var spouseflag= new Boolean(false)
	var child1flag= new Boolean(false)
	var child2flag= new Boolean(false)
	var child3flag= new Boolean(false)
	var child4flag= new Boolean(false)
	var child5flag= new Boolean(false)
	var currentlyinsuredflag= new Boolean(false)

	function validate()
	{

	var stateRange = "00215NH00544NY00795PR00851VI00988PR02791MA02940RI03897NH04992ME05495VT05544MA05907VT06389CT06390NY06928CT08989NJ09899AE14925NY19640PA19980DE20099DC20199VA20599DC21930MD24658VA26886WV28909NC29945SC31999GA33994FL34099AA34997FL36925AL38589TN39776MS39901GA42788KY45999OH47997IN49971MI52809IA54990WI56763MN57799SD58856ND59937MT62999IL65899MO67954KS69367NE71497LA72959AR73199OK73344TX74966OK79999TX81658CO83128WY83422ID83422WY83888ID84791UT86556AZ88441NM88595TX89883NV96162CA96698AP96797HI96799AS96898HI96932GU96940PW96944FM96952MP96970MH97920OR99403WA99950AK";
	
	var state_abbreviations = new Array(
			'filler', 'filler', 'AL', 'AK', 'AZ', 'AR', 'CA', 'CO', 'CT', 'DE', 'FL',
			'GA', 'HI', 'ID', 'IL', 'IN', 'IA', 'KS', 'KY', 'LA', 'ME', 'MD',
			'MA', 'MI', 'MN', 'MS', 'MO', 'MT', 'NE', 'NV', 'NH', 'NJ', 'NM', 
			'NY', 'NC', 'ND', 'OH', 'OK', 'OR', 'PA', 'PR',	'RI',	'SC',	'SD',	
			'TN',	'TX', 'UT', 'VT', 'VA',	'WA',	'WV',	'WI',	'WY'
		  );

	function getState(zip) {
		if (zip.length == 5)
			for (var i = 0; i < stateRange.length; i += 7)
				if (zip <= 1 * stateRange.substr(i, 5))
					return stateRange.substr(i + 5, 2);
		return null;
	}
		
		var valid_flag=new Boolean(true)
		var family_flag=new Boolean(true)

		var fn=new Boolean(check_name(document.getElementById("FirstName").value))
		var ln=new Boolean(check_name(document.getElementById("LastName").value))

		var dp=new Boolean(check_phone(document.getElementById("DayPhoneAC").value,document.getElementById("DayPhone1").value,document.getElementById("DayPhone2").value))
		var ea=new Boolean(check_email(document.getElementById("Email").value))

		var a1=new Boolean(check_name(document.getElementById("StreetAddress").value))
		var city=new Boolean(check_name(document.getElementById("City").value))
		var zip=new Boolean(check_zip(document.getElementById("ZipCode").value))
		
		var zipstate = getState(document.getElementById("ZipCode").value);

		var stabbrev = state_abbreviations[document.getElementById("State").value];
		
		if(fn==false){
			document.getElementById("FirstName").focus();
			document.getElementById("fname").innerHTML="First Name <font color=\"red\">*</font>"
		}
		else{
			document.getElementById("fname").innerHTML="First Name"
		}
		if(ln==false){
			document.getElementById("LastName").focus();
			document.getElementById("lname").innerHTML="Last Name <font color=\"red\">*</font>"
		}
		else{
			document.getElementById("lname").innerHTML="Last Name"
		}
		if(fn==false || ln==false ){
			document.getElementById("nameli").className="error"
			valid_flag=false
		}
		else{
			document.getElementById("nameli").className=""
		}

		if(dp==false){
			document.getElementById("DayPhoneAC").focus();
			document.getElementById("dphone").innerHTML="Daytime Phone <font color=\"red\">*</font>"
		}
		else{
			document.getElementById("dphone").innerHTML="Daytime Phone"
		}
		if(ea==false){
			document.getElementById("Email").focus();
			document.getElementById("eml").innerHTML="E-Mail Address<font color=\"red\">*</font>"
		}
		else{
			document.getElementById("eml").innerHTML="E-Mail Address"
		}

		if(dp==false || ea==false ){
			document.getElementById("contactli").className="error"
			valid_flag=false
		}
		else{
			document.getElementById("contactli").className=""
		}

		if(a1==false){
			document.getElementById("StreetAddress").focus();
			document.getElementById("saddress1").innerHTML="Street Address<font color=\"red\">*</font>"
		}
		else{
			document.getElementById("saddress1").innerHTML="Street Address"
		}
		if(city==false){
			document.getElementById("City").focus();
			document.getElementById("city1").innerHTML="City<font color=\"red\">*</font>"
		}
		else{
			document.getElementById("city1").innerHTML="City"
		}

		var st1=new Boolean(check_state())
		if(st1==false){
			document.getElementById("state1").focus();
			document.getElementById("state1").innerHTML="State<font color=\"red\">*</font>"
		}
		else{
			document.getElementById("state1").innerHTML="State"
		}

		if(zip==false){
			document.getElementById("ZipCode").focus();
			document.getElementById("zipcode1").innerHTML="Zip Code<font color=\"red\">*</font>"
		}
		else{
			if(zipstate != stabbrev)
			{
				document.getElementById("ZipCode").focus();
				document.getElementById("zipcode1").innerHTML="Zip Code<font color=\"red\">* (Does not match state)</font>"
			}
			else
			{
				document.getElementById("zipcode1").innerHTML="Zip Code"
			}
		}
		if(a1==false || city==false || zip==false || st1==false){
			document.getElementById("addressli").className="error"
			valid_flag=false
		}
		else{
			document.getElementById("addressli").className=""
		}

		var ms1=new Boolean(check_mstatus())
		if(ms1==false){
			document.getElementById("mstatus").focus();
			document.getElementById("mstatus").innerHTML="Marital Status<font color=\"red\">*</font>"
		}
		else{
			document.getElementById("mstatus").innerHTML="Marital Status"
		}
		var es1=new Boolean(check_estatus())
		if(es1==false){
			document.getElementById("estatus").focus();
			document.getElementById("estatus").innerHTML="Employment Status<font color=\"red\">*</font>"
		}
		else{
			document.getElementById("estatus").innerHTML="Employment Status"
		}
		var rs1=new Boolean(check_rstatus())
		if(rs1==false){
			document.getElementById("rstatus").focus();
			document.getElementById("rstatus").innerHTML="Residential Status<font color=\"red\">*</font>"
		}
		else{
			document.getElementById("rstatus").innerHTML="Residential Status"
		}
		if(ms1==false || es1==false || rs1==false){
			document.getElementById("pstatusli").className="error"
			valid_flag=false
		}
		else{
			document.getElementById("pstatusli").className=""
		}

		if(currentlyinsuredflag==true){
			var carrier=new Boolean(check_name(document.getElementById("Carrier").value))
			var mp=new Boolean(check_name(document.getElementById("MonthlyPremium").value))

			if(carrier==false){
				document.getElementById("Carrier").focus();
				document.getElementById("cname").innerHTML="If so, which carrier?<font color=\"red\">*</font>"
			}
			else{
				document.getElementById("cname").innerHTML="If so, which carrier?"
			}
			if(mp==false){
				document.getElementById("MonthlyPremium").focus();
				document.getElementById("mpremium").innerHTML="Monthly Premium<font color=\"red\">*</font>"
			}
			else{
				document.getElementById("mpremium").innerHTML="Monthly Premium"
			}
			if(carrier==false || mp==false ){
				document.getElementById("currentinfoli").className="error"
				valid_flag=false
			}
			else{
				document.getElementById("currentinfoli").className=""
			}
		}
		else{
			document.getElementById("cname").innerHTML="If so, which carrier?"
			document.getElementById("mpremium").innerHTML="Monthly Premium"
			document.getElementById("currentinfoli").className=""
		}

		if(checkWeight(document.getElementById("AWeight").value)==false){
			document.getElementById("aname").innerHTML="<font color=\"red\">Applicant</font>"
			document.getElementById("AWeight").focus();
			valid_flag=false
			family_flag=false
		}
		else if(checkDD(document.getElementById("AHeight").value)==false){
			document.getElementById("aname").innerHTML="<font color=\"red\">Applicant</font>"
			document.getElementById("AHeight").focus();
			valid_flag=false
			family_flag=false
		}
		else if(checkDD(document.getElementById("Ayyyy").value)==false){
			document.getElementById("aname").innerHTML="<font color=\"red\">Applicant</font>"
			document.getElementById("Ayyyy").focus();
			valid_flag=false
			family_flag=false
		}
		else if(checkDD(document.getElementById("Add").value)==false){
			document.getElementById("aname").innerHTML="<font color=\"red\">Applicant</font>"
			document.getElementById("Add").focus();
			valid_flag=false
			family_flag=false
		}
		else if(checkDD(document.getElementById("Amm").value)==false){
			document.getElementById("aname").innerHTML="<font color=\"red\">Applicant</font>"
			document.getElementById("Amm").focus();
			valid_flag=false
			family_flag=false
		}
		else{
			document.getElementById("aname").innerHTML="Applicant"
		}
		if(spouseflag==true){
			if(checkWeight(document.getElementById("SWeight").value)==false){
				document.getElementById("sname").innerHTML="<font color=\"red\">Spouse</font>"
				document.getElementById("SWeight").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("SHeight").value)==false){
				document.getElementById("sname").innerHTML="<font color=\"red\">Spouse</font>"
				document.getElementById("SHeight").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("Syyyy").value)==false){
				document.getElementById("sname").innerHTML="<font color=\"red\">Spouse</font>"
				document.getElementById("Syyyy").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("Sdd").value)==false){
				document.getElementById("sname").innerHTML="<font color=\"red\">Spouse</font>"
				document.getElementById("Sdd").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("Smm").value)==false){
				document.getElementById("sname").innerHTML="<font color=\"red\">Spouse</font>"
				document.getElementById("Smm").focus();
				valid_flag=false
				family_flag=false
			}
			else{
				document.getElementById("sname").innerHTML="Spouse"
			}
		}
		else{
			document.getElementById("sname").innerHTML="Spouse"
		}
		if(child1flag==true){
			if(checkWeight(document.getElementById("C1Weight").value)==false){
				document.getElementById("c1name").innerHTML="<font color=\"red\">Child #1</font>"
				document.getElementById("C1Weight").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C1Height").value)==false){
				document.getElementById("c1name").innerHTML="<font color=\"red\">Child #1</font>"
				document.getElementById("C1Height").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C1yyyy").value)==false){
				document.getElementById("c1name").innerHTML="<font color=\"red\">Child #1</font>"
				document.getElementById("C1yyyy").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C1dd").value)==false){
				document.getElementById("c1name").innerHTML="<font color=\"red\">Child #1</font>"
				document.getElementById("C1dd").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C1mm").value)==false){
				document.getElementById("c1name").innerHTML="<font color=\"red\">Child #1</font>"
				document.getElementById("C1mm").focus();
				valid_flag=false
				family_flag=false
			}
			else{
				document.getElementById("c1name").innerHTML="Child #1"
			}
		}
		else{
			document.getElementById("c1name").innerHTML="Child #1"
		}
		if(child2flag==true){
			if(checkWeight(document.getElementById("C2Weight").value)==false){
				document.getElementById("c2name").innerHTML="<font color=\"red\">Child #2</font>"
				document.getElementById("C2Weight").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C2Height").value)==false){
				document.getElementById("c2name").innerHTML="<font color=\"red\">Child #2</font>"
				document.getElementById("C2Height").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C2yyyy").value)==false){
				document.getElementById("c2name").innerHTML="<font color=\"red\">Child #2</font>"
				document.getElementById("C2yyyy").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C2dd").value)==false){
				document.getElementById("c2name").innerHTML="<font color=\"red\">Child #2</font>"
				document.getElementById("C2dd").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C2mm").value)==false){
				document.getElementById("c2name").innerHTML="<font color=\"red\">Child #2</font>"
				document.getElementById("C2mm").focus();
				valid_flag=false
				family_flag=false
			}
			else{
				document.getElementById("c2name").innerHTML="Child #2"
			}
		}
		else{
			document.getElementById("c2name").innerHTML="Child #2"
		}
		if(child3flag==true){
			if(checkWeight(document.getElementById("C3Weight").value)==false){
				document.getElementById("c3name").innerHTML="<font color=\"red\">Child #3</font>"
				document.getElementById("C3Weight").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C3Height").value)==false){
				document.getElementById("c3name").innerHTML="<font color=\"red\">Child #3</font>"
				document.getElementById("C3Height").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C3yyyy").value)==false){
				document.getElementById("c3name").innerHTML="<font color=\"red\">Child #3</font>"
				document.getElementById("C3yyyy").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C3dd").value)==false){
				document.getElementById("c3name").innerHTML="<font color=\"red\">Child #3</font>"
				document.getElementById("C3dd").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C3mm").value)==false){
				document.getElementById("c3name").innerHTML="<font color=\"red\">Child #3</font>"
				document.getElementById("C3mm").focus();
				valid_flag=false
				family_flag=false
			}
			else{
				document.getElementById("c3name").innerHTML="Child #3"
			}
		}
		else{
			document.getElementById("c3name").innerHTML="Child #3"
		}
		if(child4flag==true){
			if(checkWeight(document.getElementById("C4Weight").value)==false){
				document.getElementById("c4name").innerHTML="<font color=\"red\">Child #4</font>"
				document.getElementById("C4Weight").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C4Height").value)==false){
				document.getElementById("c4name").innerHTML="<font color=\"red\">Child #4</font>"
				document.getElementById("C4Height").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C4yyyy").value)==false){
				document.getElementById("c4name").innerHTML="<font color=\"red\">Child #4</font>"
				document.getElementById("C4yyyy").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C4dd").value)==false){
				document.getElementById("c4name").innerHTML="<font color=\"red\">Child #4</font>"
				document.getElementById("C4dd").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C4mm").value)==false){
				document.getElementById("c4name").innerHTML="<font color=\"red\">Child #4</font>"
				document.getElementById("C4mm").focus();
				valid_flag=false
				family_flag=false
			}
			else{
				document.getElementById("c4name").innerHTML="Child #4"
			}
		}
		else{
			document.getElementById("c4name").innerHTML="Child #4"
		}
		if(child5flag==true){
			if(checkWeight(document.getElementById("C5Weight").value)==false){
				document.getElementById("c5name").innerHTML="<font color=\"red\">Child #5</font>"
				document.getElementById("C5Weight").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C5Height").value)==false){
				document.getElementById("c5name").innerHTML="<font color=\"red\">Child #5</font>"
				document.getElementById("C5Height").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C5yyyy").value)==false){
				document.getElementById("c5name").innerHTML="<font color=\"red\">Child #5</font>"
				document.getElementById("C5yyyy").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C5dd").value)==false){
				document.getElementById("c5name").innerHTML="<font color=\"red\">Child #5</font>"
				document.getElementById("C5dd").focus();
				valid_flag=false
				family_flag=false
			}
			else if(checkDD(document.getElementById("C5mm").value)==false){
				document.getElementById("c5name").innerHTML="<font color=\"red\">Child #5</font>"
				document.getElementById("C5mm").focus();
				valid_flag=false
				family_flag=false
			}
			else{
				document.getElementById("c5name").innerHTML="Child #5"
			}
		}
		else{
			document.getElementById("c5name").innerHTML="Child #5"
		}

		if(family_flag==false){
			document.getElementById("familyli").className="error"
		}
		else{
			document.getElementById("familyli").className=""
		}

		if(valid_flag==false){
			document.getElementById("ftr").innerHTML="<font color=\"red\">*Required field(s) invalid<br />Please ensure the above information is correct.<br /><br /></font>"
		}
		else{
			document.getElementById("ftr").innerHTML=""
		}

		return valid_flag
	}

	function check_name(str)
	{
		if(str==null || str==""){
			return false
		}
		return true
	}
	function check_email(str) 
	{
		if(/^\w+([\.-]?\w+)*@\w+([\.-]?\w+)*(\.\w{2,3})+$/.test(str)){
			return true
		}
		return false
	}
	function check_zip(num)
	{
		if(/^[0-9][0-9][0-9][0-9][0-9]$/.test(num)){
			return true
		}
		return false
	}
	function check_phone(ac,num1,num2)
	{
		if( (/^[0-9][0-9][0-9]$/.test(ac)) && (/^[0-9][0-9][0-9]$/.test(num1)) && (/^[0-9][0-9][0-9][0-9]$/.test(num2)) ){
			return true
		}
		return false
	}
	function checkCurrent()
	{
		if(document.getElementById("CurrentlyInsured").value=="yes"){
			currentlyinsuredflag=true
			document.getElementById("Carrier").disabled=false
			document.getElementById("MonthlyPremium").disabled=false
			document.getElementById("EmployerPays").disabled=false
		}
		else{
			currentlyinsuredflag=false
			document.getElementById("Carrier").disabled=true
			document.getElementById("MonthlyPremium").disabled=true
			document.getElementById("EmployerPays").disabled=true
			document.getElementById("cname").innerHTML="If so, which carrier?"
			document.getElementById("mpremium").innerHTML="Monthly Premium"
		}
	}
	function checkWeight(num)
	{
		if(/^[0-9][0-9]?[0-9]?$/.test(num)){
			return true
		}
		return false
	}
	function checkDD(index)
	{
		if(index=="-1"){
			return false
		}
		return true
	}
	function spouse()
	{
		if(document.getElementById("SGender").value!="0"){
			spouseflag=true
			document.getElementById("Smm").disabled=false
			document.getElementById("Sdd").disabled=false
			document.getElementById("Syyyy").disabled=false
			document.getElementById("SHeight").disabled=false
			document.getElementById("SWeight").disabled=false
			document.getElementById("STUser").disabled=false
		}
		else{
			spouseflag=false
			document.getElementById("Smm").disabled=true
			document.getElementById("Sdd").disabled=true
			document.getElementById("Syyyy").disabled=true
			document.getElementById("SHeight").disabled=true
			document.getElementById("SWeight").disabled=true
			document.getElementById("STUser").disabled=true
			document.getElementById("sname").innerHTML="Spouse"
		}
	}
	function child1()
	{
		if(document.getElementById("C1Gender").value!="0"){
			child1flag=true
			document.getElementById("C1mm").disabled=false
			document.getElementById("C1dd").disabled=false
			document.getElementById("C1yyyy").disabled=false
			document.getElementById("C1Height").disabled=false
			document.getElementById("C1Weight").disabled=false
			document.getElementById("C1TUser").disabled=false
		}
		else{
			child1flag=false
			document.getElementById("C1mm").disabled=true
			document.getElementById("C1dd").disabled=true
			document.getElementById("C1yyyy").disabled=true
			document.getElementById("C1Height").disabled=true
			document.getElementById("C1Weight").disabled=true
			document.getElementById("C1TUser").disabled=true
			document.getElementById("c1name").innerHTML="Child #1"
		}
	}
	function child2()
	{
		if(document.getElementById("C2Gender").value!="0"){
			child2flag=true
			document.getElementById("C2mm").disabled=false
			document.getElementById("C2dd").disabled=false
			document.getElementById("C2yyyy").disabled=false
			document.getElementById("C2Height").disabled=false
			document.getElementById("C2Weight").disabled=false
			document.getElementById("C2TUser").disabled=false
		}
		else{
			child2flag=false
			document.getElementById("C2mm").disabled=true
			document.getElementById("C2dd").disabled=true
			document.getElementById("C2yyyy").disabled=true
			document.getElementById("C2Height").disabled=true
			document.getElementById("C2Weight").disabled=true
			document.getElementById("C2TUser").disabled=true
			document.getElementById("c2name").innerHTML="Child #2"
		}
	}
	function child3()
	{
		if(document.getElementById("C3Gender").value!="0"){
			child3flag=true
			document.getElementById("C3mm").disabled=false
			document.getElementById("C3dd").disabled=false
			document.getElementById("C3yyyy").disabled=false
			document.getElementById("C3Height").disabled=false
			document.getElementById("C3Weight").disabled=false
			document.getElementById("C3TUser").disabled=false
		}
		else{
			child3flag=false
			document.getElementById("C3mm").disabled=true
			document.getElementById("C3dd").disabled=true
			document.getElementById("C3yyyy").disabled=true
			document.getElementById("C3Height").disabled=true
			document.getElementById("C3Weight").disabled=true
			document.getElementById("C3TUser").disabled=true
			document.getElementById("c3name").innerHTML="Child #3"
		}
	}
	function child4()
	{
		if(document.getElementById("C4Gender").value!="0"){
			child4flag=true
			document.getElementById("C4mm").disabled=false
			document.getElementById("C4dd").disabled=false
			document.getElementById("C4yyyy").disabled=false
			document.getElementById("C4Height").disabled=false
			document.getElementById("C4Weight").disabled=false
			document.getElementById("C4TUser").disabled=false
		}
		else{
			child4flag=false
			document.getElementById("C4mm").disabled=true
			document.getElementById("C4dd").disabled=true
			document.getElementById("C4yyyy").disabled=true
			document.getElementById("C4Height").disabled=true
			document.getElementById("C4Weight").disabled=true
			document.getElementById("C4TUser").disabled=true
			document.getElementById("c4name").innerHTML="Child #4"
		}
	}
	function child5()
	{
		if(document.getElementById("C5Gender").value!="0"){
			child5flag=true
			document.getElementById("C5mm").disabled=false
			document.getElementById("C5dd").disabled=false
			document.getElementById("C5yyyy").disabled=false
			document.getElementById("C5Height").disabled=false
			document.getElementById("C5Weight").disabled=false
			document.getElementById("C5TUser").disabled=false
		}
		else{
			child5flag=false
			document.getElementById("C5mm").disabled=true
			document.getElementById("C5dd").disabled=true
			document.getElementById("C5yyyy").disabled=true
			document.getElementById("C5Height").disabled=true
			document.getElementById("C5Weight").disabled=true
			document.getElementById("C5TUser").disabled=true
			document.getElementById("c5name").innerHTML="Child #5"
		}
	}
	function check_state()
	{
		if(document.getElementById("State").value=="0" || document.getElementById("State").value=="1"){
			return false
		}
		return true
	}
	function check_mstatus()
	{
		if(document.getElementById("MaritalStatus").value=="0" || document.getElementById("MaritalStatus").value=="1"){
			return false
		}
		return true
	}
	function check_estatus()
	{
		if(document.getElementById("EmploymentStatus").value=="0" || document.getElementById("EmploymentStatus").value=="1"){
			return false
		}
		return true
	}
	function check_rstatus()
	{
		if(document.getElementById("Residence").value=="0" || document.getElementById("Residence").value=="1"){
			return false
		}
		return true
	}