How do i attach files to a form using ASP
Hi all i have got a form and a script that collects all the informational for the form and sends it to a address i was hoping someone can help me make it so the attachments from the form get sent as well, the first first of code is the form and the 2nd is the script that collects the data
<!--
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">
<input type="hidden" name="mode" value="R">
<input type="hidden" name="u" value=180112>
<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="Type_of_Residence" onChange= "if((this.value=='')||(this.value=='')){document.getElementById('Property_Flat_Number').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"> No. </div><input name="chPropertyFlatNo" id="chPropertyFlatNo" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"> Str. No. <input name="Property_Street_Number" type="Text" size="4" onBlur="checkAlphaNumeric(this,1,'','','-')"></td>
</tr>
<tr>
<td align="left" >Street Name</td>
<td valign="Bottom" align="left" ><input name="Property_Street_Name" type="Text" size="16"><img src="images/spacer.gif" width="46" height="1" border="0"><select name="Property_Street_Type" 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="Property_Suburb" type="Text" size="16"> State <select name="Property_State" 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="Property_Postcode" type="Text" size="4" maxlength="4"> </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="Property_Viewed" 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"> </td>
</tr>
<tr>
<td align="left" width="171">Commencement of lease</td>
<td width="568"><input name="Commencement_Of_Lease" type="text" size="16" maxlength="50"> Rent $ <input name="Rent" type="Text" size="4" maxlength="4">
pw<img src="images/spacer.gif" width="11" height="1" border="0">Length of lease
<input name="Length_of_Lease" 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="First_Name" 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="Middle_Name" 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="Surname" 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="Maiden_Name" type="Text" size="16" value="" maxlength="50">
<input name="Gender" 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="DOB_DAY" 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="DOB_MONTH" 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="DOB_YEAR" 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"> </td>
</tr>
<tr>
<td align="left" width="171">No. of Adults</td>
<td width="568"> <select name="Number_Of_Adults" 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="Number_Of_Children" 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="Ages_Of_Children" 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="Name_of_Adult_1" value="" type="text" size="16" maxlength="100">
<img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 2) <input name="Name_of_Adult_2" 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="Name_of_Adult_3" value="" type="text" size="16" maxlength="100">
<img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 4) <input name="Name_of_Adult_4" 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="Name_of_Adult_5" value="" type="text" size="16" maxlength="100">
<img src="images/spacer.gif" width="122" height="1" border="0">Name of Adult 6) <input name="Name_of_Adult_6" type="Text" size="16" value="" maxlength="100">
</td>
</tr>
<tr>
<td align="left" width="171">Do you smoke?</td>
<td width="568">
<input name="Do_You_Smoke" 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?
<input name="Smoking_Inside_or_Outside" 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="Do_You_Have_Pets" 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="Pet_Description" 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="International" onClick="setInternationalPresentAddressNode(0)" class="formcheckbox" checked="true" type="Radio" value="AUSTRALIAN"><span class="navytext"> AUSTRALIAN</span> <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"> No. <img src="images/spacer.gif" width="2" border="0"></div><input name="Flat_Number" 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. <input name="Street_Number" 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="Street_Name" value="" type="Text" size="16" maxlength="50"><img src="images/spacer.gif" width="46" height="1" border="0"><select
name="Street_Type" 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="Suburb" value="" type="Text" size="16">
State <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="Postcode"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="Int_Suburb" type="Text" size="16"> City <input name="Int_City" type="Text" size="16"> State/County <input name="Int_State" 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="Int_Postcode" 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="Current_Rent" 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="Time_At_Current_Address" 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> </td>
</tr>
<tr>
<td align="left" >Driver's Licence No.</td>
<td ><input name="License" value="" type="Text" size="16"> State <select name="License_State_Issue" 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="License_Card_Number" value="" type="Text" size="16"> </td>
</tr>
<tr>
<td align="left" >Vehicle Registration</td>
<td ><input name="Vehicle" value="" type="Text" size="16" onBlur="checkRego(this);"> State <select name="Vehicle_State_Issue" 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="Centrelink" 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="Proof_of_Age" value="" type="Text" size="16" maxlength="10">
</td>
</tr>
<tr><td align="left" valign="baseline">Pension No.</td>
<td ><input name="Pension_Number" 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="Pension_Type" value="" type="Text" size="16" maxlength="20">
</td>
</tr>
<tr><td align="left" valign="baseline">Working Visa</td>
<td ><input name="Working_Visa" 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="Work_Visa_Expiry" value="" type="Text" size="16" maxlength="20">
</td>
</tr>
<tr>
<td align="left" valign="baseline">Australian Passport No.</td>
<td ><input name="Aus_Passport" 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="Medicare" value="" type="Text" size="16" maxlength="10"></td>
</tr>
<tr>
<td align="left" valign="baseline">International Passport No.</td>
<td ><input name="Passport" 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="Int_License" value="" type="Text" size="16"><img src="images/spacer.gif" width="57" height="1" border="0">Country
<select name="Int_License_Country_Issue" 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="Home_Phone_One" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){Home_Phone_Two.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="Home_Phone_Two" value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){Home_Phone_Three.focus()};" size="4" maxlength="4" onBlur="checkNumeric(this,1,'','','','','');">
<input type="text" name="Home_Phone_Three" value="" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){Mobile_Phone_One.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="Mobile_Phone_One" value="" size="4" maxlength="4" onkeyup="if((this.value.length==4)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){Mobile_Phone_Two.focus()};" onBlur="checkNumeric(this,1,'','','','','');">
<input type="text" name="Mobile_Phone_Two" value="" size="3" maxlength="3" onkeyup="if((this.value.length==3)&&(event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){Mobile_Phone_Three.focus()};" onBlur="checkNumeric(this,1,'','','','','');">
<input type="text" name="Mobile_Phone_Three" 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,'','','','','');">
</td>
</tr>
<tr>
<td align="left">Email</td>
<td ><input name="Email" 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> </td>
</tr>
<tr>
<td align="left" width="171">Bank Name</td>
<td width="568"><input name="Bank_Name" value="" type="text" size="16" maxlength="50"> BSB <input name="Bank_BSB" value="" type="Text" size="4" maxlength="6"> Acc No <input name="Bank_Acc_No" value="" type="Text" size="6" maxlength="10"></td>
</tr>
<tr>
<td align="left" width="171">Bankrupt</td>
<td width="568">
<input name="Bankrupt" class="formcheckbox" type="Radio" value="Yes" maxlength="50" checked="true" > Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="isBankrupt" type="Radio" value="No" checked="true"> No</td>
</tr>
<tr>
<td align="left" width="171">Preferred payment of rent</td>
<td width="568">
<input name="Rent_Payment_Period" maxlength="50" checked="true" class="formcheckbox" type="Radio" value="Weekly"> Weekly<img src="images/spacer.gif" width="44" height="1" border="0"><input name="chRentPaymentPeriod" class="formcheckbox" type="Radio" value="Fortnightly" > Fortnightly<img src="images/spacer.gif" width="44" height="1" border="0"><input class="formcheckbox" name="chRentPaymentPeriod" type="Radio" value="Monthly" > 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" > </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="Employer_Job_Title" value="" type="Text" size="34" maxlength="50">
Employment Type<img src="images/spacer.gif" width="58" height="1" border="0"> <select name="Employment_Type" 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="Employer_Company" value="" type="Text" size="34" maxlength="128"> Employer's Phone No. <input name="Employer_Phone_Number" 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="Managers_Name" 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="Employer_Address" 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="Employer_Suburb" 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="Employer_Postcode" value="" type="Text" size="4" maxlength="4"> </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="Work_Email" type="Text" value="" style="width:199px;" onBlur="checkEmail(this);">
Net income<img src="images/spacer.gif" height="1" width="60" border="0"><input name="Net_Income" 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="Length_Of_Employment" 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="Previous_Employer_JobTitle" 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="Previous_Employer_Company" 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="Previous_Employer_Address" value="" type="Text" size="34" maxlength="50"></td>
</tr>
<tr>
<td align="left" width="171">Suburb</td>
<td width="568"><input name="Previous_Employer_Suburb" 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="Previous_Employer_Postcode" value="" type="Text" size="4" maxlength="4"> </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="Previous_Work_Email" 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" > </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="Agency_Name" value="" type="Text" maxlength="100" style="width:436px;"></td>
</tr>
<tr>
<td align="left">Property Manager's Name</td>
<td><input name="Property_Managers_Name" 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="Land_lord_FirstName" value="" maxlength="50" type="Text" size="16">
<input name="Land_lord_Surname" 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="Agent_International1" onClick="setAgentInternationalPresentAddressNode(0)" class="formcheckbox" checked="true" type="Radio" value="V1"><span class="navytext"> AUSTRALIAN</span> <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"> No. <img src="images/spacer.gif" width="2" border="0"></div><input name="Agent_Flat_Number" 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. <input name="Agent_Street_Number" 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="Agent_Street_Name" 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="Agent_Suburb" 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="Agent_Postcode" 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="Agent_Int_Suburb" type="Text" size="16"> City <input name="chAgentIntCity" type="Text" size="16"> State/County <input name="Agent_Int_State" 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="Agent_Int_Postcode" 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="Agent_Email" 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="Previous_International_1" onClick="setPreviousInternationalNode(0)" class="formcheckbox" checked="true" type="Radio" value="V1">
<span class="navytext"> AUSTRALIAN</span>
<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"> No. <img src="images/spacer.gif" width="2" border="0"></div><input name="Previous_Flat_Number" 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. <input name="Previous_Street_Number" 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="Previous_Street_Name" 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="Previous_Suburb" value="" type="Text" size="16">
State <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="Previous_Postcode" 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="Previous_Int_Suburb" type="Text" size="16"> City <input name="chPreviousIntCity" type="Text" size="16"> State/County <input name="Previous_Int_State" 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="Previous_Int_Postcode" 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="Previous_Rent" 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="Previous_Time_At_Address" 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="Previous_Bond_Refund" 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="Previous_Bond_Refund_Excuse" 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="Previous_Agency_Name" 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="Previous_Landlord_FirstName" value="" maxlength="50" type="Text" size="16">
<input name="Previous_Landlord_Surname" 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="Previous_Agent_International1" onClick="setPreviousAgentInternationalNode(0)" class="formcheckbox" checked="true" type="Radio" value="V1">
<span class="navytext"> AUSTRALIAN</span>
<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"> No. <img src="images/spacer.gif" width="2" border="0"></div><input name="Previous_Agent_FlatNo" 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. <input name="Previous_Agent_Street_Number" 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="Previous_Agent_Street_Name" 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="Previous_Agent_Suburb" value="" type="Text" size="16">
State <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="Previous_Agent_Postcode" 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="Previous_AgentIntSuburb" type="Text" size="16"> City <input name="Previous_Agent_Int_City" type="Text" size="16"> State/County <input name="Previous_Agent_Int_State" 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="Previous_Agent_Int_Postcode" 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="Previous_Agent_Email" 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"> </td>
</tr>
<tr>
<td align="left" width="171">Name</td>
<td width="568"><input name="Contact_FirstName" value="" type="Text" size="16"> <input name="Contact_Surname" 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"> No. <img src="images/spacer.gif" width="2" border="0"></div><input name="Contact_Flat_Number" 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. <input name="Contact_Street_Number" 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="Contact_Street_Name" 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="Contact_Suburb" value="" type="Text" size="16">
State <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="Contact_Postcode" 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,'','','','','');">
</td>
</tr>
<tr>
<td align="left">Email</td>
<td><input name="Contact_Email" value="" type="Text" style="width:199px;" onBlur="checkEmail(this);" maxlength="50"> Relationship <input name="Contact_Relationship" 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"> </td>
</tr>
<tr>
<td align="left" width="171">1) Name</td>
<td width="568"><input name="Reference1_FirstName" value="" type="Text" size="16" maxlength="50"> <input name="Reference_One_Surname" 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="Reference1_Occupation" 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,'','','','','');">
</td>
</tr>
<tr>
<td align="left" width="171">2) Name</td>
<td width="568"><input name="Reference_Two_FirstName" value="" type="Text" size="16" maxlength="50"> <input name="Reference_Two_Surname" 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="Reference_Two_Occupation" 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,'','','','','');">
</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> Local Press
<input type="checkbox" class="formcheckbox" name="chkAdvertisedLocalPress"> Signboard <input type="checkbox" class="formcheckbox" name="chkAdvertisedSignBoard"> Referral <input type="checkbox" class="formcheckbox" name="chkAdvertisedReferral"> Internet <input type="checkbox" class="formcheckbox" name="chkAdvertisedInternet"></td>
</tr>
<tr>
<td align="left">Other</td>
<td><input name="Advertised_Other" 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> <span class="redbackgroundwhitetext"><strong>IMPORTANT NOTICE REGARDING SCANNED DOCUMENTS:</strong></span><br>
<br>
<span class="bigbox"> Add scanned documents to speed up the process of application.<br><br>
Please do not attach all documents to a single button as a combined scan. Each individual document i.e. passport,<br>
driver’s license etc. should be attached to the correctly labelled button. This is important for privacy compliance.<br><br>
<input type="checkbox" class="formcheckbox" name="isDocIdentifiersTicked"> I, the applicant, have read and understood the above statement and take full responsibility for attaching my<br> 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"> </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"> </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.</p></span>
</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"> <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"> </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">
<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> </td>
<td><div style="width:425px;" align="center"><input type="submit" name="Submit" class="btnSmall" value="SUBMIT">
</div>
</td>
</tr>
</table>
</form>
<!--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><%@ 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://www.adbydesigns.com.au/clients/b/tenancyapplication.asp" 'This is the fully-qualified URL of your Web Form
strReturnURL = "http://www.adbydesigns.com.au/clients/b/home.asp" 'This is the fully-qualified URL of the Thank You or result page
strSMTPServer = "192.168.0.105" '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>ASKER
at the bottom of the from you would be avble to see that there are area where the client can attach file i need to att this to the script to allow the file to be attached to the emall
so, so what you want is to be able to attach file via email.
Is this .net or classic asp?
Again, as stated, you have a version of .net and a version of classic asp.
Please clarify
Is this .net or classic asp?
Again, as stated, you have a version of .net and a version of classic asp.
Please clarify
ASKER
yes this is what i want
as u can see there is a script (the aspx file) thet goes through my form (the asp file) and collect the data at the end of the asp file there is a option for attachments i wound like this to be added to the script as this need to be attached to the emil
as u can see there is a script (the aspx file) thet goes through my form (the asp file) and collect the data at the end of the asp file there is a option for attachments i wound like this to be added to the script as this need to be attached to the emil
It doesn't work like that.
You cannot mix and match asp with aspx.
Decide which of the two you want and we can go from there.
You cannot mix and match asp with aspx.
Decide which of the two you want and we can go from there.
ASKER
well it seems to be working with no issue atm with the script reading from the asp fiel so i dont really understand why it wont work like that, it is reading with no issues i just have got the files been attached
ASKER
i know this is the code but just need help adding it my script
// Beginning of attachments processing
// Check the first open file dialog for a value
if (ofdAttachment1.PostedFile != null)
{
// Get a reference to PostedFile object
HttpPostedFile ulFile = ofdAttachment1.PostedFile;
// Get size of the file
int nFileLen = ulFile.ContentLength;
// Make sure the size of the file is > 0
if( nFileLen > 0 )
{
// Get the file name
strFileName = Path.GetFileName(ofdAttachment1.PostedFile.FileName);
// Preced the file name with "attachments/" so
// the file is saved to our attachments directory
strFileName = "attachments/" + strFileName;
// Save the file on the server
ofdAttachment1.PostedFile.SaveAs(Server.MapPath(strFileName));
// Create the email attachment with the uploaded file
MailAttachment attach = new MailAttachment(Server.MapPath(strFileName));
// Attach the newly created email attachment
email.Attachments.Add(attach);
// Store filename so we can delete it later
attach1 = strFileName;
}
}
pls see attachments. tested and works.
Ok the attachment doesn't work because of dll. You can generate one and put in a bin directory.
send.aspx
send.aspx.cs
Ok the attachment doesn't work because of dll. You can generate one and put in a bin directory.
send.aspx
<%@ Page language="c#" Codebehind="Send.aspx.cs" AutoEventWireup="false" Inherits="MailWebService.WebForm1" %>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN" >
<HTML>
<HEAD>
<title></title>
<meta content="http://schemas.microsoft.com/intellisense/ie5" name="vs_targetSchema">
<style type="text/css">
TD { FONT-SIZE: 10pt; COLOR: #000000; FONT-STYLE: normal; FONT-FAMILY: Arial, Helvetica, sans-serif }
.width386 { WIDTH: 386px }
.basic { FONT-SIZE: 10pt; COLOR: #000000; FONT-STYLE: normal; FONT-FAMILY: Arial, Helvetica, sans-serif }
.titl { FONT-WEIGHT: bold; FONT-SIZE: 13pt; COLOR: #ffffff; FONT-STYLE: normal; FONT-FAMILY: Arial, Helvetica, sans-serif }
BODY { BORDER-RIGHT: 0px; BORDER-TOP: 0px; BACKGROUND: white; MARGIN: 0px; BORDER-LEFT: 0px; BORDER-BOTTOM: 0px; FONT-FAMILY: Arial, Helvetica, sans-serif }
</style>
</HEAD>
<body>
<table cellSpacing="0" cellPadding="3" width="100%" bgColor="navy" border="0">
<tr>
<td align="center"><span class="titl">ASP.NET Email</span></td>
</tr>
</table>
<br>
<div align="center"><asp:Label id="lblMessage" runat="server" Font-Names="Arial" Font-Size="X-Small" Width="540"
Visible="False"></asp:Label></div>
<br>
<div align="center">
<form id="Form1" name="form2" method="post" encType="multipart/form-data" runat="server">
<table cellSpacing="0" cellPadding="4" bgColor="navy" border="0">
<tr>
<td>
<table cellSpacing="3" cellPadding="4" width="540" bgColor="white">
<tr>
<td vAlign="middle" align="right" width="80">From:</td>
<td><asp:textbox id="txtSender" tabIndex="1" runat="server" MaxLength="100" Width="386px" CssClass="width386"
Font-Size="X-Small" Font-Names="Arial"></asp:textbox></td>
</tr>
<tr>
<td vAlign="middle" align="right" width="80">To:</td>
<td><asp:textbox id="txtReceiver" tabIndex="1" runat="server" MaxLength="100" Width="386px" CssClass="width386"
Font-Size="X-Small" Font-Names="Arial"></asp:textbox></td>
</tr>
<tr>
<td vAlign="middle" align="right">Subject:</td>
<td><asp:textbox id="txtSubject" tabIndex="2" runat="server" MaxLength="200" Width="386px" CssClass="width386"
Font-Size="X-Small" Font-Names="Arial"></asp:textbox></td>
</tr>
<tr>
<td vAlign="middle" align="right">Format:</td>
<td><asp:radiobuttonlist id="rblMailFormat" tabIndex="3" runat="server" repeatcolumns="2" repeatdirection="Horizontal">
<asp:ListItem Value="text" Selected="True">text</asp:ListItem>
<asp:ListItem Value="html">html</asp:ListItem>
</asp:radiobuttonlist></td>
</tr>
<tr>
<td vAlign="top" align="right">Message:</td>
<td height="84">
<p><asp:textbox id="txtBody" tabIndex="4" runat="server" columns="40" rows="5" textmode="MultiLine"
width="451px" CssClass="width386" Font-Size="X-Small" Font-Names="Arial"></asp:textbox></p>
</td>
</tr>
<tr>
<td vAlign="middle" align="right">Attachment:</td>
<td><input id="ofdAttachment1" tabIndex="5" type="file" size="56" name="filMyFile" runat="server"></td>
</tr>
<tr>
<td vAlign="middle" align="right">Attachment:</td>
<td><input id="ofdAttachment2" tabIndex="6" type="file" size="56" name="filMyFile" runat="server"></td>
</tr>
<tr>
<td vAlign="middle" align="right">Attachment:</td>
<td><input id="ofdAttachment3" tabIndex="7" type="file" size="56" name="filMyFile" runat="server"></td>
</tr>
<tr>
<td align="center" colSpan="2"><asp:button id="btnSend" tabIndex="9" runat="server" width="100px" text="Send"></asp:button></td>
</tr>
</table>
</td>
</tr>
</table>
</form>
<h1></h1>
<br>
<br>
<br>
<br>
<br>
</div>
</body>
</HTML>send.aspx.cs
using System;
using System.Collections;
using System.ComponentModel;
using System.Configuration;
using System.Drawing;
using System.Data;
using System.IO;
using System.Web;
using System.Web.Mail;
using System.Web.SessionState;
using System.Web.UI;
using System.Web.UI.WebControls;
using System.Web.UI.HtmlControls;
namespace MailWebService
{
/// <summary>
/// Summary description for WebForm1.
/// </summary>
public class WebForm1 : System.Web.UI.Page
{
protected System.Web.UI.WebControls.RadioButtonList rblMailFormat;
protected System.Web.UI.WebControls.Button btnSend;
protected System.Web.UI.HtmlControls.HtmlInputFile ofdAttachment1;
protected System.Web.UI.HtmlControls.HtmlInputFile ofdAttachment2;
protected System.Web.UI.HtmlControls.HtmlInputFile ofdAttachment3;
protected System.Web.UI.WebControls.TextBox txtSender;
protected System.Web.UI.WebControls.TextBox txtReceiver;
protected System.Web.UI.WebControls.TextBox txtSubject;
protected System.Web.UI.WebControls.TextBox txtBody;
protected System.Web.UI.WebControls.Label lblMessage;
protected string strFileName;
private void Page_Load(object sender, System.EventArgs e)
{
// Put user code to initialize the page here
}
#region Web Form Designer generated code
override protected void OnInit(EventArgs e)
{
//
// CODEGEN: This call is required by the ASP.NET Web Form Designer.
//
InitializeComponent();
base.OnInit(e);
}
/// <summary>
/// Required method for Designer support - do not modify
/// the contents of this method with the code editor.
/// </summary>
private void InitializeComponent()
{
this.btnSend.Click += new System.EventHandler(this.btnSend_Click);
this.Load += new System.EventHandler(this.Page_Load);
}
#endregion
private void btnSend_Click(object sender, System.EventArgs e)
{
try
{
// Create a new blank MailMessage
MailMessage email = new MailMessage ();
// Set the properties of the MailMessage to the
// values on the form
if (rblMailFormat.SelectedItem.Text == "text")
email.BodyFormat = MailFormat.Text;
else
email.BodyFormat = MailFormat.Html;
email.From = txtSender.Text;
email.To = txtReceiver.Text;
email.Subject = txtSubject.Text;
email.Body = txtBody.Text;
// We use the 3 following variables to keep track of
// attachments so we can delete them and strFileName is
// used to for the name of the file attachment being
// processed.
string attach1 = null;
string attach2 = null;
string attach3 = null;
string strFileName = null;
// Beginning of attachments processing
// Check the first open file dialog for a value
if (ofdAttachment1.PostedFile != null)
{
// Get a reference to PostedFile object
HttpPostedFile ulFile = ofdAttachment1.PostedFile;
// Get size of the file
int nFileLen = ulFile.ContentLength;
// Make sure the size of the file is > 0
if( nFileLen > 0 )
{
// Get the file name
strFileName = Path.GetFileName(ofdAttachment1.PostedFile.FileName);
// Preced the file name with "attachments/" so
// the file is saved to our attachments directory
strFileName = "attachments/" + strFileName;
// Save the file on the server
ofdAttachment1.PostedFile.SaveAs(Server.MapPath(strFileName));
// Create the email attachment with the uploaded file
MailAttachment attach = new MailAttachment(Server.MapPath(strFileName));
// Attach the newly created email attachment
email.Attachments.Add(attach);
// Store filename so we can delete it later
attach1 = strFileName;
}
}
// Repeat previous step if there is an attachment #2
if (ofdAttachment2.PostedFile != null)
{
HttpPostedFile ulFile = ofdAttachment2.PostedFile;
int nFileLen = ulFile.ContentLength;
if( nFileLen > 0 )
{
strFileName = Path.GetFileName(ofdAttachment2.PostedFile.FileName);
strFileName = "attachments/" + strFileName;
ofdAttachment2.PostedFile.SaveAs(Server.MapPath(strFileName));
MailAttachment attach = new MailAttachment(Server.MapPath(strFileName));
email.Attachments.Add(attach);
attach2 = strFileName;
}
}
// Repeat previous step if there is an attachment #3
if (ofdAttachment3.PostedFile != null)
{
HttpPostedFile ulFile = ofdAttachment3.PostedFile;
int nFileLen = ulFile.ContentLength;
if( nFileLen > 0 )
{
strFileName = Path.GetFileName(ofdAttachment3.PostedFile.FileName);
strFileName = "attachments/" + strFileName;
ofdAttachment3.PostedFile.SaveAs(Server.MapPath(strFileName));
MailAttachment attach = new MailAttachment(Server.MapPath(strFileName));
email.Attachments.Add(attach);
attach3 = strFileName;
}
}
// End of attachments processing
// Set the SMTP server and send the email
SmtpMail.SmtpServer = "localhost";
SmtpMail.Send (email);
// Delete the attachements if any
if (attach1 != null)
File.Delete(Server.MapPath(attach1));
if (attach2 != null)
File.Delete(Server.MapPath(attach2));
if (attach3 != null)
File.Delete(Server.MapPath(attach3));
// Reset the form
txtSender.Text = "";
txtReceiver.Text = "";
txtSubject.Text = "";
txtBody.Text = "";
// Dispaly a friendly message telling the user
// his email has been sent
lblMessage.Visible = true;
lblMessage.ForeColor = Color.Black;
lblMessage.Text = "Your email has been sent";
}
catch(Exception ex)
{
// Print a much less friendly message informing the
// user about the exception that was risen
lblMessage.Visible = true;
lblMessage.ForeColor = Color.Red;
lblMessage.Text = ex.ToString();
}
}
}
}ASKER
Thank you for ur help thus far but can u please show me how to include that script in my script and code
Below is my script
Below is my script
<%@ 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://www.adbydesigns.com.au/clients/b/tenancyapplication.asp" 'This is the fully-qualified URL of your Web Form
strReturnURL = "http://www.adbydesigns.com.au/clients/b/home.asp" 'This is the fully-qualified URL of the Thank You or result page
strSMTPServer = "192.168.0.105" '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>
I sent 2 different scripts. Which one do you wan to include in this one?
ASKER
<%@ 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://www.adbydesigns.com.au/clients/b/tenancyapplication.asp" 'This is the fully-qualified URL of your Web Form
strReturnURL = "http://www.adbydesigns.com.au/clients/b/home.asp" 'This is the fully-qualified URL of the Thank You or result page
strSMTPServer = "192.168.0.105" '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>ASKER
Which ever one will work to attach file :)
Ok, please explain to me a little bit what is wrong with this code.
I have it now on my vs2010 and I can see all the many browse(for attachemtns) 16 of them.
I have it now on my vs2010 and I can see all the many browse(for attachemtns) 16 of them.
ASKER
which code are you talking about the one i sent or the one you sent?? sorry confused
ASKER
if it is the code i sent you i know they are listed at hte bottom but they are not attached
Has anyone thought of showing the asker how to attach a file to a form? Perhaps that is all he/she is asking? If that is what you want then add this to your form header:
<form action="your_script" method="POST" enctype="multipart/form-da
then the rest of your form elements go here.
When you want to add the file upload section - put this code in your form...
<label for="file">Filename:</labe
<input type="file" name="file" id="file" />
<br />
<input type="submit" name="submit" value="Submit" />
</form>
The "input type="file" will place a file selection button on your form for the user to select the file for upload.
When the form is submitted, you then need to 1: process the form data as usual and 2: process the file. There are many methods for processing the file using php or asp. If you would like a php version I can help you but I don't know asp at all I'm sorry.
Is this any help to you?
<form action="your_script" method="POST" enctype="multipart/form-da
then the rest of your form elements go here.
When you want to add the file upload section - put this code in your form...
<label for="file">Filename:</labe
<input type="file" name="file" id="file" />
<br />
<input type="submit" name="submit" value="Submit" />
</form>
The "input type="file" will place a file selection button on your form for the user to select the file for upload.
When the form is submitted, you then need to 1: process the form data as usual and 2: process the file. There are many methods for processing the file using php or asp. If you would like a php version I can help you but I don't know asp at all I'm sorry.
Is this any help to you?
ASKER
it is a good help thank you, wouldf there be any chance you could helop me add it to the script i have attached above
Like I said, I don't know asp or aspx or VB. I have never coded in those languages on PHP which in my opinion is much better and easier to code in. Before all you asp and VB developers jump down my throat, I'm only saying in my opinion Php is a better choice for web development.
If you could find someone to convert php to VB then I could write a php script for you.
Just a quick thought, does your Web Hosting company have php installed on their server? If so, then why not use a php script to process your form data including uploading the files/attachments to your server?
That I can help you with but I can't do anything with your current scripts.
If you could find someone to convert php to VB then I could write a php script for you.
Just a quick thought, does your Web Hosting company have php installed on their server? If so, then why not use a php script to process your form data including uploading the files/attachments to your server?
That I can help you with but I can't do anything with your current scripts.
The problem, though, from my understanding is trying do an email attachment.
If that's the case, the code you posted is for uploading a file to a server or to some folder.
Is that what he wants?
Another option for him is to use my code that I posted worked and modified it to suit his needs.
If that's the case, the code you posted is for uploading a file to a server or to some folder.
Is that what he wants?
Another option for him is to use my code that I posted worked and modified it to suit his needs.
Hi sammySeltzer. I'm not exactly sure to be honest. I got an one of those new alerts so waqs just having a quick look over the question. If you have given him modified code that works for emailing the he should be trying to use it and asking you if he has trouble. My mistake :)
ASKER
sammySeltzer:; You code does nto work i have tried it nd i did replay but you didnt not get back to me.
elvin66: i would be more then happy to use php if it works like the one i am using, the one i am using looks through the form that is created and pulls the data out meaning i dont have to tell it each time i add a new fuild to the form
elvin66: i would be more then happy to use php if it works like the one i am using, the one i am using looks through the form that is created and pulls the data out meaning i dont have to tell it each time i add a new fuild to the form
sorry, I missed your response.
To simplify this, here is another sample:
Markup:
CodeBehind:
Test it first as is and if it works like it did for me, then integrate with your code.
To simplify this, here is another sample:
Markup:
<%@ Page Language="VB" AutoEventWireup="true" CodeFile="sendEmail.aspx.vb" Inherits="sendEmail" %>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" >
<head id="Head1" runat="server">
<title>Email with Attachment</title>
</head>
<body>
<form id="form1" runat="server">
<div>
<asp:Panel runat="server" ID="EmailForm">
<table border="0">
<tr>
<td><b>Your Email:</b></td>
<td><asp:TextBox runat="server" ID="UsersEmail" Columns="30"></asp:TextBox></td>
</tr>
<tr>
<td><b>File to Send:</b></td>
<td>
<asp:FileUpload ID="AttachmentFile" runat="server" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Body:</b><br />
<asp:TextBox runat="server" ID="Comments" TextMode="MultiLine" Columns="55" Rows="10"></asp:TextBox>
</td>
</tr>
<tr>
<td colspan="2" align="center">
<asp:Button runat="server" ID="SendEmail" Text="Send Feedback" />
</td>
</tr>
</table>
</asp:Panel>
<asp:Panel runat="server" ID="EmailSentSender">
Your email has been sent successfully... thanks!
</asp:Panel>
</asp:Content>
</div>
</fotm>CodeBehind:
Imports System.Net.Mail
Partial Class SendEmail
Inherits System.Web.UI.Page
Protected Sub SendEmail_Click(ByVal sender As Object, ByVal e As System.EventArgs) Handles SendEmail.Click
'Make sure a file has been uploaded
If String.IsNullOrEmpty(AttachmentFile.FileName) OrElse AttachmentFile.PostedFile Is Nothing Then
Throw New ApplicationException("Egad, a file wasn't uploaded... you should probably use more graceful error handling than this, though...")
End If
Const ToAddress As String = "Put your email Address!!"
'(1) Create the MailMessage instance
Dim mm As New MailMessage(UsersEmail.Text, ToAddress)
'(2) Assign the MailMessage's properties
mm.Subject = "Emailing an Uploaded File as an Attachment"
mm.Body = Body.Text
mm.IsBodyHtml = False
'Attach the file
mm.Attachments.Add(New Attachment(AttachmentFile.PostedFile.InputStream, AttachmentFile.FileName))
'(3) Create the SmtpClient object
Dim smtp As New SmtpClient
'(4) Send the MailMessage (will use the Web.config settings)
smtp.Send(mm)
'Show the EmailSentForm Panel and hide the EmailForm Panel
EmailSentForm.Visible = True
EmailForm.Visible = False
End Sub
Protected Sub Page_Load(ByVal sender As Object, ByVal e As System.EventArgs) Handles Me.Load
If Not Page.IsPostBack Then
'On the first page load, hide the EmailSentForm Panel
EmailSentForm.Visible = False
End If
End Sub
End ClassTest it first as is and if it works like it did for me, then integrate with your code.
ASKER
Hi again than you for tyhe code but i need ti to be included in aspx screipy i sent at the top of this, i need it to be part of the scan of the form. if you view the script you wtill see it scan the form and send the information in a email, i just need it to see if there is a attachement in the form, as you can see in my form there is a place for them at the bottom.
If you could show me how to do this it would be good
If you could show me how to do this it would be good
ASKER CERTIFIED SOLUTION
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ASKER
sammySeltzer:
Thank you gain fo getting back t o me but i have said many many many times where i need it and how i need it to work, could you please help me with this
Thank you gain fo getting back t o me but i have said many many many times where i need it and how i need it to work, could you please help me with this
ASKER
I've requested that this question be closed as follows:
Accepted answer: 0 points for awolarczuk's comment http:/Q_27386546.html#36976827
for the following reason:
after asking amny times for help no one helped
Accepted answer: 0 points for awolarczuk's comment http:/Q_27386546.html#36976827
for the following reason:
after asking amny times for help no one helped
ASKER
thank you everyone for you help pn this isue
Two different things.
I also noticed that you have both classic and .net files.
What are you trying to do?