var formSubmit = false;  
		
function validateForm() { //v4.0
    var errors='';
    var emailFilter  = /^([a-zA-Z0-9_\.\-])+\@(([a-zA-Z0-9\-])+\.)+([a-zA-Z0-9]{2,4})+$/;
    var zipFilter = /^\d{5}$/;
    var phoneFilter = /^\d{3}-\d{3}-\d{4}$/;

    //alert(document.forms[0].areacode.value);
    //alert(document.forms[0].prefix.value);
    //alert(document.forms[0].suffix.value);

    var phoneNumber = document.forms[0].areacode.value+'-'+document.forms[0].prefix.value+'-'+document.forms[0].suffix.value;
    document.forms[0].phone_num.value=phoneNumber;

    //alert(document.forms[0].phone_num.value);
    
    if (document.forms[0].firstname.value == "") {
        errors += '- First name is required\n';
    } 
    if (document.forms[0].lastname.value == "") {
        errors += '- Last name is required\n';
    }       
    if (document.forms[0].address1.value == "") {
        errors += '- Address1 is required\n';
    }
    if (document.forms[0].city.value == "") {
        errors += '- City is required\n';
    }  
    if (document.forms[0].state.value == "") {
        errors += '- State is required\n';
    }  
    if (!zipFilter.test(document.forms[0].zipcode.value)) {
        errors += '- Zip code should be 5 digits (e.g 12345)\n';
    }    
    if (!phoneFilter.test(document.forms[0].phone_num.value)) {
        errors += '- Phone number should be 10 digits (e.g 1112223333)\n';
    }
   
    if (!emailFilter.test(document.forms[0].email.value)) {
        errors += '- A valid email address is required (e.g abc@xyz.com)\n';
    }
    if (document.forms[0].insurance.value == "") {
        errors += '- Insurance Provider is required\n';
    }       
    

    if (errors)
        alert('The following error(s) occurred:\n'+errors);
    
    document.MM_returnValue = (errors == '');
}
        
function numbersOnly(evt) {
    evt = (evt) ? evt : event;
    var charCode = (evt.charCode) ? evt.charCode : ((evt.keyCode) ? evt.keyCode : 
        ((evt.which) ? evt.which : 0));
    if (charCode > 31 && (charCode < 48 || charCode > 57)) {       
        return false;
	  
    }
    return true;
}


function lettersOnly(evt) {
    evt = (evt) ? evt : event;
    var charCode = (evt.charCode) ? evt.charCode : ((evt.keyCode) ? evt.keyCode : 
        ((evt.which) ? evt.which : 0));
    if (charCode > 31 && (charCode!= 45) && (charCode!= 32) &&(charCode < 65 || charCode > 90) && 
        (charCode < 97 || (charCode > 122))) {       
        return false;
    }
    return true;
}