All pastes #102256 Raw Edit

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public text v1 · immutable
#102256 ·published 2006-07-27 13:30 UTC
rendered paste body
<!DOCTYPE html PUBLIC '-//W3C//DTD XHTML 1.0 Transitional//EN' 'http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd'>
<html xmlns='http://www.w3.org/1999/xhtml'>
<head>
<meta http-equiv='Content-Type' content='text/html; charset=iso-8859-1'style='width: 150px;' />
<title>Untitled Document</title>
<style>
div#personal
{
display: none;
}
div#business
{
display: none;
}
</style>
<script type="text/javascript">

function toggleLayer(whichLayer,outof)
{
if (document.getElementById)
{
for (var n in outof) {
var el = outof[n];
document.getElementById(el).style.display = '';
}
var style2 = document.getElementById(whichLayer).style;
style2.display = style2.display? "":"block";
}
else if (document.all)
{
var style2 = document.all[whichLayer].style;
style2.display = style2.display? "":"block";
}
else if (document.layers)
{
var style2 = document.layers[whichLayer].style;
style2.display = style2.display? "":"block";
}
}

</script>
</head>

<body>
<a href="javascript:toggleLayer('personal',['personal','business']);">Personal</a>
<a href="javascript:toggleLayer('business',['personal','business']);">Business</a>
<form action='.php' method='post'>
<table width='600' border='0' align='center' cellpadding='0' cellspacing='3'>
<tr>
<td height='20' colspan='2' bgcolor='#0099ff' style='padding-left: 5px;'><strong>Application Form</strong> </td>
</tr>
<tr>
<td colspan='2'>&nbsp;</td>
</tr>
<tr>
<td colspan='2' style='padding-left: 5px;'><strong>Contact Details:</strong></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Full Name: </td>
<td><input name='fullname' type='text' id='fullname'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Email Address: </td>
<td><input name='email' type='text' id='email'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Mobile No: </td>
<td><input name='mobile' type='text' id='mobile'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Telephone No. </td>
<td><input name='telephone' type='text' id='telephone'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<div id="personal">
<tr>
<td colspan='2' bgcolor='#3399FF' style='padding-left: 5px;'><strong>Personal Details:</strong></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td width='150' style='padding-left: 5px;'>Address</td>
<td><input name='address' type='text' id='address'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td><input name='address2' type='text' id='address2'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td><input name='address3' type='text' id='address3'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Postcode:</td>
<td><input name='postcode' type='text' id='postcode'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Time At Address: </td>
<td><input name='timeataddress' type='text' id='timeataddress'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Date of Birth: </td>
<td><input name='dob' type='text' id='dob'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Any Adverse Credit: </td>
<td><input name='credit' type='text' id='credit'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Martial Status: </td>
<td>
<select name='martial' style='width: 150px;'>
<option>Select...
<option value='Single'>Single
<option value='Married'>Married
<option value='Divorcing'>Divorcing
<option value='Co-Habiting'>Co-Habiting
</select></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Tenure:</td>
<td>
<select name='tenure' style='width: 150px;'>
<option>Select...
<option value='Tenant'>Tenant
<option value='Owner'>Owner
<option value='Mortgaged'>Mortgaged
<option value='Rented'>Rented
<option value='Leased'>Leased
</select></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
</div>
<div id="business">
<tr>
<td colspan='2' bgcolor='3399FF' style='padding-left: 5px;'><strong>Business Details:</strong> </td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Business Name: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Business Address: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Postcode:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Telephone No. </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Nature Of Business </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Date Established </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>V.AT. Number: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Registered Number: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Business Type: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td colspan="2" bgcolor="3399FF" style='padding-left: 5px;'><strong>Directors Details: </strong></td>
  </tr>
<tr>
  <td height="19" style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Full Name: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Date Of Birth: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Address:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Postcode:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Time At Adrress : </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Type:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Status:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Time At Previous Address: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Previous Address: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Previous Postcode:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>

<tr>
  <td colspan="2" bgcolor="3399ff" style='padding-left: 5px;'><strong>Second Directors Details </strong></td>
  </tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Full Name: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Date Of Birth: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Address:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Postcode:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Time At Adrress : </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Type:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Status:</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Time At Previous Address: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Previous Address: </td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>&nbsp;</td>
  <td>&nbsp;</td>
</tr>
<tr>
  <td style='padding-left: 5px;'>Previous Postcode:</td>
  <td>&nbsp;</td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td colspan='2' bgcolor='3399FF' style='padding-left: 5px;'><strong>Previous Address: </strong></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td style='padding-left: 5px;'>Address:</td>
<td><input name='prevaddress' type='text' id='prevaddress'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td><input name='prevaddress2' type='text' id='prevaddress2'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td><input name='prevaddress3' type='text' id='prevaddress3'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Postcode:</td>
<td><input name='prevpostcode' type='text' id='prevpostcode'style='width: 150px;' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
</div>
<tr>
<td colspan='2' bgcolor='#3399FF' style='padding-left: 5px;'><strong>Vehicle Details: </strong></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td style='padding-left: 5px;'>Vehicle:</td>
<td><input name='textfield1352' type='text'style='width: 150px;' value='<? echo("$make $model  (ID:$id)"); ?>' /></td>
</tr>
<tr>
<td style='padding-left: 5px;'>Length of Hire: </td>
<td>
<select name='term' style='width: 150px;'>
<option value='1'>1 Month   £$onemonth
<option value='3'>3 Month   £$threemonth
<option value='6'>6 Month   £$sixmonth
<option value='12'>12 Month £$twelvemonth
</select></td>
</tr>
<tr>
<td style='padding-left: 5px;'>&nbsp;</td>
<td>&nbsp;</td>
</tr>
<tr>
<td width='150' style='padding-left: 5px;'>&nbsp;</td>
<td>
<input type='submit' name='submit' value='Send Application' />
<input type='submit' name='reset' value='Reset Application' /></td>
</tr>
</table>
</form>
</body>
</html>