function ap_validate_2249() { var form = document.ap_form_2249; var regexp_28228 = /^[a-zA-Z]+(([\'\,\.\-][a-zA-Z])?[a-zA-Z]*)*$/; var regexp_28229 = /^[a-zA-Z]+(([\'\,\.\-][a-zA-Z])?[a-zA-Z]*)*$/; var regexp_28230 = /^((\+\d{1,3}(-| )?\(?\d\)?(-| )?\d{1,3})|(\(?\d{2,3}\)?))(-| )?(\d{3,4})(-| )?(\d{4})(( x| ext)\d{1,5}){0,1}$/; if (form.name === ""){ alert( "There was an error on this form." ); } else if (form.ap_field_28228.value === ""){ alert( "Please enter all required fields: First Name " ); } else if (!regexp_28228.test(form.ap_field_28228.value)){ form.ap_field_28228.focus(); form.ap_field_28228.select(); alert( "Please correct required field: First Name" ); } else if (form.ap_field_28229.value === ""){ alert( "Please enter all required fields: Last Name " ); } else if (!regexp_28229.test(form.ap_field_28229.value)){ form.ap_field_28229.focus(); form.ap_field_28229.select(); alert( "Please correct required field: Last Name" ); } else if (form.ap_field_28230.value === ""){ alert( "Please enter all required fields: Phone " ); } else if (!regexp_28230.test(form.ap_field_28230.value)){ form.ap_field_28230.focus(); form.ap_field_28230.select(); alert( "Please correct required field: Phone" ); } else if (form.ap_field_28275.value === ""){ alert( "Please enter all required fields: Issue Date " ); } else { document.ap_form_2249.submit(); } } function showForm(){ var formHTML = '
Financing Application
Fill out this application to recieve financing for services.
First Name*
Last Name*
Address
City
State
Zip
Phone*
Mobile Phone
Personal Reference Relative or person not living with you, and not the co-applicant.
Own Home or Rent Own
Rent
Rent/Mortgage Payment Amount
How Long at Current Address?
Previous Address 1 If Less Than 1 Year at Current Address
Previous Address 2
Previous City
Previous State
Previous Zip
Social Security Number
Date of Birth
Employer City
Employer State
How Long at Current Employer?
Gross Annual Salary $
Other Income
Source of Other Income Alimony, child support or seperate maintenance income need not be revealed if you do not wish to have it considered as a basis for paying the loan.
Driver"s License
Issue Date*
State of Issue Please enter the state of issue if your driver"s liscense.
Expiration Date (mmyy)

* Required Field

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'; if(!formShown){ document.writeln(formHTML); } formShown=true; } var formShown = false; showForm();