Views
Last Modified: 2012-06-21
Hi all this is a two part question all my radio buttons on my form are selected and i am not sure why and also my email script is not pickingup for for reason

The first code is that of my form
The 2nd is the script
<!-- 
  Adby Designs
  By Adam Wolarczuk
  July 2011
-->

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" 
  "http://www.w3.org/TR/html4/loose.dtd">

<html lang="en">


	<head>
		<title>Tenancy Application Form</title>
	
		<meta http-equiv="content-script-type" content="text/javascript">
		<meta http-equiv="content-type" content="text/html;charset=iso-8859-1">
		<link href ="settings.css" rel="stylesheet"  >
			<style type="text/css">
			#midcon1		{position:absolute;	height:5330px;width:800px; background-color:white;left:29px;	top:218px;border: #01466f solid 1px}   /*White pageground in the middle */
			#footer1		{position:absolute; top: 4398px; width: 800px; left:-29px}
			#bottom1 {  width:800px;height:120px;background-color: #236e9a;}  /* layout bottom*/

				ul.a {list-style-type:none;}
				
			.auto-style1 {
				border-width: 0px;
			}
				
			</style>
			
			
	</head>

<body>

		<div id="container" >
			
	
            
			
	
            <a href="home.asp"><map id="ImgMap0" name="ImgMap0">
			<area alt="" coords="5, 30, 188, 125" href="home.asp" shape="rect">
			</map>
			
	
            
			
	
          <img src="images/title.png"  alt=""  id="timage" class="auto-style1" usemap="#ImgMap0" ></a>
           	
			<div id="topl"><img src="images/topline.png"  alt="tline" width="800px"></div>
			<div id="midcon1"> 





   

    <table border="0" cellspacing="1" cellpadding="2"  width="800">

    

      <tr> 

        <td class="navytext" colspan="2"><h2><b>Tenancy Application</b></h2><span class="redstar">*</span> = Required fields<br><br></td>

      </tr>      

      

      <form method="post" action="process_mail.aspx" name="reuse">

<input type="hidden" name="mode" value="R">

<input type="hidden" name="u" value=180112>
   
      

      </form>

     

    	<tr> 

        <td class="navytext" colspan="2"><strong>CREATE A NEW APPLICATION:</strong></td>

      </tr>     

           

      

      

       <tr> 

        <td class="navytext" colspan="2"><strong>PROPERTY APPLIED FOR: <span class="redstar">*</span> </strong></td>

      </tr>

       

	  <tr> 

        <td align="left" width="171">Type of Residence</td>

        <td valign="Bottom" align="left"><select name="chPropertyPrefix" onChange=				"if((this.value=='')||(this.value=='')){document.getElementById('chPropertyFlatNo').style.display='none';document.getElementById('lblPropertyFlatNo').style.display='none';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPropertyStreetNo.focus()};}else{document.getElementById('chPropertyFlatNo').style.display='inline';document.getElementById('lblPropertyFlatNo').style.display='inline';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPropertyFlatNo.focus()};};if(this.value=='-----'){this.value='';document.getElementById('chPropertyFlatNo').style.display='none';document.getElementById('lblPropertyFlatNo').style.display='none';}" style="width:113px;">

       		    <option value="null">(Select)</option>

                <option value="">HOUSE</option>

                <option value="UNIT">UNIT</option>

                <option value="APARTMENT">APARTMENT</option>

                <option value="FLAT">FLAT</option>

                <option value="STUDIO">STUDIO</option>

                

				<option value="-----" >-----</option>

				

				<option value="BLOCK" >BLOCK</option>

				

				<option value="CABIN" >CABIN</option>

				

				<option value="COTTAGE" >COTTAGE</option>

				

				<option value="DUPLEX" >DUPLEX</option>

				

				<option value="FACTORY" >FACTORY</option>

				

				<option value="FLOOR" >FLOOR</option>

				

				<option value="LOT" >LOT</option>

				

				<option value="PIER" >PIER</option>

				

				<option value="ROOFTOP" >ROOFTOP</option>

				

				<option value="ROOM" >ROOM</option>

				

				<option value="SHOP" >SHOP</option>

				

				<option value="SUITE" >SUITE</option>

				

				<option value="TOWNHOUSE" >TOWNHOUSE</option>

				

				<option value="VILLA" >VILLA</option>

				

				<option value="WAREHOUSE" >WAREHOUSE</option>

				

              </select><div id="lblPropertyFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</div><input name="chPropertyFlatNo" id="chPropertyFlatNo" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"> Str. No. <input name="chPropertyStreetNo" type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>

              </tr>   

      

	   

	   <tr>        

        <td align="left" >Street Name</td>

        <td valign="Bottom" align="left" ><input name="chPropertyStreetName" type="Text" size="16"><img src="images/spacer.gif" width="46" height="1" border="0"><select name="chPropertyStreetType" onChange="if(this.value=='-----'){this.value='';};if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPropertySuburb.focus()};">

                <option value="">(Street Type)</option>

                

					<option value="STREET">STREET</option>

								

					<option value="ROAD">ROAD</option>

								

					<option value="AVENUE">AVENUE</option>

								

					<option value="PLACE">PLACE</option>

								

					<option value="CRESCENT">CRESCENT</option>

								

					<option value="DRIVE">DRIVE</option>

								

					<option value="PARADE">PARADE</option>

								

					<option value="CLOSE">CLOSE</option>

								

					<option value="-----">-----</option>

								

					<option value="ACCESS">ACCESS</option>

								

					<option value="ALLEY">ALLEY</option>

								

					<option value="ALLEYWAY">ALLEYWAY</option>

								

					<option value="AMBLE">AMBLE</option>

								

					<option value="ANCHORAGE">ANCHORAGE</option>

								

					<option value="APPROACH">APPROACH</option>

								

					<option value="ARCADE">ARCADE</option>

								

					<option value="ARTERY">ARTERY</option>

								

					<option value="BASIN">BASIN</option>

								

					<option value="BEACH">BEACH</option>

								

					<option value="BEND">BEND</option>

								

					<option value="BLOCK">BLOCK</option>

								

					<option value="BOULEVARD">BOULEVARD</option>

								

					<option value="BOULEVARDE">BOULEVARDE</option>

								

					<option value="BRACE">BRACE</option>

								

					<option value="BRAE">BRAE</option>

								

					<option value="BREAK">BREAK</option>

								

					<option value="BRIDGE">BRIDGE</option>

								

					<option value="BROADWAY">BROADWAY</option>

								

					<option value="BROW">BROW</option>

								

					<option value="BYPASS">BYPASS</option>

								

					<option value="BYWAY">BYWAY</option>

								

					<option value="CAUSEWAY">CAUSEWAY</option>

								

					<option value="CENTRAL">CENTRAL</option>

								

					<option value="CENTRE">CENTRE</option>

								

					<option value="CENTREWAY">CENTREWAY</option>

								

					<option value="CHASE">CHASE</option>

								

					<option value="CIRCLE">CIRCLE</option>

								

					<option value="CIRCLET">CIRCLET</option>

								

					<option value="CIRCUIT">CIRCUIT</option>

								

					<option value="CIRCUS">CIRCUS</option>

								

					<option value="COLONNADE">COLONNADE</option>

								

					<option value="COMMON">COMMON</option>

								

					<option value="CONCOURSE">CONCOURSE</option>

								

					<option value="COPSE">COPSE</option>

								

					<option value="CORNER">CORNER</option>

								

					<option value="CORSO">CORSO</option>

								

					<option value="COURT">COURT</option>

								

					<option value="COURTYARD">COURTYARD</option>

								

					<option value="COVE">COVE</option>

								

					<option value="CREST">CREST</option>

								

					<option value="CROSS">CROSS</option>

								

					<option value="CROSSING">CROSSING</option>

								

					<option value="CROSSROAD">CROSSROAD</option>

								

					<option value="CROSSWAY">CROSSWAY</option>

								

					<option value="CRUISEWAY">CRUISEWAY</option>

								

					<option value="CUL-DE-SAC">CUL-DE-SAC</option>

								

					<option value="CUTTING">CUTTING</option>

								

					<option value="DALE">DALE</option>

								

					<option value="DELL">DELL</option>

								

					<option value="DEVIATION">DEVIATION</option>

								

					<option value="DIP">DIP</option>

								

					<option value="DISTRIBUTOR">DISTRIBUTOR</option>

								

					<option value="DRIVEWAY">DRIVEWAY</option>

								

					<option value="EAST">EAST</option>

								

					<option value="EDGE">EDGE</option>

								

					<option value="ELBOW">ELBOW</option>

								

					<option value="END">END</option>

								

					<option value="ENTRANCE">ENTRANCE</option>

								

					<option value="ESPLANADE">ESPLANADE</option>

								

					<option value="ESTATE">ESTATE</option>

								

					<option value="EXPRESSWAY">EXPRESSWAY</option>

								

					<option value="EXTENSION">EXTENSION</option>

								

					<option value="EXTENSION">EXTENSION</option>

								

					<option value="FAIRWAY">FAIRWAY</option>

								

					<option value="FIRE TRACK">FIRE TRACK</option>

								

					<option value="FIRETRAIL">FIRETRAIL</option>

								

					<option value="FLAT">FLAT</option>

								

					<option value="FOLLOW">FOLLOW</option>

								

					<option value="FOOTWAY">FOOTWAY</option>

								

					<option value="FORESHORE">FORESHORE</option>

								

					<option value="FORMATION">FORMATION</option>

								

					<option value="FREEWAY">FREEWAY</option>

								

					<option value="FRONT">FRONT</option>

								

					<option value="FRONTAGE">FRONTAGE</option>

								

					<option value="GAP">GAP</option>

								

					<option value="GARDEN">GARDEN</option>

								

					<option value="GARDENS">GARDENS</option>

								

					<option value="GATE">GATE</option>

								

					<option value="GATES">GATES</option>

								

					<option value="GLADE">GLADE</option>

								

					<option value="GLEN">GLEN</option>

								

					<option value="GRANGE">GRANGE</option>

								

					<option value="GREEN">GREEN</option>

								

					<option value="GROUND">GROUND</option>

								

					<option value="GROVE">GROVE</option>

								

					<option value="GULLY">GULLY</option>

								

					<option value="HEIGHTS">HEIGHTS</option>

								

					<option value="HIGHROAD">HIGHROAD</option>

								

					<option value="HIGHWAY">HIGHWAY</option>

								

					<option value="HILL">HILL</option>

								

					<option value="INTERCHANGE">INTERCHANGE</option>

								

					<option value="INTERSECTION">INTERSECTION</option>

								

					<option value="JUNCTION">JUNCTION</option>

								

					<option value="KEY">KEY</option>

								

					<option value="LANDING">LANDING</option>

								

					<option value="LANE">LANE</option>

								

					<option value="LANEWAY">LANEWAY</option>

								

					<option value="LEES">LEES</option>

								

					<option value="LINE">LINE</option>

								

					<option value="LINK">LINK</option>

								

					<option value="LITTLE">LITTLE</option>

								

					<option value="LOOKOUT">LOOKOUT</option>

								

					<option value="LOOP">LOOP</option>

								

					<option value="LOWER">LOWER</option>

								

					<option value="LOWER">LOWER</option>

								

					<option value="MALL">MALL</option>

								

					<option value="MEANDER">MEANDER</option>

								

					<option value="MEW">MEW</option>

								

					<option value="MEWS">MEWS</option>

								

					<option value="MOTORWAY">MOTORWAY</option>

								

					<option value="MOUNT">MOUNT</option>

								

					<option value="NOOK">NOOK</option>

								

					<option value="NORTH">NORTH</option>

								

					<option value="NORTH EAST">NORTH EAST</option>

								

					<option value="NORTH WEST">NORTH WEST</option>

								

					<option value="OUTLOOK">OUTLOOK</option>

								

					<option value="PARK">PARK</option>

								

					<option value="PARKLANDS">PARKLANDS</option>

								

					<option value="PARKWAY">PARKWAY</option>

								

					<option value="PART">PART</option>

								

					<option value="PASS">PASS</option>

								

					<option value="PATH">PATH</option>

								

					<option value="PATHWAY">PATHWAY</option>

								

					<option value="PIAZZA">PIAZZA</option>

								

					<option value="PLATEAU">PLATEAU</option>

								

					<option value="PLAZA">PLAZA</option>

								

					<option value="POCKET">POCKET</option>

								

					<option value="POINT">POINT</option>

								

					<option value="PORT">PORT</option>

								

					<option value="PROMENADE">PROMENADE</option>

								

					<option value="QUAD">QUAD</option>

								

					<option value="QUADRANGLE">QUADRANGLE</option>

								

					<option value="QUADRANT">QUADRANT</option>

								

					<option value="QUAY">QUAY</option>

								

					<option value="QUAYS">QUAYS</option>

								

					<option value="RAMBLE">RAMBLE</option>

								

					<option value="RAMP">RAMP</option>

								

					<option value="RANGE">RANGE</option>

								

					<option value="REACH">REACH</option>

								

					<option value="RESERVE">RESERVE</option>

								

					<option value="REST">REST</option>

								

					<option value="RETREAT">RETREAT</option>

								

					<option value="RIDE">RIDE</option>

								

					<option value="RIDGE">RIDGE</option>

								

					<option value="RIDGEWAY">RIDGEWAY</option>

								

					<option value="RIGHT OF WAY">RIGHT OF WAY</option>

								

					<option value="RING">RING</option>

								

					<option value="RISE">RISE</option>

								

					<option value="RIVER">RIVER</option>

								

					<option value="RIVERWAY">RIVERWAY</option>

								

					<option value="RIVIERA">RIVIERA</option>

								

					<option value="ROADS">ROADS</option>

								

					<option value="ROADSIDE">ROADSIDE</option>

								

					<option value="ROADWAY">ROADWAY</option>

								

					<option value="RONDE">RONDE</option>

								

					<option value="ROSEBOWL">ROSEBOWL</option>

								

					<option value="ROTARY">ROTARY</option>

								

					<option value="ROUND">ROUND</option>

								

					<option value="ROUTE">ROUTE</option>

								

					<option value="ROW">ROW</option>

								

					<option value="RUE">RUE</option>

								

					<option value="RUN">RUN</option>

								

					<option value="SERVICE WAY">SERVICE WAY</option>

								

					<option value="SIDING">SIDING</option>

								

					<option value="SLOPE">SLOPE</option>

								

					<option value="SOUND">SOUND</option>

								

					<option value="SOUTH">SOUTH</option>

								

					<option value="SOUTH EAST">SOUTH EAST</option>

								

					<option value="SOUTH WEST">SOUTH WEST</option>

								

					<option value="SPUR">SPUR</option>

								

					<option value="SQUARE">SQUARE</option>

								

					<option value="STAIRS">STAIRS</option>

								

					<option value="STATE HIGHWAY">STATE HIGHWA</option>

								

					<option value="STEPS">STEPS</option>

								

					<option value="STEYNE">STEYNE</option>

								

					<option value="STRAND">STRAND</option>

								

					<option value="STRIP">STRIP</option>

								

					<option value="SUBWAY">SUBWAY</option>

								

					<option value="TARN">TARN</option>

								

					<option value="TERRACE">TERRACE</option>

								

					<option value="THOROUGHFARE">THOROUGHFARE</option>

								

					<option value="TOLLWAY">TOLLWAY</option>

								

					<option value="TOP">TOP</option>

								

					<option value="TOR">TOR</option>

								

					<option value="TOWERS">TOWERS</option>

								

					<option value="TRACK">TRACK</option>

								

					<option value="TRAIL">TRAIL</option>

								

					<option value="TRAILER">TRAILER</option>

								

					<option value="TRIANGLE">TRIANGLE</option>

								

					<option value="TRUNKWAY">TRUNKWAY</option>

								

					<option value="TURN">TURN</option>

								

					<option value="UNDERPASS">UNDERPASS</option>

								

					<option value="UPPER">UPPER</option>

								

					<option value="UPPER">UPPER</option>

								

					<option value="VALE">VALE</option>

								

					<option value="VIADUCT">VIADUCT</option>

								

					<option value="VIEW">VIEW</option>

								

					<option value="VILLAS">VILLAS</option>

								

					<option value="VISTA">VISTA</option>

								

					<option value="WADE">WADE</option>

								

					<option value="WALK">WALK</option>

								

					<option value="WALKWAY">WALKWAY</option>

								

					<option value="WAY">WAY</option>

								

					<option value="WEST">WEST</option>

								

					<option value="WHARF">WHARF</option>

								

					<option value="WYND">WYND</option>

								

					<option value="YARD">YARD</option>

								

          </select></td>

      </tr>	 	

         

      <tr> 

        <td align="left" >Suburb</td>

        <td align="left" ><input name="chPropertySuburb" type="Text" size="16"> State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chPropertyState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPropertyPostcode.focus()};">

					<option value=""></option>

            			

            <option value="ACT" >ACT</option>

            			

            <option value="NSW" >NSW</option>

            			

            <option value="NT" >NT</option>

            			

            <option value="QLD" >QLD</option>

            			

            <option value="SA" >SA</option>

            			

            <option value="TAS" >TAS</option>

            			

            <option value="VIC" >VIC</option>

            			

            <option value="WA " >WA </option>

            

          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="chPropertyPostcode" type="Text" size="4" maxlength="4">&nbsp;</td>

      </tr>	  

       

       <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td> 

	  </tr>

       <tr>

	  	<td align="left" width="171">Have you viewed the property?</td>

        <td  width="568">
		<input name="isPropertyViewed1" class="formcheckbox" type="Radio" value="V1" checked="true"> Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="isPropertyViewed" type="Radio" value="V1" checked="true"> No</td>

	  </tr>	  

     

	 <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

        <tr>

	  	<td align="left" width="171" class="navytext"><strong>TENANCY REQUIREMENTS: <span class="redstar">*</span> </strong></td>

        <td  width="568">&nbsp;</td>

	  </tr>  

       

       <tr>

	  	<td align="left" width="171">Commencement of lease</td>

        <td  width="568"><input name="chCommencementOfLease"  type="text" size="16" maxlength="50"> Rent $&nbsp;&nbsp;&nbsp;<input name="chRent" type="Text" size="4" maxlength="4"> 

        pw<img src="images/spacer.gif" width="11" height="1" border="0">Length of lease 

          <input name="chLengthofLease" type="Text" size="16" maxlength="50"></td>

	  </tr>

            	  

	 <tr>

	  	<td align="left" width="171" class="navytext"><strong>APPLICANT'S NAME: <span class="redstar">*</span> </strong></td>

        <td  width="568"><select name="chTitle" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chFName.focus()};">

            <option value="null" SELECTED>(Title)</option>

            <option value="MR" >Mr</option> 

			<option value="MRS" >Mrs</option>

			<option value="MS" >Ms</option>

			<option value="MISS" >Miss</option>

            <option value="DR" >Dr</option>

          </select><img src="images/spacer.gif" width="42" height="1" border="0"><input name="chFName" onfocus="if(this.value=='First name'){this.value=''};" onblur="if(this.value==''){this.value='First name'};" value="First name" type="Text" size="16"> <input name="chMName"  value="Middle name" onfocus="if(this.value=='Middle name'){this.value=''};" onblur="if(this.value==''){this.value='Middle name'};" type="Text" size="16"> <input name="chSName" value="Surname" onfocus="if(this.value=='Surname'){this.value=''};" onblur="if(this.value==''){this.value='Surname'};checkSurname(this);" type="Text" size="16"></td>

	  </tr>

      

      <tr> 

         <td align="left">Maiden name</td>

        <td ><input name="chMaidenName" type="Text" size="16" value="" maxlength="50">

          <input name="chGender1"  class="formcheckbox"    type="Radio" value="V1" checked="true"> Male 
		<input  class="formcheckbox" name="chGender"    type="Radio" value="V1" checked="true"> 

          Female<img src="images/spacer.gif" width="44" height="1" border="0">DOB 

                    

           <select name="dtDOB_dd" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtDOB_mm.focus()};">

                <option value="null" SELECTED>

				<option value="1" >1<option value="2" >2<option value="3" >3<option value="4" >4<option value="5" >5<option value="6" >6<option value="7" >7<option value="8" >8<option value="9" >9<option value="10" >10<option value="11" >11<option value="12" >12<option value="13" >13<option value="14" >14<option value="15" >15<option value="16" >16<option value="17" >17<option value="18" >18<option value="19" >19<option value="20" >20<option value="21" >21<option value="22" >22<option value="23" >23<option value="24" >24<option value="25" >25<option value="26" >26<option value="27" >27<option value="28" >28<option value="29" >29<option value="30" >30<option value="31" >31

           </select>         

           <select name="dtDOB_mm" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtDOB_yyyy.focus()};">

                <option value="null" SELECTED>

				<option value="1" >Jan<option value="2" >Feb<option value="3" >Mar<option value="4" >Apr<option value="5" >May<option value="6" >Jun<option value="7" >Jul<option value="8" >Aug<option value="9" >Sep<option value="10" >Oct<option value="11" >Nov<option value="12" >Dec

           </select>

           <select name="dtDOB_yyyy" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chNumberOfAdults.focus()};">

                <option value="null" SELECTED>

                <option value="1994" >1994<option value="1993" >1993<option value="1992" >1992<option value="1991" >1991<option value="1990" >1990<option value="1989" >1989<option value="1988" >1988<option value="1987" >1987<option value="1986" >1986<option value="1985" >1985<option value="1984" >1984<option value="1983" >1983<option value="1982" >1982<option value="1981" >1981<option value="1980" >1980<option value="1979" >1979<option value="1978" >1978<option value="1977" >1977<option value="1976" >1976<option value="1975" >1975<option value="1974" >1974<option value="1973" >1973<option value="1972" >1972<option value="1971" >1971<option value="1970" >1970<option value="1969" >1969<option value="1968" >1968<option value="1967" >1967<option value="1966" >1966<option value="1965" >1965<option value="1964" >1964<option value="1963" >1963<option value="1962" >1962<option value="1961" >1961<option value="1960" >1960<option value="1959" >1959<option value="1958" >1958<option value="1957" >1957<option value="1956" >1956<option value="1955" >1955<option value="1954" >1954<option value="1953" >1953<option value="1952" >1952<option value="1951" >1951<option value="1950" >1950<option value="1949" >1949<option value="1948" >1948<option value="1947" >1947<option value="1946" >1946<option value="1945" >1945<option value="1944" >1944<option value="1943" >1943<option value="1942" >1942<option value="1941" >1941<option value="1940" >1940<option value="1939" >1939<option value="1938" >1938<option value="1937" >1937<option value="1936" >1936<option value="1935" >1935<option value="1934" >1934<option value="1933" >1933<option value="1932" >1932<option value="1931" >1931<option value="1930" >1930<option value="1929" >1929<option value="1928" >1928<option value="1927" >1927<option value="1926" >1926<option value="1925" >1925<option value="1924" >1924<option value="1923" >1923<option value="1922" >1922<option value="1921" >1921<option value="1920" >1920<option value="1919" >1919<option value="1918" >1918<option value="1917" >1917<option value="1916" >1916<option value="1915" >1915<option value="1914" >1914<option value="1913" >1913<option value="1912" >1912<option value="1911" >1911

                </select>

           </td>

      </tr>

      

       <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

        <tr>

	  	<td align="left" width="171" class="navytext"><strong>OCCUPANCY DETAILS: <span class="redstar">*</span> </strong></td>

        <td  width="568">&nbsp;</td>

	  </tr>  

       

       <tr>

	  	<td align="left" width="171">No. of Adults</td>

        <td  width="568"> <select name="chNumberOfAdults" style="width:74px" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chNumberOfChildren.focus()};">

            <option value="null" SELECTED>(Select)</option>

            <option value="1" >1</option> 

			<option value="2" >2</option>

            <option value="3" >3</option>

            <option value="4" >4</option>

            <option value="5" >5</option>

            <option value="6" >6</option>

            <option value="6+" >6+</option>

          </select>

        No. of Children 

          <select name="chNumberOfChildren" style="width:74px" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgesOfChildren.focus()};">

            <option value="null" SELECTED>(Select)</option>

            <option value="0" >0</option> 

            <option value="1" >1</option> 

			<option value="2" >2</option>

            <option value="3" >3</option>

            <option value="4" >4</option>

            <option value="5" >5</option>

            <option value="6" >6</option>

            <option value="6+" >6+</option>

          </select> Ages of Children 

          <input name="chAgesOfChildren" type="Text" size="16"  value=""  maxlength="30"></td>

	  </tr>

      

      <tr>

	  	<td align="left" width="171">Name of Adult 1</td>

        <td  width="568"><input name="chAdult1"  value=""  type="text" size="16" maxlength="100"> 

         <img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 2) <input name="chAdult2" type="Text" size="16"  value=""  maxlength="100"> 

         </td>

	  </tr>

       

       <tr>

	  	<td align="left" width="171">Name of Adult 3</td>

        <td  width="568"><input name="chAdult3"  value=""  type="text" size="16" maxlength="100"> 

         <img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 4) <input name="chAdult4" type="Text" size="16"  value=""  maxlength="100"> 

         </td>

	  </tr>

       

       <tr>

	  	<td align="left" width="171" style="height: 34px">Name of Adult 5</td>

        <td  width="568" style="height: 34px"><input name="chAdult5"  value=""  type="text" size="16" maxlength="100"> 

         <img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 6) <input name="chAdult6" type="Text" size="16"  value=""  maxlength="100"> 

         </td>

	  </tr>

	  

      <tr>

	  	<td align="left" width="171">Do you smoke?</td>        

        <td  width="568">
		<input name="chDoYouSmoke1" class="formcheckbox"  type="Radio" value="V1" checked="true"> Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="chDoYouSmoke"    type="Radio" value="V1" checked="true"> 

        No <img src="images/spacer.gif" width="89" height="1" border="0">

        Inside or outside?&nbsp;

        <input name="chSmokingInsideOutside" type="Text" size="16" maxlength="10"></td>

	  </tr>

      

      <tr>

	  	<td align="left" width="171">Do you have any pets?</td>        

        <td  width="568">
		<input name="chDoYouHavePets1" class="formcheckbox"  type="Radio" value="V1" checked="true"> Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="chDoYouHavePets"    type="Radio" value="V1" checked="true"> 

        No </td>

	  </tr>

      

      <tr>

	  	<td align="left" width="171">Number /   Type / Breed of pets</td>

        <td  width="568"><input name="chPetDescription"  type="text" style="width:441px;" maxlength="50" ></td>

	  </tr>

      

	  <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

	  <tr> 

        <td class="navytext"><b>PRESENT ADDRESS: <span class="redstar">*</span> </b></td>

		<td class="searchgreentext">
		<input name="chInternational1" onClick="setInternationalPresentAddressNode(0)"  class="formcheckbox" checked="true" type="Radio" value="V1"><span class="navytext"> AUSTRALIAN</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input  class="formcheckbox"  onClick="setInternationalPresentAddressNode(1)" name="chInternational" type="Radio" value="V1" checked="true"><span class="navytext"> INTERNATIONAL</span></td>

      </tr>

      

	   <tr> 

         <td align="left">Type of residence</td>

        <td valign="Bottom" align="left" ><select name="chPrefix" onChange=				"if((this.value=='')||(this.value=='null')){document.getElementById('chFlatNo').style.display='none';document.getElementById('lblFlatNo').style.display='none';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chStreetNo.focus()};}else{document.getElementById('chFlatNo').style.display='inline';document.getElementById('lblFlatNo').style.display='inline';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chFlatNo.focus()}};if(this.value=='-----'){this.value='';document.getElementById('chFlatNo').style.display='none';document.getElementById('lblFlatNo').style.display='none';};" style="width:113px;">

                    <option value="null">(Select)</option>

                    <option value="" SELECTED>HOUSE</option>

                    <option value="UNIT" >UNIT</option>

                    <option value="APARTMENT" >APARTMENT</option>

                    <option value="FLAT" >FLAT</option>

                    <option value="STUDIO" >STUDIO</option>                    

                    

                

                    <option value="-----" >

                        -----</option>

				

                    <option value="BLOCK" >

                        BLOCK</option>

				

                    <option value="CABIN" >

                        CABIN</option>

				

                    <option value="COTTAGE" >

                        COTTAGE</option>

				

                    <option value="DUPLEX" >

                        DUPLEX</option>

				

                    <option value="FACTORY" >

                        FACTORY</option>

				

                    <option value="FLOOR" >

                        FLOOR</option>

				

                    <option value="LOT" >

                        LOT</option>

				

                    <option value="PIER" >

                        PIER</option>

				

                    <option value="ROOFTOP" >

                        ROOFTOP</option>

				

                    <option value="ROOM" >

                        ROOM</option>

				

                    <option value="SHOP" >

                        SHOP</option>

				

                    <option value="SUITE" >

                        SUITE</option>

				

                    <option value="TOWNHOUSE" >

                        TOWNHOUSE</option>

				

                    <option value="VILLA" >

                        VILLA</option>

				

                    <option value="WAREHOUSE" >

                        WAREHOUSE</option>

				

              </select><div id="lblFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="chFlatNo" id="chFlatNo" value="" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"><img src="images/spacer.gif" width="2" border="0">Str. No.&nbsp;<input name="chStreetNo" value=""  type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>

      </tr>

      



	   <tr>

        <td align="left" >Street Name</td>

        <td valign="Bottom" align="left" ><input name="chStreetName" value=""  type="Text" size="16" maxlength="50"><img src="images/spacer.gif" width="46" height="1" border="0"><select

                        name="chStreetType" onchange="if(this.value=='-----'){this.value='';};if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chSuburb.focus()};"><option

                            value="">(Street Type)</option>

                        

                        <option value="STREET" >

                            STREET</option>

                        

                        <option value="ROAD" >

                            ROAD</option>

                        

                        <option value="AVENUE" >

                            AVENUE</option>

                        

                        <option value="PLACE" >

                            PLACE</option>

                        

                        <option value="CRESCENT" >

                            CRESCENT</option>

                        

                        <option value="DRIVE" >

                            DRIVE</option>

                        

                        <option value="PARADE" >

                            PARADE</option>

                        

                        <option value="CLOSE" >

                            CLOSE</option>

                        

                        <option value="-----" >

                            -----</option>

                        

                        <option value="ACCESS" >

                            ACCESS</option>

                        

                        <option value="ALLEY" >

                            ALLEY</option>

                        

                        <option value="ALLEYWAY" >

                            ALLEYWAY</option>

                        

                        <option value="AMBLE" >

                            AMBLE</option>

                        

                        <option value="ANCHORAGE" >

                            ANCHORAGE</option>

                        

                        <option value="APPROACH" >

                            APPROACH</option>

                        

                        <option value="ARCADE" >

                            ARCADE</option>

                        

                        <option value="ARTERY" >

                            ARTERY</option>

                        

                        <option value="BASIN" >

                            BASIN</option>

                        

                        <option value="BEACH" >

                            BEACH</option>

                        

                        <option value="BEND" >

                            BEND</option>

                        

                        <option value="BLOCK" >

                            BLOCK</option>

                        

                        <option value="BOULEVARD" >

                            BOULEVARD</option>

                        

                        <option value="BOULEVARDE" >

                            BOULEVARDE</option>

                        

                        <option value="BRACE" >

                            BRACE</option>

                        

                        <option value="BRAE" >

                            BRAE</option>

                        

                        <option value="BREAK" >

                            BREAK</option>

                        

                        <option value="BRIDGE" >

                            BRIDGE</option>

                        

                        <option value="BROADWAY" >

                            BROADWAY</option>

                        

                        <option value="BROW" >

                            BROW</option>

                        

                        <option value="BYPASS" >

                            BYPASS</option>

                        

                        <option value="BYWAY" >

                            BYWAY</option>

                        

                        <option value="CAUSEWAY" >

                            CAUSEWAY</option>

                        

                        <option value="CENTRAL" >

                            CENTRAL</option>

                        

                        <option value="CENTRE" >

                            CENTRE</option>

                        

                        <option value="CENTREWAY" >

                            CENTREWAY</option>

                        

                        <option value="CHASE" >

                            CHASE</option>

                        

                        <option value="CIRCLE" >

                            CIRCLE</option>

                        

                        <option value="CIRCLET" >

                            CIRCLET</option>

                        

                        <option value="CIRCUIT" >

                            CIRCUIT</option>

                        

                        <option value="CIRCUS" >

                            CIRCUS</option>

                        

                        <option value="COLONNADE" >

                            COLONNADE</option>

                        

                        <option value="COMMON" >

                            COMMON</option>

                        

                        <option value="CONCOURSE" >

                            CONCOURSE</option>

                        

                        <option value="COPSE" >

                            COPSE</option>

                        

                        <option value="CORNER" >

                            CORNER</option>

                        

                        <option value="CORSO" >

                            CORSO</option>

                        

                        <option value="COURT" >

                            COURT</option>

                        

                        <option value="COURTYARD" >

                            COURTYARD</option>

                        

                        <option value="COVE" >

                            COVE</option>

                        

                        <option value="CREST" >

                            CREST</option>

                        

                        <option value="CROSS" >

                            CROSS</option>

                        

                        <option value="CROSSING" >

                            CROSSING</option>

                        

                        <option value="CROSSROAD" >

                            CROSSROAD</option>

                        

                        <option value="CROSSWAY" >

                            CROSSWAY</option>

                        

                        <option value="CRUISEWAY" >

                            CRUISEWAY</option>

                        

                        <option value="CUL-DE-SAC" >

                            CUL-DE-SAC</option>

                        

                        <option value="CUTTING" >

                            CUTTING</option>

                        

                        <option value="DALE" >

                            DALE</option>

                        

                        <option value="DELL" >

                            DELL</option>

                        

                        <option value="DEVIATION" >

                            DEVIATION</option>

                        

                        <option value="DIP" >

                            DIP</option>

                        

                        <option value="DISTRIBUTOR" >

                            DISTRIBUTOR</option>

                        

                        <option value="DRIVEWAY" >

                            DRIVEWAY</option>

                        

                        <option value="EAST" >

                            EAST</option>

                        

                        <option value="EDGE" >

                            EDGE</option>

                        

                        <option value="ELBOW" >

                            ELBOW</option>

                        

                        <option value="END" >

                            END</option>

                        

                        <option value="ENTRANCE" >

                            ENTRANCE</option>

                        

                        <option value="ESPLANADE" >

                            ESPLANADE</option>

                        

                        <option value="ESTATE" >

                            ESTATE</option>

                        

                        <option value="EXPRESSWAY" >

                            EXPRESSWAY</option>

                        

                        <option value="EXTENSION" >

                            EXTENSION</option>

                        

                        <option value="EXTENSION" >

                            EXTENSION</option>

                        

                        <option value="FAIRWAY" >

                            FAIRWAY</option>

                        

                        <option value="FIRE TRACK" >

                            FIRE TRACK</option>

                        

                        <option value="FIRETRAIL" >

                            FIRETRAIL</option>

                        

                        <option value="FLAT" >

                            FLAT</option>

                        

                        <option value="FOLLOW" >

                            FOLLOW</option>

                        

                        <option value="FOOTWAY" >

                            FOOTWAY</option>

                        

                        <option value="FORESHORE" >

                            FORESHORE</option>

                        

                        <option value="FORMATION" >

                            FORMATION</option>

                        

                        <option value="FREEWAY" >

                            FREEWAY</option>

                        

                        <option value="FRONT" >

                            FRONT</option>

                        

                        <option value="FRONTAGE" >

                            FRONTAGE</option>

                        

                        <option value="GAP" >

                            GAP</option>

                        

                        <option value="GARDEN" >

                            GARDEN</option>

                        

                        <option value="GARDENS" >

                            GARDENS</option>

                        

                        <option value="GATE" >

                            GATE</option>

                        

                        <option value="GATES" >

                            GATES</option>

                        

                        <option value="GLADE" >

                            GLADE</option>

                        

                        <option value="GLEN" >

                            GLEN</option>

                        

                        <option value="GRANGE" >

                            GRANGE</option>

                        

                        <option value="GREEN" >

                            GREEN</option>

                        

                        <option value="GROUND" >

                            GROUND</option>

                        

                        <option value="GROVE" >

                            GROVE</option>

                        

                        <option value="GULLY" >

                            GULLY</option>

                        

                        <option value="HEIGHTS" >

                            HEIGHTS</option>

                        

                        <option value="HIGHROAD" >

                            HIGHROAD</option>

                        

                        <option value="HIGHWAY" >

                            HIGHWAY</option>

                        

                        <option value="HILL" >

                            HILL</option>

                        

                        <option value="INTERCHANGE" >

                            INTERCHANGE</option>

                        

                        <option value="INTERSECTION" >

                            INTERSECTION</option>

                        

                        <option value="JUNCTION" >

                            JUNCTION</option>

                        

                        <option value="KEY" >

                            KEY</option>

                        

                        <option value="LANDING" >

                            LANDING</option>

                        

                        <option value="LANE" >

                            LANE</option>

                        

                        <option value="LANEWAY" >

                            LANEWAY</option>

                        

                        <option value="LEES" >

                            LEES</option>

                        

                        <option value="LINE" >

                            LINE</option>

                        

                        <option value="LINK" >

                            LINK</option>

                        

                        <option value="LITTLE" >

                            LITTLE</option>

                        

                        <option value="LOOKOUT" >

                            LOOKOUT</option>

                        

                        <option value="LOOP" >

                            LOOP</option>

                        

                        <option value="LOWER" >

                            LOWER</option>

                        

                        <option value="LOWER" >

                            LOWER</option>

                        

                        <option value="MALL" >

                            MALL</option>

                        

                        <option value="MEANDER" >

                            MEANDER</option>

                        

                        <option value="MEW" >

                            MEW</option>

                        

                        <option value="MEWS" >

                            MEWS</option>

                        

                        <option value="MOTORWAY" >

                            MOTORWAY</option>

                        

                        <option value="MOUNT" >

                            MOUNT</option>

                        

                        <option value="NOOK" >

                            NOOK</option>

                        

                        <option value="NORTH" >

                            NORTH</option>

                        

                        <option value="NORTH EAST" >

                            NORTH EAST</option>

                        

                        <option value="NORTH WEST" >

                            NORTH WEST</option>

                        

                        <option value="OUTLOOK" >

                            OUTLOOK</option>

                        

                        <option value="PARK" >

                            PARK</option>

                        

                        <option value="PARKLANDS" >

                            PARKLANDS</option>

                        

                        <option value="PARKWAY" >

                            PARKWAY</option>

                        

                        <option value="PART" >

                            PART</option>

                        

                        <option value="PASS" >

                            PASS</option>

                        

                        <option value="PATH" >

                            PATH</option>

                        

                        <option value="PATHWAY" >

                            PATHWAY</option>

                        

                        <option value="PIAZZA" >

                            PIAZZA</option>

                        

                        <option value="PLATEAU" >

                            PLATEAU</option>

                        

                        <option value="PLAZA" >

                            PLAZA</option>

                        

                        <option value="POCKET" >

                            POCKET</option>

                        

                        <option value="POINT" >

                            POINT</option>

                        

                        <option value="PORT" >

                            PORT</option>

                        

                        <option value="PROMENADE" >

                            PROMENADE</option>

                        

                        <option value="QUAD" >

                            QUAD</option>

                        

                        <option value="QUADRANGLE" >

                            QUADRANGLE</option>

                        

                        <option value="QUADRANT" >

                            QUADRANT</option>

                        

                        <option value="QUAY" >

                            QUAY</option>

                        

                        <option value="QUAYS" >

                            QUAYS</option>

                        

                        <option value="RAMBLE" >

                            RAMBLE</option>

                        

                        <option value="RAMP" >

                            RAMP</option>

                        

                        <option value="RANGE" >

                            RANGE</option>

                        

                        <option value="REACH" >

                            REACH</option>

                        

                        <option value="RESERVE" >

                            RESERVE</option>

                        

                        <option value="REST" >

                            REST</option>

                        

                        <option value="RETREAT" >

                            RETREAT</option>

                        

                        <option value="RIDE" >

                            RIDE</option>

                        

                        <option value="RIDGE" >

                            RIDGE</option>

                        

                        <option value="RIDGEWAY" >

                            RIDGEWAY</option>

                        

                        <option value="RIGHT OF WAY" >

                            RIGHT OF WAY</option>

                        

                        <option value="RING" >

                            RING</option>

                        

                        <option value="RISE" >

                            RISE</option>

                        

                        <option value="RIVER" >

                            RIVER</option>

                        

                        <option value="RIVERWAY" >

                            RIVERWAY</option>

                        

                        <option value="RIVIERA" >

                            RIVIERA</option>

                        

                        <option value="ROADS" >

                            ROADS</option>

                        

                        <option value="ROADSIDE" >

                            ROADSIDE</option>

                        

                        <option value="ROADWAY" >

                            ROADWAY</option>

                        

                        <option value="RONDE" >

                            RONDE</option>

                        

                        <option value="ROSEBOWL" >

                            ROSEBOWL</option>

                        

                        <option value="ROTARY" >

                            ROTARY</option>

                        

                        <option value="ROUND" >

                            ROUND</option>

                        

                        <option value="ROUTE" >

                            ROUTE</option>

                        

                        <option value="ROW" >

                            ROW</option>

                        

                        <option value="RUE" >

                            RUE</option>

                        

                        <option value="RUN" >

                            RUN</option>

                        

                        <option value="SERVICE WAY" >

                            SERVICE WAY</option>

                        

                        <option value="SIDING" >

                            SIDING</option>

                        

                        <option value="SLOPE" >

                            SLOPE</option>

                        

                        <option value="SOUND" >

                            SOUND</option>

                        

                        <option value="SOUTH" >

                            SOUTH</option>

                        

                        <option value="SOUTH EAST" >

                            SOUTH EAST</option>

                        

                        <option value="SOUTH WEST" >

                            SOUTH WEST</option>

                        

                        <option value="SPUR" >

                            SPUR</option>

                        

                        <option value="SQUARE" >

                            SQUARE</option>

                        

                        <option value="STAIRS" >

                            STAIRS</option>

                        

                        <option value="STATE HIGHWAY" >

                            STATE HIGHWA</option>

                        

                        <option value="STEPS" >

                            STEPS</option>

                        

                        <option value="STEYNE" >

                            STEYNE</option>

                        

                        <option value="STRAND" >

                            STRAND</option>

                        

                        <option value="STRIP" >

                            STRIP</option>

                        

                        <option value="SUBWAY" >

                            SUBWAY</option>

                        

                        <option value="TARN" >

                            TARN</option>

                        

                        <option value="TERRACE" >

                            TERRACE</option>

                        

                        <option value="THOROUGHFARE" >

                            THOROUGHFARE</option>

                        

                        <option value="TOLLWAY" >

                            TOLLWAY</option>

                        

                        <option value="TOP" >

                            TOP</option>

                        

                        <option value="TOR" >

                            TOR</option>

                        

                        <option value="TOWERS" >

                            TOWERS</option>

                        

                        <option value="TRACK" >

                            TRACK</option>

                        

                        <option value="TRAIL" >

                            TRAIL</option>

                        

                        <option value="TRAILER" >

                            TRAILER</option>

                        

                        <option value="TRIANGLE" >

                            TRIANGLE</option>

                        

                        <option value="TRUNKWAY" >

                            TRUNKWAY</option>

                        

                        <option value="TURN" >

                            TURN</option>

                        

                        <option value="UNDERPASS" >

                            UNDERPASS</option>

                        

                        <option value="UPPER" >

                            UPPER</option>

                        

                        <option value="UPPER" >

                            UPPER</option>

                        

                        <option value="VALE" >

                            VALE</option>

                        

                        <option value="VIADUCT" >

                            VIADUCT</option>

                        

                        <option value="VIEW" >

                            VIEW</option>

                        

                        <option value="VILLAS" >

                            VILLAS</option>

                        

                        <option value="VISTA" >

                            VISTA</option>

                        

                        <option value="WADE" >

                            WADE</option>

                        

                        <option value="WALK" >

                            WALK</option>

                        

                        <option value="WALKWAY" >

                            WALKWAY</option>

                        

                        <option value="WAY" >

                            WAY</option>

                        

                        <option value="WEST" >

                            WEST</option>

                        

                        <option value="WHARF" >

                            WHARF</option>

                        

                        <option value="WYND" >

                            WYND</option>

                        

                        <option value="YARD" >

                            YARD</option>

                        

                    </select></td>

      </tr>

      

	 	  

      <tr> 

        <td align="left"><div id="objPresentAddressAus1">Suburb</div></td>

        <td align="left"><div id="objPresentAddressAus2"><input name="chSuburb" value="" type="Text" size="16"> 

        State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPostcode.focus()};">

					<option value=""></option>

            			

            <option value="ACT" >ACT</option>

            			

            <option value="NSW" >NSW</option>

            			

            <option value="NT" >NT</option>

            			

            <option value="QLD" >QLD</option>

            			

            <option value="SA" >SA</option>

            			

            <option value="TAS" >TAS</option>

            			

            <option value="VIC" >VIC</option>

            			

            <option value="WA " >WA </option>

            

          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="chPostcode"value="" type="Text" size="4" maxlength="4">  </div></td>

      </tr>    

      

      

      <!-- INT ADDRESS STUFF --->

      

      <tr> 

        <td align="left" ><div id="objPresentAddressInt1" style="display:none">Suburb</div></td>

        <td align="left" ><div id="objPresentAddressInt2" style="display:none"><input name="chIntSuburb" type="Text" size="16"> City&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="chIntCity" type="Text" size="16"> State/County <input name="chIntState" type="Text" size="16"></div></td>

      </tr>  

       

      <tr> 

        <td height="3" align="left"><div id="objPresentAddressInt3"  style="display:none">PostCode/ZIP</div></td>

        <td height="3"><div id="objPresentAddressInt4"  style="display:none"><input name="chIntPostcode" type="Text" size="16"> Country <select name="chIntCountry"><option value="">(Select Country)</option>

            

            <option value="Afghanistan">Afghanistan</option>

            

            <option value="Albania">Albania</option>

            

            <option value="Algeria">Algeria</option>

            

            <option value="American Samoa">American Samoa</option>

            

            <option value="Andorra">Andorra</option>

            

            <option value="Angola">Angola</option>

            

            <option value="Anguilla">Anguilla</option>

            

            <option value="Antarctica">Antarctica</option>

            

            <option value="Antigua and Barbuda">Antigua and Barbuda</option>

            

            <option value="Argentina">Argentina</option>

            

            <option value="Armenia">Armenia</option>

            

            <option value="Aruba">Aruba</option>

            

            <option value="Austria">Austria</option>

            

            <option value="Azerbaijan">Azerbaijan</option>

            

            <option value="Bahamas">Bahamas</option>

            

            <option value="Bahrain">Bahrain</option>

            

            <option value="Bangladesh">Bangladesh</option>

            

            <option value="Barbados">Barbados</option>

            

            <option value="Belarus">Belarus</option>

            

            <option value="Belgium">Belgium</option>

            

            <option value="Belize">Belize</option>

            

            <option value="Benin">Benin</option>

            

            <option value="Bermuda">Bermuda</option>

            

            <option value="Bhutan">Bhutan</option>

            

            <option value="Bolivia">Bolivia</option>

            

            <option value="Bosnia and Herzegowina">Bosnia and Herzegowina</option>

            

            <option value="Botswana">Botswana</option>

            

            <option value="Bouvet Island">Bouvet Island</option>

            

            <option value="Brazil">Brazil</option>

            

            <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>

            

            <option value="Brunei Darussalam">Brunei Darussalam</option>

            

            <option value="Bulgaria">Bulgaria</option>

            

            <option value="Burkina Faso">Burkina Faso</option>

            

            <option value="Burundi">Burundi</option>

            

            <option value="Cambodia">Cambodia</option>

            

            <option value="Cameroon">Cameroon</option>

            

            <option value="Canada">Canada</option>

            

            <option value="Cape Verde">Cape Verde</option>

            

            <option value="Cayman islands">Cayman islands</option>

            

            <option value="Central African Republic">Central African Republic</option>

            

            <option value="Chad">Chad</option>

            

            <option value="Chile">Chile</option>

            

            <option value="China">China</option>

            

            <option value="Christmas Island">Christmas Island</option>

            

            <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>

            

            <option value="Colombia">Colombia</option>

            

            <option value="Comoros">Comoros</option>

            

            <option value="Congo">Congo</option>

            

            <option value="Congo, Democratic Republic">Congo, Democratic Republic</option>

            

            <option value="Cook Islands">Cook Islands</option>

            

            <option value="Costa Rica">Costa Rica</option>

            

            <option value="Cote d'ivoire">Cote d'ivoire</option>

            

            <option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>

            

            <option value="Cuba">Cuba</option>

            

            <option value="Cyprus">Cyprus</option>

            

            <option value="Czech Republic">Czech Republic</option>

            

            <option value="Denmark">Denmark</option>

            

            <option value="Djibouti">Djibouti</option>

            

            <option value="Dominica">Dominica</option>

            

            <option value="Dominican Republic">Dominican Republic</option>

            

            <option value="East Timor">East Timor</option>

            

            <option value="Ecuador">Ecuador</option>

            

            <option value="Egypt">Egypt</option>

            

            <option value="El Salvador">El Salvador</option>

            

            <option value="Equatorial Guinea">Equatorial Guinea</option>

            

            <option value="Eritrea">Eritrea</option>

            

            <option value="Estonia">Estonia</option>

            

            <option value="Ethiopia">Ethiopia</option>

            

            <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>

            

            <option value="Faroe islands">Faroe islands</option>

            

            <option value="Fiji">Fiji</option>

            

            <option value="Finland">Finland</option>

            

            <option value="France">France</option>

            

            <option value="France, Metropolitan">France, Metropolitan</option>

            

            <option value="French Guiana">French Guiana</option>

            

            <option value="French Polynesia">French Polynesia</option>

            

            <option value="French Southern Territories">French Southern Territories</option>

            

            <option value="Gabon">Gabon</option>

            

            <option value="Gambia">Gambia</option>

            

            <option value="Georgia">Georgia</option>

            

            <option value="Germany">Germany</option>

            

            <option value="Ghana">Ghana</option>

            

            <option value="Gibraltar">Gibraltar</option>

            

            <option value="Greece">Greece</option>

            

            <option value="Greenland">Greenland</option>

            

            <option value="Grenada">Grenada</option>

            

            <option value="Guadeloupe">Guadeloupe</option>

            

            <option value="Guam">Guam</option>

            

            <option value="Guatemala">Guatemala</option>

            

            <option value="Guinea">Guinea</option>

            

            <option value="Guinea-Bissau">Guinea-Bissau</option>

            

            <option value="Guyana">Guyana</option>

            

            <option value="Haiti">Haiti</option>

            

            <option value="Heard and Mc Donald Islands">Heard and Mc Donald Islands</option>

            

            <option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>

            

            <option value="Honduras">Honduras</option>

            

            <option value="Hong Kong">Hong Kong</option>

            

            <option value="Hungary">Hungary</option>

            

            <option value="Iceland">Iceland</option>

            

            <option value="India">India</option>

            

            <option value="Indonesia">Indonesia</option>

            

            <option value="Iran (Islamic Republic of)">Iran (Islamic Republic of)</option>

            

            <option value="Iraq">Iraq</option>

            

            <option value="Ireland">Ireland</option>

            

            <option value="Israel">Israel</option>

            

            <option value="Italy">Italy</option>

            

            <option value="Jamaica">Jamaica</option>

            

            <option value="Japan">Japan</option>

            

            <option value="Jordan">Jordan</option>

            

            <option value="Kazakhstan">Kazakhstan</option>

            

            <option value="Kenya">Kenya</option>

            

            <option value="Kiribati">Kiribati</option>

            

            <option value="Korea, Democratic People's Republic">Korea, Democratic People's Republic</option>

            

            <option value="Korea, Republic of">Korea, Republic of</option>

            

            <option value="Kuwait">Kuwait</option>

            

            <option value="Kyrgyzstan">Kyrgyzstan</option>

            

            <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>

            

            <option value="Latvia">Latvia</option>

            

            <option value="Lebanon">Lebanon</option>

            

            <option value="Lesotho">Lesotho</option>

            

            <option value="Liberia">Liberia</option>

            

            <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>

            

            <option value="Liechtenstein">Liechtenstein</option>

            

            <option value="Lithuania">Lithuania</option>

            

            <option value="Luxembourg">Luxembourg</option>

            

            <option value="Macau">Macau</option>

            

            <option value="Macedonia (Yugoslav Republic)">Macedonia (Yugoslav Republic)</option>

            

            <option value="Madagascar">Madagascar</option>

            

            <option value="Malawi">Malawi</option>

            

            <option value="Malaysia">Malaysia</option>

            

            <option value="Maldives">Maldives</option>

            

            <option value="Mali">Mali</option>

            

            <option value="Malta">Malta</option>

            

            <option value="Marshall Islands">Marshall Islands</option>

            

            <option value="Martinique">Martinique</option>

            

            <option value="Mauritania">Mauritania</option>

            

            <option value="Mauritius">Mauritius</option>

            

            <option value="Mayotte">Mayotte</option>

            

            <option value="Mexico">Mexico</option>

            

            <option value="Micronesia">Micronesia</option>

            

            <option value="Moldova">Moldova</option>

            

            <option value="Monaco">Monaco</option>

            

            <option value="Mongolia">Mongolia</option>

            

            <option value="Montserrat">Montserrat</option>

            

            <option value="Morocco">Morocco</option>

            

            <option value="Mozambique">Mozambique</option>

            

            <option value="Myanmar">Myanmar</option>

            

            <option value="Namibia">Namibia</option>

            

            <option value="Nauru">Nauru</option>

            

            <option value="Nepal">Nepal</option>

            

            <option value="Netherlands">Netherlands</option>

            

            <option value="Netherlands Antilles">Netherlands Antilles</option>

            

            <option value="New Caledonia">New Caledonia</option>

            

            <option value="New Zealand">New Zealand</option>

            

            <option value="Nicaragua">Nicaragua</option>

            

            <option value="Niger">Niger</option>

            

            <option value="Nigeria">Nigeria</option>

            

            <option value="Niue">Niue</option>

            

            <option value="Norfolk island">Norfolk island</option>

            

            <option value="Northern Mariana Islands">Northern Mariana Islands</option>

            

            <option value="Norway">Norway</option>

            

            <option value="Oman">Oman</option>

            

            <option value="Pakistan">Pakistan</option>

            

            <option value="Palau">Palau</option>

            

            <option value="Panama">Panama</option>

            

            <option value="Papua New Guinea">Papua New Guinea</option>

            

            <option value="Paraguay">Paraguay</option>

            

            <option value="Peru">Peru</option>

            

            <option value="Philippines">Philippines</option>

            

            <option value="Pitcairn">Pitcairn</option>

            

            <option value="Poland">Poland</option>

            

            <option value="Portugal">Portugal</option>

            

            <option value="Puerto Rico">Puerto Rico</option>

            

            <option value="Qatar">Qatar</option>

            

            <option value="Reunion">Reunion</option>

            

            <option value="Romania">Romania</option>

            

            <option value="Russian Federation">Russian Federation</option>

            

            <option value="Rwanda">Rwanda</option>

            

            <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>

            

            <option value="Saint Lucia">Saint Lucia</option>

            

            <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>

            

            <option value="Samoa">Samoa</option>

            

            <option value="San Marino">San Marino</option>

            

            <option value="Sao Tome and Principe">Sao Tome and Principe</option>

            

            <option value="Saudi Arabia">Saudi Arabia</option>

            

            <option value="Senegal">Senegal</option>

            

            <option value="Seychelles">Seychelles</option>

            

            <option value="Sierra Leone">Sierra Leone</option>

            

            <option value="Singapore">Singapore</option>

            

            <option value="Slovakia (Slovak Republic)">Slovakia (Slovak Republic)</option>

            

            <option value="Slovenia">Slovenia</option>

            

            <option value="Solomon Islands">Solomon Islands</option>

            

            <option value="Somalia">Somalia</option>

            

            <option value="South Africa">South Africa</option>

            

            <option value="South Georgia">South Georgia</option>

            

            <option value="Spain">Spain</option>

            

            <option value="Sri Lanka">Sri Lanka</option>

            

            <option value="St Helena">St Helena</option>

            

            <option value="St Pierre and Miquelon">St Pierre and Miquelon</option>

            

            <option value="Sudan">Sudan</option>

            

            <option value="Suriname">Suriname</option>

            

            <option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>

            

            <option value="Swaziland">Swaziland</option>

            

            <option value="Sweden">Sweden</option>

            

            <option value="Switzerland">Switzerland</option>

            

            <option value="Syrian Arab Republic">Syrian Arab Republic</option>

            

            <option value="Taiwan">Taiwan</option>

            

            <option value="Tajikistan">Tajikistan</option>

            

            <option value="Tanzania, United Republic of">Tanzania, United Republic of</option>

            

            <option value="Thailand">Thailand</option>

            

            <option value="Togo">Togo</option>

            

            <option value="Tokelau">Tokelau</option>

            

            <option value="Tonga">Tonga</option>

            

            <option value="Trinidad and Tobago">Trinidad and Tobago</option>

            

            <option value="Tunisia">Tunisia</option>

            

            <option value="Turkey">Turkey</option>

            

            <option value="Turkmenistan">Turkmenistan</option>

            

            <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>

            

            <option value="Tuvalu">Tuvalu</option>

            

            <option value="Uganda">Uganda</option>

            

            <option value="Ukraine">Ukraine</option>

            

            <option value="United Arab Emirates">United Arab Emirates</option>

            

            <option value="United Kingdom">United Kingdom</option>

            

            <option value="United States">United States</option>

            

            <option value="Uruguay">Uruguay</option>

            

            <option value="Uzbekistan">Uzbekistan</option>

            

            <option value="Vanuatu">Vanuatu</option>

            

            <option value="Venezuela">Venezuela</option>

            

            <option value="Vietnam">Vietnam</option>

            

            <option value="Virgin Islands (British)">Virgin Islands (British)</option>

            

            <option value="Virgin Islands (US)">Virgin Islands (US)</option>

            

            <option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>

            

            <option value="Western Sahara">Western Sahara</option>

            

            <option value="Yemen">Yemen</option>

            

            <option value="Yugoslavia">Yugoslavia</option>

            

            <option value="Zambia">Zambia</option>

            

            <option value="Zimbabwe">Zimbabwe</option>

            

          </select></div></td>

      </tr>

      

      <!--- END INT ADDRESS STUFF -->

       <tr>

	  	<td align="left" width="171"><table cellpadding="0" width="100%" cellspacing="0" border="0"><tr>

	  	      <td>Current Rent</td><td align="right">$ </td></tr></table></td>

        <td  width="568"><input name="chCurrentRent" value=""  type="text" size="4" maxlength="10"> 

        pw

        <img src="images/spacer.gif" height="1" width="29" border="0">Length of tenancy at current address<img src="images/spacer.gif" height="1" width="28" border="0">

        <input name="chCurrentTimeAtAddress"  value=""  type="Text" size="16" maxlength="16"> 

	  </tr>

      

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      <tr>

	  	<td align="left" width="171" class="navytext"><strong>IDENTIFIERS:</strong></td>

        <td>&nbsp;</td>

	  </tr>      

      

      <tr> 

         <td align="left" >Driver's Licence No.</td>

        <td ><input name="chLicense"  value=""  type="Text" size="16"> State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chLicenseStateIssue" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chLicenseCardNumber.focus()};">

					<option value=" " ></option>

            			

            <option value="ACT" >ACT</option>

            			

            <option value="NSW" >NSW</option>

            			

            <option value="NT" >NT</option>

            			

            <option value="QLD" >QLD</option>

            			

            <option value="SA" >SA</option>

            			

            <option value="TAS" >TAS</option>

            			

            <option value="VIC" >VIC</option>

            			

            <option value="WA " >WA </option>

            

          </select> 

        License Card No.<img src="images/spacer.gif" width="18" height="1" border="0">

        <input name="chLicenseCardNumber" value=""  type="Text" size="16"> </td>

      </tr>

      

	  

      <tr> 

         <td align="left" >Vehicle Registration</td>

        <td ><input name="chVehicle" value=""  type="Text" size="16" onBlur="checkRego(this);"> State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chVehicleStateIssue" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chCentrelink.focus()};"><option value=" " ></option>

            

            <option value="ACT" >ACT</option>

            

            <option value="NSW" >NSW</option>

            

            <option value="NT" >NT</option>

            

            <option value="QLD" >QLD</option>

            

            <option value="SA" >SA</option>

            

            <option value="TAS" >TAS</option>

            

            <option value="VIC" >VIC</option>

            

            <option value="WA " >WA </option>

            

          </select></td>

      </tr>

      

      <tr><td align="left"  valign="baseline">Centrelink No.</td>

        <td ><input name="chCentrelink" value=""  type="Text" size="16" maxlength="10"><img src="images/spacer.gif" width="100" height="1" border="0">Proof of Age Card No. <input name="chProofofAge" value=""  type="Text" size="16" maxlength="10">        

        </td>

      </tr>

      

        <tr><td align="left"  valign="baseline">Pension No.</td>

        <td ><input name="chPensionNo" value=""  type="Text" size="16" maxlength="10"><img src="images/spacer.gif" width="100" height="1" border="0">Pension Type<img src="images/spacer.gif" width="46" height="1" border="0"><input name="chPensionType" value=""  type="Text" size="16" maxlength="20">       

        </td>

      </tr>

      

      <tr><td align="left"  valign="baseline">Working Visa</td>

        <td ><input name="chWorkingVisa" value=""  type="Text" size="16" maxlength="10"><img src="images/spacer.gif" width="100" height="1" border="0">Date of expiry<img src="images/spacer.gif" width="48" height="1" border="0"><input name="chWorkVisaExpiry" value=""  type="Text" size="16" maxlength="20">       

        </td>

      </tr>

      

       <tr>

        <td   align="left" valign="baseline">Australian Passport No.</td>

        <td ><input name="chAusPassport" value=""  type="Text" size="16"><img src="images/spacer.gif" width="100" height="1" border="0">Medicare No.<img src="images/spacer.gif" width="49" height="1" border="0"><input name="chMedicare" value=""  type="Text" size="16" maxlength="10"></td>

      </tr>

      

      <tr>

        <td   align="left" valign="baseline">International Passport No.</td>

        <td ><input name="chPassport" value=""  type="Text" size="16"><img src="images/spacer.gif" width="57" height="1" border="0">Country <select name="chPassportCountry"  onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chIntLicense.focus()};">

            <option value=""></option>

            

             <option value="Afghanistan" >

                        Afghanistan</option>

            

             <option value="Albania" >

                        Albania</option>

            

             <option value="Algeria" >

                        Algeria</option>

            

             <option value="American Samoa" >

                        American Samoa</option>

            

             <option value="Andorra" >

                        Andorra</option>

            

             <option value="Angola" >

                        Angola</option>

            

             <option value="Anguilla" >

                        Anguilla</option>

            

             <option value="Antarctica" >

                        Antarctica</option>

            

             <option value="Antigua and Barbuda" >

                        Antigua and Barbuda</option>

            

             <option value="Argentina" >

                        Argentina</option>

            

             <option value="Armenia" >

                        Armenia</option>

            

             <option value="Aruba" >

                        Aruba</option>

            

             <option value="Austria" >

                        Austria</option>

            

             <option value="Azerbaijan" >

                        Azerbaijan</option>

            

             <option value="Bahamas" >

                        Bahamas</option>

            

             <option value="Bahrain" >

                        Bahrain</option>

            

             <option value="Bangladesh" >

                        Bangladesh</option>

            

             <option value="Barbados" >

                        Barbados</option>

            

             <option value="Belarus" >

                        Belarus</option>

            

             <option value="Belgium" >

                        Belgium</option>

            

             <option value="Belize" >

                        Belize</option>

            

             <option value="Benin" >

                        Benin</option>

            

             <option value="Bermuda" >

                        Bermuda</option>

            

             <option value="Bhutan" >

                        Bhutan</option>

            

             <option value="Bolivia" >

                        Bolivia</option>

            

             <option value="Bosnia and Herzegowina" >

                        Bosnia and Herzegowina</option>

            

             <option value="Botswana" >

                        Botswana</option>

            

             <option value="Bouvet Island" >

                        Bouvet Island</option>

            

             <option value="Brazil" >

                        Brazil</option>

            

             <option value="British Indian Ocean Territory" >

                        British Indian Ocean Territory</option>

            

             <option value="Brunei Darussalam" >

                        Brunei Darussalam</option>

            

             <option value="Bulgaria" >

                        Bulgaria</option>

            

             <option value="Burkina Faso" >

                        Burkina Faso</option>

            

             <option value="Burundi" >

                        Burundi</option>

            

             <option value="Cambodia" >

                        Cambodia</option>

            

             <option value="Cameroon" >

                        Cameroon</option>

            

             <option value="Canada" >

                        Canada</option>

            

             <option value="Cape Verde" >

                        Cape Verde</option>

            

             <option value="Cayman islands" >

                        Cayman islands</option>

            

             <option value="Central African Republic" >

                        Central African Republic</option>

            

             <option value="Chad" >

                        Chad</option>

            

             <option value="Chile" >

                        Chile</option>

            

             <option value="China" >

                        China</option>

            

             <option value="Christmas Island" >

                        Christmas Island</option>

            

             <option value="Cocos (Keeling) Islands" >

                        Cocos (Keeling) Islands</option>

            

             <option value="Colombia" >

                        Colombia</option>

            

             <option value="Comoros" >

                        Comoros</option>

            

             <option value="Congo" >

                        Congo</option>

            

             <option value="Congo, Democratic Republic" >

                        Congo, Democratic Republic</option>

            

             <option value="Cook Islands" >

                        Cook Islands</option>

            

             <option value="Costa Rica" >

                        Costa Rica</option>

            

             <option value="Cote d'ivoire" >

                        Cote d'ivoire</option>

            

             <option value="Croatia (Hrvatska)" >

                        Croatia (Hrvatska)</option>

            

             <option value="Cuba" >

                        Cuba</option>

            

             <option value="Cyprus" >

                        Cyprus</option>

            

             <option value="Czech Republic" >

                        Czech Republic</option>

            

             <option value="Denmark" >

                        Denmark</option>

            

             <option value="Djibouti" >

                        Djibouti</option>

            

             <option value="Dominica" >

                        Dominica</option>

            

             <option value="Dominican Republic" >

                        Dominican Republic</option>

            

             <option value="East Timor" >

                        East Timor</option>

            

             <option value="Ecuador" >

                        Ecuador</option>

            

             <option value="Egypt" >

                        Egypt</option>

            

             <option value="El Salvador" >

                        El Salvador</option>

            

             <option value="Equatorial Guinea" >

                        Equatorial Guinea</option>

            

             <option value="Eritrea" >

                        Eritrea</option>

            

             <option value="Estonia" >

                        Estonia</option>

            

             <option value="Ethiopia" >

                        Ethiopia</option>

            

             <option value="Falkland Islands (Malvinas)" >

                        Falkland Islands (Malvinas)</option>

            

             <option value="Faroe islands" >

                        Faroe islands</option>

            

             <option value="Fiji" >

                        Fiji</option>

            

             <option value="Finland" >

                        Finland</option>

            

             <option value="France" >

                        France</option>

            

             <option value="France, Metropolitan" >

                        France, Metropolitan</option>

            

             <option value="French Guiana" >

                        French Guiana</option>

            

             <option value="French Polynesia" >

                        French Polynesia</option>

            

             <option value="French Southern Territories" >

                        French Southern Territories</option>

            

             <option value="Gabon" >

                        Gabon</option>

            

             <option value="Gambia" >

                        Gambia</option>

            

             <option value="Georgia" >

                        Georgia</option>

            

             <option value="Germany" >

                        Germany</option>

            

             <option value="Ghana" >

                        Ghana</option>

            

             <option value="Gibraltar" >

                        Gibraltar</option>

            

             <option value="Greece" >

                        Greece</option>

            

             <option value="Greenland" >

                        Greenland</option>

            

             <option value="Grenada" >

                        Grenada</option>

            

             <option value="Guadeloupe" >

                        Guadeloupe</option>

            

             <option value="Guam" >

                        Guam</option>

            

             <option value="Guatemala" >

                        Guatemala</option>

            

             <option value="Guinea" >

                        Guinea</option>

            

             <option value="Guinea-Bissau" >

                        Guinea-Bissau</option>

            

             <option value="Guyana" >

                        Guyana</option>

            

             <option value="Haiti" >

                        Haiti</option>

            

             <option value="Heard and Mc Donald Islands" >

                        Heard and Mc Donald Islands</option>

            

             <option value="Holy See (Vatican City State)" >

                        Holy See (Vatican City State)</option>

            

             <option value="Honduras" >

                        Honduras</option>

            

             <option value="Hong Kong" >

                        Hong Kong</option>

            

             <option value="Hungary" >

                        Hungary</option>

            

             <option value="Iceland" >

                        Iceland</option>

            

             <option value="India" >

                        India</option>

            

             <option value="Indonesia" >

                        Indonesia</option>

            

             <option value="Iran (Islamic Republic of)" >

                        Iran (Islamic Republic of)</option>

            

             <option value="Iraq" >

                        Iraq</option>

            

             <option value="Ireland" >

                        Ireland</option>

            

             <option value="Israel" >

                        Israel</option>

            

             <option value="Italy" >

                        Italy</option>

            

             <option value="Jamaica" >

                        Jamaica</option>

            

             <option value="Japan" >

                        Japan</option>

            

             <option value="Jordan" >

                        Jordan</option>

            

             <option value="Kazakhstan" >

                        Kazakhstan</option>

            

             <option value="Kenya" >

                        Kenya</option>

            

             <option value="Kiribati" >

                        Kiribati</option>

            

             <option value="Korea, Democratic People's Republic" >

                        Korea, Democratic People's Republic</option>

            

             <option value="Korea, Republic of" >

                        Korea, Republic of</option>

            

             <option value="Kuwait" >

                        Kuwait</option>

            

             <option value="Kyrgyzstan" >

                        Kyrgyzstan</option>

            

             <option value="Lao People's Democratic Republic" >

                        Lao People's Democratic Republic</option>

            

             <option value="Latvia" >

                        Latvia</option>

            

             <option value="Lebanon" >

                        Lebanon</option>

            

             <option value="Lesotho" >

                        Lesotho</option>

            

             <option value="Liberia" >

                        Liberia</option>

            

             <option value="Libyan Arab Jamahiriya" >

                        Libyan Arab Jamahiriya</option>

            

             <option value="Liechtenstein" >

                        Liechtenstein</option>

            

             <option value="Lithuania" >

                        Lithuania</option>

            

             <option value="Luxembourg" >

                        Luxembourg</option>

            

             <option value="Macau" >

                        Macau</option>

            

             <option value="Macedonia (Yugoslav Republic)" >

                        Macedonia (Yugoslav Republic)</option>

            

             <option value="Madagascar" >

                        Madagascar</option>

            

             <option value="Malawi" >

                        Malawi</option>

            

             <option value="Malaysia" >

                        Malaysia</option>

            

             <option value="Maldives" >

                        Maldives</option>

            

             <option value="Mali" >

                        Mali</option>

            

             <option value="Malta" >

                        Malta</option>

            

             <option value="Marshall Islands" >

                        Marshall Islands</option>

            

             <option value="Martinique" >

                        Martinique</option>

            

             <option value="Mauritania" >

                        Mauritania</option>

            

             <option value="Mauritius" >

                        Mauritius</option>

            

             <option value="Mayotte" >

                        Mayotte</option>

            

             <option value="Mexico" >

                        Mexico</option>

            

             <option value="Micronesia" >

                        Micronesia</option>

            

             <option value="Moldova" >

                        Moldova</option>

            

             <option value="Monaco" >

                        Monaco</option>

            

             <option value="Mongolia" >

                        Mongolia</option>

            

             <option value="Montserrat" >

                        Montserrat</option>

            

             <option value="Morocco" >

                        Morocco</option>

            

             <option value="Mozambique" >

                        Mozambique</option>

            

             <option value="Myanmar" >

                        Myanmar</option>

            

             <option value="Namibia" >

                        Namibia</option>

            

             <option value="Nauru" >

                        Nauru</option>

            

             <option value="Nepal" >

                        Nepal</option>

            

             <option value="Netherlands" >

                        Netherlands</option>

            

             <option value="Netherlands Antilles" >

                        Netherlands Antilles</option>

            

             <option value="New Caledonia" >

                        New Caledonia</option>

            

             <option value="New Zealand" >

                        New Zealand</option>

            

             <option value="Nicaragua" >

                        Nicaragua</option>

            

             <option value="Niger" >

                        Niger</option>

            

             <option value="Nigeria" >

                        Nigeria</option>

            

             <option value="Niue" >

                        Niue</option>

            

             <option value="Norfolk island" >

                        Norfolk island</option>

            

             <option value="Northern Mariana Islands" >

                        Northern Mariana Islands</option>

            

             <option value="Norway" >

                        Norway</option>

            

             <option value="Oman" >

                        Oman</option>

            

             <option value="Pakistan" >

                        Pakistan</option>

            

             <option value="Palau" >

                        Palau</option>

            

             <option value="Panama" >

                        Panama</option>

            

             <option value="Papua New Guinea" >

                        Papua New Guinea</option>

            

             <option value="Paraguay" >

                        Paraguay</option>

            

             <option value="Peru" >

                        Peru</option>

            

             <option value="Philippines" >

                        Philippines</option>

            

             <option value="Pitcairn" >

                        Pitcairn</option>

            

             <option value="Poland" >

                        Poland</option>

            

             <option value="Portugal" >

                        Portugal</option>

            

             <option value="Puerto Rico" >

                        Puerto Rico</option>

            

             <option value="Qatar" >

                        Qatar</option>

            

             <option value="Reunion" >

                        Reunion</option>

            

             <option value="Romania" >

                        Romania</option>

            

             <option value="Russian Federation" >

                        Russian Federation</option>

            

             <option value="Rwanda" >

                        Rwanda</option>

            

             <option value="Saint Kitts and Nevis" >

                        Saint Kitts and Nevis</option>

            

             <option value="Saint Lucia" >

                        Saint Lucia</option>

            

             <option value="Saint Vincent and the Grenadines" >

                        Saint Vincent and the Grenadines</option>

            

             <option value="Samoa" >

                        Samoa</option>

            

             <option value="San Marino" >

                        San Marino</option>

            

             <option value="Sao Tome and Principe" >

                        Sao Tome and Principe</option>

            

             <option value="Saudi Arabia" >

                        Saudi Arabia</option>

            

             <option value="Senegal" >

                        Senegal</option>

            

             <option value="Seychelles" >

                        Seychelles</option>

            

             <option value="Sierra Leone" >

                        Sierra Leone</option>

            

             <option value="Singapore" >

                        Singapore</option>

            

             <option value="Slovakia (Slovak Republic)" >

                        Slovakia (Slovak Republic)</option>

            

             <option value="Slovenia" >

                        Slovenia</option>

            

             <option value="Solomon Islands" >

                        Solomon Islands</option>

            

             <option value="Somalia" >

                        Somalia</option>

            

             <option value="South Africa" >

                        South Africa</option>

            

             <option value="South Georgia" >

                        South Georgia</option>

            

             <option value="Spain" >

                        Spain</option>

            

             <option value="Sri Lanka" >

                        Sri Lanka</option>

            

             <option value="St Helena" >

                        St Helena</option>

            

             <option value="St Pierre and Miquelon" >

                        St Pierre and Miquelon</option>

            

             <option value="Sudan" >

                        Sudan</option>

            

             <option value="Suriname" >

                        Suriname</option>

            

             <option value="Svalbard and Jan Mayen Islands" >

                        Svalbard and Jan Mayen Islands</option>

            

             <option value="Swaziland" >

                        Swaziland</option>

            

             <option value="Sweden" >

                        Sweden</option>

            

             <option value="Switzerland" >

                        Switzerland</option>

            

             <option value="Syrian Arab Republic" >

                        Syrian Arab Republic</option>

            

             <option value="Taiwan" >

                        Taiwan</option>

            

             <option value="Tajikistan" >

                        Tajikistan</option>

            

             <option value="Tanzania, United Republic of" >

                        Tanzania, United Republic of</option>

            

             <option value="Thailand" >

                        Thailand</option>

            

             <option value="Togo" >

                        Togo</option>

            

             <option value="Tokelau" >

                        Tokelau</option>

            

             <option value="Tonga" >

                        Tonga</option>

            

             <option value="Trinidad and Tobago" >

                        Trinidad and Tobago</option>

            

             <option value="Tunisia" >

                        Tunisia</option>

            

             <option value="Turkey" >

                        Turkey</option>

            

             <option value="Turkmenistan" >

                        Turkmenistan</option>

            

             <option value="Turks and Caicos Islands" >

                        Turks and Caicos Islands</option>

            

             <option value="Tuvalu" >

                        Tuvalu</option>

            

             <option value="Uganda" >

                        Uganda</option>

            

             <option value="Ukraine" >

                        Ukraine</option>

            

             <option value="United Arab Emirates" >

                        United Arab Emirates</option>

            

             <option value="United Kingdom" >

                        United Kingdom</option>

            

             <option value="United States" >

                        United States</option>

            

             <option value="Uruguay" >

                        Uruguay</option>

            

             <option value="Uzbekistan" >

                        Uzbekistan</option>

            

             <option value="Vanuatu" >

                        Vanuatu</option>

            

             <option value="Venezuela" >

                        Venezuela</option>

            

             <option value="Vietnam" >

                        Vietnam</option>

            

             <option value="Virgin Islands (British)" >

                        Virgin Islands (British)</option>

            

             <option value="Virgin Islands (US)" >

                        Virgin Islands (US)</option>

            

             <option value="Wallis and Futuna Islands" >

                        Wallis and Futuna Islands</option>

            

             <option value="Western Sahara" >

                        Western Sahara</option>

            

             <option value="Yemen" >

                        Yemen</option>

            

             <option value="Yugoslavia" >

                        Yugoslavia</option>

            

             <option value="Zambia" >

                        Zambia</option>

            

             <option value="Zimbabwe" >

                        Zimbabwe</option>

            </select></td>

      </tr>

      

	  <tr><td  align="left" valign="baseline">Inter Driver's Licence No.</td>

        <td ><input name="chIntLicense" value="" type="Text" size="16"><img src="images/spacer.gif" width="57" height="1" border="0">Country 

          <select name="chIntLicenseCountryIssue"  onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chHomePhone1.focus()};"><option value=""></option>

            <option value="Afghanistan" >

                        Afghanistan</option>

<option value="Albania" >

                        Albania</option>

<option value="Algeria" >

                        Algeria</option>

<option value="American Samoa" >

                        American Samoa</option>

<option value="Andorra" >

                        Andorra</option>

<option value="Angola" >

                        Angola</option>

<option value="Anguilla" >

                        Anguilla</option>

<option value="Antarctica" >

                        Antarctica</option>

<option value="Antigua and Barbuda" >

                        Antigua and Barbuda</option>

<option value="Argentina" >

                        Argentina</option>

<option value="Armenia" >

                        Armenia</option>

<option value="Aruba" >

                        Aruba</option>

<option value="Austria" >

                        Austria</option>

<option value="Azerbaijan" >

                        Azerbaijan</option>

<option value="Bahamas" >

                        Bahamas</option>

<option value="Bahrain" >

                        Bahrain</option>

<option value="Bangladesh" >

                        Bangladesh</option>

<option value="Barbados" >

                        Barbados</option>

<option value="Belarus" >

                        Belarus</option>

<option value="Belgium" >

                        Belgium</option>

<option value="Belize" >

                        Belize</option>

<option value="Benin" >

                        Benin</option>

<option value="Bermuda" >

                        Bermuda</option>

<option value="Bhutan" >

                        Bhutan</option>

<option value="Bolivia" >

                        Bolivia</option>

<option value="Bosnia and Herzegowina" >

                        Bosnia and Herzegowina</option>

<option value="Botswana" >

                        Botswana</option>

<option value="Bouvet Island" >

                        Bouvet Island</option>

<option value="Brazil" >

                        Brazil</option>

<option value="British Indian Ocean Territory" >

                        British Indian Ocean Territory</option>

<option value="Brunei Darussalam" >

                        Brunei Darussalam</option>

<option value="Bulgaria" >

                        Bulgaria</option>

<option value="Burkina Faso" >

                        Burkina Faso</option>

<option value="Burundi" >

                        Burundi</option>

<option value="Cambodia" >

                        Cambodia</option>

<option value="Cameroon" >

                        Cameroon</option>

<option value="Canada" >

                        Canada</option>

<option value="Cape Verde" >

                        Cape Verde</option>

<option value="Cayman islands" >

                        Cayman islands</option>

<option value="Central African Republic" >

                        Central African Republic</option>

<option value="Chad" >

                        Chad</option>

<option value="Chile" >

                        Chile</option>

<option value="China" >

                        China</option>

<option value="Christmas Island" >

                        Christmas Island</option>

<option value="Cocos (Keeling) Islands" >

                        Cocos (Keeling) Islands</option>

<option value="Colombia" >

                        Colombia</option>

<option value="Comoros" >

                        Comoros</option>

<option value="Congo" >

                        Congo</option>

<option value="Congo, Democratic Republic" >

                        Congo, Democratic Republic</option>

<option value="Cook Islands" >

                        Cook Islands</option>

<option value="Costa Rica" >

                        Costa Rica</option>

<option value="Cote d'ivoire" >

                        Cote d'ivoire</option>

<option value="Croatia (Hrvatska)" >

                        Croatia (Hrvatska)</option>

<option value="Cuba" >

                        Cuba</option>

<option value="Cyprus" >

                        Cyprus</option>

<option value="Czech Republic" >

                        Czech Republic</option>

<option value="Denmark" >

                        Denmark</option>

<option value="Djibouti" >

                        Djibouti</option>

<option value="Dominica" >

                        Dominica</option>

<option value="Dominican Republic" >

                        Dominican Republic</option>

<option value="East Timor" >

                        East Timor</option>

<option value="Ecuador" >

                        Ecuador</option>

<option value="Egypt" >

                        Egypt</option>

<option value="El Salvador" >

                        El Salvador</option>

<option value="Equatorial Guinea" >

                        Equatorial Guinea</option>

<option value="Eritrea" >

                        Eritrea</option>

<option value="Estonia" >

                        Estonia</option>

<option value="Ethiopia" >

                        Ethiopia</option>

<option value="Falkland Islands (Malvinas)" >

                        Falkland Islands (Malvinas)</option>

<option value="Faroe islands" >

                        Faroe islands</option>

<option value="Fiji" >

                        Fiji</option>

<option value="Finland" >

                        Finland</option>

<option value="France" >

                        France</option>

<option value="France, Metropolitan" >

                        France, Metropolitan</option>

<option value="French Guiana" >

                        French Guiana</option>

<option value="French Polynesia" >

                        French Polynesia</option>

<option value="French Southern Territories" >

                        French Southern Territories</option>

<option value="Gabon" >

                        Gabon</option>

<option value="Gambia" >

                        Gambia</option>

<option value="Georgia" >

                        Georgia</option>

<option value="Germany" >

                        Germany</option>

<option value="Ghana" >

                        Ghana</option>

<option value="Gibraltar" >

                        Gibraltar</option>

<option value="Greece" >

                        Greece</option>

<option value="Greenland" >

                        Greenland</option>

<option value="Grenada" >

                        Grenada</option>

<option value="Guadeloupe" >

                        Guadeloupe</option>

<option value="Guam" >

                        Guam</option>

<option value="Guatemala" >

                        Guatemala</option>

<option value="Guinea" >

                        Guinea</option>

<option value="Guinea-Bissau" >

                        Guinea-Bissau</option>

<option value="Guyana" >

                        Guyana</option>

<option value="Haiti" >

                        Haiti</option>

<option value="Heard and Mc Donald Islands" >

                        Heard and Mc Donald Islands</option>

<option value="Holy See (Vatican City State)" >

                        Holy See (Vatican City State)</option>

<option value="Honduras" >

                        Honduras</option>

<option value="Hong Kong" >

                        Hong Kong</option>

<option value="Hungary" >

                        Hungary</option>

<option value="Iceland" >

                        Iceland</option>

<option value="India" >

                        India</option>

<option value="Indonesia" >

                        Indonesia</option>

<option value="Iran (Islamic Republic of)" >

                        Iran (Islamic Republic of)</option>

<option value="Iraq" >

                        Iraq</option>

<option value="Ireland" >

                        Ireland</option>

<option value="Israel" >

                        Israel</option>

<option value="Italy" >

                        Italy</option>

<option value="Jamaica" >

                        Jamaica</option>

<option value="Japan" >

                        Japan</option>

<option value="Jordan" >

                        Jordan</option>

<option value="Kazakhstan" >

                        Kazakhstan</option>

<option value="Kenya" >

                        Kenya</option>

<option value="Kiribati" >

                        Kiribati</option>

<option value="Korea, Democratic People's Republic" >

                        Korea, Democratic People's Republic</option>

<option value="Korea, Republic of" >

                        Korea, Republic of</option>

<option value="Kuwait" >

                        Kuwait</option>

<option value="Kyrgyzstan" >

                        Kyrgyzstan</option>

<option value="Lao People's Democratic Republic" >

                        Lao People's Democratic Republic</option>

<option value="Latvia" >

                        Latvia</option>

<option value="Lebanon" >

                        Lebanon</option>

<option value="Lesotho" >

                        Lesotho</option>

<option value="Liberia" >

                        Liberia</option>

<option value="Libyan Arab Jamahiriya" >

                        Libyan Arab Jamahiriya</option>

<option value="Liechtenstein" >

                        Liechtenstein</option>

<option value="Lithuania" >

                        Lithuania</option>

<option value="Luxembourg" >

                        Luxembourg</option>

<option value="Macau" >

                        Macau</option>

<option value="Macedonia (Yugoslav Republic)" >

                        Macedonia (Yugoslav Republic)</option>

<option value="Madagascar" >

                        Madagascar</option>

<option value="Malawi" >

                        Malawi</option>

<option value="Malaysia" >

                        Malaysia</option>

<option value="Maldives" >

                        Maldives</option>

<option value="Mali" >

                        Mali</option>

<option value="Malta" >

                        Malta</option>

<option value="Marshall Islands" >

                        Marshall Islands</option>

<option value="Martinique" >

                        Martinique</option>

<option value="Mauritania" >

                        Mauritania</option>

<option value="Mauritius" >

                        Mauritius</option>

<option value="Mayotte" >

                        Mayotte</option>

<option value="Mexico" >

                        Mexico</option>

<option value="Micronesia" >

                        Micronesia</option>

<option value="Moldova" >

                        Moldova</option>

<option value="Monaco" >

                        Monaco</option>

<option value="Mongolia" >

                        Mongolia</option>

<option value="Montserrat" >

                        Montserrat</option>

<option value="Morocco" >

                        Morocco</option>

<option value="Mozambique" >

                        Mozambique</option>

<option value="Myanmar" >

                        Myanmar</option>

<option value="Namibia" >

                        Namibia</option>

<option value="Nauru" >

                        Nauru</option>

<option value="Nepal" >

                        Nepal</option>

<option value="Netherlands" >

                        Netherlands</option>

<option value="Netherlands Antilles" >

                        Netherlands Antilles</option>

<option value="New Caledonia" >

                        New Caledonia</option>

<option value="New Zealand" >

                        New Zealand</option>

<option value="Nicaragua" >

                        Nicaragua</option>

<option value="Niger" >

                        Niger</option>

<option value="Nigeria" >

                        Nigeria</option>

<option value="Niue" >

                        Niue</option>

<option value="Norfolk island" >

                        Norfolk island</option>

<option value="Northern Mariana Islands" >

                        Northern Mariana Islands</option>

<option value="Norway" >

                        Norway</option>

<option value="Oman" >

                        Oman</option>

<option value="Pakistan" >

                        Pakistan</option>

<option value="Palau" >

                        Palau</option>

<option value="Panama" >

                        Panama</option>

<option value="Papua New Guinea" >

                        Papua New Guinea</option>

<option value="Paraguay" >

                        Paraguay</option>

<option value="Peru" >

                        Peru</option>

<option value="Philippines" >

                        Philippines</option>

<option value="Pitcairn" >

                        Pitcairn</option>

<option value="Poland" >

                        Poland</option>

<option value="Portugal" >

                        Portugal</option>

<option value="Puerto Rico" >

                        Puerto Rico</option>

<option value="Qatar" >

                        Qatar</option>

<option value="Reunion" >

                        Reunion</option>

<option value="Romania" >

                        Romania</option>

<option value="Russian Federation" >

                        Russian Federation</option>

<option value="Rwanda" >

                        Rwanda</option>

<option value="Saint Kitts and Nevis" >

                        Saint Kitts and Nevis</option>

<option value="Saint Lucia" >

                        Saint Lucia</option>

<option value="Saint Vincent and the Grenadines" >

                        Saint Vincent and the Grenadines</option>

<option value="Samoa" >

                        Samoa</option>

<option value="San Marino" >

                        San Marino</option>

<option value="Sao Tome and Principe" >

                        Sao Tome and Principe</option>

<option value="Saudi Arabia" >

                        Saudi Arabia</option>

<option value="Senegal" >

                        Senegal</option>

<option value="Seychelles" >

                        Seychelles</option>

<option value="Sierra Leone" >

                        Sierra Leone</option>

<option value="Singapore" >

                        Singapore</option>

<option value="Slovakia (Slovak Republic)" >

                        Slovakia (Slovak Republic)</option>

<option value="Slovenia" >

                        Slovenia</option>

<option value="Solomon Islands" >

                        Solomon Islands</option>

<option value="Somalia" >

                        Somalia</option>

<option value="South Africa" >

                        South Africa</option>

<option value="South Georgia" >

                        South Georgia</option>

<option value="Spain" >

                        Spain</option>

<option value="Sri Lanka" >

                        Sri Lanka</option>

<option value="St Helena" >

                        St Helena</option>

<option value="St Pierre and Miquelon" >

                        St Pierre and Miquelon</option>

<option value="Sudan" >

                        Sudan</option>

<option value="Suriname" >

                        Suriname</option>

<option value="Svalbard and Jan Mayen Islands" >

                        Svalbard and Jan Mayen Islands</option>

<option value="Swaziland" >

                        Swaziland</option>

<option value="Sweden" >

                        Sweden</option>

<option value="Switzerland" >

                        Switzerland</option>

<option value="Syrian Arab Republic" >

                        Syrian Arab Republic</option>

<option value="Taiwan" >

                        Taiwan</option>

<option value="Tajikistan" >

                        Tajikistan</option>

<option value="Tanzania, United Republic of" >

                        Tanzania, United Republic of</option>

<option value="Thailand" >

                        Thailand</option>

<option value="Togo" >

                        Togo</option>

<option value="Tokelau" >

                        Tokelau</option>

<option value="Tonga" >

                        Tonga</option>

<option value="Trinidad and Tobago" >

                        Trinidad and Tobago</option>

<option value="Tunisia" >

                        Tunisia</option>

<option value="Turkey" >

                        Turkey</option>

<option value="Turkmenistan" >

                        Turkmenistan</option>

<option value="Turks and Caicos Islands" >

                        Turks and Caicos Islands</option>

<option value="Tuvalu" >

                        Tuvalu</option>

<option value="Uganda" >

                        Uganda</option>

<option value="Ukraine" >

                        Ukraine</option>

<option value="United Arab Emirates" >

                        United Arab Emirates</option>

<option value="United Kingdom" >

                        United Kingdom</option>

<option value="United States" >

                        United States</option>

<option value="Uruguay" >

                        Uruguay</option>

<option value="Uzbekistan" >

                        Uzbekistan</option>

<option value="Vanuatu" >

                        Vanuatu</option>

<option value="Venezuela" >

                        Venezuela</option>

<option value="Vietnam" >

                        Vietnam</option>

<option value="Virgin Islands (British)" >

                        Virgin Islands (British)</option>

<option value="Virgin Islands (US)" >

                        Virgin Islands (US)</option>

<option value="Wallis and Futuna Islands" >

                        Wallis and Futuna Islands</option>

<option value="Western Sahara" >

                        Western Sahara</option>

<option value="Yemen" >

                        Yemen</option>

<option value="Yugoslavia" >

                        Yugoslavia</option>

<option value="Zambia" >

                        Zambia</option>

<option value="Zimbabwe" >

                        Zimbabwe</option>

</select></td>

      </tr>

      

      <tr> 

         <td align="left">Home Phone</td>

        <td ><select name="chHomePhone1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chHomePhone2.focus()};" id="chHomePhone1">

		  		<option value="">(Area Code)</option>	

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>		

		  </select>

			  <input type="text" name="chHomePhone2" value=""  onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chHomePhone3.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			  <input type="text" name="chHomePhone3" value=""  onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chMobilePhone1.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			 <img src="images/spacer.gif" width="45" height="1" border="0">Mobile 

			 <input type="text" name="chMobilePhone1" value=""  size="4" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chMobilePhone2.focus()};" onBlur="checkNumeric(this,1,'','','','','');">	

		  <input type="text" name="chMobilePhone2" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chMobilePhone3.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  <input type="text" name="chMobilePhone3" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chEmail.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  &nbsp;         

		</td>

      </tr>

      

      

      <tr> 

         <td align="left">Email</td>

        <td ><input name="chEmail" value="" maxlength="50"  type="Text" style="width:199px;" onBlur="checkEmail(this);">         

		</td>

      </tr>

	  

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

        <tr>

	  	<td align="left" width="171" class="navytext"><strong>PERSONAL DETAILS:</strong></td>

        <td>&nbsp;</td>

	  </tr> 

      

      <tr>

	  	<td align="left" width="171">Bank Name</td>

        <td  width="568"><input name="chBankName"  value=""  type="text" size="16" maxlength="50">&nbsp;&nbsp;&nbsp;BSB <input name="chBankBSB" value=""  type="Text" size="4" maxlength="6">&nbsp;&nbsp;&nbsp;Acc No <input name="chBankAccNo" value=""  type="Text" size="6" maxlength="10"></td>

	  </tr>

      

       <tr>

	  	<td align="left" width="171">Bankrupt</td>

        <td  width="568">
		<input name="isBankrupt1" class="formcheckbox" type="Radio"  value="V1" maxlength="50" checked="true" > Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="isBankrupt" type="Radio"  value="V1" checked="true"> No</td>

	  </tr>

      

        <tr>

	  	<td align="left" width="171">Preferred payment of rent</td>

        <td  width="568">
		<input name="chRentPaymentPeriod1" maxlength="50" checked="true" class="formcheckbox" type="Radio" value="V1"> Weekly<img src="images/spacer.gif" width="44" height="1" border="0"><input name="chRentPaymentPeriod2" class="formcheckbox" type="Radio" value="V1" checked="true"> Fortnightly<img src="images/spacer.gif" width="44" height="1" border="0"><input  class="formcheckbox" name="chRentPaymentPeriod" type="Radio" value="V1" checked="true"> Monthly</td>

	  </tr>

      

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr>   

       <tr><td class="navytext"><strong>EMPLOYMENT HISTORY:</strong></td>

		 <td valign="Bottom" >&nbsp;</td>

      </tr> 

       <tr>

		 <td class="navytext"><strong>Current Employment: <span class="redstar">*</span> </strong></td>

		 <td valign="Bottom" ><input type="checkbox" name="isUnemployed"  class="formcheckbox" value="1" onClick="setEmploymentNode(this.checked)"><span class="searchgreentext"> Tick the box if the applicant is unemployed</span></td>

      </tr>   

     

	   <tr> 

         <td align="left"  width="171"><div id="objEmploymentNode">Job Title</div></td>

         <td valign="Bottom"   width="568"> <div id="objEmploymentNode2"><input name="chEmployerJobTitle" value=""  type="Text" size="34" maxlength="50">

         Employment Type<img src="images/spacer.gif" width="58" height="1" border="0"> <select name="chEmploymentType" style="width:80px" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chEmployerCompany.focus()};">

            <option value="null" SELECTED>(Select)</option>

            <option value="Full time" >Full time</option> 

			<option value="Part time" >Part time</option>

			<option value="Casual" >Casual</option>

          </select>

         </div></td>

      </tr>

      

      <tr> 

        <td align="left"  width="171"><div id="objEmploymentNode3">Employer's Company Name</div></td>

        <td valign="Bottom"   width="568"><div id="objEmploymentNode4"><input name="chEmployerCompany" value="" type="Text" size="34" maxlength="128"> Employer's Phone No. <input name="chEmployerPhoneNo" value="" type="Text" size="16" maxlength="50"></div></td>

      </tr>

	 

       <tr> 

         <td align="left"><div id="objEmploymentNode15">Manager's Name</div></td>

        <td><div id="objEmploymentNode16"><input name="chManagersName" value="" type="Text" maxlength="100" size="34"></div></td>

      </tr> 

       

      <tr> 

         <td align="left"  width="171"><div id="objEmploymentNode5">Employer's Address</div></td>

        <td valign="Bottom"  width="568"><div id="objEmploymentNode6"><input name="chEmployerAddress" value=""  type="Text" size="34"></div></td>

      </tr>

      

      <tr> 

         <td align="left"  width="171"><div id="objEmploymentNode7">Suburb</div></td>

        <td  width="568"><div id="objEmploymentNode8"><input name="chEmployerSuburb" value=""  type="Text" size="16"> State<img src="images/spacer.gif" width="4" height="1" border="0"><select name="chEmployerState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chEmployerPostcode.focus()};"><option value="null" ></option>

            

            <option value="ACT" >ACT</option>

            

            <option value="NSW" >NSW</option>

            

            <option value="NT" >NT</option>

            

            <option value="QLD" >QLD</option>

            

            <option value="SA" >SA</option>

            

            <option value="TAS" >TAS</option>

            

            <option value="VIC" >VIC</option>

            

            <option value="WA " >WA </option>

            

          </select> 

        Postcode<img src="images/spacer.gif" width="18" height="1" border="0"><input name="chEmployerPostcode" value=""  type="Text" size="4" maxlength="4">&nbsp;</div></td>

      </tr>

      	 

      <tr> 

         <td align="left"><div id="objEmploymentNode9">Work Phone</div></td>

        <td ><div id="objEmploymentNode10"><select name="chWorkPhone1" id="chWorkPhone1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chWorkPhone2.focus()};">

		  		<option value="">(Area Code)</option>	

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>			

		  </select>

			  <input type="text" name="chWorkPhone2" value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chWorkPhone3.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			  <input type="text" name="chWorkPhone3" value=""  onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chWorkMobilePhone1.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">



			 Work Mobile<img src="images/spacer.gif" height="1" width="10" border="0"><input type="text" name="chWorkMobilePhone1" value="" size="4" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chWorkMobilePhone2.focus()};" onBlur="checkNumeric(this,1,'','','','','');">	

		  <input type="text" name="chWorkMobilePhone2" value=""  size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chWorkMobilePhone3.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  <input type="text" name="chWorkMobilePhone3" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chWorkEmail.focus()};" onBlur="checkNumeric(this,1,'','','','','');"></div>

		</td>

      </tr>

      	 

      <tr> 

         <td align="left"><div id="objEmploymentNode11">Work Email</div></td>

        <td><div id="objEmploymentNode12"><input name="chWorkEmail" type="Text"  value="" style="width:199px;" onBlur="checkEmail(this);">

           Net income<img src="images/spacer.gif" height="1" width="60" border="0"><input name="chNetIncome" maxlength="50"  value=""  type="Text" size="16">

          </div>

		</td>

      </tr>

      	 

        <tr> 

         <td align="left"><div id="objEmploymentNode13">Length of Employment</div></td>

        <td><div id="objEmploymentNode14"><input name="chLengthOfEmployment" value="" type="Text" maxlength="50" style="width:199px;" > Commenced<img src="images/spacer.gif" height="1" width="11" border="0">

            <select name="dtEmploymentDateCommenced_dd" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtEmploymentDateCommenced_mm.focus()};">

                <option value="null" >

				<option value="1" >1<option value="2" >2<option value="3" >3<option value="4" >4<option value="5" >5<option value="6" >6<option value="7" >7<option value="8" >8<option value="9" >9<option value="10" >10<option value="11" >11<option value="12" >12<option value="13" >13<option value="14" >14<option value="15" >15<option value="16" >16<option value="17" >17<option value="18" >18<option value="19" >19<option value="20" >20<option value="21" >21<option value="22" >22<option value="23" >23<option value="24" >24<option value="25" >25<option value="26" >26<option value="27" >27<option value="28" >28<option value="29" >29<option value="30" >30<option value="31" >31

           </select>         

           <select name="dtEmploymentDateCommenced_mm" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtEmploymentDateCommenced_yyyy.focus()};">

                <option value="null" >

				<option value="1" >Jan<option value="2" >Feb<option value="3" >Mar<option value="4" >Apr<option value="5" >May<option value="6" >Jun<option value="7" >Jul<option value="8" >Aug<option value="9" >Sep<option value="10" >Oct<option value="11" >Nov<option value="12" >Dec

           </select>

           <select name="dtEmploymentDateCommenced_yyyy" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousEmployerJobTitle.focus()};">

                <option value="null" >

                <option value="2011" >2011<option value="2010" >2010<option value="2009" >2009<option value="2008" >2008<option value="2007" >2007<option value="2006" >2006<option value="2005" >2005<option value="2004" >2004<option value="2003" >2003<option value="2002" >2002<option value="2001" >2001<option value="2000" >2000<option value="1999" >1999<option value="1998" >1998<option value="1997" >1997<option value="1996" >1996<option value="1995" >1995<option value="1994" >1994<option value="1993" >1993<option value="1992" >1992<option value="1991" >1991<option value="1990" >1990<option value="1989" >1989<option value="1988" >1988<option value="1987" >1987<option value="1986" >1986<option value="1985" >1985<option value="1984" >1984<option value="1983" >1983<option value="1982" >1982<option value="1981" >1981<option value="1980" >1980<option value="1979" >1979<option value="1978" >1978<option value="1977" >1977<option value="1976" >1976<option value="1975" >1975<option value="1974" >1974<option value="1973" >1973<option value="1972" >1972<option value="1971" >1971<option value="1970" >1970<option value="1969" >1969<option value="1968" >1968<option value="1967" >1967<option value="1966" >1966<option value="1965" >1965<option value="1964" >1964<option value="1963" >1963<option value="1962" >1962<option value="1961" >1961<option value="1960" >1960<option value="1959" >1959<option value="1958" >1958<option value="1957" >1957<option value="1956" >1956<option value="1955" >1955<option value="1954" >1954<option value="1953" >1953<option value="1952" >1952<option value="1951" >1951<option value="1950" >1950<option value="1949" >1949<option value="1948" >1948<option value="1947" >1947<option value="1946" >1946<option value="1945" >1945<option value="1944" >1944<option value="1943" >1943<option value="1942" >1942<option value="1941" >1941<option value="1940" >1940<option value="1939" >1939<option value="1938" >1938<option value="1937" >1937<option value="1936" >1936<option value="1935" >1935<option value="1934" >1934<option value="1933" >1933<option value="1932" >1932<option value="1931" >1931<option value="1930" >1930<option value="1929" >1929<option value="1928" >1928<option value="1927" >1927<option value="1926" >1926<option value="1925" >1925<option value="1924" >1924<option value="1923" >1923<option value="1922" >1922<option value="1921" >1921<option value="1920" >1920<option value="1919" >1919<option value="1918" >1918<option value="1917" >1917<option value="1916" >1916<option value="1915" >1915<option value="1914" >1914<option value="1913" >1913<option value="1912" >1912<option value="1911" >1911

                </select></div>

		</td>

      </tr>

      

       <tr>

         <td class="navytext" colspan="2"><strong>Previous Employment if less than 3 years:</strong></td>

       </tr>   

      

     

	   <tr> 

         <td align="left"  width="171">Job Title</td>

         <td valign="Bottom" width="568"><input name="chPreviousEmployerJobTitle" value=""  type="Text" size="34" maxlength="50"></td>

      </tr>

      	 

      <tr> 

        <td align="left"  width="171">Employer's Company Name</td>

        <td valign="Bottom"   width="568"><input name="chPreviousEmployerCompany" value=""  type="Text" size="34" maxlength="50"></td>

      </tr>

      	 



      <tr> 

         <td align="left"  width="171">Employer's Address</td>

        <td valign="Bottom"  width="568"><input name="chPreviousEmployerAddress" value=""  type="Text" size="34" maxlength="50"></td>

      </tr>

      	 

      <tr> 

         <td align="left"  width="171">Suburb</td>

        <td  width="568"><input name="chPreviousEmployerSuburb" value=""  type="Text" size="16" maxlength="50"> State<img src="images/spacer.gif" width="4" height="1" border="0"><select name="chPreviousEmployerState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousEmployerPostcode.focus()};"><option value="null" ></option>

            

            <option value="ACT" >ACT</option>

            

            <option value="NSW" >NSW</option>

            

            <option value="NT" >NT</option>

            

            <option value="QLD" >QLD</option>

            

            <option value="SA" >SA</option>

            

            <option value="TAS" >TAS</option>

            

            <option value="VIC" >VIC</option>

            

            <option value="WA " >WA </option>

            

          </select> 

        Postcode<img src="images/spacer.gif" width="18" height="1" border="0"><input name="chPreviousEmployerPostcode" value="" type="Text" size="4" maxlength="4">&nbsp;</td>

      </tr>

      	 

            <tr> 

         <td align="left">Work Phone</td>

        <td ><select name="chPreviousWorkPhone1" id="chPreviousWorkPhone1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousWorkPhone2.focus()};">

		  		<option value="">(Area Code)</option>	

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>			

		  </select>

			  <input type="text" name="chPreviousWorkPhone2" value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousWorkPhone3.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			  <input type="text" name="chPreviousWorkPhone3" value=""  onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousWorkMobilePhone1.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">



			 Work Mobile<img src="images/spacer.gif" height="1" width="11" border="0"><input type="text" name="chPreviousWorkMobilePhone1" value=""  size="4" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousWorkMobilePhone2.focus()};" onBlur="checkNumeric(this,1,'','','','','');">	

		  <input type="text" name="chPreviousWorkMobilePhone2" value=""  size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousWorkMobilePhone3.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  <input type="text" name="chPreviousWorkMobilePhone3" value=""  size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousWorkEmail.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		</td>

      </tr>

      	 

         <tr> 

         <td align="left">Work Email</td>

        <td><input name="chPreviousWorkEmail" type="Text" value="" style="width:199px;" onBlur="checkEmail(this);" maxlength="50"> 

		</td>

      </tr>

       <tr> 

         <td align="left">Commenced </td>

        <td><select name="dtPreviousEmploymentDateCommenced_dd" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtPreviousEmploymentDateCommenced_mm.focus()};">

                <option value="null" >

				<option value="1" >1<option value="2" >2<option value="3" >3<option value="4" >4<option value="5" >5<option value="6" >6<option value="7" >7<option value="8" >8<option value="9" >9<option value="10" >10<option value="11" >11<option value="12" >12<option value="13" >13<option value="14" >14<option value="15" >15<option value="16" >16<option value="17" >17<option value="18" >18<option value="19" >19<option value="20" >20<option value="21" >21<option value="22" >22<option value="23" >23<option value="24" >24<option value="25" >25<option value="26" >26<option value="27" >27<option value="28" >28<option value="29" >29<option value="30" >30<option value="31" >31

           </select>         

           <select name="dtPreviousEmploymentDateCommenced_mm" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtPreviousEmploymentDateCommenced_yyyy.focus()};">

                <option value="null" >

				<option value="1" >Jan<option value="2" >Feb<option value="3" >Mar<option value="4" >Apr<option value="5" >May<option value="6" >Jun<option value="7" >Jul<option value="8" >Aug<option value="9" >Sep<option value="10" >Oct<option value="11" >Nov<option value="12" >Dec

           </select>

           <select name="dtPreviousEmploymentDateCommenced_yyyy" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtPreviousEmploymentDateTerminated_dd.focus()};">

                <option value="null" >

                <option value="2011" >2011<option value="2010" >2010<option value="2009" >2009<option value="2008" >2008<option value="2007" >2007<option value="2006" >2006<option value="2005" >2005<option value="2004" >2004<option value="2003" >2003<option value="2002" >2002<option value="2001" >2001<option value="2000" >2000<option value="1999" >1999<option value="1998" >1998<option value="1997" >1997<option value="1996" >1996<option value="1995" >1995<option value="1994" >1994<option value="1993" >1993<option value="1992" >1992<option value="1991" >1991<option value="1990" >1990<option value="1989" >1989<option value="1988" >1988<option value="1987" >1987<option value="1986" >1986<option value="1985" >1985<option value="1984" >1984<option value="1983" >1983<option value="1982" >1982<option value="1981" >1981<option value="1980" >1980<option value="1979" >1979<option value="1978" >1978<option value="1977" >1977<option value="1976" >1976<option value="1975" >1975<option value="1974" >1974<option value="1973" >1973<option value="1972" >1972<option value="1971" >1971<option value="1970" >1970<option value="1969" >1969<option value="1968" >1968<option value="1967" >1967<option value="1966" >1966<option value="1965" >1965<option value="1964" >1964<option value="1963" >1963<option value="1962" >1962<option value="1961" >1961<option value="1960" >1960<option value="1959" >1959<option value="1958" >1958<option value="1957" >1957<option value="1956" >1956<option value="1955" >1955<option value="1954" >1954<option value="1953" >1953<option value="1952" >1952<option value="1951" >1951<option value="1950" >1950<option value="1949" >1949<option value="1948" >1948<option value="1947" >1947<option value="1946" >1946<option value="1945" >1945<option value="1944" >1944<option value="1943" >1943<option value="1942" >1942<option value="1941" >1941<option value="1940" >1940<option value="1939" >1939<option value="1938" >1938<option value="1937" >1937<option value="1936" >1936<option value="1935" >1935<option value="1934" >1934<option value="1933" >1933<option value="1932" >1932<option value="1931" >1931<option value="1930" >1930<option value="1929" >1929<option value="1928" >1928<option value="1927" >1927<option value="1926" >1926<option value="1925" >1925<option value="1924" >1924<option value="1923" >1923<option value="1922" >1922<option value="1921" >1921<option value="1920" >1920<option value="1919" >1919<option value="1918" >1918<option value="1917" >1917<option value="1916" >1916<option value="1915" >1915<option value="1914" >1914<option value="1913" >1913<option value="1912" >1912<option value="1911" >1911

          </select> <img src="images/spacer.gif" height="1" width="56" border="0">Terminated<img src="images/spacer.gif" height="1" width="18" border="0">

<select name="dtPreviousEmploymentDateTerminated_dd" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtPreviousEmploymentDateTerminated_mm.focus()};">

                <option value="null" >

				<option value="1" >1<option value="2" >2<option value="3" >3<option value="4" >4<option value="5" >5<option value="6" >6<option value="7" >7<option value="8" >8<option value="9" >9<option value="10" >10<option value="11" >11<option value="12" >12<option value="13" >13<option value="14" >14<option value="15" >15<option value="16" >16<option value="17" >17<option value="18" >18<option value="19" >19<option value="20" >20<option value="21" >21<option value="22" >22<option value="23" >23<option value="24" >24<option value="25" >25<option value="26" >26<option value="27" >27<option value="28" >28<option value="29" >29<option value="30" >30<option value="31" >31

           </select>         

           <select name="dtPreviousEmploymentDateTerminated_mm" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtPreviousEmploymentDateTerminated_yyyy.focus()};">

                <option value="null" >

				<option value="1" >Jan<option value="2" >Feb<option value="3" >Mar<option value="4" >Apr<option value="5" >May<option value="6" >Jun<option value="7" >Jul<option value="8" >Aug<option value="9" >Sep<option value="10" >Oct<option value="11" >Nov<option value="12" >Dec

           </select>

           <select name="dtPreviousEmploymentDateTerminated_yyyy" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgencyName.focus()};">

                <option value="null" >

                <option value="2011" >2011<option value="2010" >2010<option value="2009" >2009<option value="2008" >2008<option value="2007" >2007<option value="2006" >2006<option value="2005" >2005<option value="2004" >2004<option value="2003" >2003<option value="2002" >2002<option value="2001" >2001<option value="2000" >2000<option value="1999" >1999<option value="1998" >1998<option value="1997" >1997<option value="1996" >1996<option value="1995" >1995<option value="1994" >1994<option value="1993" >1993<option value="1992" >1992<option value="1991" >1991<option value="1990" >1990<option value="1989" >1989<option value="1988" >1988<option value="1987" >1987<option value="1986" >1986<option value="1985" >1985<option value="1984" >1984<option value="1983" >1983<option value="1982" >1982<option value="1981" >1981<option value="1980" >1980<option value="1979" >1979<option value="1978" >1978<option value="1977" >1977<option value="1976" >1976<option value="1975" >1975<option value="1974" >1974<option value="1973" >1973<option value="1972" >1972<option value="1971" >1971<option value="1970" >1970<option value="1969" >1969<option value="1968" >1968<option value="1967" >1967<option value="1966" >1966<option value="1965" >1965<option value="1964" >1964<option value="1963" >1963<option value="1962" >1962<option value="1961" >1961<option value="1960" >1960<option value="1959" >1959<option value="1958" >1958<option value="1957" >1957<option value="1956" >1956<option value="1955" >1955<option value="1954" >1954<option value="1953" >1953<option value="1952" >1952<option value="1951" >1951<option value="1950" >1950<option value="1949" >1949<option value="1948" >1948<option value="1947" >1947<option value="1946" >1946<option value="1945" >1945<option value="1944" >1944<option value="1943" >1943<option value="1942" >1942<option value="1941" >1941<option value="1940" >1940<option value="1939" >1939<option value="1938" >1938<option value="1937" >1937<option value="1936" >1936<option value="1935" >1935<option value="1934" >1934<option value="1933" >1933<option value="1932" >1932<option value="1931" >1931<option value="1930" >1930<option value="1929" >1929<option value="1928" >1928<option value="1927" >1927<option value="1926" >1926<option value="1925" >1925<option value="1924" >1924<option value="1923" >1923<option value="1922" >1922<option value="1921" >1921<option value="1920" >1920<option value="1919" >1919<option value="1918" >1918<option value="1917" >1917<option value="1916" >1916<option value="1915" >1915<option value="1914" >1914<option value="1913" >1913<option value="1912" >1912<option value="1911" >1911

          </select>  

		</td>

      </tr>

      	 

	<tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      <tr><td class="navytext"><strong>TENANT HISTORY:</strong></td>

		 <td valign="Bottom" >&nbsp;</td>

      </tr> 

      <tr>

        <td class="navytext" colspan="2"><strong>Contact Details of Current Landlord or Agent: <span class="redstar">*</span> </strong></td>

      </tr> 

      	 

        <tr> 

         <td align="left">Agency Name</td>

        <td><input name="chAgencyName" value="" type="Text" maxlength="100" style="width:436px;"></td>

      </tr> 

      	 

          <tr> 

         <td align="left">Property Manager's Name</td>

        <td><input name="chPropertyManagersName" value="" type="Text" maxlength="100"  style="width:199px;"></td>

      </tr> 

       <tr><td class="navytext" colspan="2"><strong>Or</strong></td>

      </tr>  

         <tr> 

         <td align="left">Landlord's Name</td>

        <td><input name="chLandlordFirstName"  value="" maxlength="50" type="Text" size="16"> 

        <input name="chLandlordSurname"  value="" type="Text" maxlength="50" size="16">

		</td>

      </tr> 

      	   

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr>      

        <tr> 

        <td class="navytext"><b>Address of agent/landlord: <span class="redstar">*</span> </b></td>

		<td class="searchgreentext">
		<input name="chAgentInternational1"  onClick="setAgentInternationalPresentAddressNode(0)"  class="formcheckbox" checked="true" type="Radio" value="V1"><span class="navytext"> AUSTRALIAN</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input  class="formcheckbox"  onClick="setAgentInternationalPresentAddressNode(1)" name="chAgentInternational" type="Radio" value="V1" checked="true"><span class="navytext"> INTERNATIONAL</span></td>

      </tr>

      

      <tr> 

         <td align="left">Type of Residence</td>

        <td valign="Bottom" align="left" ><select name="chAgentPrefix" onChange=				"if((this.value=='')||(this.value=='null')){document.getElementById('chAgentFlatNo').style.display='none';document.getElementById('lblAgentFlatNo').style.display='none';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentStreetNo.focus()};}else{document.getElementById('chAgentFlatNo').style.display='inline';document.getElementById('lblAgentFlatNo').style.display='inline';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentFlatNo.focus()}};if(this.value=='-----'){this.value='';document.getElementById('chAgentFlatNo').style.display='none';document.getElementById('lblAgentFlatNo').style.display='none';};" style="width:113px;">

                    <option value="null">(Select)</option>

                    <option value="" SELECTED>HOUSE</option>

                    <option value="UNIT" >UNIT</option>

                    <option value="APARTMENT" >APARTMENT</option>

                    <option value="FLAT" >FLAT</option>

                    <option value="STUDIO" >STUDIO</option>

                

				<option value="-----" >-----</option>

				

				<option value="BLOCK" >BLOCK</option>

				

				<option value="CABIN" >CABIN</option>

				

				<option value="COTTAGE" >COTTAGE</option>

				

				<option value="DUPLEX" >DUPLEX</option>

				

				<option value="FACTORY" >FACTORY</option>

				

				<option value="FLOOR" >FLOOR</option>

				

				<option value="LOT" >LOT</option>

				

				<option value="PIER" >PIER</option>

				

				<option value="ROOFTOP" >ROOFTOP</option>

				

				<option value="ROOM" >ROOM</option>

				

				<option value="SHOP" >SHOP</option>

				

				<option value="SUITE" >SUITE</option>

				

				<option value="TOWNHOUSE" >TOWNHOUSE</option>

				

				<option value="VILLA" >VILLA</option>

				

				<option value="WAREHOUSE" >WAREHOUSE</option>

				

              </select><div id="lblAgentFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="chAgentFlatNo" id="chAgentFlatNo" value="" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"><img src="images/spacer.gif" width="2" border="0">Str. No.&nbsp;<input name="chAgentStreetNo" value=""  type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>

      </tr>

           

      	  

	   <tr>

        <td align="left" >Street Name</td>

        <td valign="Bottom" align="left" ><input name="chAgentStreetName" value="" type="Text" size="16"><img src="images/spacer.gif" width="46" height="1" border="0"><select name="chAgentStreetType" onChange="if(this.value=='-----'){this.value='';};if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentSuburb.focus()};"><option value="">(Street Type)</option>

                

					  <option value="STREET" >

                            STREET</option>

								

					  <option value="ROAD" >

                            ROAD</option>

								

					  <option value="AVENUE" >

                            AVENUE</option>

								

					  <option value="PLACE" >

                            PLACE</option>

								

					  <option value="CRESCENT" >

                            CRESCENT</option>

								

					  <option value="DRIVE" >

                            DRIVE</option>

								

					  <option value="PARADE" >

                            PARADE</option>

								

					  <option value="CLOSE" >

                            CLOSE</option>

								

					  <option value="-----" >

                            -----</option>

								

					  <option value="ACCESS" >

                            ACCESS</option>

								

					  <option value="ALLEY" >

                            ALLEY</option>

								

					  <option value="ALLEYWAY" >

                            ALLEYWAY</option>

								

					  <option value="AMBLE" >

                            AMBLE</option>

								

					  <option value="ANCHORAGE" >

                            ANCHORAGE</option>

								

					  <option value="APPROACH" >

                            APPROACH</option>

								

					  <option value="ARCADE" >

                            ARCADE</option>

								

					  <option value="ARTERY" >

                            ARTERY</option>

								

					  <option value="BASIN" >

                            BASIN</option>

								

					  <option value="BEACH" >

                            BEACH</option>

								

					  <option value="BEND" >

                            BEND</option>

								

					  <option value="BLOCK" >

                            BLOCK</option>

								

					  <option value="BOULEVARD" >

                            BOULEVARD</option>

								

					  <option value="BOULEVARDE" >

                            BOULEVARDE</option>

								

					  <option value="BRACE" >

                            BRACE</option>

								

					  <option value="BRAE" >

                            BRAE</option>

								

					  <option value="BREAK" >

                            BREAK</option>

								

					  <option value="BRIDGE" >

                            BRIDGE</option>

								

					  <option value="BROADWAY" >

                            BROADWAY</option>

								

					  <option value="BROW" >

                            BROW</option>

								

					  <option value="BYPASS" >

                            BYPASS</option>

								

					  <option value="BYWAY" >

                            BYWAY</option>

								

					  <option value="CAUSEWAY" >

                            CAUSEWAY</option>

								

					  <option value="CENTRAL" >

                            CENTRAL</option>

								

					  <option value="CENTRE" >

                            CENTRE</option>

								

					  <option value="CENTREWAY" >

                            CENTREWAY</option>

								

					  <option value="CHASE" >

                            CHASE</option>

								

					  <option value="CIRCLE" >

                            CIRCLE</option>

								

					  <option value="CIRCLET" >

                            CIRCLET</option>

								

					  <option value="CIRCUIT" >

                            CIRCUIT</option>

								

					  <option value="CIRCUS" >

                            CIRCUS</option>

								

					  <option value="COLONNADE" >

                            COLONNADE</option>

								

					  <option value="COMMON" >

                            COMMON</option>

								

					  <option value="CONCOURSE" >

                            CONCOURSE</option>

								

					  <option value="COPSE" >

                            COPSE</option>

								

					  <option value="CORNER" >

                            CORNER</option>

								

					  <option value="CORSO" >

                            CORSO</option>

								

					  <option value="COURT" >

                            COURT</option>

								

					  <option value="COURTYARD" >

                            COURTYARD</option>

								

					  <option value="COVE" >

                            COVE</option>

								

					  <option value="CREST" >

                            CREST</option>

								

					  <option value="CROSS" >

                            CROSS</option>

								

					  <option value="CROSSING" >

                            CROSSING</option>

								

					  <option value="CROSSROAD" >

                            CROSSROAD</option>

								

					  <option value="CROSSWAY" >

                            CROSSWAY</option>

								

					  <option value="CRUISEWAY" >

                            CRUISEWAY</option>

								

					  <option value="CUL-DE-SAC" >

                            CUL-DE-SAC</option>

								

					  <option value="CUTTING" >

                            CUTTING</option>

								

					  <option value="DALE" >

                            DALE</option>

								

					  <option value="DELL" >

                            DELL</option>

								

					  <option value="DEVIATION" >

                            DEVIATION</option>

								

					  <option value="DIP" >

                            DIP</option>

								

					  <option value="DISTRIBUTOR" >

                            DISTRIBUTOR</option>

								

					  <option value="DRIVEWAY" >

                            DRIVEWAY</option>

								

					  <option value="EAST" >

                            EAST</option>

								

					  <option value="EDGE" >

                            EDGE</option>

								

					  <option value="ELBOW" >

                            ELBOW</option>

								

					  <option value="END" >

                            END</option>

								

					  <option value="ENTRANCE" >

                            ENTRANCE</option>

								

					  <option value="ESPLANADE" >

                            ESPLANADE</option>

								

					  <option value="ESTATE" >

                            ESTATE</option>

								

					  <option value="EXPRESSWAY" >

                            EXPRESSWAY</option>

								

					  <option value="EXTENSION" >

                            EXTENSION</option>

								

					  <option value="EXTENSION" >

                            EXTENSION</option>

								

					  <option value="FAIRWAY" >

                            FAIRWAY</option>

								

					  <option value="FIRE TRACK" >

                            FIRE TRACK</option>

								

					  <option value="FIRETRAIL" >

                            FIRETRAIL</option>

								

					  <option value="FLAT" >

                            FLAT</option>

								

					  <option value="FOLLOW" >

                            FOLLOW</option>

								

					  <option value="FOOTWAY" >

                            FOOTWAY</option>

								

					  <option value="FORESHORE" >

                            FORESHORE</option>

								

					  <option value="FORMATION" >

                            FORMATION</option>

								

					  <option value="FREEWAY" >

                            FREEWAY</option>

								

					  <option value="FRONT" >

                            FRONT</option>

								

					  <option value="FRONTAGE" >

                            FRONTAGE</option>

								

					  <option value="GAP" >

                            GAP</option>

								

					  <option value="GARDEN" >

                            GARDEN</option>

								

					  <option value="GARDENS" >

                            GARDENS</option>

								

					  <option value="GATE" >

                            GATE</option>

								

					  <option value="GATES" >

                            GATES</option>

								

					  <option value="GLADE" >

                            GLADE</option>

								

					  <option value="GLEN" >

                            GLEN</option>

								

					  <option value="GRANGE" >

                            GRANGE</option>

								

					  <option value="GREEN" >

                            GREEN</option>

								

					  <option value="GROUND" >

                            GROUND</option>

								

					  <option value="GROVE" >

                            GROVE</option>

								

					  <option value="GULLY" >

                            GULLY</option>

								

					  <option value="HEIGHTS" >

                            HEIGHTS</option>

								

					  <option value="HIGHROAD" >

                            HIGHROAD</option>

								

					  <option value="HIGHWAY" >

                            HIGHWAY</option>

								

					  <option value="HILL" >

                            HILL</option>

								

					  <option value="INTERCHANGE" >

                            INTERCHANGE</option>

								

					  <option value="INTERSECTION" >

                            INTERSECTION</option>

								

					  <option value="JUNCTION" >

                            JUNCTION</option>

								

					  <option value="KEY" >

                            KEY</option>

								

					  <option value="LANDING" >

                            LANDING</option>

								

					  <option value="LANE" >

                            LANE</option>

								

					  <option value="LANEWAY" >

                            LANEWAY</option>

								

					  <option value="LEES" >

                            LEES</option>

								

					  <option value="LINE" >

                            LINE</option>

								

					  <option value="LINK" >

                            LINK</option>

								

					  <option value="LITTLE" >

                            LITTLE</option>

								

					  <option value="LOOKOUT" >

                            LOOKOUT</option>

								

					  <option value="LOOP" >

                            LOOP</option>

								

					  <option value="LOWER" >

                            LOWER</option>

								

					  <option value="LOWER" >

                            LOWER</option>

								

					  <option value="MALL" >

                            MALL</option>

								

					  <option value="MEANDER" >

                            MEANDER</option>

								

					  <option value="MEW" >

                            MEW</option>

								

					  <option value="MEWS" >

                            MEWS</option>

								

					  <option value="MOTORWAY" >

                            MOTORWAY</option>

								

					  <option value="MOUNT" >

                            MOUNT</option>

								

					  <option value="NOOK" >

                            NOOK</option>

								

					  <option value="NORTH" >

                            NORTH</option>

								

					  <option value="NORTH EAST" >

                            NORTH EAST</option>

								

					  <option value="NORTH WEST" >

                            NORTH WEST</option>

								

					  <option value="OUTLOOK" >

                            OUTLOOK</option>

								

					  <option value="PARK" >

                            PARK</option>

								

					  <option value="PARKLANDS" >

                            PARKLANDS</option>

								

					  <option value="PARKWAY" >

                            PARKWAY</option>

								

					  <option value="PART" >

                            PART</option>

								

					  <option value="PASS" >

                            PASS</option>

								

					  <option value="PATH" >

                            PATH</option>

								

					  <option value="PATHWAY" >

                            PATHWAY</option>

								

					  <option value="PIAZZA" >

                            PIAZZA</option>

								

					  <option value="PLATEAU" >

                            PLATEAU</option>

								

					  <option value="PLAZA" >

                            PLAZA</option>

								

					  <option value="POCKET" >

                            POCKET</option>

								

					  <option value="POINT" >

                            POINT</option>

								

					  <option value="PORT" >

                            PORT</option>

								

					  <option value="PROMENADE" >

                            PROMENADE</option>

								

					  <option value="QUAD" >

                            QUAD</option>

								

					  <option value="QUADRANGLE" >

                            QUADRANGLE</option>

								

					  <option value="QUADRANT" >

                            QUADRANT</option>

								

					  <option value="QUAY" >

                            QUAY</option>

								

					  <option value="QUAYS" >

                            QUAYS</option>

								

					  <option value="RAMBLE" >

                            RAMBLE</option>

								

					  <option value="RAMP" >

                            RAMP</option>

								

					  <option value="RANGE" >

                            RANGE</option>

								

					  <option value="REACH" >

                            REACH</option>

								

					  <option value="RESERVE" >

                            RESERVE</option>

								

					  <option value="REST" >

                            REST</option>

								

					  <option value="RETREAT" >

                            RETREAT</option>

								

					  <option value="RIDE" >

                            RIDE</option>

								

					  <option value="RIDGE" >

                            RIDGE</option>

								

					  <option value="RIDGEWAY" >

                            RIDGEWAY</option>

								

					  <option value="RIGHT OF WAY" >

                            RIGHT OF WAY</option>

								

					  <option value="RING" >

                            RING</option>

								

					  <option value="RISE" >

                            RISE</option>

								

					  <option value="RIVER" >

                            RIVER</option>

								

					  <option value="RIVERWAY" >

                            RIVERWAY</option>

								

					  <option value="RIVIERA" >

                            RIVIERA</option>

								

					  <option value="ROADS" >

                            ROADS</option>

								

					  <option value="ROADSIDE" >

                            ROADSIDE</option>

								

					  <option value="ROADWAY" >

                            ROADWAY</option>

								

					  <option value="RONDE" >

                            RONDE</option>

								

					  <option value="ROSEBOWL" >

                            ROSEBOWL</option>

								

					  <option value="ROTARY" >

                            ROTARY</option>

								

					  <option value="ROUND" >

                            ROUND</option>

								

					  <option value="ROUTE" >

                            ROUTE</option>

								

					  <option value="ROW" >

                            ROW</option>

								

					  <option value="RUE" >

                            RUE</option>

								

					  <option value="RUN" >

                            RUN</option>

								

					  <option value="SERVICE WAY" >

                            SERVICE WAY</option>

								

					  <option value="SIDING" >

                            SIDING</option>

								

					  <option value="SLOPE" >

                            SLOPE</option>

								

					  <option value="SOUND" >

                            SOUND</option>

								

					  <option value="SOUTH" >

                            SOUTH</option>

								

					  <option value="SOUTH EAST" >

                            SOUTH EAST</option>

								

					  <option value="SOUTH WEST" >

                            SOUTH WEST</option>

								

					  <option value="SPUR" >

                            SPUR</option>

								

					  <option value="SQUARE" >

                            SQUARE</option>

								

					  <option value="STAIRS" >

                            STAIRS</option>

								

					  <option value="STATE HIGHWAY" >

                            STATE HIGHWA</option>

								

					  <option value="STEPS" >

                            STEPS</option>

								

					  <option value="STEYNE" >

                            STEYNE</option>

								

					  <option value="STRAND" >

                            STRAND</option>

								

					  <option value="STRIP" >

                            STRIP</option>

								

					  <option value="SUBWAY" >

                            SUBWAY</option>

								

					  <option value="TARN" >

                            TARN</option>

								

					  <option value="TERRACE" >

                            TERRACE</option>

								

					  <option value="THOROUGHFARE" >

                            THOROUGHFARE</option>

								

					  <option value="TOLLWAY" >

                            TOLLWAY</option>

								

					  <option value="TOP" >

                            TOP</option>

								

					  <option value="TOR" >

                            TOR</option>

								

					  <option value="TOWERS" >

                            TOWERS</option>

								

					  <option value="TRACK" >

                            TRACK</option>

								

					  <option value="TRAIL" >

                            TRAIL</option>

								

					  <option value="TRAILER" >

                            TRAILER</option>

								

					  <option value="TRIANGLE" >

                            TRIANGLE</option>

								

					  <option value="TRUNKWAY" >

                            TRUNKWAY</option>

								

					  <option value="TURN" >

                            TURN</option>

								

					  <option value="UNDERPASS" >

                            UNDERPASS</option>

								

					  <option value="UPPER" >

                            UPPER</option>

								

					  <option value="UPPER" >

                            UPPER</option>

								

					  <option value="VALE" >

                            VALE</option>

								

					  <option value="VIADUCT" >

                            VIADUCT</option>

								

					  <option value="VIEW" >

                            VIEW</option>

								

					  <option value="VILLAS" >

                            VILLAS</option>

								

					  <option value="VISTA" >

                            VISTA</option>

								

					  <option value="WADE" >

                            WADE</option>

								

					  <option value="WALK" >

                            WALK</option>

								

					  <option value="WALKWAY" >

                            WALKWAY</option>

								

					  <option value="WAY" >

                            WAY</option>

								

					  <option value="WEST" >

                            WEST</option>

								

					  <option value="WHARF" >

                            WHARF</option>

								

					  <option value="WYND" >

                            WYND</option>

								

					  <option value="YARD" >

                            YARD</option>

								

              </select></td>

      </tr>

      	 

	 

            <tr> 

        <td align="left"><div id="objAgentPresentAddressAus1">Suburb</div></td>

        <td align="left"><div id="objAgentPresentAddressAus2"><input name="chAgentSuburb" value=""   type="Text" size="16"> 

        State<img src="images/spacer.gif" width="15" height="1" border="0"><select name="chAgentState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentPostcode.focus()};">

					<option value=""></option>

            			

            <option value="ACT" >ACT</option>

            			

            <option value="NSW" >NSW</option>

            			

            <option value="NT" >NT</option>

            			

            <option value="QLD" >QLD</option>

            			

            <option value="SA" >SA</option>

            			

            <option value="TAS" >TAS</option>

            			

            <option value="VIC" >VIC</option>

            			

            <option value="WA " >WA </option>

            

          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="chAgentPostcode" value=""  type="Text" size="4" maxlength="4">  </div></td>

      </tr>  

      

      

      <tr> 

        <td align="left" ><div id="objAgentPresentAddressInt1" style="display:none">Suburb</div></td>

        <td align="left" ><div id="objAgentPresentAddressInt2" style="display:none"><input name="chAgentIntSuburb" type="Text" size="16"> City&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="chAgentIntCity" type="Text" size="16"> State/County <input name="chAgentIntState" type="Text" size="16"></div></td>

      </tr>  

      

       <tr> 

        <td height="3" align="left"><div id="objAgentPresentAddressInt3"  style="display:none">PostCode/ZIP</div></td>

        <td height="3"><div id="objAgentPresentAddressInt4"  style="display:none"><input name="chAgentIntPostcode" type="Text" size="16"> Country <select name="chAgentIntCountry"><option value="">(Select Country)</option>

            

            <option value="Afghanistan">Afghanistan</option>

            

            <option value="Albania">Albania</option>

            

            <option value="Algeria">Algeria</option>

            

            <option value="American Samoa">American Samoa</option>

            

            <option value="Andorra">Andorra</option>

            

            <option value="Angola">Angola</option>

            

            <option value="Anguilla">Anguilla</option>

            

            <option value="Antarctica">Antarctica</option>

            

            <option value="Antigua and Barbuda">Antigua and Barbuda</option>

            

            <option value="Argentina">Argentina</option>

            

            <option value="Armenia">Armenia</option>

            

            <option value="Aruba">Aruba</option>

            

            <option value="Austria">Austria</option>

            

            <option value="Azerbaijan">Azerbaijan</option>

            

            <option value="Bahamas">Bahamas</option>

            

            <option value="Bahrain">Bahrain</option>

            

            <option value="Bangladesh">Bangladesh</option>

            

            <option value="Barbados">Barbados</option>

            

            <option value="Belarus">Belarus</option>

            

            <option value="Belgium">Belgium</option>

            

            <option value="Belize">Belize</option>

            

            <option value="Benin">Benin</option>

            

            <option value="Bermuda">Bermuda</option>

            

            <option value="Bhutan">Bhutan</option>

            

            <option value="Bolivia">Bolivia</option>

            

            <option value="Bosnia and Herzegowina">Bosnia and Herzegowina</option>

            

            <option value="Botswana">Botswana</option>

            

            <option value="Bouvet Island">Bouvet Island</option>

            

            <option value="Brazil">Brazil</option>

            

            <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>

            

            <option value="Brunei Darussalam">Brunei Darussalam</option>

            

            <option value="Bulgaria">Bulgaria</option>

            

            <option value="Burkina Faso">Burkina Faso</option>

            

            <option value="Burundi">Burundi</option>

            

            <option value="Cambodia">Cambodia</option>

            

            <option value="Cameroon">Cameroon</option>

            

            <option value="Canada">Canada</option>

            

            <option value="Cape Verde">Cape Verde</option>

            

            <option value="Cayman islands">Cayman islands</option>

            

            <option value="Central African Republic">Central African Republic</option>

            

            <option value="Chad">Chad</option>

            

            <option value="Chile">Chile</option>

            

            <option value="China">China</option>

            

            <option value="Christmas Island">Christmas Island</option>

            

            <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>

            

            <option value="Colombia">Colombia</option>

            

            <option value="Comoros">Comoros</option>

            

            <option value="Congo">Congo</option>

            

            <option value="Congo, Democratic Republic">Congo, Democratic Republic</option>

            

            <option value="Cook Islands">Cook Islands</option>

            

            <option value="Costa Rica">Costa Rica</option>

            

            <option value="Cote d'ivoire">Cote d'ivoire</option>

            

            <option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>

            

            <option value="Cuba">Cuba</option>

            

            <option value="Cyprus">Cyprus</option>

            

            <option value="Czech Republic">Czech Republic</option>

            

            <option value="Denmark">Denmark</option>

            

            <option value="Djibouti">Djibouti</option>

            

            <option value="Dominica">Dominica</option>

            

            <option value="Dominican Republic">Dominican Republic</option>

            

            <option value="East Timor">East Timor</option>

            

            <option value="Ecuador">Ecuador</option>

            

            <option value="Egypt">Egypt</option>

            

            <option value="El Salvador">El Salvador</option>

            

            <option value="Equatorial Guinea">Equatorial Guinea</option>

            

            <option value="Eritrea">Eritrea</option>

            

            <option value="Estonia">Estonia</option>

            

            <option value="Ethiopia">Ethiopia</option>

            

            <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>

            

            <option value="Faroe islands">Faroe islands</option>

            

            <option value="Fiji">Fiji</option>

            

            <option value="Finland">Finland</option>

            

            <option value="France">France</option>

            

            <option value="France, Metropolitan">France, Metropolitan</option>

            

            <option value="French Guiana">French Guiana</option>

            

            <option value="French Polynesia">French Polynesia</option>

            

            <option value="French Southern Territories">French Southern Territories</option>

            

            <option value="Gabon">Gabon</option>

            

            <option value="Gambia">Gambia</option>

            

            <option value="Georgia">Georgia</option>

            

            <option value="Germany">Germany</option>

            

            <option value="Ghana">Ghana</option>

            

            <option value="Gibraltar">Gibraltar</option>

            

            <option value="Greece">Greece</option>

            

            <option value="Greenland">Greenland</option>

            

            <option value="Grenada">Grenada</option>

            

            <option value="Guadeloupe">Guadeloupe</option>

            

            <option value="Guam">Guam</option>

            

            <option value="Guatemala">Guatemala</option>

            

            <option value="Guinea">Guinea</option>

            

            <option value="Guinea-Bissau">Guinea-Bissau</option>

            

            <option value="Guyana">Guyana</option>

            

            <option value="Haiti">Haiti</option>

            

            <option value="Heard and Mc Donald Islands">Heard and Mc Donald Islands</option>

            

            <option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>

            

            <option value="Honduras">Honduras</option>

            

            <option value="Hong Kong">Hong Kong</option>

            

            <option value="Hungary">Hungary</option>

            

            <option value="Iceland">Iceland</option>

            

            <option value="India">India</option>

            

            <option value="Indonesia">Indonesia</option>

            

            <option value="Iran (Islamic Republic of)">Iran (Islamic Republic of)</option>

            

            <option value="Iraq">Iraq</option>

            

            <option value="Ireland">Ireland</option>

            

            <option value="Israel">Israel</option>

            

            <option value="Italy">Italy</option>

            

            <option value="Jamaica">Jamaica</option>

            

            <option value="Japan">Japan</option>

            

            <option value="Jordan">Jordan</option>

            

            <option value="Kazakhstan">Kazakhstan</option>

            

            <option value="Kenya">Kenya</option>

            

            <option value="Kiribati">Kiribati</option>

            

            <option value="Korea, Democratic People's Republic">Korea, Democratic People's Republic</option>

            

            <option value="Korea, Republic of">Korea, Republic of</option>

            

            <option value="Kuwait">Kuwait</option>

            

            <option value="Kyrgyzstan">Kyrgyzstan</option>

            

            <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>

            

            <option value="Latvia">Latvia</option>

            

            <option value="Lebanon">Lebanon</option>

            

            <option value="Lesotho">Lesotho</option>

            

            <option value="Liberia">Liberia</option>

            

            <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>

            

            <option value="Liechtenstein">Liechtenstein</option>

            

            <option value="Lithuania">Lithuania</option>

            

            <option value="Luxembourg">Luxembourg</option>

            

            <option value="Macau">Macau</option>

            

            <option value="Macedonia (Yugoslav Republic)">Macedonia (Yugoslav Republic)</option>

            

            <option value="Madagascar">Madagascar</option>

            

            <option value="Malawi">Malawi</option>

            

            <option value="Malaysia">Malaysia</option>

            

            <option value="Maldives">Maldives</option>

            

            <option value="Mali">Mali</option>

            

            <option value="Malta">Malta</option>

            

            <option value="Marshall Islands">Marshall Islands</option>

            

            <option value="Martinique">Martinique</option>

            

            <option value="Mauritania">Mauritania</option>

            

            <option value="Mauritius">Mauritius</option>

            

            <option value="Mayotte">Mayotte</option>

            

            <option value="Mexico">Mexico</option>

            

            <option value="Micronesia">Micronesia</option>

            

            <option value="Moldova">Moldova</option>

            

            <option value="Monaco">Monaco</option>

            

            <option value="Mongolia">Mongolia</option>

            

            <option value="Montserrat">Montserrat</option>

            

            <option value="Morocco">Morocco</option>

            

            <option value="Mozambique">Mozambique</option>

            

            <option value="Myanmar">Myanmar</option>

            

            <option value="Namibia">Namibia</option>

            

            <option value="Nauru">Nauru</option>

            

            <option value="Nepal">Nepal</option>

            

            <option value="Netherlands">Netherlands</option>

            

            <option value="Netherlands Antilles">Netherlands Antilles</option>

            

            <option value="New Caledonia">New Caledonia</option>

            

            <option value="New Zealand">New Zealand</option>

            

            <option value="Nicaragua">Nicaragua</option>

            

            <option value="Niger">Niger</option>

            

            <option value="Nigeria">Nigeria</option>

            

            <option value="Niue">Niue</option>

            

            <option value="Norfolk island">Norfolk island</option>

            

            <option value="Northern Mariana Islands">Northern Mariana Islands</option>

            

            <option value="Norway">Norway</option>

            

            <option value="Oman">Oman</option>

            

            <option value="Pakistan">Pakistan</option>

            

            <option value="Palau">Palau</option>

            

            <option value="Panama">Panama</option>

            

            <option value="Papua New Guinea">Papua New Guinea</option>

            

            <option value="Paraguay">Paraguay</option>

            

            <option value="Peru">Peru</option>

            

            <option value="Philippines">Philippines</option>

            

            <option value="Pitcairn">Pitcairn</option>

            

            <option value="Poland">Poland</option>

            

            <option value="Portugal">Portugal</option>

            

            <option value="Puerto Rico">Puerto Rico</option>

            

            <option value="Qatar">Qatar</option>

            

            <option value="Reunion">Reunion</option>

            

            <option value="Romania">Romania</option>

            

            <option value="Russian Federation">Russian Federation</option>

            

            <option value="Rwanda">Rwanda</option>

            

            <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>

            

            <option value="Saint Lucia">Saint Lucia</option>

            

            <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>

            

            <option value="Samoa">Samoa</option>

            

            <option value="San Marino">San Marino</option>

            

            <option value="Sao Tome and Principe">Sao Tome and Principe</option>

            

            <option value="Saudi Arabia">Saudi Arabia</option>

            

            <option value="Senegal">Senegal</option>

            

            <option value="Seychelles">Seychelles</option>

            

            <option value="Sierra Leone">Sierra Leone</option>

            

            <option value="Singapore">Singapore</option>

            

            <option value="Slovakia (Slovak Republic)">Slovakia (Slovak Republic)</option>

            

            <option value="Slovenia">Slovenia</option>

            

            <option value="Solomon Islands">Solomon Islands</option>

            

            <option value="Somalia">Somalia</option>

            

            <option value="South Africa">South Africa</option>

            

            <option value="South Georgia">South Georgia</option>

            

            <option value="Spain">Spain</option>

            

            <option value="Sri Lanka">Sri Lanka</option>

            

            <option value="St Helena">St Helena</option>

            

            <option value="St Pierre and Miquelon">St Pierre and Miquelon</option>

            

            <option value="Sudan">Sudan</option>

            

            <option value="Suriname">Suriname</option>

            

            <option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>

            

            <option value="Swaziland">Swaziland</option>

            

            <option value="Sweden">Sweden</option>

            

            <option value="Switzerland">Switzerland</option>

            

            <option value="Syrian Arab Republic">Syrian Arab Republic</option>

            

            <option value="Taiwan">Taiwan</option>

            

            <option value="Tajikistan">Tajikistan</option>

            

            <option value="Tanzania, United Republic of">Tanzania, United Republic of</option>

            

            <option value="Thailand">Thailand</option>

            

            <option value="Togo">Togo</option>

            

            <option value="Tokelau">Tokelau</option>

            

            <option value="Tonga">Tonga</option>

            

            <option value="Trinidad and Tobago">Trinidad and Tobago</option>

            

            <option value="Tunisia">Tunisia</option>

            

            <option value="Turkey">Turkey</option>

            

            <option value="Turkmenistan">Turkmenistan</option>

            

            <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>

            

            <option value="Tuvalu">Tuvalu</option>

            

            <option value="Uganda">Uganda</option>

            

            <option value="Ukraine">Ukraine</option>

            

            <option value="United Arab Emirates">United Arab Emirates</option>

            

            <option value="United Kingdom">United Kingdom</option>

            

            <option value="United States">United States</option>

            

            <option value="Uruguay">Uruguay</option>

            

            <option value="Uzbekistan">Uzbekistan</option>

            

            <option value="Vanuatu">Vanuatu</option>

            

            <option value="Venezuela">Venezuela</option>

            

            <option value="Vietnam">Vietnam</option>

            

            <option value="Virgin Islands (British)">Virgin Islands (British)</option>

            

            <option value="Virgin Islands (US)">Virgin Islands (US)</option>

            

            <option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>

            

            <option value="Western Sahara">Western Sahara</option>

            

            <option value="Yemen">Yemen</option>

            

            <option value="Yugoslavia">Yugoslavia</option>

            

            <option value="Zambia">Zambia</option>

            

            <option value="Zimbabwe">Zimbabwe</option>

            

          </select></div></td>

      </tr>

      

      <tr> 

         <td align="left">Phone</td>

        <td ><select name="chAgentPhone1" id="chAgentPhone1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentPhone2.focus()};">

		  		<option value="">(Area Code)</option>	

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>			

		  </select>

			  <input type="text" name="chAgentPhone2"  value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentPhone3.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			  <input type="text" name="chAgentPhone3"  value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentMobilePhone1.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');"><img src="images/spacer.gif" width="10" height="1" border="0"> Mobile<img src="images/spacer.gif" width="36" height="1" border="0"><input type="text" name="chAgentMobilePhone1" value="" size="4" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentMobilePhone2.focus()};" onBlur="checkNumeric(this,1,'','','','','');">	

		  <input type="text" name="chAgentMobilePhone2"  value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentMobilePhone3.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  <input type="text" name="chAgentMobilePhone3"  value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgentEmail.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		</td>

      </tr>

      	 

       <tr> 

         <td align="left">Email</td>

        <td><input name="chAgentEmail" type="Text"   value=""  style="width:199px;" onBlur="checkEmail(this);" maxlength="50">

		</td>

      </tr>

      

      <tr> 

        <td class="navytext"><b>Previous Address:</b></td>

		<td class="searchgreentext">
		<input name="chPreviousInternational1" onClick="setPreviousInternationalNode(0)"  class="formcheckbox" checked="true" type="Radio" value="V1">

		  <span class="navytext"> AUSTRALIAN</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

		  <input  class="formcheckbox"  onClick="setPreviousInternationalNode(1)" name="chPreviousInternational" type="Radio" value="V1" checked="true">

	    <span class="navytext"> INTERNATIONAL</span></td>

      </tr>

      

      <tr> 

         <td align="left">Type of Residence</td>

        <td valign="Bottom" align="left" ><select name="chPreviousPrefix" onChange=				"if((this.value=='')||(this.value=='null')){document.getElementById('chPreviousFlatNo').style.display='none';document.getElementById('lblPreviousFlatNo').style.display='none';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousStreetNo.focus()};}else{document.getElementById('chPreviousFlatNo').style.display='inline';document.getElementById('lblPreviousFlatNo').style.display='inline';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousFlatNo.focus()}};if(this.value=='-----'){this.value='';document.getElementById('chPreviousFlatNo').style.display='none';document.getElementById('lblPreviousFlatNo').style.display='none';};" style="width:113px;">

                    <option value="null">(Select)</option>

                    <option value="" SELECTED>HOUSE</option>

                    <option value="UNIT" >UNIT</option>

                    <option value="APARTMENT" >APARTMENT</option>

                    <option value="FLAT" >FLAT</option>

                    <option value="STUDIO" >STUDIO</option>

                

				    <option value="-----" >

                        -----</option>

				

				    <option value="BLOCK" >

                        BLOCK</option>

				

				    <option value="CABIN" >

                        CABIN</option>

				

				    <option value="COTTAGE" >

                        COTTAGE</option>

				

				    <option value="DUPLEX" >

                        DUPLEX</option>

				

				    <option value="FACTORY" >

                        FACTORY</option>

				

				    <option value="FLOOR" >

                        FLOOR</option>

				

				    <option value="LOT" >

                        LOT</option>

				

				    <option value="PIER" >

                        PIER</option>

				

				    <option value="ROOFTOP" >

                        ROOFTOP</option>

				

				    <option value="ROOM" >

                        ROOM</option>

				

				    <option value="SHOP" >

                        SHOP</option>

				

				    <option value="SUITE" >

                        SUITE</option>

				

				    <option value="TOWNHOUSE" >

                        TOWNHOUSE</option>

				

				    <option value="VILLA" >

                        VILLA</option>

				

				    <option value="WAREHOUSE" >

                        WAREHOUSE</option>

				

              </select><div id="lblPreviousFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="chPreviousFlatNo" id="chPreviousFlatNo"  value="" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"><img src="images/spacer.gif" width="2" border="0">Str. No.&nbsp;<input name="chPreviousStreetNo"  value=""  type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>

      </tr>  

      	     

        

	   <tr>

        <td align="left" >Street Name</td>

        <td valign="Bottom" align="left" ><input name="chPreviousStreetName" value="" type="Text" size="16"><img src="images/spacer.gif" width="46" height="1" border="0"><select name="chPreviousStreetType" onChange="if(this.value=='-----'){this.value='';};if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousSuburb.focus()};"><option value="">(Street Type)</option>

                

					 <option value="STREET" >

                            STREET</option>

								

					 <option value="ROAD" >

                            ROAD</option>

								

					 <option value="AVENUE" >

                            AVENUE</option>

								

					 <option value="PLACE" >

                            PLACE</option>

								

					 <option value="CRESCENT" >

                            CRESCENT</option>

								

					 <option value="DRIVE" >

                            DRIVE</option>

								

					 <option value="PARADE" >

                            PARADE</option>

								

					 <option value="CLOSE" >

                            CLOSE</option>

								

					 <option value="-----" >

                            -----</option>

								

					 <option value="ACCESS" >

                            ACCESS</option>

								

					 <option value="ALLEY" >

                            ALLEY</option>

								

					 <option value="ALLEYWAY" >

                            ALLEYWAY</option>

								

					 <option value="AMBLE" >

                            AMBLE</option>

								

					 <option value="ANCHORAGE" >

                            ANCHORAGE</option>

								

					 <option value="APPROACH" >

                            APPROACH</option>

								

					 <option value="ARCADE" >

                            ARCADE</option>

								

					 <option value="ARTERY" >

                            ARTERY</option>

								

					 <option value="BASIN" >

                            BASIN</option>

								

					 <option value="BEACH" >

                            BEACH</option>

								

					 <option value="BEND" >

                            BEND</option>

								

					 <option value="BLOCK" >

                            BLOCK</option>

								

					 <option value="BOULEVARD" >

                            BOULEVARD</option>

								

					 <option value="BOULEVARDE" >

                            BOULEVARDE</option>

								

					 <option value="BRACE" >

                            BRACE</option>

								

					 <option value="BRAE" >

                            BRAE</option>

								

					 <option value="BREAK" >

                            BREAK</option>

								

					 <option value="BRIDGE" >

                            BRIDGE</option>

								

					 <option value="BROADWAY" >

                            BROADWAY</option>

								

					 <option value="BROW" >

                            BROW</option>

								

					 <option value="BYPASS" >

                            BYPASS</option>

								

					 <option value="BYWAY" >

                            BYWAY</option>

								

					 <option value="CAUSEWAY" >

                            CAUSEWAY</option>

								

					 <option value="CENTRAL" >

                            CENTRAL</option>

								

					 <option value="CENTRE" >

                            CENTRE</option>

								

					 <option value="CENTREWAY" >

                            CENTREWAY</option>

								

					 <option value="CHASE" >

                            CHASE</option>

								

					 <option value="CIRCLE" >

                            CIRCLE</option>

								

					 <option value="CIRCLET" >

                            CIRCLET</option>

								

					 <option value="CIRCUIT" >

                            CIRCUIT</option>

								

					 <option value="CIRCUS" >

                            CIRCUS</option>

								

					 <option value="COLONNADE" >

                            COLONNADE</option>

								

					 <option value="COMMON" >

                            COMMON</option>

								

					 <option value="CONCOURSE" >

                            CONCOURSE</option>

								

					 <option value="COPSE" >

                            COPSE</option>

								

					 <option value="CORNER" >

                            CORNER</option>

								

					 <option value="CORSO" >

                            CORSO</option>

								

					 <option value="COURT" >

                            COURT</option>

								

					 <option value="COURTYARD" >

                            COURTYARD</option>

								

					 <option value="COVE" >

                            COVE</option>

								

					 <option value="CREST" >

                            CREST</option>

								

					 <option value="CROSS" >

                            CROSS</option>

								

					 <option value="CROSSING" >

                            CROSSING</option>

								

					 <option value="CROSSROAD" >

                            CROSSROAD</option>

								

					 <option value="CROSSWAY" >

                            CROSSWAY</option>

								

					 <option value="CRUISEWAY" >

                            CRUISEWAY</option>

								

					 <option value="CUL-DE-SAC" >

                            CUL-DE-SAC</option>

								

					 <option value="CUTTING" >

                            CUTTING</option>

								

					 <option value="DALE" >

                            DALE</option>

								

					 <option value="DELL" >

                            DELL</option>

								

					 <option value="DEVIATION" >

                            DEVIATION</option>

								

					 <option value="DIP" >

                            DIP</option>

								

					 <option value="DISTRIBUTOR" >

                            DISTRIBUTOR</option>

								

					 <option value="DRIVEWAY" >

                            DRIVEWAY</option>

								

					 <option value="EAST" >

                            EAST</option>

								

					 <option value="EDGE" >

                            EDGE</option>

								

					 <option value="ELBOW" >

                            ELBOW</option>

								

					 <option value="END" >

                            END</option>

								

					 <option value="ENTRANCE" >

                            ENTRANCE</option>

								

					 <option value="ESPLANADE" >

                            ESPLANADE</option>

								

					 <option value="ESTATE" >

                            ESTATE</option>

								

					 <option value="EXPRESSWAY" >

                            EXPRESSWAY</option>

								

					 <option value="EXTENSION" >

                            EXTENSION</option>

								

					 <option value="EXTENSION" >

                            EXTENSION</option>

								

					 <option value="FAIRWAY" >

                            FAIRWAY</option>

								

					 <option value="FIRE TRACK" >

                            FIRE TRACK</option>

								

					 <option value="FIRETRAIL" >

                            FIRETRAIL</option>

								

					 <option value="FLAT" >

                            FLAT</option>

								

					 <option value="FOLLOW" >

                            FOLLOW</option>

								

					 <option value="FOOTWAY" >

                            FOOTWAY</option>

								

					 <option value="FORESHORE" >

                            FORESHORE</option>

								

					 <option value="FORMATION" >

                            FORMATION</option>

								

					 <option value="FREEWAY" >

                            FREEWAY</option>

								

					 <option value="FRONT" >

                            FRONT</option>

								

					 <option value="FRONTAGE" >

                            FRONTAGE</option>

								

					 <option value="GAP" >

                            GAP</option>

								

					 <option value="GARDEN" >

                            GARDEN</option>

								

					 <option value="GARDENS" >

                            GARDENS</option>

								

					 <option value="GATE" >

                            GATE</option>

								

					 <option value="GATES" >

                            GATES</option>

								

					 <option value="GLADE" >

                            GLADE</option>

								

					 <option value="GLEN" >

                            GLEN</option>

								

					 <option value="GRANGE" >

                            GRANGE</option>

								

					 <option value="GREEN" >

                            GREEN</option>

								

					 <option value="GROUND" >

                            GROUND</option>

								

					 <option value="GROVE" >

                            GROVE</option>

								

					 <option value="GULLY" >

                            GULLY</option>

								

					 <option value="HEIGHTS" >

                            HEIGHTS</option>

								

					 <option value="HIGHROAD" >

                            HIGHROAD</option>

								

					 <option value="HIGHWAY" >

                            HIGHWAY</option>

								

					 <option value="HILL" >

                            HILL</option>

								

					 <option value="INTERCHANGE" >

                            INTERCHANGE</option>

								

					 <option value="INTERSECTION" >

                            INTERSECTION</option>

								

					 <option value="JUNCTION" >

                            JUNCTION</option>

								

					 <option value="KEY" >

                            KEY</option>

								

					 <option value="LANDING" >

                            LANDING</option>

								

					 <option value="LANE" >

                            LANE</option>

								

					 <option value="LANEWAY" >

                            LANEWAY</option>

								

					 <option value="LEES" >

                            LEES</option>

								

					 <option value="LINE" >

                            LINE</option>

								

					 <option value="LINK" >

                            LINK</option>

								

					 <option value="LITTLE" >

                            LITTLE</option>

								

					 <option value="LOOKOUT" >

                            LOOKOUT</option>

								

					 <option value="LOOP" >

                            LOOP</option>

								

					 <option value="LOWER" >

                            LOWER</option>

								

					 <option value="LOWER" >

                            LOWER</option>

								

					 <option value="MALL" >

                            MALL</option>

								

					 <option value="MEANDER" >

                            MEANDER</option>

								

					 <option value="MEW" >

                            MEW</option>

								

					 <option value="MEWS" >

                            MEWS</option>

								

					 <option value="MOTORWAY" >

                            MOTORWAY</option>

								

					 <option value="MOUNT" >

                            MOUNT</option>

								

					 <option value="NOOK" >

                            NOOK</option>

								

					 <option value="NORTH" >

                            NORTH</option>

								

					 <option value="NORTH EAST" >

                            NORTH EAST</option>

								

					 <option value="NORTH WEST" >

                            NORTH WEST</option>

								

					 <option value="OUTLOOK" >

                            OUTLOOK</option>

								

					 <option value="PARK" >

                            PARK</option>

								

					 <option value="PARKLANDS" >

                            PARKLANDS</option>

								

					 <option value="PARKWAY" >

                            PARKWAY</option>

								

					 <option value="PART" >

                            PART</option>

								

					 <option value="PASS" >

                            PASS</option>

								

					 <option value="PATH" >

                            PATH</option>

								

					 <option value="PATHWAY" >

                            PATHWAY</option>

								

					 <option value="PIAZZA" >

                            PIAZZA</option>

								

					 <option value="PLATEAU" >

                            PLATEAU</option>

								

					 <option value="PLAZA" >

                            PLAZA</option>

								

					 <option value="POCKET" >

                            POCKET</option>

								

					 <option value="POINT" >

                            POINT</option>

								

					 <option value="PORT" >

                            PORT</option>

								

					 <option value="PROMENADE" >

                            PROMENADE</option>

								

					 <option value="QUAD" >

                            QUAD</option>

								

					 <option value="QUADRANGLE" >

                            QUADRANGLE</option>

								

					 <option value="QUADRANT" >

                            QUADRANT</option>

								

					 <option value="QUAY" >

                            QUAY</option>

								

					 <option value="QUAYS" >

                            QUAYS</option>

								

					 <option value="RAMBLE" >

                            RAMBLE</option>

								

					 <option value="RAMP" >

                            RAMP</option>

								

					 <option value="RANGE" >

                            RANGE</option>

								

					 <option value="REACH" >

                            REACH</option>

								

					 <option value="RESERVE" >

                            RESERVE</option>

								

					 <option value="REST" >

                            REST</option>

								

					 <option value="RETREAT" >

                            RETREAT</option>

								

					 <option value="RIDE" >

                            RIDE</option>

								

					 <option value="RIDGE" >

                            RIDGE</option>

								

					 <option value="RIDGEWAY" >

                            RIDGEWAY</option>

								

					 <option value="RIGHT OF WAY" >

                            RIGHT OF WAY</option>

								

					 <option value="RING" >

                            RING</option>

								

					 <option value="RISE" >

                            RISE</option>

								

					 <option value="RIVER" >

                            RIVER</option>

								

					 <option value="RIVERWAY" >

                            RIVERWAY</option>

								

					 <option value="RIVIERA" >

                            RIVIERA</option>

								

					 <option value="ROADS" >

                            ROADS</option>

								

					 <option value="ROADSIDE" >

                            ROADSIDE</option>

								

					 <option value="ROADWAY" >

                            ROADWAY</option>

								

					 <option value="RONDE" >

                            RONDE</option>

								

					 <option value="ROSEBOWL" >

                            ROSEBOWL</option>

								

					 <option value="ROTARY" >

                            ROTARY</option>

								

					 <option value="ROUND" >

                            ROUND</option>

								

					 <option value="ROUTE" >

                            ROUTE</option>

								

					 <option value="ROW" >

                            ROW</option>

								

					 <option value="RUE" >

                            RUE</option>

								

					 <option value="RUN" >

                            RUN</option>

								

					 <option value="SERVICE WAY" >

                            SERVICE WAY</option>

								

					 <option value="SIDING" >

                            SIDING</option>

								

					 <option value="SLOPE" >

                            SLOPE</option>

								

					 <option value="SOUND" >

                            SOUND</option>

								

					 <option value="SOUTH" >

                            SOUTH</option>

								

					 <option value="SOUTH EAST" >

                            SOUTH EAST</option>

								

					 <option value="SOUTH WEST" >

                            SOUTH WEST</option>

								

					 <option value="SPUR" >

                            SPUR</option>

								

					 <option value="SQUARE" >

                            SQUARE</option>

								

					 <option value="STAIRS" >

                            STAIRS</option>

								

					 <option value="STATE HIGHWAY" >

                            STATE HIGHWA</option>

								

					 <option value="STEPS" >

                            STEPS</option>

								

					 <option value="STEYNE" >

                            STEYNE</option>

								

					 <option value="STRAND" >

                            STRAND</option>

								

					 <option value="STRIP" >

                            STRIP</option>

								

					 <option value="SUBWAY" >

                            SUBWAY</option>

								

					 <option value="TARN" >

                            TARN</option>

								

					 <option value="TERRACE" >

                            TERRACE</option>

								

					 <option value="THOROUGHFARE" >

                            THOROUGHFARE</option>

								

					 <option value="TOLLWAY" >

                            TOLLWAY</option>

								

					 <option value="TOP" >

                            TOP</option>

								

					 <option value="TOR" >

                            TOR</option>

								

					 <option value="TOWERS" >

                            TOWERS</option>

								

					 <option value="TRACK" >

                            TRACK</option>

								

					 <option value="TRAIL" >

                            TRAIL</option>

								

					 <option value="TRAILER" >

                            TRAILER</option>

								

					 <option value="TRIANGLE" >

                            TRIANGLE</option>

								

					 <option value="TRUNKWAY" >

                            TRUNKWAY</option>

								

					 <option value="TURN" >

                            TURN</option>

								

					 <option value="UNDERPASS" >

                            UNDERPASS</option>

								

					 <option value="UPPER" >

                            UPPER</option>

								

					 <option value="UPPER" >

                            UPPER</option>

								

					 <option value="VALE" >

                            VALE</option>

								

					 <option value="VIADUCT" >

                            VIADUCT</option>

								

					 <option value="VIEW" >

                            VIEW</option>

								

					 <option value="VILLAS" >

                            VILLAS</option>

								

					 <option value="VISTA" >

                            VISTA</option>

								

					 <option value="WADE" >

                            WADE</option>

								

					 <option value="WALK" >

                            WALK</option>

								

					 <option value="WALKWAY" >

                            WALKWAY</option>

								

					 <option value="WAY" >

                            WAY</option>

								

					 <option value="WEST" >

                            WEST</option>

								

					 <option value="WHARF" >

                            WHARF</option>

								

					 <option value="WYND" >

                            WYND</option>

								

					 <option value="YARD" >

                            YARD</option>

								

              </select></td>

      </tr>

      	 



      <tr> 

        <td align="left"><div id="objPreviousAddressAus1">Suburb</div></td>

        <td align="left"><div id="objPreviousAddressAus2"><input name="chPreviousSuburb"  value="" type="Text" size="16"> 

        State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chPreviousState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousPostcode.focus()};">

					<option value=""></option>

            			

              <option value="ACT" >

                            ACT</option>

            			

              <option value="NSW" >

                            NSW</option>

            			

              <option value="NT" >

                            NT</option>

            			

              <option value="QLD" >

                            QLD</option>

            			

              <option value="SA" >

                            SA</option>

            			

              <option value="TAS" >

                            TAS</option>

            			

              <option value="VIC" >

                            VIC</option>

            			

              <option value="WA " >

                            WA </option>

            



          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="chPreviousPostcode" value=""  type="Text" size="4" maxlength="4">  </div></td>

      </tr> 

      

      

       <tr> 

        <td align="left" ><div id="objPreviousAddressInt1" style="display:none">Suburb</div></td>

        <td align="left" ><div id="objPreviousAddressInt2" style="display:none"><input name="chPreviousIntSuburb" type="Text" size="16"> City&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="chPreviousIntCity" type="Text" size="16"> State/County <input name="chPreviousIntState" type="Text" size="16"></div></td>

      </tr>  

             

      <tr> 

        <td height="3" align="left"><div id="objPreviousAddressInt3"  style="display:none">PostCode/ZIP</div></td>

        <td height="3"><div id="objPreviousAddressInt4"  style="display:none"><input name="chPreviousIntPostcode" type="Text" size="16"> Country <select name="chPreviousIntCountry"><option value="">(Select Country)</option>

            

            <option value="Afghanistan">Afghanistan</option>

            

            <option value="Albania">Albania</option>

            

            <option value="Algeria">Algeria</option>

            

            <option value="American Samoa">American Samoa</option>

            

            <option value="Andorra">Andorra</option>

            

            <option value="Angola">Angola</option>

            

            <option value="Anguilla">Anguilla</option>

            

            <option value="Antarctica">Antarctica</option>

            

            <option value="Antigua and Barbuda">Antigua and Barbuda</option>

            

            <option value="Argentina">Argentina</option>

            

            <option value="Armenia">Armenia</option>

            

            <option value="Aruba">Aruba</option>

            

            <option value="Austria">Austria</option>

            

            <option value="Azerbaijan">Azerbaijan</option>

            

            <option value="Bahamas">Bahamas</option>

            

            <option value="Bahrain">Bahrain</option>

            

            <option value="Bangladesh">Bangladesh</option>

            

            <option value="Barbados">Barbados</option>

            

            <option value="Belarus">Belarus</option>

            

            <option value="Belgium">Belgium</option>

            

            <option value="Belize">Belize</option>

            

            <option value="Benin">Benin</option>

            

            <option value="Bermuda">Bermuda</option>

            

            <option value="Bhutan">Bhutan</option>

            

            <option value="Bolivia">Bolivia</option>

            

            <option value="Bosnia and Herzegowina">Bosnia and Herzegowina</option>

            

            <option value="Botswana">Botswana</option>

            

            <option value="Bouvet Island">Bouvet Island</option>

            

            <option value="Brazil">Brazil</option>

            

            <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>

            

            <option value="Brunei Darussalam">Brunei Darussalam</option>

            

            <option value="Bulgaria">Bulgaria</option>

            

            <option value="Burkina Faso">Burkina Faso</option>

            

            <option value="Burundi">Burundi</option>

            

            <option value="Cambodia">Cambodia</option>

            

            <option value="Cameroon">Cameroon</option>

            

            <option value="Canada">Canada</option>

            

            <option value="Cape Verde">Cape Verde</option>

            

            <option value="Cayman islands">Cayman islands</option>

            

            <option value="Central African Republic">Central African Republic</option>

            

            <option value="Chad">Chad</option>

            

            <option value="Chile">Chile</option>

            

            <option value="China">China</option>

            

            <option value="Christmas Island">Christmas Island</option>

            

            <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>

            

            <option value="Colombia">Colombia</option>

            

            <option value="Comoros">Comoros</option>

            

            <option value="Congo">Congo</option>

            

            <option value="Congo, Democratic Republic">Congo, Democratic Republic</option>

            

            <option value="Cook Islands">Cook Islands</option>

            

            <option value="Costa Rica">Costa Rica</option>

            

            <option value="Cote d'ivoire">Cote d'ivoire</option>

            

            <option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>

            

            <option value="Cuba">Cuba</option>

            

            <option value="Cyprus">Cyprus</option>

            

            <option value="Czech Republic">Czech Republic</option>

            

            <option value="Denmark">Denmark</option>

            

            <option value="Djibouti">Djibouti</option>

            

            <option value="Dominica">Dominica</option>

            

            <option value="Dominican Republic">Dominican Republic</option>

            

            <option value="East Timor">East Timor</option>

            

            <option value="Ecuador">Ecuador</option>

            

            <option value="Egypt">Egypt</option>

            

            <option value="El Salvador">El Salvador</option>

            

            <option value="Equatorial Guinea">Equatorial Guinea</option>

            

            <option value="Eritrea">Eritrea</option>

            

            <option value="Estonia">Estonia</option>

            

            <option value="Ethiopia">Ethiopia</option>

            

            <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>

            

            <option value="Faroe islands">Faroe islands</option>

            

            <option value="Fiji">Fiji</option>

            

            <option value="Finland">Finland</option>

            

            <option value="France">France</option>

            

            <option value="France, Metropolitan">France, Metropolitan</option>

            

            <option value="French Guiana">French Guiana</option>

            

            <option value="French Polynesia">French Polynesia</option>

            

            <option value="French Southern Territories">French Southern Territories</option>

            

            <option value="Gabon">Gabon</option>

            

            <option value="Gambia">Gambia</option>

            

            <option value="Georgia">Georgia</option>

            

            <option value="Germany">Germany</option>

            

            <option value="Ghana">Ghana</option>

            

            <option value="Gibraltar">Gibraltar</option>

            

            <option value="Greece">Greece</option>

            

            <option value="Greenland">Greenland</option>

            

            <option value="Grenada">Grenada</option>

            

            <option value="Guadeloupe">Guadeloupe</option>

            

            <option value="Guam">Guam</option>

            

            <option value="Guatemala">Guatemala</option>

            

            <option value="Guinea">Guinea</option>

            

            <option value="Guinea-Bissau">Guinea-Bissau</option>

            

            <option value="Guyana">Guyana</option>

            

            <option value="Haiti">Haiti</option>

            

            <option value="Heard and Mc Donald Islands">Heard and Mc Donald Islands</option>

            

            <option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>

            

            <option value="Honduras">Honduras</option>

            

            <option value="Hong Kong">Hong Kong</option>

            

            <option value="Hungary">Hungary</option>

            

            <option value="Iceland">Iceland</option>

            

            <option value="India">India</option>

            

            <option value="Indonesia">Indonesia</option>

            

            <option value="Iran (Islamic Republic of)">Iran (Islamic Republic of)</option>

            

            <option value="Iraq">Iraq</option>

            

            <option value="Ireland">Ireland</option>

            

            <option value="Israel">Israel</option>

            

            <option value="Italy">Italy</option>

            

            <option value="Jamaica">Jamaica</option>

            

            <option value="Japan">Japan</option>

            

            <option value="Jordan">Jordan</option>

            

            <option value="Kazakhstan">Kazakhstan</option>

            

            <option value="Kenya">Kenya</option>

            

            <option value="Kiribati">Kiribati</option>

            

            <option value="Korea, Democratic People's Republic">Korea, Democratic People's Republic</option>

            

            <option value="Korea, Republic of">Korea, Republic of</option>

            

            <option value="Kuwait">Kuwait</option>

            

            <option value="Kyrgyzstan">Kyrgyzstan</option>

            

            <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>

            

            <option value="Latvia">Latvia</option>

            

            <option value="Lebanon">Lebanon</option>

            

            <option value="Lesotho">Lesotho</option>

            

            <option value="Liberia">Liberia</option>

            

            <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>

            

            <option value="Liechtenstein">Liechtenstein</option>

            

            <option value="Lithuania">Lithuania</option>

            

            <option value="Luxembourg">Luxembourg</option>

            

            <option value="Macau">Macau</option>

            

            <option value="Macedonia (Yugoslav Republic)">Macedonia (Yugoslav Republic)</option>

            

            <option value="Madagascar">Madagascar</option>

            

            <option value="Malawi">Malawi</option>

            

            <option value="Malaysia">Malaysia</option>

            

            <option value="Maldives">Maldives</option>

            

            <option value="Mali">Mali</option>

            

            <option value="Malta">Malta</option>

            

            <option value="Marshall Islands">Marshall Islands</option>

            

            <option value="Martinique">Martinique</option>

            

            <option value="Mauritania">Mauritania</option>

            

            <option value="Mauritius">Mauritius</option>

            

            <option value="Mayotte">Mayotte</option>

            

            <option value="Mexico">Mexico</option>

            

            <option value="Micronesia">Micronesia</option>

            

            <option value="Moldova">Moldova</option>

            

            <option value="Monaco">Monaco</option>

            

            <option value="Mongolia">Mongolia</option>

            

            <option value="Montserrat">Montserrat</option>

            

            <option value="Morocco">Morocco</option>

            

            <option value="Mozambique">Mozambique</option>

            

            <option value="Myanmar">Myanmar</option>

            

            <option value="Namibia">Namibia</option>

            

            <option value="Nauru">Nauru</option>

            

            <option value="Nepal">Nepal</option>

            

            <option value="Netherlands">Netherlands</option>

            

            <option value="Netherlands Antilles">Netherlands Antilles</option>

            

            <option value="New Caledonia">New Caledonia</option>

            

            <option value="New Zealand">New Zealand</option>

            

            <option value="Nicaragua">Nicaragua</option>

            

            <option value="Niger">Niger</option>

            

            <option value="Nigeria">Nigeria</option>

            

            <option value="Niue">Niue</option>

            

            <option value="Norfolk island">Norfolk island</option>

            

            <option value="Northern Mariana Islands">Northern Mariana Islands</option>

            

            <option value="Norway">Norway</option>

            

            <option value="Oman">Oman</option>

            

            <option value="Pakistan">Pakistan</option>

            

            <option value="Palau">Palau</option>

            

            <option value="Panama">Panama</option>

            

            <option value="Papua New Guinea">Papua New Guinea</option>

            

            <option value="Paraguay">Paraguay</option>

            

            <option value="Peru">Peru</option>

            

            <option value="Philippines">Philippines</option>

            

            <option value="Pitcairn">Pitcairn</option>

            

            <option value="Poland">Poland</option>

            

            <option value="Portugal">Portugal</option>

            

            <option value="Puerto Rico">Puerto Rico</option>

            

            <option value="Qatar">Qatar</option>

            

            <option value="Reunion">Reunion</option>

            

            <option value="Romania">Romania</option>

            

            <option value="Russian Federation">Russian Federation</option>

            

            <option value="Rwanda">Rwanda</option>

            

            <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>

            

            <option value="Saint Lucia">Saint Lucia</option>

            

            <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>

            

            <option value="Samoa">Samoa</option>

            

            <option value="San Marino">San Marino</option>

            

            <option value="Sao Tome and Principe">Sao Tome and Principe</option>

            

            <option value="Saudi Arabia">Saudi Arabia</option>

            

            <option value="Senegal">Senegal</option>

            

            <option value="Seychelles">Seychelles</option>

            

            <option value="Sierra Leone">Sierra Leone</option>

            

            <option value="Singapore">Singapore</option>

            

            <option value="Slovakia (Slovak Republic)">Slovakia (Slovak Republic)</option>

            

            <option value="Slovenia">Slovenia</option>

            

            <option value="Solomon Islands">Solomon Islands</option>

            

            <option value="Somalia">Somalia</option>

            

            <option value="South Africa">South Africa</option>

            

            <option value="South Georgia">South Georgia</option>

            

            <option value="Spain">Spain</option>

            

            <option value="Sri Lanka">Sri Lanka</option>

            

            <option value="St Helena">St Helena</option>

            

            <option value="St Pierre and Miquelon">St Pierre and Miquelon</option>

            

            <option value="Sudan">Sudan</option>

            

            <option value="Suriname">Suriname</option>

            

            <option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>

            

            <option value="Swaziland">Swaziland</option>

            

            <option value="Sweden">Sweden</option>

            

            <option value="Switzerland">Switzerland</option>

            

            <option value="Syrian Arab Republic">Syrian Arab Republic</option>

            

            <option value="Taiwan">Taiwan</option>

            

            <option value="Tajikistan">Tajikistan</option>

            

            <option value="Tanzania, United Republic of">Tanzania, United Republic of</option>

            

            <option value="Thailand">Thailand</option>

            

            <option value="Togo">Togo</option>

            

            <option value="Tokelau">Tokelau</option>

            

            <option value="Tonga">Tonga</option>

            

            <option value="Trinidad and Tobago">Trinidad and Tobago</option>

            

            <option value="Tunisia">Tunisia</option>

            

            <option value="Turkey">Turkey</option>

            

            <option value="Turkmenistan">Turkmenistan</option>

            

            <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>

            

            <option value="Tuvalu">Tuvalu</option>

            

            <option value="Uganda">Uganda</option>

            

            <option value="Ukraine">Ukraine</option>

            

            <option value="United Arab Emirates">United Arab Emirates</option>

            

            <option value="United Kingdom">United Kingdom</option>

            

            <option value="United States">United States</option>

            

            <option value="Uruguay">Uruguay</option>

            

            <option value="Uzbekistan">Uzbekistan</option>

            

            <option value="Vanuatu">Vanuatu</option>

            

            <option value="Venezuela">Venezuela</option>

            

            <option value="Vietnam">Vietnam</option>

            

            <option value="Virgin Islands (British)">Virgin Islands (British)</option>

            

            <option value="Virgin Islands (US)">Virgin Islands (US)</option>

            

            <option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>

            

            <option value="Western Sahara">Western Sahara</option>

            

            <option value="Yemen">Yemen</option>

            

            <option value="Yugoslavia">Yugoslavia</option>

            

            <option value="Zambia">Zambia</option>

            

            <option value="Zimbabwe">Zimbabwe</option>

            

          </select></div></td>

      </tr>      

    

        <tr>

	  	<td align="left" width="171"><table cellpadding="0" width="100%" cellspacing="0" border="0"><tr>

	  	      <td>Rent</td><td align="right">$ </td></tr></table></td>

        <td  width="568"><input name="chPreviousRent" value=""   type="text" size="4" maxlength="50"> 

        pw

        <img src="images/spacer.gif" height="1" width="42" border="0">Length of tenancy<img src="images/spacer.gif" height="1" width="22" border="0">

        <input name="chPreviousTimeAtAddress" value="" type="Text" size="16" maxlength="20"> 

	  </tr>

      

               

      <tr>

	  	<td align="left" width="171">Was bond refunded in full?</td>

        <td  width="568"><input name="chPreviousBondRefund"  value="" type="text" size="4" maxlength="10"> 

        <img src="images/spacer.gif" width="62" height="1" border="0">If not, why not? 

         <img src="images/spacer.gif" width="37" height="1" border="0"><input name="chPreviousBondRefundExcuse"  value=""  type="Text" style="width:199px" maxlength="50">

	  </tr>

      

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      

      <tr>

        <td class="navytext" colspan="2"><strong>Contact Details of Previous Landlord or Agent if less than 3 years:</strong></td>

      </tr> 

      	 

      <tr> 

             <td align="left">Agency Name</td>

            <td><input name="chPreviousAgencyName" value="" maxlength="100"  type="Text" style="width:436px;"></td>

          </tr> 

           <tr><td class="navytext" colspan="2"><strong>Or</strong></td>

          </tr> 

          <tr> 

         <td align="left">Landlord's Name</td>

        <td><input name="chPreviousLandlordFirstName" value="" maxlength="50"  type="Text" size="16"> 

        <input name="chPreviousLandlordSurname" value="" maxlength="50"  type="Text" size="16">

		</td>

      </tr>  

      

      <tr> 

        <td class="navytext"><b>Address of agent/landlord:</b></td>

		<td class="searchgreentext">
		<input name="chPreviousAgentInternational1" onClick="setPreviousAgentInternationalNode(0)"  class="formcheckbox" checked="true" type="Radio" value="V1">

		  <span class="navytext"> AUSTRALIAN</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

		  <input  class="formcheckbox"  onClick="setPreviousAgentInternationalNode(1)" name="chPreviousAgentInternational" type="Radio" value="V1" checked="true">

	    <span class="navytext"> INTERNATIONAL</span></td>

      </tr>

      

       <tr> 

         <td align="left">Type of Residence</td>

        <td valign="Bottom" align="left" ><select name="chPreviousAgentPrefix" onChange=				"if((this.value=='')||(this.value=='null')){document.getElementById('chPreviousAgentFlatNo').style.display='none';document.getElementById('lblPreviousAgentFlatNo').style.display='none';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentStreetNo.focus()};}else{document.getElementById('chPreviousAgentFlatNo').style.display='inline';document.getElementById('lblPreviousAgentFlatNo').style.display='inline';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentFlatNo.focus()}};if(this.value=='-----'){this.value='';document.getElementById('chPreviousAgentFlatNo').style.display='none';document.getElementById('lblPreviousAgentFlatNo').style.display='none';};" style="width:113px;">

                    <option value="null">(Select)</option>

                    <option value="" SELECTED>HOUSE</option>

                    <option value="UNIT" >UNIT</option>

                    <option value="APARTMENT" >APARTMENT</option>

                    <option value="FLAT" >FLAT</option>

                    <option value="STUDIO" >STUDIO</option>

                

				<option value="-----" >

                        -----</option>

				

				<option value="BLOCK" >

                        BLOCK</option>

				

				<option value="CABIN" >

                        CABIN</option>

				

				<option value="COTTAGE" >

                        COTTAGE</option>

				

				<option value="DUPLEX" >

                        DUPLEX</option>

				

				<option value="FACTORY" >

                        FACTORY</option>

				

				<option value="FLOOR" >

                        FLOOR</option>

				

				<option value="LOT" >

                        LOT</option>

				

				<option value="PIER" >

                        PIER</option>

				

				<option value="ROOFTOP" >

                        ROOFTOP</option>

				

				<option value="ROOM" >

                        ROOM</option>

				

				<option value="SHOP" >

                        SHOP</option>

				

				<option value="SUITE" >

                        SUITE</option>

				

				<option value="TOWNHOUSE" >

                        TOWNHOUSE</option>

				

				<option value="VILLA" >

                        VILLA</option>

				

				<option value="WAREHOUSE" >

                        WAREHOUSE</option>

				

              </select><div id="lblPreviousAgentFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="chPreviousAgentFlatNo"  value="" id="chPreviousAgentFlatNo" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"><img src="images/spacer.gif" width="2" border="0">Str. No.&nbsp;<input name="chPreviousAgentStreetNo" value=""  type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>

      </tr>

      	 

      

         <tr>

        <td align="left" >Street Name</td>

        <td valign="Bottom" align="left" ><input name="chPreviousAgentStreetName" value=""  type="Text" size="16"><img src="images/spacer.gif" width="46" height="1" border="0"><select name="chPreviousAgentStreetType" onChange="if(this.value=='-----'){this.value='';};if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentSuburb.focus()};"><option value="">(Street Type)</option>

                

					 <option value="STREET" >

                            STREET</option>

								

					 <option value="ROAD" >

                            ROAD</option>

								

					 <option value="AVENUE" >

                            AVENUE</option>

								

					 <option value="PLACE" >

                            PLACE</option>

								

					 <option value="CRESCENT" >

                            CRESCENT</option>

								

					 <option value="DRIVE" >

                            DRIVE</option>

								

					 <option value="PARADE" >

                            PARADE</option>

								

					 <option value="CLOSE" >

                            CLOSE</option>

								

					 <option value="-----" >

                            -----</option>

								

					 <option value="ACCESS" >

                            ACCESS</option>

								

					 <option value="ALLEY" >

                            ALLEY</option>

								

					 <option value="ALLEYWAY" >

                            ALLEYWAY</option>

								

					 <option value="AMBLE" >

                            AMBLE</option>

								

					 <option value="ANCHORAGE" >

                            ANCHORAGE</option>

								

					 <option value="APPROACH" >

                            APPROACH</option>

								

					 <option value="ARCADE" >

                            ARCADE</option>

								

					 <option value="ARTERY" >

                            ARTERY</option>

								

					 <option value="BASIN" >

                            BASIN</option>

								

					 <option value="BEACH" >

                            BEACH</option>

								

					 <option value="BEND" >

                            BEND</option>

								

					 <option value="BLOCK" >

                            BLOCK</option>

								

					 <option value="BOULEVARD" >

                            BOULEVARD</option>

								

					 <option value="BOULEVARDE" >

                            BOULEVARDE</option>

								

					 <option value="BRACE" >

                            BRACE</option>

								

					 <option value="BRAE" >

                            BRAE</option>

								

					 <option value="BREAK" >

                            BREAK</option>

								

					 <option value="BRIDGE" >

                            BRIDGE</option>

								

					 <option value="BROADWAY" >

                            BROADWAY</option>

								

					 <option value="BROW" >

                            BROW</option>

								

					 <option value="BYPASS" >

                            BYPASS</option>

								

					 <option value="BYWAY" >

                            BYWAY</option>

								

					 <option value="CAUSEWAY" >

                            CAUSEWAY</option>

								

					 <option value="CENTRAL" >

                            CENTRAL</option>

								

					 <option value="CENTRE" >

                            CENTRE</option>

								

					 <option value="CENTREWAY" >

                            CENTREWAY</option>

								

					 <option value="CHASE" >

                            CHASE</option>

								

					 <option value="CIRCLE" >

                            CIRCLE</option>

								

					 <option value="CIRCLET" >

                            CIRCLET</option>

								

					 <option value="CIRCUIT" >

                            CIRCUIT</option>

								

					 <option value="CIRCUS" >

                            CIRCUS</option>

								

					 <option value="COLONNADE" >

                            COLONNADE</option>

								

					 <option value="COMMON" >

                            COMMON</option>

								

					 <option value="CONCOURSE" >

                            CONCOURSE</option>

								

					 <option value="COPSE" >

                            COPSE</option>

								

					 <option value="CORNER" >

                            CORNER</option>

								

					 <option value="CORSO" >

                            CORSO</option>

								

					 <option value="COURT" >

                            COURT</option>

								

					 <option value="COURTYARD" >

                            COURTYARD</option>

								

					 <option value="COVE" >

                            COVE</option>

								

					 <option value="CREST" >

                            CREST</option>

								

					 <option value="CROSS" >

                            CROSS</option>

								

					 <option value="CROSSING" >

                            CROSSING</option>

								

					 <option value="CROSSROAD" >

                            CROSSROAD</option>

								

					 <option value="CROSSWAY" >

                            CROSSWAY</option>

								

					 <option value="CRUISEWAY" >

                            CRUISEWAY</option>

								

					 <option value="CUL-DE-SAC" >

                            CUL-DE-SAC</option>

								

					 <option value="CUTTING" >

                            CUTTING</option>

								

					 <option value="DALE" >

                            DALE</option>

								

					 <option value="DELL" >

                            DELL</option>

								

					 <option value="DEVIATION" >

                            DEVIATION</option>

								

					 <option value="DIP" >

                            DIP</option>

								

					 <option value="DISTRIBUTOR" >

                            DISTRIBUTOR</option>

								

					 <option value="DRIVEWAY" >

                            DRIVEWAY</option>

								

					 <option value="EAST" >

                            EAST</option>

								

					 <option value="EDGE" >

                            EDGE</option>

								

					 <option value="ELBOW" >

                            ELBOW</option>

								

					 <option value="END" >

                            END</option>

								

					 <option value="ENTRANCE" >

                            ENTRANCE</option>

								

					 <option value="ESPLANADE" >

                            ESPLANADE</option>

								

					 <option value="ESTATE" >

                            ESTATE</option>

								

					 <option value="EXPRESSWAY" >

                            EXPRESSWAY</option>

								

					 <option value="EXTENSION" >

                            EXTENSION</option>

								

					 <option value="EXTENSION" >

                            EXTENSION</option>

								

					 <option value="FAIRWAY" >

                            FAIRWAY</option>

								

					 <option value="FIRE TRACK" >

                            FIRE TRACK</option>

								

					 <option value="FIRETRAIL" >

                            FIRETRAIL</option>

								

					 <option value="FLAT" >

                            FLAT</option>

								

					 <option value="FOLLOW" >

                            FOLLOW</option>

								

					 <option value="FOOTWAY" >

                            FOOTWAY</option>

								

					 <option value="FORESHORE" >

                            FORESHORE</option>

								

					 <option value="FORMATION" >

                            FORMATION</option>

								

					 <option value="FREEWAY" >

                            FREEWAY</option>

								

					 <option value="FRONT" >

                            FRONT</option>

								

					 <option value="FRONTAGE" >

                            FRONTAGE</option>

								

					 <option value="GAP" >

                            GAP</option>

								

					 <option value="GARDEN" >

                            GARDEN</option>

								

					 <option value="GARDENS" >

                            GARDENS</option>

								

					 <option value="GATE" >

                            GATE</option>

								

					 <option value="GATES" >

                            GATES</option>

								

					 <option value="GLADE" >

                            GLADE</option>

								

					 <option value="GLEN" >

                            GLEN</option>

								

					 <option value="GRANGE" >

                            GRANGE</option>

								

					 <option value="GREEN" >

                            GREEN</option>

								

					 <option value="GROUND" >

                            GROUND</option>

								

					 <option value="GROVE" >

                            GROVE</option>

								

					 <option value="GULLY" >

                            GULLY</option>

								

					 <option value="HEIGHTS" >

                            HEIGHTS</option>

								

					 <option value="HIGHROAD" >

                            HIGHROAD</option>

								

					 <option value="HIGHWAY" >

                            HIGHWAY</option>

								

					 <option value="HILL" >

                            HILL</option>

								

					 <option value="INTERCHANGE" >

                            INTERCHANGE</option>

								

					 <option value="INTERSECTION" >

                            INTERSECTION</option>

								

					 <option value="JUNCTION" >

                            JUNCTION</option>

								

					 <option value="KEY" >

                            KEY</option>

								

					 <option value="LANDING" >

                            LANDING</option>

								

					 <option value="LANE" >

                            LANE</option>

								

					 <option value="LANEWAY" >

                            LANEWAY</option>

								

					 <option value="LEES" >

                            LEES</option>

								

					 <option value="LINE" >

                            LINE</option>

								

					 <option value="LINK" >

                            LINK</option>

								

					 <option value="LITTLE" >

                            LITTLE</option>

								

					 <option value="LOOKOUT" >

                            LOOKOUT</option>

								

					 <option value="LOOP" >

                            LOOP</option>

								

					 <option value="LOWER" >

                            LOWER</option>

								

					 <option value="LOWER" >

                            LOWER</option>

								

					 <option value="MALL" >

                            MALL</option>

								

					 <option value="MEANDER" >

                            MEANDER</option>

								

					 <option value="MEW" >

                            MEW</option>

								

					 <option value="MEWS" >

                            MEWS</option>

								

					 <option value="MOTORWAY" >

                            MOTORWAY</option>

								

					 <option value="MOUNT" >

                            MOUNT</option>

								

					 <option value="NOOK" >

                            NOOK</option>

								

					 <option value="NORTH" >

                            NORTH</option>

								

					 <option value="NORTH EAST" >

                            NORTH EAST</option>

								

					 <option value="NORTH WEST" >

                            NORTH WEST</option>

								

					 <option value="OUTLOOK" >

                            OUTLOOK</option>

								

					 <option value="PARK" >

                            PARK</option>

								

					 <option value="PARKLANDS" >

                            PARKLANDS</option>

								

					 <option value="PARKWAY" >

                            PARKWAY</option>

								

					 <option value="PART" >

                            PART</option>

								

					 <option value="PASS" >

                            PASS</option>

								

					 <option value="PATH" >

                            PATH</option>

								

					 <option value="PATHWAY" >

                            PATHWAY</option>

								

					 <option value="PIAZZA" >

                            PIAZZA</option>

								

					 <option value="PLATEAU" >

                            PLATEAU</option>

								

					 <option value="PLAZA" >

                            PLAZA</option>

								

					 <option value="POCKET" >

                            POCKET</option>

								

					 <option value="POINT" >

                            POINT</option>

								

					 <option value="PORT" >

                            PORT</option>

								

					 <option value="PROMENADE" >

                            PROMENADE</option>

								

					 <option value="QUAD" >

                            QUAD</option>

								

					 <option value="QUADRANGLE" >

                            QUADRANGLE</option>

								

					 <option value="QUADRANT" >

                            QUADRANT</option>

								

					 <option value="QUAY" >

                            QUAY</option>

								

					 <option value="QUAYS" >

                            QUAYS</option>

								

					 <option value="RAMBLE" >

                            RAMBLE</option>

								

					 <option value="RAMP" >

                            RAMP</option>

								

					 <option value="RANGE" >

                            RANGE</option>

								

					 <option value="REACH" >

                            REACH</option>

								

					 <option value="RESERVE" >

                            RESERVE</option>

								

					 <option value="REST" >

                            REST</option>

								

					 <option value="RETREAT" >

                            RETREAT</option>

								

					 <option value="RIDE" >

                            RIDE</option>

								

					 <option value="RIDGE" >

                            RIDGE</option>

								

					 <option value="RIDGEWAY" >

                            RIDGEWAY</option>

								

					 <option value="RIGHT OF WAY" >

                            RIGHT OF WAY</option>

								

					 <option value="RING" >

                            RING</option>

								

					 <option value="RISE" >

                            RISE</option>

								

					 <option value="RIVER" >

                            RIVER</option>

								

					 <option value="RIVERWAY" >

                            RIVERWAY</option>

								

					 <option value="RIVIERA" >

                            RIVIERA</option>

								

					 <option value="ROADS" >

                            ROADS</option>

								

					 <option value="ROADSIDE" >

                            ROADSIDE</option>

								

					 <option value="ROADWAY" >

                            ROADWAY</option>

								

					 <option value="RONDE" >

                            RONDE</option>

								

					 <option value="ROSEBOWL" >

                            ROSEBOWL</option>

								

					 <option value="ROTARY" >

                            ROTARY</option>

								

					 <option value="ROUND" >

                            ROUND</option>

								

					 <option value="ROUTE" >

                            ROUTE</option>

								

					 <option value="ROW" >

                            ROW</option>

								

					 <option value="RUE" >

                            RUE</option>

								

					 <option value="RUN" >

                            RUN</option>

								

					 <option value="SERVICE WAY" >

                            SERVICE WAY</option>

								

					 <option value="SIDING" >

                            SIDING</option>

								

					 <option value="SLOPE" >

                            SLOPE</option>

								

					 <option value="SOUND" >

                            SOUND</option>

								

					 <option value="SOUTH" >

                            SOUTH</option>

								

					 <option value="SOUTH EAST" >

                            SOUTH EAST</option>

								

					 <option value="SOUTH WEST" >

                            SOUTH WEST</option>

								

					 <option value="SPUR" >

                            SPUR</option>

								

					 <option value="SQUARE" >

                            SQUARE</option>

								

					 <option value="STAIRS" >

                            STAIRS</option>

								

					 <option value="STATE HIGHWAY" >

                            STATE HIGHWA</option>

								

					 <option value="STEPS" >

                            STEPS</option>

								

					 <option value="STEYNE" >

                            STEYNE</option>

								

					 <option value="STRAND" >

                            STRAND</option>

								

					 <option value="STRIP" >

                            STRIP</option>

								

					 <option value="SUBWAY" >

                            SUBWAY</option>

								

					 <option value="TARN" >

                            TARN</option>

								

					 <option value="TERRACE" >

                            TERRACE</option>

								

					 <option value="THOROUGHFARE" >

                            THOROUGHFARE</option>

								

					 <option value="TOLLWAY" >

                            TOLLWAY</option>

								

					 <option value="TOP" >

                            TOP</option>

								

					 <option value="TOR" >

                            TOR</option>

								

					 <option value="TOWERS" >

                            TOWERS</option>

								

					 <option value="TRACK" >

                            TRACK</option>

								

					 <option value="TRAIL" >

                            TRAIL</option>

								

					 <option value="TRAILER" >

                            TRAILER</option>

								

					 <option value="TRIANGLE" >

                            TRIANGLE</option>

								

					 <option value="TRUNKWAY" >

                            TRUNKWAY</option>

								

					 <option value="TURN" >

                            TURN</option>

								

					 <option value="UNDERPASS" >

                            UNDERPASS</option>

								

					 <option value="UPPER" >

                            UPPER</option>

								

					 <option value="UPPER" >

                            UPPER</option>

								

					 <option value="VALE" >

                            VALE</option>

								

					 <option value="VIADUCT" >

                            VIADUCT</option>

								

					 <option value="VIEW" >

                            VIEW</option>

								

					 <option value="VILLAS" >

                            VILLAS</option>

								

					 <option value="VISTA" >

                            VISTA</option>

								

					 <option value="WADE" >

                            WADE</option>

								

					 <option value="WALK" >

                            WALK</option>

								

					 <option value="WALKWAY" >

                            WALKWAY</option>

								

					 <option value="WAY" >

                            WAY</option>

								

					 <option value="WEST" >

                            WEST</option>

								

					 <option value="WHARF" >

                            WHARF</option>

								

					 <option value="WYND" >

                            WYND</option>

								

					 <option value="YARD" >

                            YARD</option>

								

              </select></td>

      </tr>

            

      

      <tr> 

        <td align="left"><div id="objPreviousAgentAus1">Suburb</div></td>

        <td align="left"><div id="objPreviousAgentAus2"><input name="chPreviousAgentSuburb"  value="" type="Text" size="16"> 

        State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chPreviousAgentState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentPostcode.focus()};">

					<option value=""></option>

            			

             <option value="ACT" >

                            ACT</option>

            			

             <option value="NSW" >

                            NSW</option>

            			

             <option value="NT" >

                            NT</option>

            			

             <option value="QLD" >

                            QLD</option>

            			

             <option value="SA" >

                            SA</option>

            			

             <option value="TAS" >

                            TAS</option>

            			

             <option value="VIC" >

                            VIC</option>

            			

             <option value="WA " >

                            WA </option>

            



          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="chPreviousAgentPostcode" value="" type="Text" size="4" maxlength="4">  </div></td>

      </tr> 

      	 

      

      <tr> 

        <td align="left" ><div id="objPreviousAgentInt1" style="display:none">Suburb</div></td>

        <td align="left" ><div id="objPreviousAgentInt2" style="display:none"><input name="chPreviousAgentIntSuburb" type="Text" size="16"> City&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="chPreviousAgentIntCity" type="Text" size="16"> State/County <input name="chPreviousAgentIntState" type="Text" size="16"></div></td>

      </tr>  

      

       <tr> 

        <td height="3" align="left"><div id="objPreviousAgentInt3"  style="display:none">PostCode/ZIP</div></td>

        <td height="3"><div id="objPreviousAgentInt4"  style="display:none"><input name="chPreviousAgentIntPostcode" type="Text" size="16"> Country <select name="chPreviousAgentIntCountry"><option value="">(Select Country)</option>

            

            <option value="Afghanistan">Afghanistan</option>

            

            <option value="Albania">Albania</option>

            

            <option value="Algeria">Algeria</option>

            

            <option value="American Samoa">American Samoa</option>

            

            <option value="Andorra">Andorra</option>

            

            <option value="Angola">Angola</option>

            

            <option value="Anguilla">Anguilla</option>

            

            <option value="Antarctica">Antarctica</option>

            

            <option value="Antigua and Barbuda">Antigua and Barbuda</option>

            

            <option value="Argentina">Argentina</option>

            

            <option value="Armenia">Armenia</option>

            

            <option value="Aruba">Aruba</option>

            

            <option value="Austria">Austria</option>

            

            <option value="Azerbaijan">Azerbaijan</option>

            

            <option value="Bahamas">Bahamas</option>

            

            <option value="Bahrain">Bahrain</option>

            

            <option value="Bangladesh">Bangladesh</option>

            

            <option value="Barbados">Barbados</option>

            

            <option value="Belarus">Belarus</option>

            

            <option value="Belgium">Belgium</option>

            

            <option value="Belize">Belize</option>

            

            <option value="Benin">Benin</option>

            

            <option value="Bermuda">Bermuda</option>

            

            <option value="Bhutan">Bhutan</option>

            

            <option value="Bolivia">Bolivia</option>

            

            <option value="Bosnia and Herzegowina">Bosnia and Herzegowina</option>

            

            <option value="Botswana">Botswana</option>

            

            <option value="Bouvet Island">Bouvet Island</option>

            

            <option value="Brazil">Brazil</option>

            

            <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>

            

            <option value="Brunei Darussalam">Brunei Darussalam</option>

            

            <option value="Bulgaria">Bulgaria</option>

            

            <option value="Burkina Faso">Burkina Faso</option>

            

            <option value="Burundi">Burundi</option>

            

            <option value="Cambodia">Cambodia</option>

            

            <option value="Cameroon">Cameroon</option>

            

            <option value="Canada">Canada</option>

            

            <option value="Cape Verde">Cape Verde</option>

            

            <option value="Cayman islands">Cayman islands</option>

            

            <option value="Central African Republic">Central African Republic</option>

            

            <option value="Chad">Chad</option>

            

            <option value="Chile">Chile</option>

            

            <option value="China">China</option>

            

            <option value="Christmas Island">Christmas Island</option>

            

            <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>

            

            <option value="Colombia">Colombia</option>

            

            <option value="Comoros">Comoros</option>

            

            <option value="Congo">Congo</option>

            

            <option value="Congo, Democratic Republic">Congo, Democratic Republic</option>

            

            <option value="Cook Islands">Cook Islands</option>

            

            <option value="Costa Rica">Costa Rica</option>

            

            <option value="Cote d'ivoire">Cote d'ivoire</option>

            

            <option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>

            

            <option value="Cuba">Cuba</option>

            

            <option value="Cyprus">Cyprus</option>

            

            <option value="Czech Republic">Czech Republic</option>

            

            <option value="Denmark">Denmark</option>

            

            <option value="Djibouti">Djibouti</option>

            

            <option value="Dominica">Dominica</option>

            

            <option value="Dominican Republic">Dominican Republic</option>

            

            <option value="East Timor">East Timor</option>

            

            <option value="Ecuador">Ecuador</option>

            

            <option value="Egypt">Egypt</option>

            

            <option value="El Salvador">El Salvador</option>

            

            <option value="Equatorial Guinea">Equatorial Guinea</option>

            

            <option value="Eritrea">Eritrea</option>

            

            <option value="Estonia">Estonia</option>

            

            <option value="Ethiopia">Ethiopia</option>

            

            <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>

            

            <option value="Faroe islands">Faroe islands</option>

            

            <option value="Fiji">Fiji</option>

            

            <option value="Finland">Finland</option>

            

            <option value="France">France</option>

            

            <option value="France, Metropolitan">France, Metropolitan</option>

            

            <option value="French Guiana">French Guiana</option>

            

            <option value="French Polynesia">French Polynesia</option>

            

            <option value="French Southern Territories">French Southern Territories</option>

            

            <option value="Gabon">Gabon</option>

            

            <option value="Gambia">Gambia</option>

            

            <option value="Georgia">Georgia</option>

            

            <option value="Germany">Germany</option>

            

            <option value="Ghana">Ghana</option>

            

            <option value="Gibraltar">Gibraltar</option>

            

            <option value="Greece">Greece</option>

            

            <option value="Greenland">Greenland</option>

            

            <option value="Grenada">Grenada</option>

            

            <option value="Guadeloupe">Guadeloupe</option>

            

            <option value="Guam">Guam</option>

            

            <option value="Guatemala">Guatemala</option>

            

            <option value="Guinea">Guinea</option>

            

            <option value="Guinea-Bissau">Guinea-Bissau</option>

            

            <option value="Guyana">Guyana</option>

            

            <option value="Haiti">Haiti</option>

            

            <option value="Heard and Mc Donald Islands">Heard and Mc Donald Islands</option>

            

            <option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>

            

            <option value="Honduras">Honduras</option>

            

            <option value="Hong Kong">Hong Kong</option>

            

            <option value="Hungary">Hungary</option>

            

            <option value="Iceland">Iceland</option>

            

            <option value="India">India</option>

            

            <option value="Indonesia">Indonesia</option>

            

            <option value="Iran (Islamic Republic of)">Iran (Islamic Republic of)</option>

            

            <option value="Iraq">Iraq</option>

            

            <option value="Ireland">Ireland</option>

            

            <option value="Israel">Israel</option>

            

            <option value="Italy">Italy</option>

            

            <option value="Jamaica">Jamaica</option>

            

            <option value="Japan">Japan</option>

            

            <option value="Jordan">Jordan</option>

            

            <option value="Kazakhstan">Kazakhstan</option>

            

            <option value="Kenya">Kenya</option>

            

            <option value="Kiribati">Kiribati</option>

            

            <option value="Korea, Democratic People's Republic">Korea, Democratic People's Republic</option>

            

            <option value="Korea, Republic of">Korea, Republic of</option>

            

            <option value="Kuwait">Kuwait</option>

            

            <option value="Kyrgyzstan">Kyrgyzstan</option>

            

            <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>

            

            <option value="Latvia">Latvia</option>

            

            <option value="Lebanon">Lebanon</option>

            

            <option value="Lesotho">Lesotho</option>

            

            <option value="Liberia">Liberia</option>

            

            <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>

            

            <option value="Liechtenstein">Liechtenstein</option>

            

            <option value="Lithuania">Lithuania</option>

            

            <option value="Luxembourg">Luxembourg</option>

            

            <option value="Macau">Macau</option>

            

            <option value="Macedonia (Yugoslav Republic)">Macedonia (Yugoslav Republic)</option>

            

            <option value="Madagascar">Madagascar</option>

            

            <option value="Malawi">Malawi</option>

            

            <option value="Malaysia">Malaysia</option>

            

            <option value="Maldives">Maldives</option>

            

            <option value="Mali">Mali</option>

            

            <option value="Malta">Malta</option>

            

            <option value="Marshall Islands">Marshall Islands</option>

            

            <option value="Martinique">Martinique</option>

            

            <option value="Mauritania">Mauritania</option>

            

            <option value="Mauritius">Mauritius</option>

            

            <option value="Mayotte">Mayotte</option>

            

            <option value="Mexico">Mexico</option>

            

            <option value="Micronesia">Micronesia</option>

            

            <option value="Moldova">Moldova</option>

            

            <option value="Monaco">Monaco</option>

            

            <option value="Mongolia">Mongolia</option>

            

            <option value="Montserrat">Montserrat</option>

            

            <option value="Morocco">Morocco</option>

            

            <option value="Mozambique">Mozambique</option>

            

            <option value="Myanmar">Myanmar</option>

            

            <option value="Namibia">Namibia</option>

            

            <option value="Nauru">Nauru</option>

            

            <option value="Nepal">Nepal</option>

            

            <option value="Netherlands">Netherlands</option>

            

            <option value="Netherlands Antilles">Netherlands Antilles</option>

            

            <option value="New Caledonia">New Caledonia</option>

            

            <option value="New Zealand">New Zealand</option>

            

            <option value="Nicaragua">Nicaragua</option>

            

            <option value="Niger">Niger</option>

            

            <option value="Nigeria">Nigeria</option>

            

            <option value="Niue">Niue</option>

            

            <option value="Norfolk island">Norfolk island</option>

            

            <option value="Northern Mariana Islands">Northern Mariana Islands</option>

            

            <option value="Norway">Norway</option>

            

            <option value="Oman">Oman</option>

            

            <option value="Pakistan">Pakistan</option>

            

            <option value="Palau">Palau</option>

            

            <option value="Panama">Panama</option>

            

            <option value="Papua New Guinea">Papua New Guinea</option>

            

            <option value="Paraguay">Paraguay</option>

            

            <option value="Peru">Peru</option>

            

            <option value="Philippines">Philippines</option>

            

            <option value="Pitcairn">Pitcairn</option>

            

            <option value="Poland">Poland</option>

            

            <option value="Portugal">Portugal</option>

            

            <option value="Puerto Rico">Puerto Rico</option>

            

            <option value="Qatar">Qatar</option>

            

            <option value="Reunion">Reunion</option>

            

            <option value="Romania">Romania</option>

            

            <option value="Russian Federation">Russian Federation</option>

            

            <option value="Rwanda">Rwanda</option>

            

            <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>

            

            <option value="Saint Lucia">Saint Lucia</option>

            

            <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>

            

            <option value="Samoa">Samoa</option>

            

            <option value="San Marino">San Marino</option>

            

            <option value="Sao Tome and Principe">Sao Tome and Principe</option>

            

            <option value="Saudi Arabia">Saudi Arabia</option>

            

            <option value="Senegal">Senegal</option>

            

            <option value="Seychelles">Seychelles</option>

            

            <option value="Sierra Leone">Sierra Leone</option>

            

            <option value="Singapore">Singapore</option>

            

            <option value="Slovakia (Slovak Republic)">Slovakia (Slovak Republic)</option>

            

            <option value="Slovenia">Slovenia</option>

            

            <option value="Solomon Islands">Solomon Islands</option>

            

            <option value="Somalia">Somalia</option>

            

            <option value="South Africa">South Africa</option>

            

            <option value="South Georgia">South Georgia</option>

            

            <option value="Spain">Spain</option>

            

            <option value="Sri Lanka">Sri Lanka</option>

            

            <option value="St Helena">St Helena</option>

            

            <option value="St Pierre and Miquelon">St Pierre and Miquelon</option>

            

            <option value="Sudan">Sudan</option>

            

            <option value="Suriname">Suriname</option>

            

            <option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>

            

            <option value="Swaziland">Swaziland</option>

            

            <option value="Sweden">Sweden</option>

            

            <option value="Switzerland">Switzerland</option>

            

            <option value="Syrian Arab Republic">Syrian Arab Republic</option>

            

            <option value="Taiwan">Taiwan</option>

            

            <option value="Tajikistan">Tajikistan</option>

            

            <option value="Tanzania, United Republic of">Tanzania, United Republic of</option>

            

            <option value="Thailand">Thailand</option>

            

            <option value="Togo">Togo</option>

            

            <option value="Tokelau">Tokelau</option>

            

            <option value="Tonga">Tonga</option>

            

            <option value="Trinidad and Tobago">Trinidad and Tobago</option>

            

            <option value="Tunisia">Tunisia</option>

            

            <option value="Turkey">Turkey</option>

            

            <option value="Turkmenistan">Turkmenistan</option>

            

            <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>

            

            <option value="Tuvalu">Tuvalu</option>

            

            <option value="Uganda">Uganda</option>

            

            <option value="Ukraine">Ukraine</option>

            

            <option value="United Arab Emirates">United Arab Emirates</option>

            

            <option value="United Kingdom">United Kingdom</option>

            

            <option value="United States">United States</option>

            

            <option value="Uruguay">Uruguay</option>

            

            <option value="Uzbekistan">Uzbekistan</option>

            

            <option value="Vanuatu">Vanuatu</option>

            

            <option value="Venezuela">Venezuela</option>

            

            <option value="Vietnam">Vietnam</option>

            

            <option value="Virgin Islands (British)">Virgin Islands (British)</option>

            

            <option value="Virgin Islands (US)">Virgin Islands (US)</option>

            

            <option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>

            

            <option value="Western Sahara">Western Sahara</option>

            

            <option value="Yemen">Yemen</option>

            

            <option value="Yugoslavia">Yugoslavia</option>

            

            <option value="Zambia">Zambia</option>

            

            <option value="Zimbabwe">Zimbabwe</option>

            

          </select></div></td>

      </tr>

      

       <tr> 

         <td align="left">Phone</td>

        <td ><select name="chPreviousAgentPhone1" id="chPreviousAgentPhone1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentPhone2.focus()};">

		  		<option value="">(Area Code)</option>	

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>				

		  </select>

			  <input type="text" name="chPreviousAgentPhone2"  value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentPhone3.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			  <input type="text" name="chPreviousAgentPhone3" value=""  onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentMobilePhone1.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">



			<img src="images/spacer.gif" width="6" height="1" border="0"> Mobile<img src="images/spacer.gif" width="37" height="1" border="0"><input type="text" name="chPreviousAgentMobilePhone1" value=""  size="4" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentMobilePhone2.focus()};" onBlur="checkNumeric(this,1,'','','','','');">	

		  <input type="text" name="chPreviousAgentMobilePhone2" value=""  size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentMobilePhone3.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  <input type="text" name="chPreviousAgentMobilePhone3" value=""  size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentEmail.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		</td>

      </tr>

      

      

      <tr> 

         <td align="left">Email</td>

        <td><input name="chPreviousAgentEmail" value="" type="Text" style="width:199px;" onBlur="checkEmail(this);" maxlength="50">

		</td>

      </tr>

      

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      <tr>

	  	<td align="left" width="171" class="navytext"><strong>EMERGENCY CONTACT: <span class="redstar">*</span> </strong></td>

        <td  width="568">&nbsp;</td>

	  </tr>

      	 

      <tr>

	  	<td align="left" width="171">Name</td>

        <td  width="568"><input name="chContactFirstName" value=""  type="Text" size="16"> <input name="chContactSurname" value=""  type="Text" size="16"></td>

	  </tr>

      	 

      

       <tr> 

         <td align="left">Type of Residence</td>

        <td valign="Bottom" align="left" ><select name="chContactPrefix" onChange=				"if((this.value=='')||(this.value=='null')){document.getElementById('chContactFlatNo').style.display='none';document.getElementById('lblContactFlatNo').style.display='none';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactStreetNo.focus()};}else{document.getElementById('chContactFlatNo').style.display='inline';document.getElementById('lblContactFlatNo').style.display='inline';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactFlatNo.focus()}};if(this.value=='-----'){this.value='';document.getElementById('chContactFlatNo').style.display='none';document.getElementById('lblContactFlatNo').style.display='none';};" style="width:113px;">

                    <option value="null">(Select)</option>

                    <option value="" SELECTED>HOUSE</option>

                    <option value="UNIT" >UNIT</option>

                    <option value="APARTMENT" >APARTMENT</option>

                    <option value="FLAT" >FLAT</option>

                    <option value="STUDIO" >STUDIO</option>

                

			    <option value="-----" >

                        -----</option>

				

			    <option value="BLOCK" >

                        BLOCK</option>

				

			    <option value="CABIN" >

                        CABIN</option>

				

			    <option value="COTTAGE" >

                        COTTAGE</option>

				

			    <option value="DUPLEX" >

                        DUPLEX</option>

				

			    <option value="FACTORY" >

                        FACTORY</option>

				

			    <option value="FLOOR" >

                        FLOOR</option>

				

			    <option value="LOT" >

                        LOT</option>

				

			    <option value="PIER" >

                        PIER</option>

				

			    <option value="ROOFTOP" >

                        ROOFTOP</option>

				

			    <option value="ROOM" >

                        ROOM</option>

				

			    <option value="SHOP" >

                        SHOP</option>

				

			    <option value="SUITE" >

                        SUITE</option>

				

			    <option value="TOWNHOUSE" >

                        TOWNHOUSE</option>

				

			    <option value="VILLA" >

                        VILLA</option>

				

			    <option value="WAREHOUSE" >

                        WAREHOUSE</option>

				

              </select><div id="lblContactFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="chContactFlatNo" id="chContactFlatNo" value=""  type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"><img src="images/spacer.gif" width="2" border="0">Str. No.&nbsp;<input name="chContactStreetNo"  value=""  type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>

      </tr>

      	 

      

         <tr>

        <td align="left" >Street Name</td>

        <td valign="Bottom" align="left" ><input name="chContactStreetName" value="" type="Text" size="16"><img src="images/spacer.gif" width="46" height="1" border="0"><select name="chContactStreetType" onChange="if(this.value=='-----'){this.value='';};if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactSuburb.focus()};"><option value="">(Street Type)</option>

                

					  <option value="STREET" >

                            STREET</option>

								

					  <option value="ROAD" >

                            ROAD</option>

								

					  <option value="AVENUE" >

                            AVENUE</option>

								

					  <option value="PLACE" >

                            PLACE</option>

								

					  <option value="CRESCENT" >

                            CRESCENT</option>

								

					  <option value="DRIVE" >

                            DRIVE</option>

								

					  <option value="PARADE" >

                            PARADE</option>

								

					  <option value="CLOSE" >

                            CLOSE</option>

								

					  <option value="-----" >

                            -----</option>

								

					  <option value="ACCESS" >

                            ACCESS</option>

								

					  <option value="ALLEY" >

                            ALLEY</option>

								

					  <option value="ALLEYWAY" >

                            ALLEYWAY</option>

								

					  <option value="AMBLE" >

                            AMBLE</option>

								

					  <option value="ANCHORAGE" >

                            ANCHORAGE</option>

								

					  <option value="APPROACH" >

                            APPROACH</option>

								

					  <option value="ARCADE" >

                            ARCADE</option>

								

					  <option value="ARTERY" >

                            ARTERY</option>

								

					  <option value="BASIN" >

                            BASIN</option>

								

					  <option value="BEACH" >

                            BEACH</option>

								

					  <option value="BEND" >

                            BEND</option>

								

					  <option value="BLOCK" >

                            BLOCK</option>

								

					  <option value="BOULEVARD" >

                            BOULEVARD</option>

								

					  <option value="BOULEVARDE" >

                            BOULEVARDE</option>

								

					  <option value="BRACE" >

                            BRACE</option>

								

					  <option value="BRAE" >

                            BRAE</option>

								

					  <option value="BREAK" >

                            BREAK</option>

								

					  <option value="BRIDGE" >

                            BRIDGE</option>

								

					  <option value="BROADWAY" >

                            BROADWAY</option>

								

					  <option value="BROW" >

                            BROW</option>

								

					  <option value="BYPASS" >

                            BYPASS</option>

								

					  <option value="BYWAY" >

                            BYWAY</option>

								

					  <option value="CAUSEWAY" >

                            CAUSEWAY</option>

								

					  <option value="CENTRAL" >

                            CENTRAL</option>

								

					  <option value="CENTRE" >

                            CENTRE</option>

								

					  <option value="CENTREWAY" >

                            CENTREWAY</option>

								

					  <option value="CHASE" >

                            CHASE</option>

								

					  <option value="CIRCLE" >

                            CIRCLE</option>

								

					  <option value="CIRCLET" >

                            CIRCLET</option>

								

					  <option value="CIRCUIT" >

                            CIRCUIT</option>

								

					  <option value="CIRCUS" >

                            CIRCUS</option>

								

					  <option value="COLONNADE" >

                            COLONNADE</option>

								

					  <option value="COMMON" >

                            COMMON</option>

								

					  <option value="CONCOURSE" >

                            CONCOURSE</option>

								

					  <option value="COPSE" >

                            COPSE</option>

								

					  <option value="CORNER" >

                            CORNER</option>

								

					  <option value="CORSO" >

                            CORSO</option>

								

					  <option value="COURT" >

                            COURT</option>

								

					  <option value="COURTYARD" >

                            COURTYARD</option>

								

					  <option value="COVE" >

                            COVE</option>

								

					  <option value="CREST" >

                            CREST</option>

								

					  <option value="CROSS" >

                            CROSS</option>

								

					  <option value="CROSSING" >

                            CROSSING</option>

								

					  <option value="CROSSROAD" >

                            CROSSROAD</option>

								

					  <option value="CROSSWAY" >

                            CROSSWAY</option>

								

					  <option value="CRUISEWAY" >

                            CRUISEWAY</option>

								

					  <option value="CUL-DE-SAC" >

                            CUL-DE-SAC</option>

								

					  <option value="CUTTING" >

                            CUTTING</option>

								

					  <option value="DALE" >

                            DALE</option>

								

					  <option value="DELL" >

                            DELL</option>

								

					  <option value="DEVIATION" >

                            DEVIATION</option>

								

					  <option value="DIP" >

                            DIP</option>

								

					  <option value="DISTRIBUTOR" >

                            DISTRIBUTOR</option>

								

					  <option value="DRIVEWAY" >

                            DRIVEWAY</option>

								

					  <option value="EAST" >

                            EAST</option>

								

					  <option value="EDGE" >

                            EDGE</option>

								

					  <option value="ELBOW" >

                            ELBOW</option>

								

					  <option value="END" >

                            END</option>

								

					  <option value="ENTRANCE" >

                            ENTRANCE</option>

								

					  <option value="ESPLANADE" >

                            ESPLANADE</option>

								

					  <option value="ESTATE" >

                            ESTATE</option>

								

					  <option value="EXPRESSWAY" >

                            EXPRESSWAY</option>

								

					  <option value="EXTENSION" >

                            EXTENSION</option>

								

					  <option value="EXTENSION" >

                            EXTENSION</option>

								

					  <option value="FAIRWAY" >

                            FAIRWAY</option>

								

					  <option value="FIRE TRACK" >

                            FIRE TRACK</option>

								

					  <option value="FIRETRAIL" >

                            FIRETRAIL</option>

								

					  <option value="FLAT" >

                            FLAT</option>

								

					  <option value="FOLLOW" >

                            FOLLOW</option>

								

					  <option value="FOOTWAY" >

                            FOOTWAY</option>

								

					  <option value="FORESHORE" >

                            FORESHORE</option>

								

					  <option value="FORMATION" >

                            FORMATION</option>

								

					  <option value="FREEWAY" >

                            FREEWAY</option>

								

					  <option value="FRONT" >

                            FRONT</option>

								

					  <option value="FRONTAGE" >

                            FRONTAGE</option>

								

					  <option value="GAP" >

                            GAP</option>

								

					  <option value="GARDEN" >

                            GARDEN</option>

								

					  <option value="GARDENS" >

                            GARDENS</option>

								

					  <option value="GATE" >

                            GATE</option>

								

					  <option value="GATES" >

                            GATES</option>

								

					  <option value="GLADE" >

                            GLADE</option>

								

					  <option value="GLEN" >

                            GLEN</option>

								

					  <option value="GRANGE" >

                            GRANGE</option>

								

					  <option value="GREEN" >

                            GREEN</option>

								

					  <option value="GROUND" >

                            GROUND</option>

								

					  <option value="GROVE" >

                            GROVE</option>

								

					  <option value="GULLY" >

                            GULLY</option>

								

					  <option value="HEIGHTS" >

                            HEIGHTS</option>

								

					  <option value="HIGHROAD" >

                            HIGHROAD</option>

								

					  <option value="HIGHWAY" >

                            HIGHWAY</option>

								

					  <option value="HILL" >

                            HILL</option>

								

					  <option value="INTERCHANGE" >

                            INTERCHANGE</option>

								

					  <option value="INTERSECTION" >

                            INTERSECTION</option>

								

					  <option value="JUNCTION" >

                            JUNCTION</option>

								

					  <option value="KEY" >

                            KEY</option>

								

					  <option value="LANDING" >

                            LANDING</option>

								

					  <option value="LANE" >

                            LANE</option>

								

					  <option value="LANEWAY" >

                            LANEWAY</option>

								

					  <option value="LEES" >

                            LEES</option>

								

					  <option value="LINE" >

                            LINE</option>

								

					  <option value="LINK" >

                            LINK</option>

								

					  <option value="LITTLE" >

                            LITTLE</option>

								

					  <option value="LOOKOUT" >

                            LOOKOUT</option>

								

					  <option value="LOOP" >

                            LOOP</option>

								

					  <option value="LOWER" >

                            LOWER</option>

								

					  <option value="LOWER" >

                            LOWER</option>

								

					  <option value="MALL" >

                            MALL</option>

								

					  <option value="MEANDER" >

                            MEANDER</option>

								

					  <option value="MEW" >

                            MEW</option>

								

					  <option value="MEWS" >

                            MEWS</option>

								

					  <option value="MOTORWAY" >

                            MOTORWAY</option>

								

					  <option value="MOUNT" >

                            MOUNT</option>

								

					  <option value="NOOK" >

                            NOOK</option>

								

					  <option value="NORTH" >

                            NORTH</option>

								

					  <option value="NORTH EAST" >

                            NORTH EAST</option>

								

					  <option value="NORTH WEST" >

                            NORTH WEST</option>

								

					  <option value="OUTLOOK" >

                            OUTLOOK</option>

								

					  <option value="PARK" >

                            PARK</option>

								

					  <option value="PARKLANDS" >

                            PARKLANDS</option>

								

					  <option value="PARKWAY" >

                            PARKWAY</option>

								

					  <option value="PART" >

                            PART</option>

								

					  <option value="PASS" >

                            PASS</option>

								

					  <option value="PATH" >

                            PATH</option>

								

					  <option value="PATHWAY" >

                            PATHWAY</option>

								

					  <option value="PIAZZA" >

                            PIAZZA</option>

								

					  <option value="PLATEAU" >

                            PLATEAU</option>

								

					  <option value="PLAZA" >

                            PLAZA</option>

								

					  <option value="POCKET" >

                            POCKET</option>

								

					  <option value="POINT" >

                            POINT</option>

								

					  <option value="PORT" >

                            PORT</option>

								

					  <option value="PROMENADE" >

                            PROMENADE</option>

								

					  <option value="QUAD" >

                            QUAD</option>

								

					  <option value="QUADRANGLE" >

                            QUADRANGLE</option>

								

					  <option value="QUADRANT" >

                            QUADRANT</option>

								

					  <option value="QUAY" >

                            QUAY</option>

								

					  <option value="QUAYS" >

                            QUAYS</option>

								

					  <option value="RAMBLE" >

                            RAMBLE</option>

								

					  <option value="RAMP" >

                            RAMP</option>

								

					  <option value="RANGE" >

                            RANGE</option>

								

					  <option value="REACH" >

                            REACH</option>

								

					  <option value="RESERVE" >

                            RESERVE</option>

								

					  <option value="REST" >

                            REST</option>

								

					  <option value="RETREAT" >

                            RETREAT</option>

								

					  <option value="RIDE" >

                            RIDE</option>

								

					  <option value="RIDGE" >

                            RIDGE</option>

								

					  <option value="RIDGEWAY" >

                            RIDGEWAY</option>

								

					  <option value="RIGHT OF WAY" >

                            RIGHT OF WAY</option>

								

					  <option value="RING" >

                            RING</option>

								

					  <option value="RISE" >

                            RISE</option>

								

					  <option value="RIVER" >

                            RIVER</option>

								

					  <option value="RIVERWAY" >

                            RIVERWAY</option>

								

					  <option value="RIVIERA" >

                            RIVIERA</option>

								

					  <option value="ROADS" >

                            ROADS</option>

								

					  <option value="ROADSIDE" >

                            ROADSIDE</option>

								

					  <option value="ROADWAY" >

                            ROADWAY</option>

								

					  <option value="RONDE" >

                            RONDE</option>

								

					  <option value="ROSEBOWL" >

                            ROSEBOWL</option>

								

					  <option value="ROTARY" >

                            ROTARY</option>

								

					  <option value="ROUND" >

                            ROUND</option>

								

					  <option value="ROUTE" >

                            ROUTE</option>

								

					  <option value="ROW" >

                            ROW</option>

								

					  <option value="RUE" >

                            RUE</option>

								

					  <option value="RUN" >

                            RUN</option>

								

					  <option value="SERVICE WAY" >

                            SERVICE WAY</option>

								

					  <option value="SIDING" >

                            SIDING</option>

								

					  <option value="SLOPE" >

                            SLOPE</option>

								

					  <option value="SOUND" >

                            SOUND</option>

								

					  <option value="SOUTH" >

                            SOUTH</option>

								

					  <option value="SOUTH EAST" >

                            SOUTH EAST</option>

								

					  <option value="SOUTH WEST" >

                            SOUTH WEST</option>

								

					  <option value="SPUR" >

                            SPUR</option>

								

					  <option value="SQUARE" >

                            SQUARE</option>

								

					  <option value="STAIRS" >

                            STAIRS</option>

								

					  <option value="STATE HIGHWAY" >

                            STATE HIGHWA</option>

								

					  <option value="STEPS" >

                            STEPS</option>

								

					  <option value="STEYNE" >

                            STEYNE</option>

								

					  <option value="STRAND" >

                            STRAND</option>

								

					  <option value="STRIP" >

                            STRIP</option>

								

					  <option value="SUBWAY" >

                            SUBWAY</option>

								

					  <option value="TARN" >

                            TARN</option>

								

					  <option value="TERRACE" >

                            TERRACE</option>

								

					  <option value="THOROUGHFARE" >

                            THOROUGHFARE</option>

								

					  <option value="TOLLWAY" >

                            TOLLWAY</option>

								

					  <option value="TOP" >

                            TOP</option>

								

					  <option value="TOR" >

                            TOR</option>

								

					  <option value="TOWERS" >

                            TOWERS</option>

								

					  <option value="TRACK" >

                            TRACK</option>

								

					  <option value="TRAIL" >

                            TRAIL</option>

								

					  <option value="TRAILER" >

                            TRAILER</option>

								

					  <option value="TRIANGLE" >

                            TRIANGLE</option>

								

					  <option value="TRUNKWAY" >

                            TRUNKWAY</option>

								

					  <option value="TURN" >

                            TURN</option>

								

					  <option value="UNDERPASS" >

                            UNDERPASS</option>

								

					  <option value="UPPER" >

                            UPPER</option>

								

					  <option value="UPPER" >

                            UPPER</option>

								

					  <option value="VALE" >

                            VALE</option>

								

					  <option value="VIADUCT" >

                            VIADUCT</option>

								

					  <option value="VIEW" >

                            VIEW</option>

								

					  <option value="VILLAS" >

                            VILLAS</option>

								

					  <option value="VISTA" >

                            VISTA</option>

								

					  <option value="WADE" >

                            WADE</option>

								

					  <option value="WALK" >

                            WALK</option>

								

					  <option value="WALKWAY" >

                            WALKWAY</option>

								

					  <option value="WAY" >

                            WAY</option>

								

					  <option value="WEST" >

                            WEST</option>

								

					  <option value="WHARF" >

                            WHARF</option>

								

					  <option value="WYND" >

                            WYND</option>

								

					  <option value="YARD" >

                            YARD</option>

								

              </select></td>

      </tr>

      	 

      

      <tr> 

        <td align="left"><div id="objContactAus1">Suburb</div></td>

        <td align="left"><div id="objContactAus2"><input name="chContactSuburb"  value="" type="Text" size="16"> 

        State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chContactState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactPostcode.focus()};">

					<option value=""></option>

            			

            <option value="ACT" >ACT</option>

            			

            <option value="NSW" >NSW</option>

            			

            <option value="NT" >NT</option>

            			

            <option value="QLD" >QLD</option>

            			

            <option value="SA" >SA</option>

            			

            <option value="TAS" >TAS</option>

            			

            <option value="VIC" >VIC</option>

            			

            <option value="WA " >WA </option>

            

          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="chContactPostcode" value="" type="Text" size="4" maxlength="4">  </div></td>

      </tr> 

      	 

      

       <tr> 

         <td align="left">Daytime Phone</td>

        <td ><select name="chContactPhone1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactPhone2.focus()};" id="chContactPhone1">

		  		<option value="">(Area Code)</option>	

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>			

		  </select>

			  <input type="text" name="chContactPhone2"   value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactPhone3.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			  <input type="text" name="chContactPhone3" value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactMobile1.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			 <img src="images/spacer.gif" width="1" height="1" border="0">Mobile<img src="images/spacer.gif" width="44" height="1" border="0"><input type="text" name="chContactMobile1" size="4" value="" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactMobile2.focus()};" onBlur="checkNumeric(this,1,'','','','','');">	

		  <input type="text" name="chContactMobile2" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactMobile3.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  <input type="text" name="chContactMobile3" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactEmail.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  &nbsp;         

		</td>

      </tr>    

      	   

            

      <tr> 

         <td align="left">Email</td>

        <td><input name="chContactEmail"  value="" type="Text" style="width:199px;" onBlur="checkEmail(this);" maxlength="50"> Relationship <input name="chContactRelationship"  value="" type="Text" size="26" maxlength="50">

		</td>

      </tr> 

      

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      <tr>

	  	<td align="left" width="171"><strong class="navytext">REFEREES: <span class="redstar">*</span> </strong> (not relatives)</td>

        <td  width="568">&nbsp;</td>

	  </tr>

      

      <tr>

	  	<td align="left" width="171">1) Name</td>

        <td  width="568"><input name="chReference1FirstName"  value="" type="Text"   size="16" maxlength="50"> <input name="chReference1Surname" value="" type="Text" size="16" maxlength="50"><img src="images/spacer.gif" height="1" border="0" width="33">Occupation<img src="images/spacer.gif" height="1" border="0" width="7"><input name="chReference1Occupation" value="" type="Text" size="16" maxlength="50"> </td>

	  </tr>

      	 

      <tr> 

         <td align="left">Daytime Phone</td>

        <td ><select name="chReference1Phone1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference1Phone2.focus()};" id="chReference1Phone1">

		  		<option value="">(Area Code)</option>	

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>			

		  </select>

			  <input type="text" name="chReference1Phone2" value=""  onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference1Phone3.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			  <input type="text" name="chReference1Phone3" value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference1Mobile1.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			 <img src="images/spacer.gif" height="1" border="0" width="42">Mobile <input type="text" name="chReference1Mobile1" value="" size="4" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference1Mobile2.focus()};" onBlur="checkNumeric(this,1,'','','','','');">	

		  <input type="text" name="chReference1Mobile2" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference1Mobile3.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  <input type="text" name="chReference1Mobile3" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference2FirstName.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  &nbsp;         

		</td>

      </tr>

      	 

            <tr>

	  	<td align="left" width="171">2) Name</td>

        <td  width="568"><input name="chReference2FirstName" value="" type="Text" size="16" maxlength="50"> <input name="chReference2Surname" value="" type="Text" size="16" maxlength="50"><img src="images/spacer.gif" height="1" border="0" width="33">Occupation<img src="images/spacer.gif" height="1" border="0" width="7"><input name="chReference2Occupation"  value="" type="Text" size="16" maxlength="50"> </td>

	  </tr>

      	 

      <tr> 

         <td align="left">Daytime Phone</td>

        <td ><select name="chReference2Phone1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference2Phone2.focus()};" id="chReference2Phone1">

		  		<option value="">(Area Code)</option>	

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>				

		  </select>

			  <input type="text" name="chReference2Phone2"  value=""  onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference2Phone3.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			  <input type="text" name="chReference2Phone3" value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference2Mobile1.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">

			<img src="images/spacer.gif" height="1" border="0" width="42">Mobile <input type="text" name="chReference2Mobile1" value="" size="4" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference2Mobile2.focus()};" onBlur="checkNumeric(this,1,'','','','','');">	

		  <input type="text" name="chReference2Mobile2"  value=""size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chReference2Mobile3.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  <input type="text" name="chReference2Mobile3" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chkAdvertisedLocalPress.focus()};" onBlur="checkNumeric(this,1,'','','','','');">

		  &nbsp;         

		</td>

      </tr>

      

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

       <tr> 

         <td align="left" colspan="2"><strong class="navytext">Where did you see the property advertised?</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Local Press 

           <input type="checkbox" class="formcheckbox" name="chkAdvertisedLocalPress">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Signboard <input type="checkbox" class="formcheckbox" name="chkAdvertisedSignBoard">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Referral <input type="checkbox" class="formcheckbox" name="chkAdvertisedReferral">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Internet <input type="checkbox" class="formcheckbox" name="chkAdvertisedInternet"></td>

      </tr> 

        <tr> 

         <td align="left">Other</td>

        <td><input name="chAdvertisedOther" type="Text" style="width:436px;" maxlength="50"></td>

      </tr>

            

    

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 		

	 <tr valign="top" align="left"> 

        <td height="3" colspan="2" width="100%" class="bigbox2"><table cellpadding="0" cellspacing="0" width="90%" style="border-style:double; border-width:3px; border-color:#647882"><tr><td><br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="redbackgroundwhitetext"><strong>IMPORTANT NOTICE REGARDING SCANNED DOCUMENTS:</strong></span><br>

        <br>

        <span class="bigbox">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Add scanned documents to speed up the process of application.<br><br>

       &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Please do not attach all documents to a single button as a combined scan. Each individual document i.e. passport,<br>

       &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;driver&#8217;s license etc. should be attached to the correctly labelled button. This is important for privacy compliance.<br><br>    

       &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="checkbox"  class="formcheckbox" name="isDocIdentifiersTicked">&nbsp;&nbsp;I, the applicant, have read and understood the above statement and take full responsibility for attaching my<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;documents to the correct buttons.</span><br><br>

</td></tr></table></td>

      </tr>

      

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      

      <tr valign="top" align="left">

        <td colspan="2">

        To add a scan, click the 'Browse' button of the description of the object scanned, for   example TRA Disclosure or Drivers Licence<br>

        to 

        locate the file on your computer, then click on that file which will attach to your application.<br>

Allowable file formats are: .gif, .jpg, .png, .pdf. Maximum size 200KB. </td>

      </tr>

        <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

        <tr>

	  	<td align="left" width="171" class="navytext"><strong>IDENTIFIER DOCUMENTS:</strong></td>

        <td  width="568">&nbsp;</td>

	  </tr>  

      <tr align="left"> 

        <td height="3">TRA Disclosure</td>

        <td height="3" ><input type="file" name="chFilename1"> Working Visa<img src="images/spacer.gif" width="25" height="1" border="0"><input type="file" name="chFilename9"></td>

      </tr>

      <tr align="left"> 

        <td height="3">Drivers Licence</td>

        <td height="3" ><input type="file" name="chFilename2"> 

        Birth Certificate<img src="images/spacer.gif" width="14" height="1" border="0"><input type="file" name="chFilename10"></td>

      </tr>

      

      <tr align="left"> 

        <td height="3" nowrap>Passport</td>

        <td height="3" ><input type="file" name="chFilename3"> 

        Photo Id<img src="images/spacer.gif" width="52" height="1" border="0"><input type="file" name="chFilename6"></td>

      </tr>

      

       <tr align="left"> 

        <td height="3" nowrap>Student ID</td>

        <td height="3" ><input type="file" name="chFilename11"></td>

      </tr>

  

        <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

        <tr>

	  	<td align="left" width="171" class="navytext"><strong>CONFIDENTAL DOCUMENTS:</strong></td>

        <td  width="568">&nbsp;</td>

	  </tr>  



      <tr align="left"> 

        <td height="3">Ledger</td>

        <td height="3"><input type="file" name="chFilename12"> Business Reg<img src="images/spacer.gif" width="30" height="1" border="0"><input type="file" name="chFilename13"></td>

      </tr>

      <tr align="left"> 

        <td height="3">Bank Statement</td>

        <td height="3" ><input type="file" name="chFilename14"> 

        Water Rates<img src="images/spacer.gif" width="41" height="1" border="0"><input type="file" name="chFilename15"></td>

      </tr>

      

      <tr align="left"> 

        <td height="3" nowrap>Utility Bills</td>

        <td height="3" ><input type="file" name="chFilename16"> 

        Comp. Statement<img src="images/spacer.gif" width="13" height="1" border="0"><input type="file" name="chFilename17"></td>

      </tr>

      

       <tr align="left"> 

        <td height="3" nowrap>Current Pay Slip</td>

        <td height="3" ><input type="file" name="chFilename18"> 

        Council Rates<img src="images/spacer.gif" width="31" height="1" border="0"><input type="file" name="chFilename19"></td>

      </tr>

      

       <tr align="left"> 

        <td height="3" nowrap>Written Reference</td>

        <td height="3" ><input type="file" name="chFilename20"></td>

      </tr>  

        <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      

      <tr valign="top" align="left"> 

        <td height="3" colspan="2" width="100%" class="bigbox2"><br><table cellpadding="0" cellspacing="0" width="90%" style="border-style:double; border-width:3px; border-color:#647882"><tr><td>
			<span class="redbackgroundwhitetext"><strong>IMPORTANT NOTICE:</strong></span><span class="bigbox"><p>To process your application we need a signed TRA disclosure. Click here to view and print: <a href="https://tradingreference.com/forms/tendec.pdf" target="_blank">TRA Tenancy Disclosure</a>.</p>

        <p>If you don't have a printer we will provide you   with this document. Scan and attach it to this application, or print and take into our office at your convenience.</span></p>
      
</td></tr></table><br></td>

      </tr>

      	

     <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

       <tr>

	  	<td align="left" colspan="2" class="navytext"><strong>NSW FAIR TRADING TENANT CHECKLIST:</strong></td>

	  </tr>  

      <tr><td height="3" colspan="2"> 

          <table cellpadding=0 cellspacing=0 border=0>		  

		  	<tr  valign="top">

			  <td><input type="checkbox"  class="formcheckbox" name="isFairTradeTicked">&nbsp;&nbsp;<span class="navytext"><strong>I, </strong></span> the <span class="navytext"><strong>APPLICANT</strong></span>, have read and understood the following document: <a href="http://www.fairtrading.nsw.gov.au/Factsheet_print/Tenants_and_home_owners/Renting_a_home/FTR72_New_tenant_checklist.pdf" target="_blank">Tenant Checklist</a></td>

	  		</tr>

		  </table>

        </td>

      </tr> 

      

                

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      <tr>

	  	<td align="left" width="171" class="navytext"><strong>TRA PRIVACY CONSENT:</strong></td>

        <td  width="568">&nbsp;</td>

	  </tr>  

      <tr><td height="3" colspan="2"> 

          <table cellpadding=0 cellspacing=0 border=0>		  

		  	<tr  valign="top">

			  <td><input type="checkbox" onclick="disclosurepopup()"  class="formcheckbox" name="isPrivacyConsent">

			  &nbsp;&nbsp;<span class="navytext"><strong>I, </strong></span> the <span class="navytext"><strong>APPLICANT</strong></span>, understand and agree that the information entered onto the TRA database will be delivered through the TRA website to any agency I am applying to or may apply to   for rental of property for examination and evaluation of such application for   identification of me.

			  <br>

			    <br>

			    <span class="redtext"><strong>I also state that the TRA Disclosure, Drivers Licence, Passport and Photo ID   attached to this document belong to me as do the signatures. I   understand that all search results and logins are monitored within an internal   auditing system and are date-time stamped together with my IP address and   account details. Any misuse of the TRA facilities can be traced to my point of   access origin and may lead to civil action or criminal prosecution for serious   offences.</strong>

			    </span><br>

			    <p>I acknowledge and agree that information provided to TRA and/or the agent by   these authorities given by me be disclosed to: a) Real Estate Agents, Landlords,   Trades persons, Emergency Contacts, Employers past, present or prospective,   Referees, Housing New South Wales, Compass Housing, Dentists, Video stores to   assist them in evaluating applications which may be made by me to any of these   parties, for the purpose of managing any property and my requirements as   tenant/s during my tenancy of any property owned or managed by any of those   parties and b) Real Estate Agents, Landlords, Dentists, Video stores, Banks,   Utility companies, Commercial Agents, organisations or any other members for the   reason of locating me for any lawful purpose and I hereby consent to such use and disclosure of that information for those purposes. Should any such party   transfer its business to another person, I consent to the new person (and any further person to whom that business may be transferred) taking any step which   the former party could have taken. </p>

<p>To the   extent permitted by law I agree that TRA will not be liable to me for any misuse of my information by any party to whom my information is disclosed in accordance   with the these authorities and release TRA from any such liability. I acknowledge that the information entered by me onto the TRA database and   disclosed by TRA in accordance with these authorities given by me for such time as TRA shall be entitled by law to hold such information on its   database.</p></td>

	  		</tr>

		  </table>

        </td>

      </tr>	  

    

      <tr> 

      	<td>&nbsp;</td>

        <td><div style="width:425px;" align="center"><input type="submit" name="Submit" class="btnSmall"  value="SUBMIT">

          </div>        	

        </td>

      </tr>

    </table>

			
	 
 	
	

		
	
	<!--Welcome text-->
		<!--end Welcome text-->		
							
							


		
			<!--*Menu*-->
		   <!--*End Menu*-->			
		   
		   <div id="footer1">
		      <!--#include FILE="footer.inc" -->
		   		<!--<div id="bottom1"></div>-->
			
			<!-- THis is the devider from the links to the contents -->
		  </div> <!-- THis is the footer div -->
			
			
		</div>
		


			
			
	
	
	</div>	
	</body>
</html>

Open in new window

<%@ Page Language="VB" %>
<%@ Import Namespace="System.Net.Mail" %>
<script runat="server">
    Private Sub Page_Load(ByVal sender As System.Object, ByVal e As System.EventArgs)

		'***************************************************************************************************************************
		'* TERMS OF USE
		'* The purpose of this script is to allow Santa Barbara City College Students to create form email.
		'* This script is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.
		'* This script was designed for use on Tango Students Hosting.
		'* This script was designed for use on Microsoft IIS Servers that utilize Net.Mail using VB.NET 2
		'* This script must not be used for illegal purposes.
		'* Version Date: 4/27/2011
		'***************************************************************************************************************************
		
		'Dimension variables (DO NOT CHANGE THIS SECTION UNLESS YOU KNOW WHAT YOU ARE DOING)
		Dim objSendMail, strUsername, strPassword
		Dim strTo, strFrom, strHTMLSubject, strSubject, strHTMLHeader, strHTMLBody, strHTMLFooter
		Dim strDateTime, strEmailAddress, strFromURL, strContactName, strReturnURL, objItem, strSMTPServer, strExcludedFields
		Dim strHTTP_REFERER, strHTTP_USER_AGENT, strHTTP_HOST
		
		'***************************************************************************************************************************
		'* Begin User Specified Variables (YOU MAY CHANGE THESE VALUES)
		'***************************************************************************************************************************
		strContactName = "Oria"	'This is the name of the person who is receiving the form email
		strTo = "itsupport@adbydesigns.com.au"	'This is the recipient of this Web Form email and will usually be your email address. 
		strSubject = "Tenancy Application"	'This is the subject of the email that the recipient receive (unless there is a form field named Subject)
		strFromURL = "http://localhost/adbydesigns/Clients/b/tenancyapplication.asp"	'This is the fully-qualified URL of your Web Form
		strReturnURL = "http://localhost/adbydesigns/Clients/b/thank_you.asp"	'This is the fully-qualified URL of the Thank You or result page
		strSMTPServer = "mail.adbydesigns.com.au"	'This is the Tango Students SMTP server. Your host will provide this information
		strUsername = ""	'Enter username to authenticate to the email server 
		strPassword = ""	'Enter password to authenticate to the email server 
		'***************************************************************************************************************************
		'* End User Specified Variables
		'***************************************************************************************************************************
		
		'***************************************************************************************************************************
		'* PLEASE DO NOT CHANGE ANYTHING BELOW UNLESS YOU KNOW WHAT YOU ARE DOING 
		'***************************************************************************************************************************
		
		'Automatically acquire the referring page and the browser information
		strHTTP_REFERER = Request.ServerVariables("HTTP_REFERER")
		strHTTP_USER_AGENT = Request.ServerVariables("HTTP_USER_AGENT")
		strHTTP_HOST = Request.ServerVariables("HTTP_HOST")
		
		'Check to see if the form is on this domain, if so process the mail, if not, sent them back to the form
		If (InStr(LCase(strHTTP_REFERER), LCase(strHTTP_HOST)) = 0) Then
		  Response.Redirect(strFromURL & "?Referer=NotLocal")
		  Response.End()
		End If

		'If the form specifies a Subject, use it
		If Trim(Request.Form("Subject")) <> "" Then
			strSubject = Trim(Request.Form("Subject"))
		End If
		
		'Encode form information for display in the HTML email and the time of submission
		strHTMLSubject = Server.HTMLEncode(strSubject)
		strDateTime = Now
		strFromURL = Server.HTMLEncode(strFromURL)
		strContactName = Server.HTMLEncode(strContactName)
		
		'Check for the existence of a FromURL Form Field - Use it if it there
		If Trim(Request.Form("FromURL")) <> "" Then
			strFromURL = Trim(Request.Form("FromURL"))
		End If
		
		'Check for the existence of a ReturnURL Form Field - Use it if it there
		If Trim(Request.Form("ReturnURL")) <> "" Then
			strReturnURL = Trim(Request.Form("ReturnURL"))
		End If
		
		strExcludedFields = "subject, fromurl, returnurl, submit" 'Exclude these fields from the email
		
		'Check for a valid email address. If the address appears valid, use it as the sender, if not use the recipient
		If Trim(Request.Form("EmailAddress")) <> "" Then
		  If InStr(Trim(Request.Form("EmailAddress")),"@") <> 0  Then
			If InStr(Trim(Request.Form("EmailAddress")),".") <> 0 Then
			  strFrom = Trim(Request.Form("EmailAddress"))
			  strEmailAddress = strFrom
			Else
			  strFrom = strTo
			  strEmailAddress = "Invalid Email Address"
			End If
		  Else
			strFrom = strTo
			strEmailAddress = "Invalid Email Address"
		  End If
		Else
		  strFrom = strTo
		  strEmailAddress = "No Email Address Submitted"
		End If  
		
		'Compose the HTML Header for the email
		strHTMLHeader = vbCr & _
		"<" & "!" & "DOCTYPE HTML PUBLIC ""-//W3C//DTD HTML 4.01 Transitional//EN"" ""http://www.w3.org/TR/html4/loose.dtd"">" & vbCr & _
		"<html lang=""en-us"">" & vbCr & _
		"<head>" & vbCr & _
		"<meta http-equiv=""Content-Type"" content=""text/html; charset=iso-8859-1"">" & vbCr & _
		"<title>" & strHTMLSubject & "</title>" & vbCr & _
		"<style type=""text/css"">" & vbCr & _
		"<!--" & vbCr & _
		"body {" & vbCr & _
		"	font-family: Verdana, Arial, Helvetica, sans-serif;" & vbCr & _
		"	font-size: 12px;" & vbCr & _
		"	color: #000000;" & vbCr & _
		"	background-color: #FFFFFF;" & vbCr & _
		"}" & vbCr & _
		"td {" & vbCr & _
		"	font-family: Verdana, Arial, Helvetica, sans-serif;" & vbCr & _
		"	font-size: 12px;" & vbCr & _
		"	color: #000000;" & vbCr & _
		"	padding: 3px;" & vbCr & _
		"	background-color: #FFFFFF;" & vbCr & _
		"}" & vbCr & _
		"th {" & vbCr & _
		"	font-family: Verdana, Arial, Helvetica, sans-serif;" & vbCr & _
		"	font-size: 12px;" & vbCr & _
		"	color: #FFFFFF;" & vbCr & _
		"	background-color: #003399;" & vbCr & _
		"	font-weight: bold;" & vbCr & _
		"	padding: 3px;" & vbCr & _
		"	text-align: left;" & vbCr & _
		"}" & vbCr & _
		"h1 {" & vbCr & _
		"	font-size: 18px;" & vbCr & _
		"}" & vbCr & _
		"h2 {" & vbCr & _
		"	font-size: 16px;" & vbCr & _
		"}" & vbCr & _
		"h3 {" & vbCr & _
		"	font-size: 14px;" & vbCr & _
		"}" & vbCr & _
		".Footer {" & vbCr & _
		"	font-size: 10px;" & vbCr & _
		"	color: #999999;" & vbCr & _
		"}" & vbCr & _
		".GrayText {" & vbCr & _
		"	color: #999999;" & vbCr & _
		"}" & vbCr & _
		".BlueText {" & vbCr & _
		"	color: #003399;" & vbCr & _
		"}" & vbCr & _
		".SectionHeading {" & vbCr & _
		"	background-color: #DDDDFF;" & vbCr & _
		"}" & vbCr & _
		"-->" & vbCr & _
		"</style>" & vbCr & _
		"</head>" & vbCr & _
		"<body>" & vbCr & _
		"<h1>"& strHTMLSubject & "</h1>" & vbCr & _
		"<p>This information was submitted on: " &  strDateTime & "</p>"
		
		'Start the table to display the form fields and values
		strHTMLBody =  vbCr & _
		"<table width=""100%"" cellpadding=""0"" cellspacing=""1"" bgcolor=""#DDDDFF"">" & vbCr & _
		"  <tr>" & vbCr & _
		"    <th scope=""col"">Field</th>" & vbCr & _
		"    <th scope=""col"">Value</th>" & vbCr & _
		"  </tr>" & vbCr
		
		'Get each of the form fields and compile them into table rows
		For Each objItem in Request.Form
			If InStr(strExcludedFields,LCase(objItem)) = 0 Then
				If Trim(Request.Form(objItem)) <> "" Then
					strHTMLBody = strHTMLBody & _
					"  <tr>" & vbCr & _
					"    <td valign=""top"">" & objItem & "</td>" & vbCr & _
					"    <td class=""BlueText"">" & Replace(Server.HTMLEncode(Trim(Request.Form(objItem))),vbCr,"<br>") & "</td>" & vbCr & _
					"  </tr>" & vbCr
				Else
					strHTMLBody = strHTMLBody & _
					"  <tr>" & vbCr & _
					"    <td>" & objItem & "</td>" & vbCr & _
					"    <td class=""GrayText"">No Response</td>" & vbCr & _
					"  </tr>" & vbCr
				End If
			End If
		Next
		
		'Get the Referer and the User Agent Information and put it at the bottom of the table
		'strHTMLBody = strHTMLBody & vbCr & _
		'"  <tr>" & vbCr & _
		'"    <td valign=""top"" colspan=""2"" class=""SectionHeading"">Browser Information</td>" & vbCr & _
		'"  </tr>" & vbCr & _
		'"  <tr>" & vbCr & _
		'"    <td valign=""top"">HTTP User Agent</td>" & vbCr & _
		'"    <td class=""BlueText"">" & strHTTP_USER_AGENT & "</td>" & vbCr & _
		'"  </tr>" & vbCr & _
		'"</table>" & vbCr
		
		'Get the Referer and the User Agent Information and put it at the bottom of the table
		strHTMLBody = strHTMLBody & vbCr & _
		"</table>" & vbCr		
		
		'Compose the footer of the email
		'strHTMLFooter = vbCr & _
		'"<p><hr align=""left"" width=""100%"" size=""1"" noshade>" & vbCr & _
		'"<div class=""Footer"">This automated email was sent from <a href=""" & strFromURL & """>" & strFromURL & "</a>.<br>" & vbCr & _
		'"Please contact " & strContactName & ", <a href=""mailto:" & strTo & """>" & strTo & "</a>, if you have questions or problems with this email.</div></p>" & vbCr & _
		'"</body>" & vbCr & _
		'"</html>"

		'Compose the footer of the email
		strHTMLFooter = vbCr & _
		"<p><hr align=""left"" width=""100%"" size=""1"" noshade>" & vbCr & _
		"<div class=""Footer"">This automated email was sent from <a href=""" & strFromURL & """>" & strFromURL & "</a>.<br>" & vbCr & _
		"</body>" & vbCr & _
		"</html>"
		
		' Create the Mail object and send the email as HTML
        Dim MailMsg As New MailMessage(New MailAddress(strFrom.Trim()), New MailAddress(strTo))
        MailMsg.BodyEncoding = Encoding.Default
        MailMsg.Bcc.Add("barneybeale@gmail.com")
        MailMsg.Bcc.Add("selfservemediaarchive@dbasplus.com")
        MailMsg.Subject = strSubject
        MailMsg.Body = strHTMLHeader & strHTMLBody & strHTMLFooter
        MailMsg.Priority = MailPriority.Normal
        MailMsg.IsBodyHtml = True
		
        'Dimension and instantiate object to send the mail message (new in 2011 to allow for basic authentication)
        Dim SmtpMail As New SmtpClient
        Dim basicAuthenticationInfo As New System.Net.NetworkCredential(strUsername, strPassword) 
        SmtpMail.Host = strSMTPServer
        SmtpMail.UseDefaultCredentials = False
	    SmtpMail.Credentials = basicAuthenticationInfo
        SmtpMail.Send(MailMsg)
		
		'Send your visitor to the Thank You page and quit
		MailMsg = Nothing
		SmtpMail = Nothing
		Response.Redirect(strReturnURL)
		Response.End()
		
		'***************************************************************************************************************************
		'* End Script
		'***************************************************************************************************************************

    End Sub
</script>

Open in new window

0
Comment
Question by:awolarczuk
  • 13
  • 4
18 Comments
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923478
remove "checked="true""  in all the check boxes
0
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923486
also you don't have unique common name for those radio buttons....

see here,
<input name="chDoYouSmoke1" class="formcheckbox"  type="Radio" value="V1" checked="true"> Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="chDoYouSmoke"    type="Radio" value="V1" checked="true">

you should have one name "chDoYouSmoke" for both radio buttons ... instead of one chDoYouSmoke1 other chDoYouSmoke
0
 

Expert Comment

by:shaniceweiwei
ID: 36923492
on line 1141: checked="false"
0
VIDEO: THE CONCERTO CLOUD FOR HEALTHCARE

Modern healthcare requires a modern cloud. View this brief video to understand how the Concerto Cloud for Healthcare can help your organization.

 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923493
also values looks same..  you could make difference please,

 value="V1" for both radio the same value.. .you must change each one each
0
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923510
as a whole you need to make 2 things,

1. Group name to be common on the radio buttons like if 2 buttons to have same name...

2. keep checked = "true" for one radio button among the group
0
 

Author Comment

by:awolarczuk
ID: 36923520
shaniceweiwei: did that no difference

logudotcom: Thanks for that is there a quick way to do this as you can see there is alot of code there
0
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923539
Please try my suggestions.
0
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923542
You have to change by now and need to put proper value for each radio button group... please try by yourself.
0
 

Author Comment

by:awolarczuk
ID: 36923549
logudotcom: happy to do this but wanted to know if there was a quicker way as there isa lot of code and do you mid changing one to show me waht you man
0
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923585
OK just see this,

you can see the name, value how it is filled
<tr>

	  	<td align="left" width="171">Have you viewed the property?</td>

        <td  width="568">
		<input name="isPropertyViewed" class="formcheckbox" type="Radio" value="Yes" checked="checked" > Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="isPropertyViewed" type="Radio" value="No" > No</td>

	  </tr>

Open in new window

0
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923589
replace checked="checked"  to  checked="true"
0
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923592
for male / female,

 <input name="chGender"  class="formcheckbox"    type="Radio" value="Male" checked="true"> Male
            <input  class="formcheckbox" name="chGender"    type="Radio" value="Female" > 
0
 

Author Comment

by:awolarczuk
ID: 36923597
replace checked="checked"  to  checked="true" is this in all the code
0
 
LVL 36

Expert Comment

by:Loganathan Natarajan
ID: 36923600
partially i have done for few radio buttons... just ref.
<!-- 
  Adby Designs
  By Adam Wolarczuk
  July 2011
-->

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" 
  "http://www.w3.org/TR/html4/loose.dtd">

<html lang="en">


	<head>
		<title>Tenancy Application Form</title>
	
		<meta http-equiv="content-script-type" content="text/javascript">
		<meta http-equiv="content-type" content="text/html;charset=iso-8859-1">
		<link href ="settings.css" rel="stylesheet"  >
			<style type="text/css">
			#midcon1		{position:absolute;	height:5330px;width:800px; background-color:white;left:29px;	top:218px;border: #01466f solid 1px}   /*White pageground in the middle */
			#footer1		{position:absolute; top: 4398px; width: 800px; left:-29px}
			#bottom1 {  width:800px;height:120px;background-color: #236e9a;}  /* layout bottom*/

				ul.a {list-style-type:none;}
				
			.auto-style1 {
				border-width: 0px;
			}
				
			</style>
			
			
	</head>

<body>

		<div id="container" >
			
	
            
			
	
            <a href="home.asp"><map id="ImgMap0" name="ImgMap0">
			<area alt="" coords="5, 30, 188, 125" href="home.asp" shape="rect">
			</map>
			
	
            
			
	
          <img src="images/title.png"  alt=""  id="timage" class="auto-style1" usemap="#ImgMap0" ></a>
           	
			<div id="topl"><img src="images/topline.png"  alt="tline" width="800px"></div>
			<div id="midcon1"> 





   

    <table border="0" cellspacing="1" cellpadding="2"  width="800">

    

      <tr> 

        <td class="navytext" colspan="2"><h2><b>Tenancy Application</b></h2><span class="redstar">*</span> = Required fields<br><br></td>

      </tr>      

      

      <form method="post" action="process_mail.aspx" name="reuse">

<input type="hidden" name="mode" value="R">

<input type="hidden" name="u" value=180112>
   
      

      </form>

     

    	<tr> 

        <td class="navytext" colspan="2"><strong>CREATE A NEW APPLICATION:</strong></td>

      </tr>     

           

      

      

       <tr> 

        <td class="navytext" colspan="2"><strong>PROPERTY APPLIED FOR: <span class="redstar">*</span> </strong></td>

      </tr>

       

	  <tr> 

        <td align="left" width="171">Type of Residence</td>

        <td valign="Bottom" align="left"><select name="chPropertyPrefix" onChange=				"if((this.value=='')||(this.value=='')){document.getElementById('chPropertyFlatNo').style.display='none';document.getElementById('lblPropertyFlatNo').style.display='none';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPropertyStreetNo.focus()};}else{document.getElementById('chPropertyFlatNo').style.display='inline';document.getElementById('lblPropertyFlatNo').style.display='inline';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPropertyFlatNo.focus()};};if(this.value=='-----'){this.value='';document.getElementById('chPropertyFlatNo').style.display='none';document.getElementById('lblPropertyFlatNo').style.display='none';}" style="width:113px;">

       		    <option value="null">(Select)</option>

                <option value="">HOUSE</option>

                <option value="UNIT">UNIT</option>

                <option value="APARTMENT">APARTMENT</option>

                <option value="FLAT">FLAT</option>

                <option value="STUDIO">STUDIO</option>

                

				<option value="-----" >-----</option>

				

				<option value="BLOCK" >BLOCK</option>

				

				<option value="CABIN" >CABIN</option>

				

				<option value="COTTAGE" >COTTAGE</option>

				

				<option value="DUPLEX" >DUPLEX</option>

				

				<option value="FACTORY" >FACTORY</option>

				

				<option value="FLOOR" >FLOOR</option>

				

				<option value="LOT" >LOT</option>

				

				<option value="PIER" >PIER</option>

				

				<option value="ROOFTOP" >ROOFTOP</option>

				

				<option value="ROOM" >ROOM</option>

				

				<option value="SHOP" >SHOP</option>

				

				<option value="SUITE" >SUITE</option>

				

				<option value="TOWNHOUSE" >TOWNHOUSE</option>

				

				<option value="VILLA" >VILLA</option>

				

				<option value="WAREHOUSE" >WAREHOUSE</option>

				

              </select><div id="lblPropertyFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</div><input name="chPropertyFlatNo" id="chPropertyFlatNo" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"> Str. No. <input name="chPropertyStreetNo" type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>

              </tr>   

      

	   

	   <tr>        

        <td align="left" >Street Name</td>

        <td valign="Bottom" align="left" ><input name="chPropertyStreetName" type="Text" size="16"><img src="images/spacer.gif" width="46" height="1" border="0"><select name="chPropertyStreetType" onChange="if(this.value=='-----'){this.value='';};if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPropertySuburb.focus()};">

                <option value="">(Street Type)</option>

                

					<option value="STREET">STREET</option>

								

					<option value="ROAD">ROAD</option>

								

					<option value="AVENUE">AVENUE</option>

								

					<option value="PLACE">PLACE</option>

								

					<option value="CRESCENT">CRESCENT</option>

								

					<option value="DRIVE">DRIVE</option>

								

					<option value="PARADE">PARADE</option>

								

					<option value="CLOSE">CLOSE</option>

								

					<option value="-----">-----</option>

								

					<option value="ACCESS">ACCESS</option>

								

					<option value="ALLEY">ALLEY</option>

								

					<option value="ALLEYWAY">ALLEYWAY</option>

								

					<option value="AMBLE">AMBLE</option>

								

					<option value="ANCHORAGE">ANCHORAGE</option>

								

					<option value="APPROACH">APPROACH</option>

								

					<option value="ARCADE">ARCADE</option>

								

					<option value="ARTERY">ARTERY</option>

								

					<option value="BASIN">BASIN</option>

								

					<option value="BEACH">BEACH</option>

								

					<option value="BEND">BEND</option>

								

					<option value="BLOCK">BLOCK</option>

								

					<option value="BOULEVARD">BOULEVARD</option>

								

					<option value="BOULEVARDE">BOULEVARDE</option>

								

					<option value="BRACE">BRACE</option>

								

					<option value="BRAE">BRAE</option>

								

					<option value="BREAK">BREAK</option>

								

					<option value="BRIDGE">BRIDGE</option>

								

					<option value="BROADWAY">BROADWAY</option>

								

					<option value="BROW">BROW</option>

								

					<option value="BYPASS">BYPASS</option>

								

					<option value="BYWAY">BYWAY</option>

								

					<option value="CAUSEWAY">CAUSEWAY</option>

								

					<option value="CENTRAL">CENTRAL</option>

								

					<option value="CENTRE">CENTRE</option>

								

					<option value="CENTREWAY">CENTREWAY</option>

								

					<option value="CHASE">CHASE</option>

								

					<option value="CIRCLE">CIRCLE</option>

								

					<option value="CIRCLET">CIRCLET</option>

								

					<option value="CIRCUIT">CIRCUIT</option>

								

					<option value="CIRCUS">CIRCUS</option>

								

					<option value="COLONNADE">COLONNADE</option>

								

					<option value="COMMON">COMMON</option>

								

					<option value="CONCOURSE">CONCOURSE</option>

								

					<option value="COPSE">COPSE</option>

								

					<option value="CORNER">CORNER</option>

								

					<option value="CORSO">CORSO</option>

								

					<option value="COURT">COURT</option>

								

					<option value="COURTYARD">COURTYARD</option>

								

					<option value="COVE">COVE</option>

								

					<option value="CREST">CREST</option>

								

					<option value="CROSS">CROSS</option>

								

					<option value="CROSSING">CROSSING</option>

								

					<option value="CROSSROAD">CROSSROAD</option>

								

					<option value="CROSSWAY">CROSSWAY</option>

								

					<option value="CRUISEWAY">CRUISEWAY</option>

								

					<option value="CUL-DE-SAC">CUL-DE-SAC</option>

								

					<option value="CUTTING">CUTTING</option>

								

					<option value="DALE">DALE</option>

								

					<option value="DELL">DELL</option>

								

					<option value="DEVIATION">DEVIATION</option>

								

					<option value="DIP">DIP</option>

								

					<option value="DISTRIBUTOR">DISTRIBUTOR</option>

								

					<option value="DRIVEWAY">DRIVEWAY</option>

								

					<option value="EAST">EAST</option>

								

					<option value="EDGE">EDGE</option>

								

					<option value="ELBOW">ELBOW</option>

								

					<option value="END">END</option>

								

					<option value="ENTRANCE">ENTRANCE</option>

								

					<option value="ESPLANADE">ESPLANADE</option>

								

					<option value="ESTATE">ESTATE</option>

								

					<option value="EXPRESSWAY">EXPRESSWAY</option>

								

					<option value="EXTENSION">EXTENSION</option>

								

					<option value="EXTENSION">EXTENSION</option>

								

					<option value="FAIRWAY">FAIRWAY</option>

								

					<option value="FIRE TRACK">FIRE TRACK</option>

								

					<option value="FIRETRAIL">FIRETRAIL</option>

								

					<option value="FLAT">FLAT</option>

								

					<option value="FOLLOW">FOLLOW</option>

								

					<option value="FOOTWAY">FOOTWAY</option>

								

					<option value="FORESHORE">FORESHORE</option>

								

					<option value="FORMATION">FORMATION</option>

								

					<option value="FREEWAY">FREEWAY</option>

								

					<option value="FRONT">FRONT</option>

								

					<option value="FRONTAGE">FRONTAGE</option>

								

					<option value="GAP">GAP</option>

								

					<option value="GARDEN">GARDEN</option>

								

					<option value="GARDENS">GARDENS</option>

								

					<option value="GATE">GATE</option>

								

					<option value="GATES">GATES</option>

								

					<option value="GLADE">GLADE</option>

								

					<option value="GLEN">GLEN</option>

								

					<option value="GRANGE">GRANGE</option>

								

					<option value="GREEN">GREEN</option>

								

					<option value="GROUND">GROUND</option>

								

					<option value="GROVE">GROVE</option>

								

					<option value="GULLY">GULLY</option>

								

					<option value="HEIGHTS">HEIGHTS</option>

								

					<option value="HIGHROAD">HIGHROAD</option>

								

					<option value="HIGHWAY">HIGHWAY</option>

								

					<option value="HILL">HILL</option>

								

					<option value="INTERCHANGE">INTERCHANGE</option>

								

					<option value="INTERSECTION">INTERSECTION</option>

								

					<option value="JUNCTION">JUNCTION</option>

								

					<option value="KEY">KEY</option>

								

					<option value="LANDING">LANDING</option>

								

					<option value="LANE">LANE</option>

								

					<option value="LANEWAY">LANEWAY</option>

								

					<option value="LEES">LEES</option>

								

					<option value="LINE">LINE</option>

								

					<option value="LINK">LINK</option>

								

					<option value="LITTLE">LITTLE</option>

								

					<option value="LOOKOUT">LOOKOUT</option>

								

					<option value="LOOP">LOOP</option>

								

					<option value="LOWER">LOWER</option>

								

					<option value="LOWER">LOWER</option>

								

					<option value="MALL">MALL</option>

								

					<option value="MEANDER">MEANDER</option>

								

					<option value="MEW">MEW</option>

								

					<option value="MEWS">MEWS</option>


								

					<option value="MOTORWAY">MOTORWAY</option>

								

					<option value="MOUNT">MOUNT</option>

								

					<option value="NOOK">NOOK</option>

								

					<option value="NORTH">NORTH</option>

								

					<option value="NORTH EAST">NORTH EAST</option>

								

					<option value="NORTH WEST">NORTH WEST</option>

								

					<option value="OUTLOOK">OUTLOOK</option>

								

					<option value="PARK">PARK</option>

								

					<option value="PARKLANDS">PARKLANDS</option>

								

					<option value="PARKWAY">PARKWAY</option>

								

					<option value="PART">PART</option>

								

					<option value="PASS">PASS</option>

								

					<option value="PATH">PATH</option>

								

					<option value="PATHWAY">PATHWAY</option>

								

					<option value="PIAZZA">PIAZZA</option>

								

					<option value="PLATEAU">PLATEAU</option>

								

					<option value="PLAZA">PLAZA</option>

								

					<option value="POCKET">POCKET</option>

								

					<option value="POINT">POINT</option>

								

					<option value="PORT">PORT</option>

								

					<option value="PROMENADE">PROMENADE</option>

								

					<option value="QUAD">QUAD</option>

								

					<option value="QUADRANGLE">QUADRANGLE</option>

								

					<option value="QUADRANT">QUADRANT</option>

								

					<option value="QUAY">QUAY</option>

								

					<option value="QUAYS">QUAYS</option>

								

					<option value="RAMBLE">RAMBLE</option>

								

					<option value="RAMP">RAMP</option>

								

					<option value="RANGE">RANGE</option>

								

					<option value="REACH">REACH</option>

								

					<option value="RESERVE">RESERVE</option>

								

					<option value="REST">REST</option>

								

					<option value="RETREAT">RETREAT</option>

								

					<option value="RIDE">RIDE</option>

								

					<option value="RIDGE">RIDGE</option>

								

					<option value="RIDGEWAY">RIDGEWAY</option>

								

					<option value="RIGHT OF WAY">RIGHT OF WAY</option>

								

					<option value="RING">RING</option>

								

					<option value="RISE">RISE</option>

								

					<option value="RIVER">RIVER</option>

								

					<option value="RIVERWAY">RIVERWAY</option>

								

					<option value="RIVIERA">RIVIERA</option>

								

					<option value="ROADS">ROADS</option>

								

					<option value="ROADSIDE">ROADSIDE</option>

								

					<option value="ROADWAY">ROADWAY</option>

								

					<option value="RONDE">RONDE</option>

								

					<option value="ROSEBOWL">ROSEBOWL</option>

								

					<option value="ROTARY">ROTARY</option>

								

					<option value="ROUND">ROUND</option>

								

					<option value="ROUTE">ROUTE</option>

								

					<option value="ROW">ROW</option>

								

					<option value="RUE">RUE</option>

								

					<option value="RUN">RUN</option>

								

					<option value="SERVICE WAY">SERVICE WAY</option>

								

					<option value="SIDING">SIDING</option>

								

					<option value="SLOPE">SLOPE</option>

								

					<option value="SOUND">SOUND</option>

								

					<option value="SOUTH">SOUTH</option>

								

					<option value="SOUTH EAST">SOUTH EAST</option>

								

					<option value="SOUTH WEST">SOUTH WEST</option>

								

					<option value="SPUR">SPUR</option>

								

					<option value="SQUARE">SQUARE</option>

								

					<option value="STAIRS">STAIRS</option>

								

					<option value="STATE HIGHWAY">STATE HIGHWA</option>

								

					<option value="STEPS">STEPS</option>

								

					<option value="STEYNE">STEYNE</option>

								

					<option value="STRAND">STRAND</option>

								

					<option value="STRIP">STRIP</option>

								

					<option value="SUBWAY">SUBWAY</option>

								

					<option value="TARN">TARN</option>

								

					<option value="TERRACE">TERRACE</option>

								

					<option value="THOROUGHFARE">THOROUGHFARE</option>

								

					<option value="TOLLWAY">TOLLWAY</option>

								

					<option value="TOP">TOP</option>

								

					<option value="TOR">TOR</option>

								

					<option value="TOWERS">TOWERS</option>

								

					<option value="TRACK">TRACK</option>

								

					<option value="TRAIL">TRAIL</option>

								

					<option value="TRAILER">TRAILER</option>

								

					<option value="TRIANGLE">TRIANGLE</option>

								

					<option value="TRUNKWAY">TRUNKWAY</option>

								

					<option value="TURN">TURN</option>

								

					<option value="UNDERPASS">UNDERPASS</option>

								

					<option value="UPPER">UPPER</option>

								

					<option value="UPPER">UPPER</option>

								

					<option value="VALE">VALE</option>

								

					<option value="VIADUCT">VIADUCT</option>

								

					<option value="VIEW">VIEW</option>

								

					<option value="VILLAS">VILLAS</option>

								

					<option value="VISTA">VISTA</option>

								

					<option value="WADE">WADE</option>

								

					<option value="WALK">WALK</option>

								

					<option value="WALKWAY">WALKWAY</option>

								

					<option value="WAY">WAY</option>

								

					<option value="WEST">WEST</option>

								

					<option value="WHARF">WHARF</option>

								

					<option value="WYND">WYND</option>

								

					<option value="YARD">YARD</option>

								

          </select></td>

      </tr>	 	

         

      <tr> 

        <td align="left" >Suburb</td>

        <td align="left" ><input name="chPropertySuburb" type="Text" size="16"> State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chPropertyState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPropertyPostcode.focus()};">

					<option value=""></option>

            			

            <option value="ACT" >ACT</option>

            			

            <option value="NSW" >NSW</option>

            			

            <option value="NT" >NT</option>

            			

            <option value="QLD" >QLD</option>

            			

            <option value="SA" >SA</option>

            			

            <option value="TAS" >TAS</option>

            			

            <option value="VIC" >VIC</option>

            			

            <option value="WA " >WA </option>

            

          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="chPropertyPostcode" type="Text" size="4" maxlength="4">&nbsp;</td>

      </tr>	  

       

       <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td> 

	  </tr>

       <tr>

	  	<td align="left" width="171">Have you viewed the property?</td>

        <td  width="568">
		<input name="isPropertyViewed" type="Radio" class="formcheckbox" value="Yes" checked="true" > 
		Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="isPropertyViewed" type="Radio" value="No" > No</td>

	  </tr>	  

     

	 <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

        <tr>

	  	<td align="left" width="171" class="navytext"><strong>TENANCY REQUIREMENTS: <span class="redstar">*</span> </strong></td>

        <td  width="568">&nbsp;</td>

	  </tr>  

       

       <tr>

	  	<td align="left" width="171">Commencement of lease</td>

        <td  width="568"><input name="chCommencementOfLease"  type="text" size="16" maxlength="50"> Rent $&nbsp;&nbsp;&nbsp;<input name="chRent" type="Text" size="4" maxlength="4"> 

        pw<img src="images/spacer.gif" width="11" height="1" border="0">Length of lease 

          <input name="chLengthofLease" type="Text" size="16" maxlength="50"></td>

	  </tr>

            	  

	 <tr>

	  	<td align="left" width="171" class="navytext"><strong>APPLICANT'S NAME: <span class="redstar">*</span> </strong></td>

        <td  width="568"><select name="chTitle" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chFName.focus()};">

            <option value="null" SELECTED>(Title)</option>

            <option value="MR" >Mr</option> 

			<option value="MRS" >Mrs</option>

			<option value="MS" >Ms</option>

			<option value="MISS" >Miss</option>

            <option value="DR" >Dr</option>

          </select><img src="images/spacer.gif" width="42" height="1" border="0"><input name="chFName" onfocus="if(this.value=='First name'){this.value=''};" onblur="if(this.value==''){this.value='First name'};" value="First name" type="Text" size="16"> <input name="chMName"  value="Middle name" onfocus="if(this.value=='Middle name'){this.value=''};" onblur="if(this.value==''){this.value='Middle name'};" type="Text" size="16"> <input name="chSName" value="Surname" onfocus="if(this.value=='Surname'){this.value=''};" onblur="if(this.value==''){this.value='Surname'};checkSurname(this);" type="Text" size="16"></td>

	  </tr>

      

      <tr> 

         <td align="left">Maiden name</td>

        <td ><input name="chMaidenName" type="Text" size="16" value="" maxlength="50">

          <input name="chGender"  class="formcheckbox"    type="Radio" value="Male" checked="true"> Male 
		<input  class="formcheckbox" name="chGender"    type="Radio" value="Female" > 

          Female<img src="images/spacer.gif" width="44" height="1" border="0">DOB 

                    

           <select name="dtDOB_dd" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtDOB_mm.focus()};">

                <option value="null" SELECTED>

				<option value="1" >1<option value="2" >2<option value="3" >3<option value="4" >4<option value="5" >5<option value="6" >6<option value="7" >7<option value="8" >8<option value="9" >9<option value="10" >10<option value="11" >11<option value="12" >12<option value="13" >13<option value="14" >14<option value="15" >15<option value="16" >16<option value="17" >17<option value="18" >18<option value="19" >19<option value="20" >20<option value="21" >21<option value="22" >22<option value="23" >23<option value="24" >24<option value="25" >25<option value="26" >26<option value="27" >27<option value="28" >28<option value="29" >29<option value="30" >30<option value="31" >31

           </select>         

           <select name="dtDOB_mm" size="1" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){dtDOB_yyyy.focus()};">

                <option value="null" SELECTED>

				<option value="1" >Jan<option value="2" >Feb<option value="3" >Mar<option value="4" >Apr<option value="5" >May<option value="6" >Jun<option value="7" >Jul<option value="8" >Aug<option value="9" >Sep<option value="10" >Oct<option value="11" >Nov<option value="12" >Dec

           </select>

           <select name="dtDOB_yyyy" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chNumberOfAdults.focus()};">

                <option value="null" SELECTED>

                <option value="1994" >1994<option value="1993" >1993<option value="1992" >1992<option value="1991" >1991<option value="1990" >1990<option value="1989" >1989<option value="1988" >1988<option value="1987" >1987<option value="1986" >1986<option value="1985" >1985<option value="1984" >1984<option value="1983" >1983<option value="1982" >1982<option value="1981" >1981<option value="1980" >1980<option value="1979" >1979<option value="1978" >1978<option value="1977" >1977<option value="1976" >1976<option value="1975" >1975<option value="1974" >1974<option value="1973" >1973<option value="1972" >1972<option value="1971" >1971<option value="1970" >1970<option value="1969" >1969<option value="1968" >1968<option value="1967" >1967<option value="1966" >1966<option value="1965" >1965<option value="1964" >1964<option value="1963" >1963<option value="1962" >1962<option value="1961" >1961<option value="1960" >1960<option value="1959" >1959<option value="1958" >1958<option value="1957" >1957<option value="1956" >1956<option value="1955" >1955<option value="1954" >1954<option value="1953" >1953<option value="1952" >1952<option value="1951" >1951<option value="1950" >1950<option value="1949" >1949<option value="1948" >1948<option value="1947" >1947<option value="1946" >1946<option value="1945" >1945<option value="1944" >1944<option value="1943" >1943<option value="1942" >1942<option value="1941" >1941<option value="1940" >1940<option value="1939" >1939<option value="1938" >1938<option value="1937" >1937<option value="1936" >1936<option value="1935" >1935<option value="1934" >1934<option value="1933" >1933<option value="1932" >1932<option value="1931" >1931<option value="1930" >1930<option value="1929" >1929<option value="1928" >1928<option value="1927" >1927<option value="1926" >1926<option value="1925" >1925<option value="1924" >1924<option value="1923" >1923<option value="1922" >1922<option value="1921" >1921<option value="1920" >1920<option value="1919" >1919<option value="1918" >1918<option value="1917" >1917<option value="1916" >1916<option value="1915" >1915<option value="1914" >1914<option value="1913" >1913<option value="1912" >1912<option value="1911" >1911

                </select>

           </td>

      </tr>

      

       <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

        <tr>

	  	<td align="left" width="171" class="navytext"><strong>OCCUPANCY DETAILS: <span class="redstar">*</span> </strong></td>

        <td  width="568">&nbsp;</td>

	  </tr>  

       

       <tr>

	  	<td align="left" width="171">No. of Adults</td>

        <td  width="568"> <select name="chNumberOfAdults" style="width:74px" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chNumberOfChildren.focus()};">

            <option value="null" SELECTED>(Select)</option>

            <option value="1" >1</option> 

			<option value="2" >2</option>

            <option value="3" >3</option>

            <option value="4" >4</option>

            <option value="5" >5</option>

            <option value="6" >6</option>

            <option value="6+" >6+</option>

          </select>

        No. of Children 

          <select name="chNumberOfChildren" style="width:74px" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chAgesOfChildren.focus()};">

            <option value="null" SELECTED>(Select)</option>

            <option value="0" >0</option> 

            <option value="1" >1</option> 

			<option value="2" >2</option>

            <option value="3" >3</option>

            <option value="4" >4</option>

            <option value="5" >5</option>

            <option value="6" >6</option>

            <option value="6+" >6+</option>

          </select> Ages of Children 

          <input name="chAgesOfChildren" type="Text" size="16"  value=""  maxlength="30"></td>

	  </tr>

      

      <tr>

	  	<td align="left" width="171">Name of Adult 1</td>

        <td  width="568"><input name="chAdult1"  value=""  type="text" size="16" maxlength="100"> 

         <img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 2) <input name="chAdult2" type="Text" size="16"  value=""  maxlength="100"> 

         </td>

	  </tr>

       

       <tr>

	  	<td align="left" width="171">Name of Adult 3</td>

        <td  width="568"><input name="chAdult3"  value=""  type="text" size="16" maxlength="100"> 

         <img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 4) <input name="chAdult4" type="Text" size="16"  value=""  maxlength="100"> 

         </td>

	  </tr>

       

       <tr>

	  	<td align="left" width="171" style="height: 34px">Name of Adult 5</td>

        <td  width="568" style="height: 34px"><input name="chAdult5"  value=""  type="text" size="16" maxlength="100"> 

         <img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 6) <input name="chAdult6" type="Text" size="16"  value=""  maxlength="100"> 

         </td>

	  </tr>

	  

      <tr>

	  	<td align="left" width="171">Do you smoke?</td>        

        <td  width="568">
		<input name="chDoYouSmoke" class="formcheckbox"  type="Radio" value="Yes" checked="true"> Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="chDoYouSmoke"    type="Radio" value="No"> 

        No <img src="images/spacer.gif" width="89" height="1" border="0">

        Inside or outside?&nbsp;

        <input name="chSmokingInsideOutside" type="Text" size="16" maxlength="10"></td>

	  </tr>

      

      <tr>

	  	<td align="left" width="171">Do you have any pets?</td>        

        <td  width="568">
		<input name="chDoYouHavePets" class="formcheckbox"  type="Radio" value="Yes" checked="true"> Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="chDoYouHavePets"    type="Radio" value="No"> 

        No </td>

	  </tr>

      

      <tr>

	  	<td align="left" width="171">Number /   Type / Breed of pets</td>

        <td  width="568"><input name="chPetDescription"  type="text" style="width:441px;" maxlength="50" ></td>

	  </tr>

      

	  <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

	  <tr> 

        <td class="navytext"><b>PRESENT ADDRESS: <span class="redstar">*</span> </b></td>

		<td class="searchgreentext">
		<input name="chInternational" onClick="setInternationalPresentAddressNode(0)"  class="formcheckbox" checked="true" type="Radio" value="AUSTRALIAN"><span class="navytext"> AUSTRALIAN</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input  class="formcheckbox"  onClick="setInternationalPresentAddressNode(1)" name="chInternational" type="Radio" value="INTERNATIONAL" ><span class="navytext"> INTERNATIONAL</span></td>

      </tr>

      

	   <tr> 

         <td align="left">Type of residence</td>

        <td valign="Bottom" align="left" ><select name="chPrefix" onChange=				"if((this.value=='')||(this.value=='null')){document.getElementById('chFlatNo').style.display='none';document.getElementById('lblFlatNo').style.display='none';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chStreetNo.focus()};}else{document.getElementById('chFlatNo').style.display='inline';document.getElementById('lblFlatNo').style.display='inline';if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chFlatNo.focus()}};if(this.value=='-----'){this.value='';document.getElementById('chFlatNo').style.display='none';document.getElementById('lblFlatNo').style.display='none';};" style="width:113px;">

                    <option value="null">(Select)</option>

                    <option value="" SELECTED>HOUSE</option>

                    <option value="UNIT" >UNIT</option>

                    <option value="APARTMENT" >APARTMENT</option>

                    <option value="FLAT" >FLAT</option>

                    <option value="STUDIO" >STUDIO</option>                    

                    

                

                    <option value="-----" >

                        -----</option>

				

                    <option value="BLOCK" >

                        BLOCK</option>

				

                    <option value="CABIN" >

                        CABIN</option>

				

                    <option value="COTTAGE" >

                        COTTAGE</option>

				

                    <option value="DUPLEX" >

                        DUPLEX</option>

				

                    <option value="FACTORY" >

                        FACTORY</option>

				

                    <option value="FLOOR" >

                        FLOOR</option>

				

                    <option value="LOT" >

                        LOT</option>

				

                    <option value="PIER" >

                        PIER</option>

				

                    <option value="ROOFTOP" >

                        ROOFTOP</option>

				

                    <option value="ROOM" >

                        ROOM</option>

				

                    <option value="SHOP" >

                        SHOP</option>

				

                    <option value="SUITE" >

                        SUITE</option>

				

                    <option value="TOWNHOUSE" >

                        TOWNHOUSE</option>

				

                    <option value="VILLA" >

                        VILLA</option>

				

                    <option value="WAREHOUSE" >

                        WAREHOUSE</option>

				

              </select><div id="lblFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="chFlatNo" id="chFlatNo" value="" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"><img src="images/spacer.gif" width="2" border="0">Str. No.&nbsp;<input name="chStreetNo" value=""  type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>

      </tr>

      



	   <tr>

        <td align="left" >Street Name</td>

        <td valign="Bottom" align="left" ><input name="chStreetName" value=""  type="Text" size="16" maxlength="50"><img src="images/spacer.gif" width="46" height="1" border="0"><select

                        name="chStreetType" onchange="if(this.value=='-----'){this.value='';};if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chSuburb.focus()};"><option

                            value="">(Street Type)</option>

                        

                        <option value="STREET" >

                            STREET</option>

                        

                        <option value="ROAD" >

                            ROAD</option>

                        

                        <option value="AVENUE" >

                            AVENUE</option>

                        

                        <option value="PLACE" >

                            PLACE</option>

                        

                        <option value="CRESCENT" >

                            CRESCENT</option>

                        

                        <option value="DRIVE" >

                            DRIVE</option>

                        

                        <option value="PARADE" >

                            PARADE</option>

                        

                        <option value="CLOSE" >

                            CLOSE</option>

                        

                        <option value="-----" >

                            -----</option>

                        

                        <option value="ACCESS" >

                            ACCESS</option>

                        

                        <option value="ALLEY" >

                            ALLEY</option>

                        

                        <option value="ALLEYWAY" >

                            ALLEYWAY</option>

                        

                        <option value="AMBLE" >

                            AMBLE</option>

                        

                        <option value="ANCHORAGE" >

                            ANCHORAGE</option>

                        

                        <option value="APPROACH" >

                            APPROACH</option>

                        

                        <option value="ARCADE" >

                            ARCADE</option>

                        

                        <option value="ARTERY" >

                            ARTERY</option>

                        

                        <option value="BASIN" >

                            BASIN</option>

                        

                        <option value="BEACH" >

                            BEACH</option>

                        

                        <option value="BEND" >

                            BEND</option>

                        

                        <option value="BLOCK" >

                            BLOCK</option>

                        

                        <option value="BOULEVARD" >

                            BOULEVARD</option>

                        

                        <option value="BOULEVARDE" >

                            BOULEVARDE</option>

                        

                        <option value="BRACE" >

                            BRACE</option>

                        

                        <option value="BRAE" >

                            BRAE</option>

                        

                        <option value="BREAK" >

                            BREAK</option>

                        

                        <option value="BRIDGE" >

                            BRIDGE</option>

                        

                        <option value="BROADWAY" >

                            BROADWAY</option>

                        

                        <option value="BROW" >

                            BROW</option>

                        

                        <option value="BYPASS" >

                            BYPASS</option>

                        

                        <option value="BYWAY" >

                            BYWAY</option>

                        

                        <option value="CAUSEWAY" >

                            CAUSEWAY</option>

                        

                        <option value="CENTRAL" >

                            CENTRAL</option>

                        

                        <option value="CENTRE" >

                            CENTRE</option>

                        

                        <option value="CENTREWAY" >

                            CENTREWAY</option>

                        

                        <option value="CHASE" >

                            CHASE</option>

                        

                        <option value="CIRCLE" >

                            CIRCLE</option>

                        

                        <option value="CIRCLET" >

                            CIRCLET</option>

                        

                        <option value="CIRCUIT" >

                            CIRCUIT</option>

                        

                        <option value="CIRCUS" >

                            CIRCUS</option>

                        

                        <option value="COLONNADE" >

                            COLONNADE</option>

                        

                        <option value="COMMON" >

                            COMMON</option>

                        

                        <option value="CONCOURSE" >

                            CONCOURSE</option>

                        

                        <option value="COPSE" >

                            COPSE</option>

                        

                        <option value="CORNER" >

                            CORNER</option>

                        

                        <option value="CORSO" >

                            CORSO</option>

                        

                        <option value="COURT" >

                            COURT</option>

                        

                        <option value="COURTYARD" >

                            COURTYARD</option>

                        

                        <option value="COVE" >

                            COVE</option>

                        

                        <option value="CREST" >

                            CREST</option>

                        

                        <option value="CROSS" >

                            CROSS</option>

                        

                        <option value="CROSSING" >

                            CROSSING</option>

                        

                        <option value="CROSSROAD" >

                            CROSSROAD</option>

                        

                        <option value="CROSSWAY" >

                            CROSSWAY</option>

                        

                        <option value="CRUISEWAY" >

                            CRUISEWAY</option>

                        

                        <option value="CUL-DE-SAC" >

                            CUL-DE-SAC</option>

                        

                        <option value="CUTTING" >

                            CUTTING</option>

                        

                        <option value="DALE" >

                            DALE</option>

                        

                        <option value="DELL" >

                            DELL</option>

                        

                        <option value="DEVIATION" >

                            DEVIATION</option>

                        

                        <option value="DIP" >

                            DIP</option>

                        

                        <option value="DISTRIBUTOR" >

                            DISTRIBUTOR</option>

                        

                        <option value="DRIVEWAY" >

                            DRIVEWAY</option>

                        

                        <option value="EAST" >

                            EAST</option>

                        

                        <option value="EDGE" >

                            EDGE</option>

                        

                        <option value="ELBOW" >

                            ELBOW</option>

                        

                        <option value="END" >

                            END</option>

                        

                        <option value="ENTRANCE" >

                            ENTRANCE</option>

                        

                        <option value="ESPLANADE" >

                            ESPLANADE</option>

                        

                        <option value="ESTATE" >

                            ESTATE</option>

                        

                        <option value="EXPRESSWAY" >

                            EXPRESSWAY</option>

                        

                        <option value="EXTENSION" >

                            EXTENSION</option>

                        

                        <option value="EXTENSION" >

                            EXTENSION</option>

                        

                        <option value="FAIRWAY" >

                            FAIRWAY</option>

                        

                        <option value="FIRE TRACK" >

                            FIRE TRACK</option>

                        

                        <option value="FIRETRAIL" >

                            FIRETRAIL</option>

                        

                        <option value="FLAT" >

                            FLAT</option>

                        

                        <option value="FOLLOW" >

                            FOLLOW</option>

                        

                        <option value="FOOTWAY" >

                            FOOTWAY</option>

                        

                        <option value="FORESHORE" >

                            FORESHORE</option>

                        

                        <option value="FORMATION" >

                            FORMATION</option>

                        

                        <option value="FREEWAY" >

                            FREEWAY</option>

                        

                        <option value="FRONT" >

                            FRONT</option>

                        

                        <option value="FRONTAGE" >

                            FRONTAGE</option>

                        

                        <option value="GAP" >

                            GAP</option>

                        

                        <option value="GARDEN" >

                            GARDEN</option>

                        

                        <option value="GARDENS" >

                            GARDENS</option>

                        

                        <option value="GATE" >

                            GATE</option>

                        

                        <option value="GATES" >

                            GATES</option>

                        

                        <option value="GLADE" >

                            GLADE</option>

                        

                        <option value="GLEN" >

                            GLEN</option>

                        

                        <option value="GRANGE" >

                            GRANGE</option>

                        

                        <option value="GREEN" >

                            GREEN</option>

                        

                        <option value="GROUND" >

                            GROUND</option>

                        

                        <option value="GROVE" >

                            GROVE</option>

                        

                        <option value="GULLY" >

                            GULLY</option>

                        

                        <option value="HEIGHTS" >

                            HEIGHTS</option>

                        

                        <option value="HIGHROAD" >

                            HIGHROAD</option>

                        

                        <option value="HIGHWAY" >

                            HIGHWAY</option>

                        

                        <option value="HILL" >

                            HILL</option>

                        

                        <option value="INTERCHANGE" >

                            INTERCHANGE</option>

                        

                        <option value="INTERSECTION" >

                            INTERSECTION</option>

                        

                        <option value="JUNCTION" >

                            JUNCTION</option>

                        

                        <option value="KEY" >

                            KEY</option>

                        

                        <option value="LANDING" >

                            LANDING</option>

                        

                        <option value="LANE" >

                            LANE</option>

                        

                        <option value="LANEWAY" >

                            LANEWAY</option>

                        

                        <option value="LEES" >

                            LEES</option>

                        

                        <option value="LINE" >

                            LINE</option>

                        

                        <option value="LINK" >

                            LINK</option>

                        

                        <option value="LITTLE" >

                            LITTLE</option>

                        

                        <option value="LOOKOUT" >

                            LOOKOUT</option>

                        

                        <option value="LOOP" >

                            LOOP</option>

                        

                        <option value="LOWER" >

                            LOWER</option>

                        

                        <option value="LOWER" >

                            LOWER</option>

                        

                        <option value="MALL" >

                            MALL</option>

                        

                        <option value="MEANDER" >

                            MEANDER</option>

                        

                        <option value="MEW" >

                            MEW</option>

                        

                        <option value="MEWS" >

                            MEWS</option>

                        

                        <option value="MOTORWAY" >

                            MOTORWAY</option>

                        

                        <option value="MOUNT" >

                            MOUNT</option>

                        

                        <option value="NOOK" >

                            NOOK</option>

                        

                        <option value="NORTH" >

                            NORTH</option>

                        

                        <option value="NORTH EAST" >

                            NORTH EAST</option>

                        

                        <option value="NORTH WEST" >

                            NORTH WEST</option>

                        

                        <option value="OUTLOOK" >

                            OUTLOOK</option>

                        

                        <option value="PARK" >

                            PARK</option>

                        

                        <option value="PARKLANDS" >

                            PARKLANDS</option>

                        

                        <option value="PARKWAY" >

                            PARKWAY</option>

                        

                        <option value="PART" >

                            PART</option>

                        

                        <option value="PASS" >

                            PASS</option>

                        

                        <option value="PATH" >

                            PATH</option>

                        

                        <option value="PATHWAY" >

                            PATHWAY</option>

                        

                        <option value="PIAZZA" >

                            PIAZZA</option>

                        

                        <option value="PLATEAU" >

                            PLATEAU</option>

                        

                        <option value="PLAZA" >

                            PLAZA</option>

                        

                        <option value="POCKET" >

                            POCKET</option>

                        

                        <option value="POINT" >

                            POINT</option>

                        

                        <option value="PORT" >

                            PORT</option>

                        

                        <option value="PROMENADE" >

                            PROMENADE</option>

                        

                        <option value="QUAD" >

                            QUAD</option>

                        

                        <option value="QUADRANGLE" >

                            QUADRANGLE</option>

                        

                        <option value="QUADRANT" >

                            QUADRANT</option>

                        

                        <option value="QUAY" >

                            QUAY</option>

                        

                        <option value="QUAYS" >

                            QUAYS</option>

                        

                        <option value="RAMBLE" >

                            RAMBLE</option>

                        

                        <option value="RAMP" >

                            RAMP</option>

                        

                        <option value="RANGE" >

                            RANGE</option>

                        

                        <option value="REACH" >

                            REACH</option>

                        

                        <option value="RESERVE" >

                            RESERVE</option>

                        

                        <option value="REST" >

                            REST</option>

                        

                        <option value="RETREAT" >

                            RETREAT</option>

                        

                        <option value="RIDE" >

                            RIDE</option>

                        

                        <option value="RIDGE" >

                            RIDGE</option>

                        

                        <option value="RIDGEWAY" >

                            RIDGEWAY</option>

                        

                        <option value="RIGHT OF WAY" >

                            RIGHT OF WAY</option>

                        

                        <option value="RING" >

                            RING</option>

                        

                        <option value="RISE" >

                            RISE</option>

                        

                        <option value="RIVER" >

                            RIVER</option>

                        

                        <option value="RIVERWAY" >

                            RIVERWAY</option>

                        

                        <option value="RIVIERA" >

                            RIVIERA</option>

                        

                        <option value="ROADS" >

                            ROADS</option>

                        

                        <option value="ROADSIDE" >

                            ROADSIDE</option>

                        

                        <option value="ROADWAY" >

                            ROADWAY</option>

                        

                        <option value="RONDE" >

                            RONDE</option>

                        

                        <option value="ROSEBOWL" >

                            ROSEBOWL</option>

                        

                        <option value="ROTARY" >

                            ROTARY</option>

                        

                        <option value="ROUND" >

                            ROUND</option>

                        

                        <option value="ROUTE" >

                            ROUTE</option>

                        

                        <option value="ROW" >

                            ROW</option>

                        

                        <option value="RUE" >

                            RUE</option>

                        

                        <option value="RUN" >

                            RUN</option>

                        

                        <option value="SERVICE WAY" >

                            SERVICE WAY</option>

                        

                        <option value="SIDING" >

                            SIDING</option>

                        

                        <option value="SLOPE" >

                            SLOPE</option>

                        

                        <option value="SOUND" >

                            SOUND</option>

                        

                        <option value="SOUTH" >

                            SOUTH</option>

                        

                        <option value="SOUTH EAST" >

                            SOUTH EAST</option>

                        

                        <option value="SOUTH WEST" >

                            SOUTH WEST</option>

                        

                        <option value="SPUR" >

                            SPUR</option>

                        

                        <option value="SQUARE" >

                            SQUARE</option>

                        

                        <option value="STAIRS" >

                            STAIRS</option>

                        

                        <option value="STATE HIGHWAY" >

                            STATE HIGHWA</option>

                        

                        <option value="STEPS" >

                            STEPS</option>

                        

                        <option value="STEYNE" >

                            STEYNE</option>

                        

                        <option value="STRAND" >

                            STRAND</option>

                        

                        <option value="STRIP" >

                            STRIP</option>

                        

                        <option value="SUBWAY" >

                            SUBWAY</option>

                        

                        <option value="TARN" >

                            TARN</option>

                        

                        <option value="TERRACE" >

                            TERRACE</option>

                        

                        <option value="THOROUGHFARE" >

                            THOROUGHFARE</option>

                        

                        <option value="TOLLWAY" >

                            TOLLWAY</option>

                        

                        <option value="TOP" >

                            TOP</option>

                        

                        <option value="TOR" >

                            TOR</option>

                        

                        <option value="TOWERS" >

                            TOWERS</option>

                        

                        <option value="TRACK" >

                            TRACK</option>

                        

                        <option value="TRAIL" >

                            TRAIL</option>

                        

                        <option value="TRAILER" >

                            TRAILER</option>

                        

                        <option value="TRIANGLE" >

                            TRIANGLE</option>

                        

                        <option value="TRUNKWAY" >

                            TRUNKWAY</option>

                        

                        <option value="TURN" >

                            TURN</option>

                        

                        <option value="UNDERPASS" >

                            UNDERPASS</option>

                        

                        <option value="UPPER" >

                            UPPER</option>

                        

                        <option value="UPPER" >

                            UPPER</option>

                        

                        <option value="VALE" >

                            VALE</option>

                        

                        <option value="VIADUCT" >

                            VIADUCT</option>

                        

                        <option value="VIEW" >

                            VIEW</option>

                        

                        <option value="VILLAS" >

                            VILLAS</option>

                        

                        <option value="VISTA" >

                            VISTA</option>

                        

                        <option value="WADE" >

                            WADE</option>

                        

                        <option value="WALK" >

                            WALK</option>

                        

                        <option value="WALKWAY" >

                            WALKWAY</option>

                        

                        <option value="WAY" >

                            WAY</option>

                        

                        <option value="WEST" >

                            WEST</option>

                        

                        <option value="WHARF" >

                            WHARF</option>

                        

                        <option value="WYND" >

                            WYND</option>

                        

                        <option value="YARD" >

                            YARD</option>

                        

                    </select></td>

      </tr>

      

	 	  

      <tr> 

        <td align="left"><div id="objPresentAddressAus1">Suburb</div></td>

        <td align="left"><div id="objPresentAddressAus2"><input name="chSuburb" value="" type="Text" size="16"> 

        State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPostcode.focus()};">

					<option value=""></option>

            			

            <option value="ACT" >ACT</option>

            			

            <option value="NSW" >NSW</option>

            			

            <option value="NT" >NT</option>

            			

            <option value="QLD" >QLD</option>

            			

            <option value="SA" >SA</option>

            			

            <option value="TAS" >TAS</option>

            			

            <option value="VIC" >VIC</option>

            			

            <option value="WA " >WA </option>

            

          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="chPostcode"value="" type="Text" size="4" maxlength="4">  </div></td>

      </tr>    

      

      

      <!-- INT ADDRESS STUFF --->

      

      <tr> 

        <td align="left" ><div id="objPresentAddressInt1" style="display:none">Suburb</div></td>

        <td align="left" ><div id="objPresentAddressInt2" style="display:none"><input name="chIntSuburb" type="Text" size="16"> City&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input name="chIntCity" type="Text" size="16"> State/County <input name="chIntState" type="Text" size="16"></div></td>

      </tr>  

       

      <tr> 

        <td height="3" align="left"><div id="objPresentAddressInt3"  style="display:none">PostCode/ZIP</div></td>

        <td height="3"><div id="objPresentAddressInt4"  style="display:none"><input name="chIntPostcode" type="Text" size="16"> Country <select name="chIntCountry"><option value="">(Select Country)</option>

            

            <option value="Afghanistan">Afghanistan</option>

            

            <option value="Albania">Albania</option>

            

            <option value="Algeria">Algeria</option>

            

            <option value="American Samoa">American Samoa</option>

            

            <option value="Andorra">Andorra</option>

            

            <option value="Angola">Angola</option>

            

            <option value="Anguilla">Anguilla</option>

            

            <option value="Antarctica">Antarctica</option>

            

            <option value="Antigua and Barbuda">Antigua and Barbuda</option>

            

            <option value="Argentina">Argentina</option>

            

            <option value="Armenia">Armenia</option>

            

            <option value="Aruba">Aruba</option>

            

            <option value="Austria">Austria</option>

            

            <option value="Azerbaijan">Azerbaijan</option>

            

            <option value="Bahamas">Bahamas</option>

            

            <option value="Bahrain">Bahrain</option>

            

            <option value="Bangladesh">Bangladesh</option>

            

            <option value="Barbados">Barbados</option>

            

            <option value="Belarus">Belarus</option>

            

            <option value="Belgium">Belgium</option>

            

            <option value="Belize">Belize</option>

            

            <option value="Benin">Benin</option>

            

            <option value="Bermuda">Bermuda</option>

            

            <option value="Bhutan">Bhutan</option>

            

            <option value="Bolivia">Bolivia</option>

            

            <option value="Bosnia and Herzegowina">Bosnia and Herzegowina</option>

            

            <option value="Botswana">Botswana</option>

            

            <option value="Bouvet Island">Bouvet Island</option>

            

            <option value="Brazil">Brazil</option>

            

            <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>

            

            <option value="Brunei Darussalam">Brunei Darussalam</option>

            

            <option value="Bulgaria">Bulgaria</option>

            

            <option value="Burkina Faso">Burkina Faso</option>

            

            <option value="Burundi">Burundi</option>

            

            <option value="Cambodia">Cambodia</option>

            

            <option value="Cameroon">Cameroon</option>

            

            <option value="Canada">Canada</option>

            

            <option value="Cape Verde">Cape Verde</option>

            

            <option value="Cayman islands">Cayman islands</option>

            

            <option value="Central African Republic">Central African Republic</option>

            

            <option value="Chad">Chad</option>

            

            <option value="Chile">Chile</option>

            

            <option value="China">China</option>

            

            <option value="Christmas Island">Christmas Island</option>

            

            <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>

            

            <option value="Colombia">Colombia</option>

            

            <option value="Comoros">Comoros</option>

            

            <option value="Congo">Congo</option>

            

            <option value="Congo, Democratic Republic">Congo, Democratic Republic</option>

            

            <option value="Cook Islands">Cook Islands</option>

            

            <option value="Costa Rica">Costa Rica</option>

            

            <option value="Cote d'ivoire">Cote d'ivoire</option>

            

            <option value="Croatia (Hrvatska)">Croatia (Hrvatska)</option>

            

            <option value="Cuba">Cuba</option>

            

            <option value="Cyprus">Cyprus</option>

            

            <option value="Czech Republic">Czech Republic</option>

            

            <option value="Denmark">Denmark</option>

            

            <option value="Djibouti">Djibouti</option>

            

            <option value="Dominica">Dominica</option>

            

            <option value="Dominican Republic">Dominican Republic</option>

            

            <option value="East Timor">East Timor</option>

            

            <option value="Ecuador">Ecuador</option>

            

            <option value="Egypt">Egypt</option>

            

            <option value="El Salvador">El Salvador</option>

            

            <option value="Equatorial Guinea">Equatorial Guinea</option>

            

            <option value="Eritrea">Eritrea</option>

            

            <option value="Estonia">Estonia</option>

            

            <option value="Ethiopia">Ethiopia</option>

            

            <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>

            

            <option value="Faroe islands">Faroe islands</option>

            

            <option value="Fiji">Fiji</option>

            

            <option value="Finland">Finland</option>

            

            <option value="France">France</option>

            

            <option value="France, Metropolitan">France, Metropolitan</option>

            

            <option value="French Guiana">French Guiana</option>

            

            <option value="French Polynesia">French Polynesia</option>

            

            <option value="French Southern Territories">French Southern Territories</option>

            

            <option value="Gabon">Gabon</option>

            

            <option value="Gambia">Gambia</option>

            

            <option value="Georgia">Georgia</option>

            

            <option value="Germany">Germany</option>

            

            <option value="Ghana">Ghana</option>

            

            <option value="Gibraltar">Gibraltar</option>

            

            <option value="Greece">Greece</option>

            

            <option value="Greenland">Greenland</option>

            

            <option value="Grenada">Grenada</option>

            

            <option value="Guadeloupe">Guadeloupe</option>

            

            <option value="Guam">Guam</option>

            

            <option value="Guatemala">Guatemala</option>

            

            <option value="Guinea">Guinea</option>

            

            <option value="Guinea-Bissau">Guinea-Bissau</option>

            

            <option value="Guyana">Guyana</option>

            

            <option value="Haiti">Haiti</option>

            

            <option value="Heard and Mc Donald Islands">Heard and Mc Donald Islands</option>

            

            <option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>

            

            <option value="Honduras">Honduras</option>

            

            <option value="Hong Kong">Hong Kong</option>

            

            <option value="Hungary">Hungary</option>

            

            <option value="Iceland">Iceland</option>

            

            <option value="India">India</option>

            

            <option value="Indonesia">Indonesia</option>

            

            <option value="Iran (Islamic Republic of)">Iran (Islamic Republic of)</option>

            

            <option value="Iraq">Iraq</option>

            

            <option value="Ireland">Ireland</option>

            

            <option value="Israel">Israel</option>

            

            <option value="Italy">Italy</option>

            

            <option value="Jamaica">Jamaica</option>

            

            <option value="Japan">Japan</option>

            

            <option value="Jordan">Jordan</option>

            

            <option value="Kazakhstan">Kazakhstan</option>

            

            <option value="Kenya">Kenya</option>

            

            <option value="Kiribati">Kiribati</option>

            

            <option value="Korea, Democratic People's Republic">Korea, Democratic People's Republic</option>

            

            <option value="Korea, Republic of">Korea, Republic of</option>

            

            <option value="Kuwait">Kuwait</option>

            

            <option value="Kyrgyzstan">Kyrgyzstan</option>

            

            <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>

            

            <option value="Latvia">Latvia</option>

            

            <option value="Lebanon">Lebanon</option>

            

            <option value="Lesotho">Lesotho</option>

            

            <option value="Liberia">Liberia</option>

            

            <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>

            

            <option value="Liechtenstein">Liechtenstein</option>

            

            <option value="Lithuania">Lithuania</option>

            

            <option value="Luxembourg">Luxembourg</option>

            

            <option value="Macau">Macau</option>

            

            <option value="Macedonia (Yugoslav Republic)">Macedonia (Yugoslav Republic)</option>

            

            <option value="Madagascar">Madagascar</option>

            

            <option value="Malawi">Malawi</option>

            

            <option value="Malaysia">Malaysia</option>

            

            <option value="Maldives">Maldives</option>

            

            <option value="Mali">Mali</option>

            

            <option value="Malta">Malta</option>

            

            <option value="Marshall Islands">Marshall Islands</option>

            

            <option value="Martinique">Martinique</option>

            

            <option value="Mauritania">Mauritania</option>

            

            <option value="Mauritius">Mauritius</option>

            

            <option value="Mayotte">Mayotte</option>

            

            <option value="Mexico">Mexico</option>

            

            <option value="Micronesia">Micronesia</option>

            

            <option value="Moldova">Moldova</option>

            

            <option value="Monaco">Monaco</option>

            

            <option value="Mongolia">Mongolia</option>

            

            <option value="Montserrat">Montserrat</option>

            

            <option value="Morocco">Morocco</option>

            

            <option value="Mozambique">Mozambique</option>

            

            <option value="Myanmar">Myanmar</option>

            

            <option value="Namibia">Namibia</option>

            

            <option value="Nauru">Nauru</option>

            

            <option value="Nepal">Nepal</option>

            

            <option value="Netherlands">Netherlands</option>

            

            <option value="Netherlands Antilles">Netherlands Antilles</option>

            

            <option value="New Caledonia">New Caledonia</option>

            

            <option value="New Zealand">New Zealand</option>

            

            <option value="Nicaragua">Nicaragua</option>

            

            <option value="Niger">Niger</option>

            

            <option value="Nigeria">Nigeria</option>

            

            <option value="Niue">Niue</option>

            

            <option value="Norfolk island">Norfolk island</option>

            

            <option value="Northern Mariana Islands">Northern Mariana Islands</option>

            

            <option value="Norway">Norway</option>

            

            <option value="Oman">Oman</option>

            

            <option value="Pakistan">Pakistan</option>

            

            <option value="Palau">Palau</option>

            

            <option value="Panama">Panama</option>

            

            <option value="Papua New Guinea">Papua New Guinea</option>

            

            <option value="Paraguay">Paraguay</option>

            

            <option value="Peru">Peru</option>

            

            <option value="Philippines">Philippines</option>

            

            <option value="Pitcairn">Pitcairn</option>

            

            <option value="Poland">Poland</option>

            

            <option value="Portugal">Portugal</option>

            

            <option value="Puerto Rico">Puerto Rico</option>

            

            <option value="Qatar">Qatar</option>

            

            <option value="Reunion">Reunion</option>

            

            <option value="Romania">Romania</option>

            

            <option value="Russian Federation">Russian Federation</option>

            

            <option value="Rwanda">Rwanda</option>

            

            <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>

            

            <option value="Saint Lucia">Saint Lucia</option>

            

            <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>

            

            <option value="Samoa">Samoa</option>

            

            <option value="San Marino">San Marino</option>

            

            <option value="Sao Tome and Principe">Sao Tome and Principe</option>

            

            <option value="Saudi Arabia">Saudi Arabia</option>

            

            <option value="Senegal">Senegal</option>

            

            <option value="Seychelles">Seychelles</option>

            

            <option value="Sierra Leone">Sierra Leone</option>

            

            <option value="Singapore">Singapore</option>

            

            <option value="Slovakia (Slovak Republic)">Slovakia (Slovak Republic)</option>

            

            <option value="Slovenia">Slovenia</option>

            

            <option value="Solomon Islands">Solomon Islands</option>

            

            <option value="Somalia">Somalia</option>

            

            <option value="South Africa">South Africa</option>

            

            <option value="South Georgia">South Georgia</option>

            

            <option value="Spain">Spain</option>

            

            <option value="Sri Lanka">Sri Lanka</option>

            

            <option value="St Helena">St Helena</option>

            

            <option value="St Pierre and Miquelon">St Pierre and Miquelon</option>

            

            <option value="Sudan">Sudan</option>

            

            <option value="Suriname">Suriname</option>

            

            <option value="Svalbard and Jan Mayen Islands">Svalbard and Jan Mayen Islands</option>

            

            <option value="Swaziland">Swaziland</option>

            

            <option value="Sweden">Sweden</option>

            

            <option value="Switzerland">Switzerland</option>

            

            <option value="Syrian Arab Republic">Syrian Arab Republic</option>

            

            <option value="Taiwan">Taiwan</option>

            

            <option value="Tajikistan">Tajikistan</option>

            

            <option value="Tanzania, United Republic of">Tanzania, United Republic of</option>

            

            <option value="Thailand">Thailand</option>

            

            <option value="Togo">Togo</option>

            

            <option value="Tokelau">Tokelau</option>

            

            <option value="Tonga">Tonga</option>

            

            <option value="Trinidad and Tobago">Trinidad and Tobago</option>

            

            <option value="Tunisia">Tunisia</option>

            

            <option value="Turkey">Turkey</option>

            

            <option value="Turkmenistan">Turkmenistan</option>

            

            <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>

            

            <option value="Tuvalu">Tuvalu</option>

            

            <option value="Uganda">Uganda</option>

            

            <option value="Ukraine">Ukraine</option>

            

            <option value="United Arab Emirates">United Arab Emirates</option>

            

            <option value="United Kingdom">United Kingdom</option>

            

            <option value="United States">United States</option>

            

            <option value="Uruguay">Uruguay</option>

            

            <option value="Uzbekistan">Uzbekistan</option>

            

            <option value="Vanuatu">Vanuatu</option>

            

            <option value="Venezuela">Venezuela</option>

            

            <option value="Vietnam">Vietnam</option>

            

            <option value="Virgin Islands (British)">Virgin Islands (British)</option>

            

            <option value="Virgin Islands (US)">Virgin Islands (US)</option>

            

            <option value="Wallis and Futuna Islands">Wallis and Futuna Islands</option>

            

            <option value="Western Sahara">Western Sahara</option>

            

            <option value="Yemen">Yemen</option>

            

            <option value="Yugoslavia">Yugoslavia</option>

            

            <option value="Zambia">Zambia</option>

            

            <option value="Zimbabwe">Zimbabwe</option>

            

          </select></div></td>

      </tr>

      

      <!--- END INT ADDRESS STUFF -->

       <tr>

	  	<td align="left" width="171"><table cellpadding="0" width="100%" cellspacing="0" border="0"><tr>

	  	      <td>Current Rent</td><td align="right">$ </td></tr></table></td>

        <td  width="568"><input name="chCurrentRent" value=""  type="text" size="4" maxlength="10"> 

        pw

        <img src="images/spacer.gif" height="1" width="29" border="0">Length of tenancy at current address<img src="images/spacer.gif" height="1" width="28" border="0">

        <input name="chCurrentTimeAtAddress"  value=""  type="Text" size="16" maxlength="16"> 

	  </tr>

      

      <tr>

	  	<td align="left" colspan="2" style="height:10px;"></td>

	  </tr> 

      <tr>

	  	<td align="left" width="171" class="navytext"><strong>IDENTIFIERS:</strong></td>

        <td>&nbsp;</td>

	  </tr>      

      

      <tr> 

         <td align="left" >Driver's Licence No.</td>

        <td ><input name="chLicense"  value=""  type="Text" size="16"> State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chLicenseStateIssue" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chLicenseCardNumber.focus()};">

					<option value=" " ></option>

            			

            <option value="ACT" >ACT</option>

            			

            <option value="NSW" >NSW</option>

            			

            <option value="NT" >NT</option>

            			

            <option value="QLD" >QLD</option>

            			

            <option value="SA" >SA</option>

            			

            <option value="TAS" >TAS</option>

            			

            <option value="VIC" >VIC</option>

            			

            <option value="WA " >WA </option>

            

          </select> 

        License Card No.<img src="images/spacer.gif" width="18" height="1" border="0">

        <input name="chLicenseCardNumber" value=""  type="Text" size="16"> </td>

      </tr>

      

	  

      <tr> 

         <td align="left" >Vehicle Registration</td>

        <td ><input name="chVehicle" value=""  type="Text" size="16" onBlur="checkRego(this);"> State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chVehicleStateIssue" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chCentrelink.focus()};"><option value=" " ></option>

            

            <option value="ACT" >ACT</option>

            

            <option value="NSW" >NSW</option>

            

            <option value="NT" >NT</option>

            

            <option value="QLD" >QLD</option>

            

            <option value="SA" >SA</option>

            

            <option value="TAS" >TAS</option>

            

            <option value="VIC" >VIC</option>

            

            <option value="WA " >WA </option>

            

          </select></td>

      </tr>

      

      <tr><td align="left"  valign="baseline">Centrelink No.</td>

        <td ><input name="chCentrelink" value=""  type="Text" size="16" maxlength="10"><img src="images/spacer.gif" width="100" height="1" border="0">Proof of Age Card No. <input name="chProofofAge" value=""  type="Text" size="16" maxlength="10">        

        </td>

      </tr>

      

        <tr><td align="left"  valign="baseline">Pension No.</td>

        <td ><input name="chPensionNo" value=""  type="Text" size="16" maxlength="10"><img src="images/spacer.gif" width="100" height="1" border="0">Pension Type<img src="images/spacer.gif" width="46" height="1" border="0"><input name="chPensionType" value=""  type="Text" size="16" maxlength="20">       

        </td>

      </tr>

      

      <tr><td align="left"  valign="baseline">Working Visa</td>

        <td ><input name="chWorkingVisa" value=""  type="Text" size="16" maxlength="10"><img src="images/spacer.gif" width="100" height="1" border="0">Date of expiry<img src="images/spacer.gif" width="48" height="1" border="0"><input name="chWorkVisaExpiry" value=""  type="Text" size="16" maxlength="20">       

        </td>

      </tr>

      

       <tr>

        <td   align="left" valign="baseline">Australian Passport No.</td>

        <td ><input name="chAusPassport" value=""  type="Text" size="16"><img src="images/spacer.gif" width="100" height="1" border="0">Medicare No.<img src="images/spacer.gif" width="49" height="1" border="0"><input name="chMedicare" value=""  type="Text" size="16" maxlength="10"></td>

      </tr>

      

      <tr>

        <td   align="left" valign="baseline">International Passport No.</td>

        <td ><input name="chPassport" value=""  type="Text" size="16"><img src="images/spacer.gif" width="57" height="1" border="0">Country <select name="chPassportCountry"  onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chIntLicense.focus()};">

            <option value=""></option>

            

             <option value="Afghanistan" >

                        Afghanistan</option>

            

             <option value="Albania" >

                        Albania</option>

            

             <option value="Algeria" >

                        Algeria</option>

            

             <option value="American Samoa" >

                        American Samoa</option>

            

             <option value="Andorra" >

                        Andorra</option>

            

             <option value="Angola" >

                        Angola</option>

            

             <option value="Anguilla" >

                        Anguilla</option>

            

             <option value="Antarctica" >

                        Antarctica</option>

            

             <option value="Antigua and Barbuda" >

                        Antigua and Barbuda</option>

            

             <option value="Argentina" >

                        Argentina</option>

            

             <option value="Armenia" >

                        Armenia</option>

            

             <option value="Aruba" >

                        Aruba</option>

            

             <option value="Austria" >

                        Austria</option>

            

             <option value="Azerbaijan" >

                        Azerbaijan</option>

            

             <option value="Bahamas" >

                        Bahamas</option>

            

             <option value="Bahrain" >

                        Bahrain</option>

            

             <option value="Bangladesh" >

                        Bangladesh</option>

            

             <option value="Barbados" >

                        Barbados</option>

            

             <option value="Belarus" >

                        Belarus</option>

            

             <option value="Belgium" >

                        Belgium</option>

            

             <option value="Belize" >

                        Belize</option>

            

             <option value="Benin" >

                        Benin</option>

            

             <option value="Bermuda" >

                        Bermuda</option>

            

             <option value="Bhutan" >

                        Bhutan</option>

            

             <option value="Bolivia" >

                        Bolivia</option>

            

             <option value="Bosnia and Herzegowina" >

                        Bosnia and Herzegowina</option>

            

             <option value="Botswana" >

                        Botswana</option>

            

             <option value="Bouvet Island" >

                        Bouvet Island</option>

            

             <option value="Brazil" >

                        Brazil</option>

            

             <option value="British Indian Ocean Territory" >

                        British Indian Ocean Territory</option>

            

             <option value="Brunei Darussalam" >

                        Brunei Darussalam</option>

            

             <option value="Bulgaria" >

                        Bulgaria</option>

            

             <option value="Burkina Faso" >

                        Burkina Faso</option>

            

             <option value="Burundi" >

                        Burundi</option>

            

             <option value="Cambodia" >

                        Cambodia</option>

            

             <option value="Cameroon" >

                        Cameroon</option>

            

             <option value="Canada" >

                        Canada</option>

            

             <option value="Cape Verde" >

                        Cape Verde</option>

            

             <option value="Cayman islands" >

                        Cayman islands</option>

            

             <option value="Central African Republic" >

                        Central African Republic</option>

            

             <option value="Chad" >

                        Chad</option>

            

             <option value="Chile" >

                        Chile</option>

            

             <option value="China" >

                        China</option>

            

             <option value="Christmas Island" >

                        Christmas Island</option>

            

             <option value="Cocos (Keeling) Islands" >

                        Cocos (Keeling) Islands</option>

            

             <option value="Colombia" >

                        Colombia</option>

            

             <option value="Comoros" >

                        Comoros</option>

            

             <option value="Congo" >

                        Congo</option>

            

             <option value="Congo, Democratic Republic" >

                        Congo, Democratic Republic</option>

            

             <option value="Cook Islands" >

                        Cook Islands</option>

            

             <option value="Costa Rica" >

                        Costa Rica</option>

            

             <option value="Cote d'ivoire" >

                        Cote d'ivoire</option>

            

             <option value="Croatia (Hrvatska)" >

                        Croatia (Hrvatska)</option>

            

             <option value="Cuba" >

                        Cuba</option>

            

             <option value="Cyprus" >

                        Cyprus</option>

            

             <option value="Czech Republic" >

                        Czech Republic</option>

            

             <option value="Denmark" >

                        Denmark</option>

            

             <option value="Djibouti" >

                        Djibouti</option>

            

             <option value="Dominica" >

                        Dominica</option>

            

             <option value="Dominican Republic" >

                        Dominican Republic</option>

            

             <option value="East Timor" >

                        East Timor</option>

            

             <option value="Ecuador" >

                        Ecuador</option>

            

             <option value="Egypt" >

                        Egypt</option>

            

             <option value="El Salvador" >

                        El Salvador</option>

            

             <option value="Equatorial Guinea" >

                        Equatorial Guinea</option>

            

             <option value="Eritrea" >

                        Eritrea</option>

            

             <option value="Estonia" >

                        Estonia</option>

            

             <option value="Ethiopia" >

                        Ethiopia</option>

            

             <option value="Falkland Islands (Malvinas)" >

                        Falkland Islands (Malvinas)</option>

            

             <option value="Faroe islands" >

                        Faroe islands</option>

            

             <option value="Fiji" >

                        Fiji</option>

            

             <option value="Finland" >

                        Finland</option>

            

             <option value="France" >

                        France</option>

            

             <option value="France, Metropolitan" >

                        France, Metropolitan</option>

            

             <option value="French Guiana" >

                        French Guiana</option>

            

             <option value="French Polynesia" >

                        French Polynesia</option>

            

             <option value="French Southern Territories" >

                        French Southern Territories</option>

            

             <option value="Gabon" >

                        Gabon</option>

            

             <option value="Gambia" >

                        Gambia</option>

            

             <option value="Georgia" >

                        Georgia</option>

            

             <option value="Germany" >

                        Germany</option>

            

             <option value="Ghana" >

                        Ghana</option>

            

             <option value="Gibraltar" >

                        Gibraltar</option>

            

             <option value="Greece" >

                        Greece</option>

            

             <option value="Greenland" >

                        Greenland</option>

            

             <option value="Grenada" >

                        Grenada</option>

            

             <option value="Guadeloupe" >

                        Guadeloupe</option>

            

             <option value="Guam" >

                        Guam</option>

            

             <option value="Guatemala" >

                        Guatemala</option>

            

             <option value="Guinea" >

                        Guinea</option>

            

             <option value="Guinea-Bissau" >

                        Guinea-Bissau</option>

            

             <option value="Guyana" >

                        Guyana</option>

            

             <option value="Haiti" >

                        Haiti</option>

            

             <option value="Heard and Mc Donald Islands" >

                        Heard and Mc Donald Islands</option>

            

             <option value="Holy See (Vatican City State)" >

                        Holy See (Vatican City State)</option>

            

             <option value="Honduras" >

                        Honduras</option>

            

             <option value="Hong Kong" >

                        Hong Kong</option>

            

             <option value="Hungary" >

                        Hungary</option>

            

             <option value="Iceland" >

                        Iceland</option>

            

             <option value="India" >

                        India</option>

            

             <option value="Indonesia" >

                        Indonesia</option>

            

             <option value="Iran (Islamic Republic of)" >

                        Iran (Islamic Republic of)</option>

            

             <option value="Iraq" >

                        Iraq</option>

            

             <option value="Ireland" >

                        Ireland</option>

            

             <option value="Israel" >

                        Israel</option>

            

             <option value="Italy" >

                        Italy</option>

            

             <option value="Jamaica" >

                        Jamaica</option>

            

             <option value="Japan" >

                        Japan</option>

            

             <option value="Jordan" >

                        Jordan</option>

            

             <option value="Kazakhstan" >

                        Kazakhstan</option>

            

             <option value="Kenya" >

                        Kenya</option>

            

             <option value="Kiribati" >

                        Kiribati</option>

            

             <option value="Korea, Democratic People's Republic" >

                        Korea, Democratic People's Republic</option>

            

             <option value="Korea, Republic of" >

                        Korea, Republic of</option>

            

             <option value="Kuwait" >

                        Kuwait</option>

            

             <option value="Kyrgyzstan" >

                        Kyrgyzstan</option>

            

             <option value="Lao People's Democratic Republic" >

                        Lao People's Democratic Republic</option>

            

             <option value="Latvia" >

                        Latvia</option>

            

             <option value="Lebanon" >

                        Lebanon</option>

            

             <option value="Lesotho" >

                        Lesotho</option>

            

             <option value="Liberia" >

                        Liberia</option>

            

             <option value="Libyan Arab Jamahiriya" >

                        Libyan Arab Jamahiriya</option>

            

             <option value="Liechtenstein" >

                        Liechtenstein</option>

            

             <option value="Lithuania" >

                        Lithuania</option>

            

             <option value="Luxembourg" >

                        Luxembourg</option>

            

             <option value="Macau" >

                        Macau</option>

            

             <option value="Macedonia (Yugoslav Republic)" >

                        Macedonia (Yugoslav Republic)</option>

            

             <option value="Madagascar" >

                        Madagascar</option>

            

             <option value="Malawi" >

                        Malawi</option>

            

             <option value="Malaysia" >


                        Malaysia</option>

            

             <option value="Maldives" >

                        Maldives</option>

            

             <option value="Mali" >

                        Mali</option>

            

             <option value="Malta" >

                        Malta</option>

            

             <option value="Marshall Islands" >

                        Marshall Islands</option>

            

             <option value="Martinique" >

                        Martinique</option>

            

             <option value="Mauritania" >

                        Mauritania</option>

            

             <option value="Mauritius" >

                        Mauritius</option>

            

             <option value="Mayotte" >

                        Mayotte</option>

            

             <option value="Mexico" >

                        Mexico</option>

            

             <option value="Micronesia" >

                        Micronesia</option>

            

             <option value="Moldova" >

                        Moldova</option>

            

             <option value="Monaco" >

                        Monaco</option>

            

             <option value="Mongolia" >

                        Mongolia</option>

            

             <option value="Montserrat" >

                        Montserrat</option>

            

             <option value="Morocco" >

                        Morocco</option>

            

             <option value="Mozambique" >

                        Mozambique</option>

            

             <option value="Myanmar" >

                        Myanmar</option>

            

             <option value="Namibia" >

                        Namibia</option>

            

             <option value="Nauru" >

                        Nauru</option>

            

             <option value="Nepal" >

                        Nepal</option>

            

             <option value="Netherlands" >

                        Netherlands</option>

            

             <option value="Netherlands Antilles" >

                        Netherlands Antilles</option>

            

             <option value="New Caledonia" >

                        New Caledonia</option>

            

             <option value="New Zealand" >

                        New Zealand</option>

            

             <option value="Nicaragua" >

                        Nicaragua</option>

            

             <option value="Niger" >

                        Niger</option>

            

             <option value="Nigeria" >

                        Nigeria</option>

            

             <option value="Niue" >

                        Niue</option>

            

             <option value="Norfolk island" >

                        Norfolk island</option>

            

             <option value="Northern Mariana Islands" >

                        Northern Mariana Islands</option>

            

             <option value="Norway" >

                        Norway</option>

            

             <option value="Oman" >

                        Oman</option>

            

             <option value="Pakistan" >

                        Pakistan</option>

            

             <option value="Palau" >

                        Palau</option>

            

             <option value="Panama" >

                        Panama</option>

            

             <option value="Papua New Guinea" >

                        Papua New Guinea</option>

            

             <option value="Paraguay" >

                        Paraguay</option>

            

             <option value="Peru" >

                        Peru</option>

            

             <option value="Philippines" >

                        Philippines</option>

            

             <option value="Pitcairn" >

                        Pitcairn</option>

            

             <option value="Poland" >

                        Poland</option>

            

             <option value="Portugal" >

                        Portugal</option>

            

             <option value="Puerto Rico" >

                        Puerto Rico</option>

            

             <option value="Qatar" >

                        Qatar</option>

            

             <option value="Reunion" >

                        Reunion</option>

            

             <option value="Romania" >

                        Romania</option>

            

             <option value="Russian Federation" >

                        Russian Federation</option>

            

             <option value="Rwanda" >

                        Rwanda</option>

            

             <option value="Saint Kitts and Nevis" >

                        Saint Kitts and Nevis</option>

            

             <option value="Saint Lucia" >

                        Saint Lucia</option>

            

             <option value="Saint Vincent and the Grenadines" >

                        Saint Vincent and the Grenadines</option>

            

             <option value="Samoa" >

                        Samoa</option>

            

             <option value="San Marino" >

                        San Marino</option>

            

             <option value="Sao Tome and Principe" >

                        Sao Tome and Principe</option>

            

             <option value="Saudi Arabia" >

                        Saudi Arabia</option>

            

             <option value="Senegal" >

                        Senegal</option>

            

             <option value="Seychelles" >

                        Seychelles</option>

            

             <option value="Sierra Leone" >

                        Sierra Leone</option>

            

             <option value="Singapore" >

                        Singapore</option>

            

             <option value="Slovakia (Slovak Republic)" >

                        Slovakia (Slovak Republic)</option>

            

             <option value="Slovenia" >

                        Slovenia</option>

            

             <option value="Solomon Islands" >

                        Solomon Islands</option>

            

             <option value="Somalia" >

                        Somalia</option>

            

             <option value="South Africa" >

                        South Africa</option>

            

             <option value="South Georgia" >

                        South Georgia</option>

            

             <option value="Spain" >

                        Spain</option>

            

             <option value="Sri Lanka" >

                        Sri Lanka</option>

            

             <option value="St Helena" >

                        St Helena</option>

            

             <option value="St Pierre and Miquelon" >

                        St Pierre and Miquelon</option>

            

             <option value="Sudan" >

                        Sudan</option>

            

             <option value="Suriname" >

                        Suriname</option>

            

             <option value="Svalbard and Jan Mayen Islands" >

                        Svalbard and Jan Mayen Islands</option>

            

             <option value="Swaziland" >

                        Swaziland</option>

            

             <option value="Sweden" >

                        Sweden</option>

            

             <option value="Switzerland" >

                        Switzerland</option>

            

             <option value="Syrian Arab Republic" >

                        Syrian Arab Republic</option>

            

             <option value="Taiwan" >

                        Taiwan</option>

            

             <option value="Tajikistan" >

                        Tajikistan</option>

            

             <option value="Tanzania, United Republic of" >

                        Tanzania, United Republic of</option>

            

             <option value="Thailand" >

                        Thailand</option>

            

             <option value="Togo" >

                        Togo</option>

            

             <option value="Tokelau" >

                        Tokelau</option>

            

             <option value="Tonga" >

                        Tonga</option>

            

             <option value="Trinidad and Tobago" >

                        Trinidad and Tobago</option>

            

             <option value="Tunisia" >

                        Tunisia</option>

            

             <option value="Turkey" >

                        Turkey</option>

            

             <option value="Turkmenistan" >

                        Turkmenistan</option>

            

             <option value="Turks and Caicos Islands" >

                        Turks and Caicos Islands</option>

            

             <option value="Tuvalu" >

                        Tuvalu</option>

            

             <option value="Uganda" >

                        Uganda</option>

            

             <option value="Ukraine" >

                        Ukraine</option>

            

             <option value="United Arab Emirates" >

                        United Arab Emirates</option>

            

             <option value="United Kingdom" >

                        United Kingdom</option>

            

             <option value="United States" >

                        United States</option>

            

             <option value="Uruguay" >

                        Uruguay</option>

            

             <option value="Uzbekistan" >

                        Uzbekistan</option>

            

             <option value="Vanuatu" >

                        Vanuatu</option>

            

             <option value="Venezuela" >

                        Venezuela</option>

            

             <option value="Vietnam" >

                        Vietnam</option>

            

             <option value="Virgin Islands (British)" >

                        Virgin Islands (British)</option>

            

             <option value="Virgin Islands (US)" >

                        Virgin Islands (US)</option>

            

             <option value="Wallis and Futuna Islands" >

                        Wallis and Futuna Islands</option>

            

             <option value="Western Sahara" >

                        Western Sahara</option>

            

             <option value="Yemen" >

                        Yemen</option>

            

             <option value="Yugoslavia" >

                        Yugoslavia</option>

            

             <option value="Zambia" >

                        Zambia</option>

            

             <option value="Zimbabwe" >

                        Zimbabwe</option>

            </select></td>

      </tr>

      

	  <tr><td  align="left" valign="baseline">Inter Driver's Licence No.</td>

        <td ><input name="chIntLicense" value="" type="Text" size="16"><img src="images/spacer.gif" width="57" height="1" border="0">Country 

          <select name="chIntLicenseCountryIssue"  onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chHomePhone1.focus()};"><option value=""></option>

            <option value="Afghanistan" >

                        Afghanistan</option>


<option value="Albania" >

                        Albania</option>

<option value="Algeria" >

                        Algeria</option>

<option value="American Samoa" >

                        American Samoa</option>

<option value="Andorra" >

                        Andorra</option>

<option value="Angola" >

                        Angola</option>

<option value="Anguilla" >

                        Anguilla</option>

<option value="Antarctica" >

                        Antarctica</option>

<option value="Antigua and Barbuda" >

                        Antigua and Barbuda</option>

<option value="Argentina" >

                        Argentina</option>

<option value="Armenia" >

                        Armenia</option>

<option value="Aruba" >

                        Aruba</option>

<option value="Austria" >

                        Austria</option>

<option value="Azerbaijan" >

                        Azerbaijan</option>

<option value="Bahamas" >

                        Bahamas</option>

<option value="Bahrain" >

                        Bahrain</option>

<option value="Bangladesh" >

                        Bangladesh</option>

<option value="Barbados" >

                        Barbados</option>

<option value="Belarus" >

                        Belarus</option>

<option value="Belgium" >

                        Belgium</option>

<option value="Belize" >

                        Belize</option>

<option value="Benin" >

                        Benin</option>

<option value="Bermuda" >

                        Bermuda</option>

<option value="Bhutan" >

                        Bhutan</option>

<option value="Bolivia" >

                        Bolivia</option>

<option value="Bosnia and Herzegowina" >

                        Bosnia and Herzegowina</option>

<option value="Botswana" >

                        Botswana</option>

<option value="Bouvet Island" >

                        Bouvet Island</option>

<option value="Brazil" >

                        Brazil</option>

<option value="British Indian Ocean Territory" >

                        British Indian Ocean Territory</option>

<option value="Brunei Darussalam" >

                        Brunei Darussalam</option>

<option value="Bulgaria" >

                        Bulgaria</option>

<option value="Burkina Faso" >

                        Burkina Faso</option>

<option value="Burundi" >

                        Burundi</option>

<option value="Cambodia" >

                        Cambodia</option>

<option value="Cameroon" >

                        Cameroon</option>

<option value="Canada" >

                        Canada</option>

<option value="Cape Verde" >

                        Cape Verde</option>

<option value="Cayman islands" >

                        Cayman islands</option>

<option value="Central African Republic" >

                        Central African Republic</option>

<option value="Chad" >

                        Chad</option>

<option value="Chile" >

                        Chile</option>

<option value="China" >

                        China</option>

<option value="Christmas Island" >

                        Christmas Island</option>

<option value="Cocos (Keeling) Islands" >

                        Cocos (Keeling) Islands</option>

<option value="Colombia" >

                        Colombia</option>

<option value="Comoros" >

                        Comoros</option>

<option value="Congo" >

                        Congo</option>

<option value="Congo, Democratic Republic" >

                        Congo, Democratic Republic</option>

<option value="Cook Islands" >

                        Cook Islands</option>

<option value="Costa Rica" >

                        Costa Rica</option>

<option value="Cote d'ivoire" >

                        Cote d'ivoire</option>

<option value="Croatia (Hrvatska)" >

                        Croatia (Hrvatska)</option>

<option value="Cuba" >

                        Cuba</option>

<option value="Cyprus" >

                        Cyprus</option>

<option value="Czech Republic" >

                        Czech Republic</option>

<option value="Denmark" >

                        Denmark</option>

<option value="Djibouti" >

                        Djibouti</option>

<option value="Dominica" >

                        Dominica</option>

<option value="Dominican Republic" >

                        Dominican Republic</option>

<option value="East Timor" >

                        East Timor</option>

<option value="Ecuador" >

                        Ecuador</option>

<option value="Egypt" >

                        Egypt</option>

<option value="El Salvador" >

                        El Salvador</option>

<option value="Equatorial Guinea" >

                        Equatorial Guinea</option>

<option value="Eritrea" >

                        Eritrea</option>

<option value="Estonia" >

                        Estonia</option>

<option value="Ethiopia" >

                        Ethiopia</option>

<option value="Falkland Islands (Malvinas)" >

                        Falkland Islands (Malvinas)</option>

<option value="Faroe islands" >

                        Faroe islands</option>

<option value="Fiji" >

                        Fiji</option>

<option value="Finland" >

                        Finland</option>

<option value="France" >

                        France</option>

<option value="France, Metropolitan" >

                        France, Metropolitan</option>

<option value="French Guiana" >

                        French Guiana</option>

<option value="French Polynesia" >

                        French Polynesia</option>

<option value="French Southern Territories" >

                        French Southern Territories</option>

<option value="Gabon" >

                        Gabon</option>

<option value="Gambia" >

                        Gambia</option>

<option value="Georgia" >

                        Georgia</option>

<option value="Germany" >

                        Germany</option>

<option value="Ghana" >

                        Ghana</option>

<option value="Gibraltar" >

                        Gibraltar</option>

<option value="Greece" >

                        Greece</option>

<option value="Greenland" >

                        Greenland</option>

<option value="Grenada" >

                        Grenada</option>

<option value="Guadeloupe" >

                        Guadeloupe</option>

<option value="Guam" >

                        Guam</option>

<option value="Guatemala" >

                        Guatemala</option>

<option value="Guinea" >

                        Guinea</option>

<option value="Guinea-Bissau" >

                        Guinea-Bissau</option>

<option value="Guyana" >

                        Guyana</option>

<option value="Haiti" >

                        Haiti</option>

<option value="Heard and Mc Donald Islands" >

                        Heard and Mc Donald Islands</option>

<option value="Holy See (Vatican City State)" >

                        Holy See (Vatican City State)</option>

<option value="Honduras" >

                        Honduras</option>

<option value="Hong Kong" >

                        Hong Kong</option>

<option value="Hungary" >

                        Hungary</option>

<option value="Iceland" >

                        Iceland</option>

<option value="India" >

                        India</option>

<option value="Indonesia" >

                        Indonesia</option>

<option value="Iran (Islamic Republic of)" >

                        Iran (Islamic Republic of)</option>

<option value="Iraq" >

                        Iraq</option>

<option value="Ireland" >

                        Ireland</option>

<option value="Israel" >

                        Israel</option>

<option value="Italy" >

                        Italy</option>

<option value="Jamaica" >

                        Jamaica</option>

<option value="Japan" >

                        Japan</option>

<option value="Jordan" >

                        Jordan</option>

<option value="Kazakhstan" >

                        Kazakhstan</option>

<option value="Kenya" >

                        Kenya</option>

<option value="Kiribati" >

                        Kiribati</option>

<option value="Korea, Democratic People's Republic" >

                        Korea, Democratic People's Republic</option>

<option value="Korea, Republic of" >

                        Korea, Republic of</option>

<option value="Kuwait" >

                        Kuwait</option>

<option value="Kyrgyzstan" >

                        Kyrgyzstan</option>

<option value="Lao People's Democratic Republic" >

                        Lao People's Democratic Republic</option>

<option value="Latvia" >

                        Latvia</option>

<option value="Lebanon" >

                        Lebanon</option>

<option value="Lesotho" >

                        Lesotho</option>

<option value="Liberia" >

                        Liberia</option>

<option value="Libyan Arab Jamahiriya" >

                        Libyan Arab Jamahiriya</option>

<option value="Liechtenstein" >

                        Liechtenstein</option>

<option value="Lithuania" >

                        Lithuania</option>

<option value="Luxembourg" >

                        Luxembourg</option>

<option value="Macau" >

                        Macau</option>

<option value="Macedonia (Yugoslav Republic)" >

                        Macedonia (Yugoslav Republic)</option>

<option value="Madagascar" >

                        Madagascar</option>

<option value="Malawi" >

                        Malawi</option>

<option value="Malaysia" >

                        Malaysia</option>

<option value="Maldives" >

                        Maldives</option>

<option value="Mali" >

                        Mali</option>

<option value="Malta" >

                        Malta</option>

<option value="Marshall Islands" >

                        Marshall Islands</option>

<option value="Martinique" >

                        Martinique</option>

<option value="Mauritania" >

                        Mauritania</option>

<option value="Mauritius" >

                        Mauritius</option>

<option value="Mayotte" >

                        Mayotte</option>

<option value="Mexico" >

                        Mexico</option>

<option value="Micronesia" >

                        Micronesia</option>

<option value="Moldova" >

                        Moldova</option>

<option value="Monaco" >

                        Monaco</option>

<option value="Mongolia" >

                        Mongolia</option>

<option value="Montserrat" >

                        Montserrat</option>

<option value="Morocco" >

                        Morocco</option>

<option value="Mozambique" >

                        Mozambique</option>

<option value="Myanmar" >

                        Myanmar</option>

<option value="Namibia" >

                        Namibia</option>

<option value="Nauru" >

                        Nauru</option>

<option value="Nepal" >

                        Nepal</option>

<option value="Netherlands" >

                        Netherlands</option>

<option value="Netherlands Antilles" >

                        Netherlands Antilles</option>

<option value="New Caledonia" >

                        New Caledonia</option>

<option value="New Zealand" >

                        New Zealand</option>

<option value="Nicaragua" >

                        Nicaragua</option>

<option value="Niger" >

                        Niger</option>

<option value="Nigeria" >

                        Nigeria</option>

<option value="Niue" >

                        Niue</option>

<option value="Norfolk island" >

                        Norfolk island</option>

<option value="Northern Mariana Islands" >

                        Northern Mariana Islands</option>

<option value="Norway" >

                        Norway</option>

<option value="Oman" >

                        Oman</option>

<option value="Pakistan"