Test Form 2 Facility Name Facility Type Solo Cardiologist Cardiology Group Multi-Specialty Clinic Hospital Contact Name Contact Occupation Cardiologist Internal Med Physician Administrator Facility Staff Email Address Daytime Phone Number I am Looking to…… Increase Revenue with MCT Looking for service company Looking to switch service company Looking to evaluate only function test_apply() { if (document.data_form.email!=null) { if (document.data_form.email.value=='') { alert('Oops you forgot to enter your correct EMAIL ADDRESS. Please re-enter it and Click Submit again.'); document.data_form.email.focus(); return false; } var reg = /^([A-Za-z0-9_-.])+@([A-Za-z0-9_-.])+.([A-Za-z]{2,4})$/; var emailid = document.data_form.email.value; if(reg.test(emailid) == false) { alert('Invalid Email Address'); return false; } } if (document.data_form.name1!=null) { if (document.data_form.name1.value=='') { alert('Oops you forgot to enter your correct FIRST NAME. Please re-enter it and Click Submit again.'); document.data_form.name1.focus(); return false; } } if (document.data_form.name2!=null) { if (document.data_form.name2.value=='') { alert('Oops you forgot to enter your correct LAST NAME. Please re-enter it and Click Submit again.'); document.data_form.name2.focus(); return false; } } if (document.data_form.address!=null) { if (document.data_form.address.value=='') { alert('Oops you forgot to enter your correct ADDRESS. Please re-enter it and Click Submit again.'); document.data_form.address.focus(); return false; } } if (document.data_form.city!=null) { if (document.data_form.city.value=='') { alert('Oops you forgot to enter your correct CITY.'); document.data_form.city.focus(); return false; } } if (document.data_form.state!=null) { if (document.data_form.state.value=='') { alert('Oops you forgot to enter your correct STATE. Please re-enter it and Click Submit again.'); document.data_form.state.focus(); return false; } } if (document.data_form.zip!=null) { if (document.data_form.zip.value=='') { alert('Oops you forgot to enter your correct POSTAL/ZIP CODE. Please re-enter it and Click Submit again.'); document.data_form.zip.focus(); return false; } } if (document.data_form.phone!=null) { if (document.data_form.phone.value=='') { alert('Oops you forgot to enter your correct PHONE NUMBER. Please re-enter it and Click Submit again.'); document.data_form.phone.focus(); return false; } } if (document.data_form.fax!=null) { if (document.data_form.fax.value=='') { alert('Oops you forgot to enter your correct FAX NUMBER. Please re-enter it and Click Submit again, if you dont have a fax simply enter 0'); document.data_form.fax.focus(); return false; } } v = new Array(); v[0]=1; v[1]=1; var g =0; r=0; r=0; r=0; r=0; r=0; r=0; r=0; for (b = 0;b<=v.length; b++) { if (v[b]==0) { g = 0; } else if ((v[b]==1)&&(v[b-1]==1)) g = 1; } var tt = 7; for (var i = 0; i