/*  */ 

<!-- Function validation for templates-->

var eraseErrorsTimer;
function addLoadEvent(f){var oldonload=window.onload;if(typeof window.onload!='function'){window.onload=f;}else{window.onload=function(){if(oldonload){oldonload();}f();}}}
 var child=3;
 function addDependents(){
  child+=1;
  if(child<11){
   id(String('dependent' + child)).style.display="";
   if(child==10){ id("addDependents").style.display="none"; }
  }
 }
 function sort(type){
  var form=id('customizeForm');
  form.sortOrderName.value=type;
  var currentSortType = '';
  var currentSortOrder = '';
  // sort type changed, or was previously descending, sort ascending
  form.order.value = (currentSortType != type || currentSortOrder == 'descending') ? 'ascending' : 'descending';
  form.submit();
 }
 function email(e){ eraseErrors();
  var f=id("mailForm");
  if(f.selected_quotes.value=="")
   drawError('selected_quotes','<h3>Oh no!<br />What happened?</h3><p>Please select at least one plan.</p>',findPos(id(e)));
  else{
   f.submit();
  }
 }
 function compare(e){ eraseErrors();
  var f=id("detailForm");
  if(f.selected_quotes1.value=="")
   drawError('selected_quotes1','<h3>Oh no!<br />What happened?</h3><p>Please select at least one plan.</p>',findPos(id(e)));
  else if(((f.selected_quotes1.value).split(",")).length>4)
   drawError('selected_quotes1','<h3>Oh no!<br />What happened?</h3><p>Please select a <u>maximum</u> of four plans to compare.</p>',findPos(id(e)));
  else {
   f.submit();
  }
 }
 function detail(quoteId){
  var f=id("detailForm");
  f.selected_quotes1.value=quoteId;
  f.submit();
 }
 function printQuotes(){ print(); }
 function selectedPlans(c){ var e=id("selected_quotes");
  if(c.checked==true){ e.value+=((((e.value).length>0)?",":"")+c.value); }
  else{
   var a=(e.value).split(",");
   for(var i=0; i<a.length; i++){
    if(a[i]==c.value){ a.splice(i,1); e.value=a; break; }
   }
  }
  id("selected_quotes1").value=e.value;
 }
 try{ document.execCommand('BackgroundImageCache', false, true); }catch(e){}
 function findPos(o){ 
  var l=t=0;
  if(o.offsetParent){ 
   l=o.offsetLeft;
   t=o.offsetTop;
   while(o=o.offsetParent){ l+=o.offsetLeft;t+=o.offsetTop; } 
  }
  return [l,t];
 }
 function drawError(i,c,p){
   var n='popout_'+i;
   if(!id(n)){
  var e=id('errors');var d=cE('div');
  d.setAttribute('id',n);d.className="popout";
  d.innerHTML='<div class="popout-top"> </div><div class="popout-bg">'+c+'</div><div class="popout-bottom"> </div>';
  e.appendChild(d);
  n=id(n);
  n.style.visibility="visible";
  n.style.top=(p[1]-36)+"px";
  n.style.left=(("Classic Template"=="Classic Template")?(findPos(id('quote-engine'))[0]+543):(findPos(id('quote-engine'))[0])+545)+"px";
  eraseErrorsTimer=setTimeout("eraseErrors()",6000);
   }
 }
 function eraseErrors(){ clearTimeout(eraseErrorsTimer);if(id('errors')){ id('errors').innerHTML=""; } }
 function dateDifference(mm1,dd1,yyyy1, mm2,dd2,yyyy2) {
  return Math.floor(((new Date(yyyy2, mm2-1, dd2)).getTime() - (new Date(yyyy1, mm1-1, dd1)).getTime())/(1000*60*60*24*365));
 }
 function dateDifferencemonths(mm1,dd1,yyyy1, mm2,dd2,yyyy2) {
 var datediff=(new Date(yyyy2, mm2-1, dd2)).getTime() - (new Date(yyyy1, mm1-1, dd1)).getTime();
 var num_months = Math.round((datediff % 31536000000 )/2628000000);
 return num_months;
 }
 function validateStep1(f){ eraseErrors();
  var e=id("zip");
  if(e.value=="" || isNaN(e.value) || e.value.length!=5){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your zip code appears to have been entered incorrectly. Please re-enter your zip code.</p>',findPos(e));
   e.value="";
   e.focus();
   return false;
  }
  e=id("firstName");
  if(specialChar(e.value.replace(/\s+/g,''))){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your first name appears to have been entered incorrectly. Please re-enter your first name.</p>',findPos(e));
   e.focus();
   return false;
  }
  if(e.value==""&& false){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter your first name.</p>',findPos(e));
   e.focus();
   return false;
  }
  e=id("lastName");
  if(specialChar(e.value.replace(/\s+/g,''))){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your last name appears to have been entered incorrectly. Please re-enter your last name.</p>',findPos(e));
   e.focus();
   return false;
  }
  if((e.value=="" || e.value.length<2)&& false){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter your last name.</p>',findPos(e));
   e.focus();
   return false;
  }
  e=id("email");
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter your email address.</p>',findPos(e));
   e.focus();
   return false;
  }
  if (!emailCheck(e.value)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your email address appears to have been entered incorrectly. Please re-enter your email address, using the format \"name@domain.com\"</p>',findPos(e));
   e.focus();
   return false;
  }
  if(!validDomain(e.value)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your email address appears to have been entered incorrectly. Please re-enter your email address, using the format \"name@domain.com\"</p>',findPos(e));
   e.focus();
   return false;
  }
  return true;
 }
 function emailCheck(email){ return /(^[a-z0-9]([a-z0-9_\-\.]*){2,}@([a-z0-9_\-\.]{3,})([.][a-z]{2,6})$)|(^[a-z0-9]([a-z0-9_\-\.]*)@([a-z0-9_\-\.]*)(\.[a-z]{3})(\.[a-z]{3})*$)/i.test(email); }
 function validDomain(email){
  var validTLD=new Array("aero","asia","biz","cat","com","coop","edu","gov","info","int","jobs","mil","mobi","museum","name","net","org","pro","tel","travel","ac","ad","ae","af","ag","ai","al","am","an","ao","aq","ar","as","at","au","aw","ax","az","ba","bb","bd","be","bf","bg","bh","bi","bj","bm","bn","bo","br","bs","bt","bv","bw","by","bz","ca","cc","cd","cf","cg","ch","ci","ck","ch","ci","ck","cl","cm","cn","co","cr","cu","cv","cx","cy","cz","de","dj","dk","dm","do","dz","ec","ee","eg","er","es","et","eu","fi","fj","fk","fm","fo","fr","ga","gb","gd","ge","gf","gg","gh","gi","gl","gm","gn","gp","gq","gr","gs","gt","gu","gw","gy","hk","hm","hn","hr","ht","hu","id","ie","il","im","in","io","iq","ir","is","it","je","jm","jo","jp","ke","kg","kh","ki","km","kn","kr","kw","ky","la","lb","lc","li","lk","lr","ls","lt","lu","lv","ly","ma","mc","md", "mg","mh","mk","ml","mm","mn","mo","mp","mq","mr","ms","mt","mu","mv","mw","mx","my","mz","na","nc","ne","nf","ng","ni","nl","no","np","nr","nu","nz","om","pa","pe","pf","pg","ph","pk","pl","pm","pn","pr","ps","pt","pw","py","qa","re","ro","ru","rw","sa","sb","sc","sd","se","sg","sh","si","sj","sk","sl","sm","sn","so","sr","st","su","sv","sy","sz","tc","td","tf","tg","th","tj","tk","tl","tm","tn","to","tp","tr","tt","tv","tw","tz","ua","ug","uk","um","us","uy","uz","va","vc","ve","vg","vi","vn","vu","wf","ws","ye","yt","yu","za","zm","zw");
  for(var i=0; i<validTLD.length; i++){ if(email.substring(email.lastIndexOf(".")+1)==validTLD[i]){ return true; } }
  return false;
 }
 function noNum(s){ return !s.replace(/[^0-9/]/g,"").length>0; }
 function specialChar(s){ return s.replace(/[a-zA-Z/]/g,"").length>0; }
 function maxDays(m,y){return 32-new Date(int(y),int(m)-1,32).getDate();}
 function validateStep2(f){ eraseErrors();
  var e=id("applicantgender");
  var effDate=id("selEffDate").value;
  var currYear=effDate.split("/")[2];
  var currDay=effDate.split("/")[1];
  var currMonth=effDate.split("/")[0];
  var applicantName=id("applicant_name");
  var upperAgeLimit = 65;
  var today = new Date();
  if(applicantName!=null && applicantName.value=="Child"){
   upperAgeLimit = 18;
   spouse = false;
  }
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please select your gender.</p>',findPos(e));
   e.focus();
   return false;
  }
  var month=id("applicantdobMM");
  if(month.value.length<1 || isNaN(month.value) || int(month.value)<1 || int(month.value)>12){
   drawError(month.name,'<h3>Oh no!<br />What happened?</h3><p>Your date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(month));
   month.value="";
   month.focus();
   return false;
  }
  var day=id("applicantdobDD");
  if(day.value.length<1 || isNaN(day.value) || int(day.value)<1 || int(day.value)>maxDays(id("applicantdobMM").value,id("applicantdobYYYY").value)){
   drawError(day.name,'<h3>Oh no!<br />What happened?</h3><p>Your date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(day));
   day.value="";
   day.focus();
   return false;
  }
  e=id("applicantdobYYYY");
  if(e.value.length<4 || isNaN(e.value) || int(e.value)<(int(currYear)-100) || int(e.value)>int(currYear)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(e));
   e.value="";
   e.focus();
   return false;
  }
  if(dateDifference(month.value,day.value,e.value,currMonth,currDay,currYear)>=upperAgeLimit){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Individual products are only available to those under the age of '+upperAgeLimit+'.</p>',findPos(e));
   return false;
  }

  if(dateDifference(month.value,day.value,e.value,today.getMonth()+1,today.getDate(),today.getFullYear())<0){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>You have entered a birthdate that is in the future.   Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 08/20/1970</p>',findPos(e));
   return false;
  }

  e=id("applicantweight");
  if(isNaN(e.value) || int(e.value)<1 || e.value.indexOf(".") > 0){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter your weight in pounds.\nExample: 200</p>',findPos(e));
   e.value="";
   e.focus();
   return false;
  }
   if(id("spousegender").value!=""
   ||id("spousedobMM").value!=""
   ||id("spousedobDD").value!=""
   ||id("spousedobYYYY").value!=""
                )
  {
   e=id("spousegender");
  if(specialChar(e.value)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please select your spouse\'s gender.</p>',findPos(e));
   e.focus();
   return false;
  }
  month=id("spousedobMM");
  if(month.value.length<1 || isNaN(month.value) || int(month.value)<1 || int(month.value)>12){
   drawError(month.name,'<h3>Oh no!<br />What happened?</h3><p>Your spouse\'s date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(month));
   month.value="";
   month.focus();
   return false;
  }
  day=id("spousedobDD");
  if(day.value.length<1 || isNaN(day.value) || int(day.value)<1 || int(day.value)>maxDays(id("spousedobMM").value,id("spousedobYYYY").value)){
   drawError(day.name,'<h3>Oh no!<br />What happened?</h3><p>Your spouse\'s date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(day));
   day.value="";
   day.focus();
   return false;
  }
  e=id("spousedobYYYY");
  if(e.value.length<4 || isNaN(e.value) || int(e.value)<(int(currYear)-100) || int(e.value)>int(currYear)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your spouse\'s date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(e));
   e.value="";
   e.focus();
   return false;
  }
   if(dateDifference(month.value,day.value,e.value,currMonth,currDay,currYear)>65){
   id('seniorsErrorMessage').style.display="block";
   return false;
  }
  id('seniorsErrorMessage').style.display="none";
    if(dateDifference(month.value,day.value,e.value,today.getMonth()+1,today.getDate(),today.getFullYear())<0){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>You have entered a birthdate that is in the future.   Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 08/20/1970</p>',findPos(e));
   return false;
  }
      e=id("spouseweight");
  if(isNaN(e.value) || int(e.value)<1 || e.value.indexOf(".") > 0){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter your spouse\'s weight in pounds.\nExample: 200</p>',findPos(e));
   e.value="";
   e.focus();
   return false;
  }
    }
  for(var i=1; i<=child; i++){
   if(id(eval("'dependent"+i+"gender'")).value!=""
   ||id(eval("'dependent"+i+"dobMM'")).value!=""
   ||id(eval("'dependent"+i+"dobDD'")).value!=""
   ||id(eval("'dependent"+i+"dobYYYY'")).value!=""
       )
  {
   var e=id(eval("'dependent"+i+"gender'"));
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please select your dependent\'s gender.</p>',findPos(e));
   e.focus();
   return false;
  }
  month=id(eval("'dependent"+i+"dobMM'"));
  if(month.value.length<1 || isNaN(month.value) || int(month.value)<1 || int(month.value)>12){
   drawError(month.name,'<h3>Oh no!<br />What happened?</h3><p>Your dependent\'s date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(month));
   month.value="";
   month.focus();
   return false;
  }
  day=id(eval("'dependent"+i+"dobDD'"));
  if(day.value.length<1 || isNaN(day.value) || int(day.value)<1 || int(day.value)>maxDays(id(eval("'dependent"+i+"dobMM'")).value,id(eval("'dependent"+i+"dobYYYY'")).value)){
   drawError(day.name,'<h3>Oh no!<br />What happened?</h3><p>Your dependent\'s date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(day));
   day.value="";
   day.focus();
   return false;
  }
  e=id(eval("'dependent"+i+"dobYYYY'"));
  if(e.value.length<4 || isNaN(e.value) || int(e.value)<(int(currYear)-100) || int(e.value)>int(currYear)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your dependent\'s date of birth appears to have been entered incorrectly. Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 8/20/1970</p>',findPos(e));
   e.value="";
   e.focus();
   return false;
  }
  
   if(dateDifference(month.value,day.value,e.value,today.getMonth()+1,today.getDate(),today.getFullYear())<0){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>You have entered a birthdate that is in the future.   Please re-enter your date of birth, using the format "Month, Day, Year."\nExample: 08/20/1970</p>',findPos(e));
   return false;
  }
      e=id(eval("'dependent"+i+"weight'"));
  if(isNaN(e.value) || int(e.value)<1 || e.value.indexOf(".") > 0){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter your dependent\'s weight in pounds.\nExample: 200</p>',findPos(e));
   e.value="";
   e.focus();
   return false;
  }
    }
  }
  showGenQuotes();
  setTimeout('id("progressbar").src=id("progressbar").src',200);
 return true;
 }
 function validateEmailQuote(f){ eraseErrors();
  var e=id("name");
  if(!noNum(e.value)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your first name appears to have been entered incorrectly. Please re-enter your name.</p>',findPos(e));
   e.focus();
   return false;
  }
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter your name.</p>',findPos(e));
   e.focus();
   return false;
  }
  e=id("email");
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter your email address.</p>',findPos(e));
   e.focus();
   return false;
  }
  e=id("email");
  if(!emailCheck(e.value) || !validDomain(e.value)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your email address appears to have been entered incorrectly. Please re-enter your email address, using the format \"name@domain.com\"</p>',findPos(e));
   e.focus();
   return false;
  }
  e=id("to_name");
  if(!noNum(e.value)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Your first name appears to have been entered incorrectly. Please re-enter your name.</p>',findPos(e));
   e.focus();
   return false;
  }
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter the recipient\'s name.</p>',findPos(e));
   e.focus();
   return false;
  }
  e=id("to_email");
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter the recipient\'s email address.</p>',findPos(e));
   e.focus();
   return false;
  }
  if(!emailCheck(e.value) || !validDomain(e.value)){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>The recipient\'s email address appears to have been entered incorrectly. Please re-enter it, using the format \"name@domain.com\"</p>',findPos(e));
   e.focus();
   return false;
  }
  e=id("subject");
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter the email subject.</p>',findPos(e));
   e.focus();
   return false;
  }
  /*e=id("text");
  if(e.value==""){
   drawError(e.name,'<h3>Oh no!<br />What happened?</h3><p>Please enter an email message.</p>',findPos(e));
              e.focus();
              return false;
  }*/
   return formSubmissionCheck();
 }
 function showGenQuotes(v){
  var bg=id("quote-engine");
  var d=id("loadingDiv");
  d.innerHTML='<img id="progressbar" src="https://www.brokeroffice.com/quote/interface/images/progress-bar.gif" alt="" /><h3>Finding Plans</h3>';
  setOpacity(bg,33);
  d.style.left=(findPos(bg)[0]+122)+"px";
  var h = window.pageYOffset || document.body.scrollTop || document.documentElement.scrollTop;
  d.style.top= (screen.height/4 + h) + 'px';
  d.style.display="block";
 }
 function setOpacity(e,o){
  o=(o==100 && (navigator.userAgent.indexOf('Gecko')!=-1 && navigator.userAgent.indexOf('Safari')==-1))?99.99:o;
  e.style.opacity=e.style.MozOpacity=e.style.KhtmlOpacity=o/100;
  e.style.filter='alpha(opacity='+o+')';
 }
 function id(e){ return document.getElementById(e); }
 function tag(e){ return document.getElementsByTagName(e); }
 function int(v){ return parseInt(v,10); }
 function cE(e){ return document.createElement(e); }
 function applyNow(url) {
  url = url.replace("\n","");
  url = url.replace(/&amp;/g,"&");
  var form = id("applyForm"); 
  form.formAction.value=url;
    form.submit();
 }
 
 function executeApply(quoteId, isDirectApply, ehParams) {
  if (typeof GoHealthService == "undefined" || !GoHealthService) {
   alert("We're sorry, we could not process your request for quotes. Please visit www.gohealthinsurance.com to try again.");
   return;
  }  
  GoHealthService.getApplyUrl(quoteId, isDirectApply, function(applyUrl) {
   NVX.log("applying to " + applyUrl + " direct apply is " + isDirectApply);
   dynTrack.tracker.trigger(quoteId, function() {
    if(isDirectApply) {
     NVX.gh.Util.applyToEhealth(applyUrl, ehParams.getEhiParam());
    } else {
     applyNow(applyUrl);
    }
   });
  });
 };
var _unloadPage = true;
window.onbeforeunload = function () {
 if(_unloadPage){
  return "Please use the navigation links on the page."
 }
}

function disableOnBeforeUnload(){
 _unloadPage = false;
}

function formSubmissionCheck(){
 disableOnBeforeUnload();
 return true;
}

function formSubmit(formId){
 var form = id(formId);
 if(formSubmissionCheck()){
  form.submit();
 }
}

addLoadEvent(function(){
 var el=tag('a');
 for(var i=0;i<el.length;i++){
  el[i].onclick=new Function("disableOnBeforeUnload();");
 }
});
 addLoadEvent(function(){ if(id("poweredByNorvaxDiv")!=null){var e=id("poweredByNorvaxLinks"); if(e!=null){ e.style.display="none"; } } });
/* ]]&amp; */

function writeHTML() {
	var str = '<div id="norvaxEmbeddedContainer"><link xmlns="http://www.w3.org/1999/xhtml" rel="stylesheet" href="https://www.brokeroffice.com/quote/interface/styles-scripts/old-qe-styles.css" type="text/css" media="all"></link><link xmlns="http://www.w3.org/1999/xhtml" rel="stylesheet" href="https://www.brokeroffice.com/quote/interface/styles-scripts/qe-style.css" type="text/css"></link><div xmlns="http://www.w3.org/1999/xhtml" align="center" style="width:100%;">         <table id="quote-engine" class="qe" width="400" border="0" cellspacing="0" cellpadding="10" style="text-align:left;"><tbody><tr valign="top"><td align="center"><img src="https://www.brokeroffice.com/quote/images/topbar-step1.gif" alt="" border="0"></img>     <form name="step1" method="POST" action="http://www.brokeroffice.com/quoteengine?embedded=true" style="margin:0; padding:0;" onsubmit="return formSubmissionCheck()">    <input name="formAction" id="formAction" type="hidden" value="/quote/detailInformation"></input>                 <input name="source" type="hidden" value=""></input>                                     <table width="380" border="0" cellspacing="1" cellpadding="0"><tbody><tr><td align="center">             <div id="errors" class="errors">  </div>                                                                                                                                                                                                                                                                                                                                                                                                                                        <table cellpadding="2" cellspacing="1" width="300" bgcolor="#ffffff" style="text-align:left;"><tbody><tr class="title"><td colspan="2"> Please enter your contact information</td> </tr> <tr class="cell"><td nowrap="nowrap" align="right">                <em> </em>                  First Name:</td> <td><input name="firstName" id="firstName" value=""></input>          </td> </tr> <tr class="cell"><td nowrap="nowrap" align="right">                 <em> </em>                  Last Name:</td> <td><input name="lastName" id="lastName" value=""></input> </td> </tr> <tr class="cell"><td nowrap="nowrap" align="right">                 <em>*</em>                  Email:</td> <td width="160"><input name="email" id="email" value=""></input> </td> </tr> <tr class="cell"><td nowrap="nowrap" align="right">                 <em> </em>                  Address 1:</td> <td width="160"><input name="address1" id="address1" value=""></input> </td> </tr> <tr class="cell"><td nowrap="nowrap" align="right"><em> </em>  Address 2:</td> <td width="140"><input name="address2" id="address2" value=""></input> </td> </tr> <tr class="cell"><td nowrap="nowrap" align="right">                 <em> </em>                  City:</td> <td width="160"><input name="city" id="city" value=""></input> </td> </tr> <tr class="cell"><td nowrap="nowrap" align="right" valign="top"><em>*</em> Zip Code:</td> <td valign="top"><input type="text" name="zip" id="zip" value="" maxlength="5"></input> </td> </tr> <tr class="cell"><td align="center" colspan="2" valign="top"><input name="image" type="image" onclick="return validateStep1(this.form)" src="https://www.brokeroffice.com/quote/images/continue.gif"></input> </td> </tr> <tr class="required"><td nowrap="nowrap" colspan="2"><em>*</em> Required Field</td> </tr> </tbody> </table>       </td> </tr> </tbody> </table>     </form>    </td> </tr> </tbody> </table>  <div class="poweredByNorvax">  <p>Norvax form #Q-1</p>   <p id="poweredByNorvaxLinks"><a target="_blank" href="http://www.norvax.com/products/quote_engine.html">Insurance Quote Engine by Norvax</a> </p>  </div>  <div id="errors"></div>  </div> </div>';
	document.write(str);
}
writeHTML();