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How to make sure that required fields (with a * next to them) are completed by the user before submitting the form

Hi all i am waiting to know the best way to  make sure that required fields (with a * next to them) are completed by the user before submitting the form

I have put the code below
<!-- 
  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">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</div><input name="chPropertyFlatNo" id="chPropertyFlatNo" type="Text" size="4" style="display:none" onBlur="checkAlphaNumeric(this,1,'','.','');"> Str. No. <input name="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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<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">&nbsp;</td>

      </tr>	  

       

       <tr>

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

	  </tr>

       <tr>

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

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

	  </tr>	  

     

	 <tr>

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

	  </tr> 

        <tr>

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

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

	  </tr>  

       

       <tr>

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

        <td  width="568"><input name="Commencement_Of_Lease"  type="text" size="16" maxlength="50"> Rent $&nbsp;&nbsp;&nbsp;<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="Gender"    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">&nbsp;</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="chDoYouSmoke" class="formcheckbox"  type="Radio" value="Yes" checked="true"> Yes<img src="images/spacer.gif" width="62" height="1" border="0"><input class="formcheckbox" name="chDoYouSmoke"    type="Radio" value="No"> 

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

        Inside or outside?&nbsp;

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

        No </td>

	  </tr>

      

      <tr>

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

        <td  width="568"><input name="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="chInternational" onClick="setInternationalPresentAddressNode(0)"  class="formcheckbox" checked="true" type="Radio" value="AUSTRALIAN"><span class="navytext"> AUSTRALIAN</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input  class="formcheckbox"  onClick="setInternationalPresentAddressNode(1)" name="chInternational" type="Radio" value="INTERNATIONAL" ><span class="navytext"> INTERNATIONAL</span></td>

      </tr>

      

	   <tr> 

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

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

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

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

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

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

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

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

                    

                

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

                        -----</option>

				

                    <option value="BLOCK" >

                        BLOCK</option>

				

                    <option value="CABIN" >

                        CABIN</option>

				

                    <option value="COTTAGE" >

                        COTTAGE</option>

				

                    <option value="DUPLEX" >

                        DUPLEX</option>

				

                    <option value="FACTORY" >

                        FACTORY</option>

				

                    <option value="FLOOR" >

                        FLOOR</option>

				

                    <option value="LOT" >

                        LOT</option>

				

                    <option value="PIER" >

                        PIER</option>

				

                    <option value="ROOFTOP" >

                        ROOFTOP</option>

				

                    <option value="ROOM" >

                        ROOM</option>

				

                    <option value="SHOP" >

                        SHOP</option>

				

                    <option value="SUITE" >

                        SUITE</option>

				

                    <option value="TOWNHOUSE" >

                        TOWNHOUSE</option>

				

                    <option value="VILLA" >

                        VILLA</option>

				

                    <option value="WAREHOUSE" >

                        WAREHOUSE</option>

				

              </select><div id="lblFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="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.&nbsp;<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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPostcode.focus()};">

					<option value=""></option>

            			

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

            			

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

            			

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

            			

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

            			

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

            			

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

            			

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

            			

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

            

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

	  </tr>      

      

      <tr> 

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

        <td ><input name="License"  value=""  type="Text" size="16"> State&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<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,'','','','','');">

		  &nbsp;         

		</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>&nbsp;</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">&nbsp;&nbsp;&nbsp;BSB <input name="Bank_BSB" value=""  type="Text" size="4" maxlength="6">&nbsp;&nbsp;&nbsp;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="isBankrupt" 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="chRentPaymentPeriod" 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" >&nbsp;</td>

      </tr> 

       <tr>

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

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

      </tr>   

     

	   <tr> 

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

         <td valign="Bottom"   width="568"> <div id="objEmploymentNode2"><input name="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">&nbsp;</div></td>

      </tr>

      	 

      <tr> 

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

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

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

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>			

		  </select>

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

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



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

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

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

		</td>

      </tr>

      	 

      <tr> 

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

        <td><div id="objEmploymentNode12"><input name="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">&nbsp;</td>

      </tr>

      	 

            <tr> 

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

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

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

                    <option value="01" >

                        01</option>

                    <option value="02" >

                        02</option>

                    <option value="03" >

                        03</option>

                    <option value="05" >

                        05</option>

                    <option value="06" >

                        06</option>

                    <option value="07" >

                        07</option>

                    <option value="08" >

                        08</option>

                    <option value="09" >

                        09</option>			

		  </select>

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

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



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

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

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

		</td>

      </tr>

      	 

         <tr> 

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

        <td><input name="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" >&nbsp;</td>

      </tr> 

      <tr>

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

      </tr> 

      	 

        <tr> 

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

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

      </tr>

      

      <tr> 

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

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

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

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

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

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

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

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

                

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

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

				

              </select><div id="lblAgentFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="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.&nbsp;<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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<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="chPreviousInternational" onClick="setPreviousInternationalNode(0)"  class="formcheckbox" checked="true" type="Radio" value="V1">

		  <span class="navytext"> AUSTRALIAN</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

		  <input  class="formcheckbox"  onClick="setPreviousInternationalNode(1)" name="chPreviousInternational" type="Radio" value="V1">

	    <span class="navytext"> INTERNATIONAL</span></td>

      </tr>

      

      <tr> 

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

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

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

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

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

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

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

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

                

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

                        -----</option>

				

				    <option value="BLOCK" >

                        BLOCK</option>

				

				    <option value="CABIN" >

                        CABIN</option>

				

				    <option value="COTTAGE" >

                        COTTAGE</option>

				

				    <option value="DUPLEX" >

                        DUPLEX</option>

				

				    <option value="FACTORY" >

                        FACTORY</option>

				

				    <option value="FLOOR" >

                        FLOOR</option>

				

				    <option value="LOT" >

                        LOT</option>

				

				    <option value="PIER" >

                        PIER</option>

				

				    <option value="ROOFTOP" >

                        ROOFTOP</option>

				

				    <option value="ROOM" >

                        ROOM</option>

				

				    <option value="SHOP" >

                        SHOP</option>

				

				    <option value="SUITE" >

                        SUITE</option>

				

				    <option value="TOWNHOUSE" >

                        TOWNHOUSE</option>

				

				    <option value="VILLA" >

                        VILLA</option>

				

				    <option value="WAREHOUSE" >

                        WAREHOUSE</option>

				

              </select><div id="lblPreviousFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="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.&nbsp;<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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chPreviousState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousPostcode.focus()};">

					<option value=""></option>

            			

              <option value="ACT" >

                            ACT</option>

            			

              <option value="NSW" >

                            NSW</option>

            			

              <option value="NT" >

                            NT</option>

            			

              <option value="QLD" >

                            QLD</option>

            			

              <option value="SA" >

                            SA</option>

            			

              <option value="TAS" >

                            TAS</option>

            			

              <option value="VIC" >

                            VIC</option>

            			

              <option value="WA " >

                            WA </option>

            



          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<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="chPreviousAgentInternational" onClick="setPreviousAgentInternationalNode(0)"  class="formcheckbox" checked="true" type="Radio" value="V1">

		  <span class="navytext"> AUSTRALIAN</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

		  <input  class="formcheckbox"  onClick="setPreviousAgentInternationalNode(1)" name="chPreviousAgentInternational" type="Radio" value="V1">

	    <span class="navytext"> INTERNATIONAL</span></td>

      </tr>

      

       <tr> 

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

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

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

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

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

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

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

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

                

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

                        -----</option>

				

				<option value="BLOCK" >

                        BLOCK</option>

				

				<option value="CABIN" >

                        CABIN</option>

				

				<option value="COTTAGE" >

                        COTTAGE</option>

				

				<option value="DUPLEX" >

                        DUPLEX</option>

				

				<option value="FACTORY" >

                        FACTORY</option>

				

				<option value="FLOOR" >

                        FLOOR</option>

				

				<option value="LOT" >

                        LOT</option>

				

				<option value="PIER" >

                        PIER</option>

				

				<option value="ROOFTOP" >

                        ROOFTOP</option>

				

				<option value="ROOM" >

                        ROOM</option>

				

				<option value="SHOP" >

                        SHOP</option>

				

				<option value="SUITE" >

                        SUITE</option>

				

				<option value="TOWNHOUSE" >

                        TOWNHOUSE</option>

				

				<option value="VILLA" >

                        VILLA</option>

				

				<option value="WAREHOUSE" >

                        WAREHOUSE</option>

				

              </select><div id="lblPreviousAgentFlatNo" style="display:none">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/spacer.gif" width="2" border="0"></div><input name="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.&nbsp;<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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chPreviousAgentState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chPreviousAgentPostcode.focus()};">

					<option value=""></option>

            			

             <option value="ACT" >

                            ACT</option>

            			

             <option value="NSW" >

                            NSW</option>

            			

             <option value="NT" >

                            NT</option>

            			

             <option value="QLD" >

                            QLD</option>

            			

             <option value="SA" >

                            SA</option>

            			

             <option value="TAS" >

                            TAS</option>

            			

             <option value="VIC" >

                            VIC</option>

            			

             <option value="WA " >

                            WA </option>

            



          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<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">&nbsp;</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">&nbsp;&nbsp;No.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<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.&nbsp;<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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<select name="chContactState" onchange="if((event.KeyCode!=8)&&(event.keyCode!=16)&&(event.keyCode!= 9)){chContactPostcode.focus()};">

					<option value=""></option>

            			

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

            			

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

            			

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

            			

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

            			

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

            			

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

            			

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

            			

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

            

          </select> Postcode<img src="images/spacer.gif" width="10" height="1" border="0"><input name="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,'','','','','');">

		  &nbsp;         

		</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">&nbsp;</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,'','','','','');">

		  &nbsp;         

		</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,'','','','','');">

		  &nbsp;         

		</td>

      </tr>

      

      <tr>

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

	  </tr> 

       <tr> 

         <td align="left" colspan="2"><strong class="navytext">Where did you see the property advertised?</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Local Press 

           <input type="checkbox" class="formcheckbox" name="chkAdvertisedLocalPress">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Signboard <input type="checkbox" class="formcheckbox" name="chkAdvertisedSignBoard">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Referral <input type="checkbox" class="formcheckbox" name="chkAdvertisedReferral">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Internet <input type="checkbox" class="formcheckbox" name="chkAdvertisedInternet"></td>

      </tr> 

        <tr> 

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

        <td><input name="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>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="redbackgroundwhitetext"><strong>IMPORTANT NOTICE REGARDING SCANNED DOCUMENTS:</strong></span><br>

        <br>

        <span class="bigbox">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Add scanned documents to speed up the process of application.<br><br>

       &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Please do not attach all documents to a single button as a combined scan. Each individual document i.e. passport,<br>

       &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;driver&#8217;s license etc. should be attached to the correctly labelled button. This is important for privacy compliance.<br><br>    

       &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<input type="checkbox"  class="formcheckbox" name="isDocIdentifiersTicked">&nbsp;&nbsp;I, the applicant, have read and understood the above statement and take full responsibility for attaching my<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;documents to the correct buttons.</span><br><br>

</td></tr></table></td>

      </tr>

      

      <tr>

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

	  </tr> 

      

      <tr valign="top" align="left">

        <td colspan="2">

        To add a scan, click the 'Browse' button of the description of the object scanned, for   example TRA Disclosure or Drivers Licence<br>

        to 

        locate the file on your computer, then click on that file which will attach to your application.<br>

Allowable file formats are: .gif, .jpg, .png, .pdf. Maximum size 200KB. </td>

      </tr>

        <tr>

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

	  </tr> 

        <tr>

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

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

	  </tr>  

      <tr align="left"> 

        <td height="3">TRA Disclosure</td>

        <td height="3" ><input type="file" name="chFilename1"> Working Visa<img src="images/spacer.gif" width="25" height="1" border="0"><input type="file" name="chFilename9"></td>

      </tr>

      <tr align="left"> 

        <td height="3">Drivers Licence</td>

        <td height="3" ><input type="file" name="chFilename2"> 

        Birth Certificate<img src="images/spacer.gif" width="14" height="1" border="0"><input type="file" name="chFilename10"></td>

      </tr>

      

      <tr align="left"> 

        <td height="3" nowrap>Passport</td>

        <td height="3" ><input type="file" name="chFilename3"> 

        Photo Id<img src="images/spacer.gif" width="52" height="1" border="0"><input type="file" name="chFilename6"></td>

      </tr>

      

       <tr align="left"> 

        <td height="3" nowrap>Student ID</td>

        <td height="3" ><input type="file" name="chFilename11"></td>

      </tr>

  

        <tr>

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

	  </tr> 

        <tr>

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

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

	  </tr>  



      <tr align="left"> 

        <td height="3">Ledger</td>

        <td height="3"><input type="file" name="chFilename12"> Business Reg<img src="images/spacer.gif" width="30" height="1" border="0"><input type="file" name="chFilename13"></td>

      </tr>

      <tr align="left"> 

        <td height="3">Bank Statement</td>

        <td height="3" ><input type="file" name="chFilename14"> 

        Water Rates<img src="images/spacer.gif" width="41" height="1" border="0"><input type="file" name="chFilename15"></td>

      </tr>

      

      <tr align="left"> 

        <td height="3" nowrap>Utility Bills</td>

        <td height="3" ><input type="file" name="chFilename16"> 

        Comp. Statement<img src="images/spacer.gif" width="13" height="1" border="0"><input type="file" name="chFilename17"></td>

      </tr>

      

       <tr align="left"> 

        <td height="3" nowrap>Current Pay Slip</td>

        <td height="3" ><input type="file" name="chFilename18"> 

        Council Rates<img src="images/spacer.gif" width="31" height="1" border="0"><input type="file" name="chFilename19"></td>

      </tr>

      

       <tr align="left"> 

        <td height="3" nowrap>Written Reference</td>

        <td height="3" ><input type="file" name="chFilename20"></td>

      </tr>  

        <tr>

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

	  </tr> 

      

      <tr valign="top" align="left"> 

        <td height="3" colspan="2" width="100%" class="bigbox2"><br><table cellpadding="0" cellspacing="0" width="90%" style="border-style:double; border-width:3px; border-color:#647882"><tr><td>
			<span class="redbackgroundwhitetext"><strong>IMPORTANT NOTICE:</strong></span><span class="bigbox"><p>To process your application we need a signed TRA disclosure. Click here to view and print: <a href="https://tradingreference.com/forms/tendec.pdf" target="_blank">TRA Tenancy Disclosure</a>.</p>

        <p>If you don't have a printer we will provide you   with this document. Scan and attach it to this application, or print and take into our office at your convenience.</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">&nbsp;&nbsp;<span class="navytext"><strong>I, </strong></span> the <span class="navytext"><strong>APPLICANT</strong></span>, have read and understood the following document: <a href="http://www.fairtrading.nsw.gov.au/Factsheet_print/Tenants_and_home_owners/Renting_a_home/FTR72_New_tenant_checklist.pdf" target="_blank">Tenant Checklist</a></td>

	  		</tr>

		  </table>

        </td>

      </tr> 

      

                

      <tr>

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

	  </tr> 

      <tr>

	  	<td align="left" width="171" class="navytext"><strong>TRA PRIVACY CONSENT:</strong></td>

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

	  </tr>  

      <tr><td height="3" colspan="2"> 

          <table cellpadding=0 cellspacing=0 border=0>		  

		  	<tr  valign="top">

			  <td><input type="checkbox" onclick="disclosurepopup()"  class="formcheckbox" name="isPrivacyConsent">

			  &nbsp;&nbsp;<span class="navytext"><strong>I, </strong></span> the <span class="navytext"><strong>APPLICANT</strong></span>, understand and agree that the information entered onto the TRA database will be delivered through the TRA website to any agency I am applying to or may apply to   for rental of property for examination and evaluation of such application for   identification of me.

			  <br>

			    <br>

			    <span class="redtext"><strong>I also state that the TRA Disclosure, Drivers Licence, Passport and Photo ID   attached to this document belong to me as do the signatures. I   understand that all search results and logins are monitored within an internal   auditing system and are date-time stamped together with my IP address and   account details. Any misuse of the TRA facilities can be traced to my point of   access origin and may lead to civil action or criminal prosecution for serious   offences.</strong>

			    </span><br>

			    <p>I acknowledge and agree that information provided to TRA and/or the agent by   these authorities given by me be disclosed to: a) Real Estate Agents, Landlords,   Trades persons, Emergency Contacts, Employers past, present or prospective,   Referees, Housing New South Wales, Compass Housing, Dentists, Video stores to   assist them in evaluating applications which may be made by me to any of these   parties, for the purpose of managing any property and my requirements as   tenant/s during my tenancy of any property owned or managed by any of those   parties and b) Real Estate Agents, Landlords, Dentists, Video stores, Banks,   Utility companies, Commercial Agents, organisations or any other members for the   reason of locating me for any lawful purpose and I hereby consent to such use and disclosure of that information for those purposes. Should any such party   transfer its business to another person, I consent to the new person (and any further person to whom that business may be transferred) taking any step which   the former party could have taken. </p>

<p>To the   extent permitted by law I agree that TRA will not be liable to me for any misuse of my information by any party to whom my information is disclosed in accordance   with the these authorities and release TRA from any such liability. I acknowledge that the information entered by me onto the TRA database and   disclosed by TRA in accordance with these authorities given by me for such time as TRA shall be entitled by law to hold such information on its   database.</p></td>

	  		</tr>

		  </table>

        </td>

      </tr>	  

    

      <tr> 

      	<td>&nbsp;</td>

        <td><div style="width:425px;" align="center"><input type="submit" name="Submit" class="btnSmall"  value="SUBMIT">

          </div>        	

        </td>

      </tr>

    </table>

</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>

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awolarczuk
Asked:
awolarczuk
  • 10
  • 3
  • 3
  • +7
1 Solution
 
EyalCommented:
are you willing to add jQuery to your page?
0
 
ansudhindraCommented:
0
 
EyalCommented:
the general idea is to add class to all the elements that you want to validate
when submitting get all the elements with that class and check the value

if you don't want to use jQuery here is alternative to get the elements
function getElementsByClassName(node,classname) {
  if (node.getElementsByClassName) { // use native implementation if available
    return node.getElementsByClassName(classname);
  } else {
    return (function getElementsByClass(searchClass,node) {
        if ( node == null )
          node = document;
        var classElements = [],
            els = node.getElementsByTagName("*"),
            elsLen = els.length,
            pattern = new RegExp("(^|\\s)"+searchClass+"(\\s|$)"), i, j;

        for (i = 0, j = 0; i < elsLen; i++) {
          if ( pattern.test(els[i].className) ) {
              classElements[j] = els[i];
              j++;
          }
        }
        return classElements;
    })(classname, node);
  }
}

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What does it mean to be "Always On"?

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Loganathan NatarajanLAMP DeveloperCommented:
You can easily implement this jquery validate,

http://jquery.bassistance.de/validate/demo/
0
 
awolarczukAuthor Commented:
Hi All i dont mind using  java script but how do i intergrate it with my current code
0
 
awolarczukAuthor Commented:
for anuyone that is trying to help here is the code i am using atm and it doesnt seem to work, anyone pleae help me here
0
 
Michel PlungjanIT ExpertCommented:
What is ATM?
0
 
Ray PaseurCommented:
Client-side "validation" is simply a nicety for your user community.  For security reasons, your script must perform validation on the server after receiving the external data.  Here is how to do that.  You can test it on my server here:
http://www.laprbass.com/RAY_form_highlight_errors.php
<?php // RAY_form_highlight_errors.php
error_reporting(E_ALL);


// DEMONSTRATE HOW TO HIGHLIGHT ERRORS IN FORM INPUT
// CLIENT IS ASKED TO PUT IN A VALUE
// IF THE VALUE FAILS OUR TEST WE SHOW AN ERROR MESSAGE
// WE PUT A MARKER NEXT TO THE INPUT CONTROL ON THE FORM
// WE TURN THE FORM BORDER RED
// SEE http://www.w3schools.com/CSS/pr_class_visibility.asp


// THESE CONDITIONS ARE SET FOR THE INITIAL ENTRY
$error_abc = 'hidden';
$boxer_abc = 'black';
$error_xyz = 'hidden';
$boxer_xyz = 'black';
$error_any = 'hidden';


// CAPTURE AND NORMALIZE THE POST VARIABLES - ADD YOUR OWN SANITY CHECKS HERE
$abc = (isset($_POST["abc"])) ? trim(strtoupper($_POST["abc"])) : NULL;
$xyz = (isset($_POST["xyz"])) ? trim(strtoupper($_POST["xyz"])) : NULL;

// IF ANYTHING WAS POSTED, VALIDATE IT
if (!empty($_POST))
{
    // VALIDATE THE 'abc' FIELD
    if ($abc != 'ABC')
    {
        $error_any = 'visible';
        $error_abc = 'visible';
        $boxer_abc = 'red';
        // $abc       = NULL;
    }

    // VALIDATE THE 'xyz' FIELD
    if ($xyz != 'XYZ')
    {
        $error_any = 'visible';
        $error_xyz = 'visible';
        $boxer_xyz = 'red';
        // $xyz       = NULL;
    }

    // DO WE HAVE INPUT FREE FROM ANY ERRORS?
    if ($error_any != 'visible')
    {
        echo "CONGRATULATIONS";
        die();
    }

    // OOPS - WE HAVE ERRORS
}

// IF NOTHING WAS POSTED, OR IF THERE ARE ERRORS, WE NEED NEW CLIENT INPUT
$form = <<<ENDFORM
<style type="text/css" media="all">
.error_any { visibility:$error_any; }
.error_abc { visibility:$error_abc; }
.error_xyz { visibility:$error_xyz; }
</style>
<pre>
<form method="post">
<span class="error_any">PLEASE CORRECT THE FOLLOWING ERRORS</span>
<span class="error_abc">YOU MUST ENTER 'abc' IN THIS FIELD</span>
PLEASE ENTER "ABC" HERE: <input style="border-color:$boxer_abc;" name="abc" value="$abc" />
<span class="error_xyz">YOU MUST ENTER 'xyz' IN THIS FIELD</span>
PLEASE ENTER "XYZ" HERE: <input style="border-color:$boxer_xyz;" name="xyz" value="$xyz" />
<input type="submit" />
</form>
ENDFORM;

// WRITE THE FORM WITH THE APPROPRIATE CSS STYLES ON THE ERROR MESSAGE FIELDS
echo $form;

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mgfranzCommented:
Without specifying what HTML platform you are using, it's difficult to give you the best solution to your question.  If you are using something like Apache hosting then PHP orJavaScript are the best solutions, if you are on a Windows platform then using .NET is the easiest since it runs server-side, there are still some who will block the running of JavaScript at the client side.  Here is a snippet of .aspx code to perform a validation on a users last name;

 
<asp:Textbox id="txtLastName" runat="server"></asp:Textbox>
<asp:RequiredFieldValidator id="RequiredFieldValidator1" runat="server"
   ControlToValidate="txtLastName"
   ErrorMessage="Last name is a required field."
   ForeColor="Red">
</asp:RequiredFieldValidator>

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awolarczukAuthor Commented:
mplungjan:: ATM = At the moment
0
 
awolarczukAuthor Commented:
Ray_Paseur: Thank mate how would i plug this in to my code i post above
mgfranz: im sorry you i didnt explan better but i am using asp i have post a few examples for my code now i would to put it in here
0
 
mgfranzCommented:
Classic ASP or ASP.Net?  If you are using .Net the example I provided should get you going.  The RequiredFieldValidator is a built in control that works server-side so you have no issues with browsers blocking JavaScript.
0
 
awolarczukAuthor Commented:
it is .net could you please show me how to intergrate it to my code
0
 
mgfranzCommented:
It's pretty simple really, whatever form field you want to validate just make the call to the RequiredFieldValidator.  You are going to have to change the <input> fields to the correct ASP.Net control, Select List, TextBox, etc...  Here is a simple sample;

 
<form runat="server">
Name: <asp:TextBox id="name" runat="server" />
<br />
Age: <asp:TextBox id="age" runat="server" />
<br /><br />
<asp:Button runat="server" Text="Submit" />
<br /><br />
<asp:RequiredFieldValidator
ControlToValidate="name"
Text="The name field is required!"
runat="server" />
</form>

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awolarczukAuthor Commented:
mgfranz: Dumb Question is that connected to the submit??? how does it check it
0
 
David Johnson, CD, MVPOwnerCommented:
Lots of issues with your code (You forgot Northern Ireland, for shame), now how many places do you have to edit to add this error..
Your code is way too wordy, you should use data types i.e.xml, database, with combo boxes, for dates use a date control,
Males do not have a maiden name (hide this if male radio button clicked)
same with the 2nd previus address unhide it if needed only.
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David Johnson, CD, MVPOwnerCommented:
0
 
awolarczukAuthor Commented:
ve3ofa: cool mate thanks for the hint on this  just to let you know some males do change there names, in fact i did when i married

i will look at making this a SQL back end at some point but for now i really just need the requiments working if you could please help me fix my code so this works
0
 
awolarczukAuthor Commented:
mgfranz: i have been trying to match you code with mine do you mind using my code as a example
Ray_Paseur: i love your code as well but if its ok could you salso please use my code as a example i am just finding it to work out to to get it in to cide
0
 
David Johnson, CD, MVPOwnerCommented:
FYI, the Netherlands Antilles was disbanded in October, 2010 replaced with CuraƧao,  Bonaire, Sint Eustatius and Saba, Sint Maarten (Dutch part)
 
 
   
 

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awolarczukAuthor Commented:
ve3ofa: thanks for that :) and i will be happy to change this but do you trhink u could help me get this working :) please
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keyuCommented:
Hi,

Here is simple form validation example.

Instead of writing validation or onchange event directly inside onclick event please create a function and write details inside that function.

if you write return false inside function

it will never processed befor all star values get entered.


Example:

<script type='text/javascript'>

function formValidator(){
      // Make quick references to our fields
      var firstname = document.getElementById('firstname');
      var addr = document.getElementById('addr');
      var zip = document.getElementById('zip');
      var state = document.getElementById('state');
      var username = document.getElementById('username');
      var email = document.getElementById('email');
      
      // Check each input in the order that it appears in the form!
      if(isAlphabet(firstname, "Please enter only letters for your name")){
            if(isAlphanumeric(addr, "Numbers and Letters Only for Address")){
                  if(isNumeric(zip, "Please enter a valid zip code")){
                        if(madeSelection(state, "Please Choose a State")){
                              if(lengthRestriction(username, 6, 8)){
                                    if(emailValidator(email, "Please enter a valid email address")){
                                          return true;
                                    }
                              }
                        }
                  }
            }
      }
      
      
      return false;
      
}

function notEmpty(elem, helperMsg){
      if(elem.value.length == 0){
            alert(helperMsg);
            elem.focus(); // set the focus to this input
            return false;
      }
      return true;
}

function isNumeric(elem, helperMsg){
      var numericExpression = /^[0-9]+$/;
      if(elem.value.match(numericExpression)){
            return true;
      }else{
            alert(helperMsg);
            elem.focus();
            return false;
      }
}

function isAlphabet(elem, helperMsg){
      var alphaExp = /^[a-zA-Z]+$/;
      if(elem.value.match(alphaExp)){
            return true;
      }else{
            alert(helperMsg);
            elem.focus();
            return false;
      }
}

function isAlphanumeric(elem, helperMsg){
      var alphaExp = /^[0-9a-zA-Z]+$/;
      if(elem.value.match(alphaExp)){
            return true;
      }else{
            alert(helperMsg);
            elem.focus();
            return false;
      }
}

function lengthRestriction(elem, min, max){
      var uInput = elem.value;
      if(uInput.length >= min && uInput.length <= max){
            return true;
      }else{
            alert("Please enter between " +min+ " and " +max+ " characters");
            elem.focus();
            return false;
      }
}

function madeSelection(elem, helperMsg){
      if(elem.value == "Please Choose"){
            alert(helperMsg);
            elem.focus();
            return false;
      }else{
            return true;
      }
}

function emailValidator(elem, helperMsg){
      var emailExp = /^[\w\-\.\+]+\@[a-zA-Z0-9\.\-]+\.[a-zA-z0-9]{2,4}$/;
      if(elem.value.match(emailExp)){
            return true;
      }else{
            alert(helperMsg);
            elem.focus();
            return false;
      }
}
</script>

<form onsubmit='return formValidator()' >
First Name: <input type='text' id='firstname' /><br />
Address: <input type='text' id='addr' /><br />
Zip Code: <input type='text' id='zip' /><br />
State: <select id='state'>
      <option>Please Choose</option>
      <option>AL</option>
      <option>CA</option>
      <option>TX</option>
      <option>WI</option>
</select><br />
Username(6-8 characters): <input type='text' id='username' /><br />
Email: <input type='text' id='email' /><br />
<input type='submit' value='Check Form' />
</form>


Hope this helps.

Thnkas,
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awolarczukAuthor Commented:
xool looks good but again how do i intergrate it with my code if you oculd help with thqt that would be great
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NerdsOfTechTechnology ScientistCommented:
First, if you are going to use CLIENT-SIDE code such as JavaScript, make sure your form has an onSubmit attribute with your validation function. Let's use @keyu's suggested function names and code for the CLIENT-SIDE code for now.

      <form method="post" action="process_mail.aspx" onSubmit="return formValidator();">

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This will prevent the form from being submitted if the form validation function has an error E.G> a field wasn't filled out or improper data was detected.

Next, you will want to populate the Validator function with the appropriate MANDATORY fields...
Type_of_Residence
Commencement_Of_Lease
Rent
Length_of_Lease...etc.
as @keyu also describes...

function formValidator(){
      // Make quick references to our fields
      var Type_of_Residence = document.getElementById('Type_of_Residence');
      var Commencement_Of_Lease = document.getElementById('Commencement_Of_Lease');
      var Rent = document.getElementById('Rent');
...

Open in new window


You might want a more elegant approach than such a hard-coded example but I am just showing that as an example.

Besides the CLIENT-SIDE code method utilizing onSubmit like this:
onSubmit="return JavaScriptValidationFunctionHere();"

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Many programmers use scripts utilizing SERVER-SIDE code such as PHP, PERL, ASP.NET (just to name a few) that process forms; especially self-submitting forms. If error(s) occur the script can notate the fields that need to be filled out, apply styles for example highlighted fields or indication of missing fields on the page being submitted.

In this method the form is actually submitted to itself (the action url is the same page) and the form reads the $_POST fields for the required data, finds out if there is any errors then:

if errors are present:
outputs the form again with error messages or stylization of the missing or invalid fields.

if errors are not present:
processes the form and outputs a confirmation page or whatever else you want to happen.

For example, lets say you have a page called form.php and you required first and last name in the form.

The user fills out the form:
first name: Foo
last name:
phone number: 555-555-5555
...and the form is submitted to itself....

The following PHP (server-side) code would output the form again with the users info AND a WARNING that the last name needs to be filled out.

Once the user resubmits the form with all of the required fields filled out the code processes the form and outputs a Thank you message.

form.php
<?php
// do some security stuff on the form data FIRST if it exists (not covered in example)

$submitted=$_GET['submit']; // form submitted, check for required fields
$firstname=$_GET['first_name'];
$lastname=$_GET['last_name'];
$phone=$_GET['phone'];

if ($submitted == "Submit"){
	if(&& $first_name != "" && $last_name != ""){
		// form submitted and required fields are filled in. PROCESS INFO (not covered in example)
		$error = 0;
	}else{
		// one of required fields is missing flag as error
		$error = 1;
	}
}

if ($error || $submitted != "Submit"){
	// if required field is missing OR the form has not been submitted yet THEN output form
?>



<form action="form.php" method="post">
* = Required Field<br /><br />
First Name*: <input type="text" name="first_name" value="<?php echo $first_name;?>">
<?php 
// if required field is missing output warning message to the right of the field
if($first_name == "" && $error){
echo; ' <span style="color: red;">REQUIRED FIELD PLEASE FILL OUT</span>';
}
?><br />

Last Name*: <input type="text" name="last_name" value="<?php echo $last_name;?>">
<?php 
if($last_name == "" && $error){
echo; ' <span style="color: red;">REQUIRED FIELD PLEASE FILL OUT</span>';
}
?><br />
Phone Number: <input type="text" name="phone" value="<?php echo $phone;?>">
<br />
<input type="submit" name="submit" value="Submit"><br />



<?php
}else{
// form submit was done without error so do something here...
?>

Thank You! The form was successfully processed.

<?php
}
?>

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