function init(){	
	document.getElementById('name').value='';
	document.getElementById('address').value='';
	document.getElementById('city').value='';
	document.getElementById('hphone').value='';
	document.getElementById('wphone').value='';
	document.getElementById('email').value='';
	document.getElementById('dob_year').selectedIndex=0;
	document.getElementById('dob_day').selectedIndex=0;
	document.getElementById('dob_month').selectedIndex=0;
	document.getElementById('male').checked=false;
	document.getElementById('female').checked=false;
	document.getElementById('feet').selectedIndex=0;
	document.getElementById('inches').selectedIndex=0;
	document.getElementById('weight').value='';
	document.getElementById('type').selectedIndex=0;
	document.getElementById('amount').selectedIndex=0;
	document.getElementById('coverage').selectedIndex=0;
	document.getElementById('ty').checked=false;
	document.getElementById('tn').checked=true;
	document.getElementById('dy').checked=false;
	document.getElementById('dn').checked=true;
	document.getElementById('disease_more').style.display='none';
	document.getElementById('hy').checked=false;
	document.getElementById('hn').checked=true;
	document.getElementById('product').selectedIndex=0;
	document.getElementById('buttons').style.display='block';			
	document.getElementById('response').innerHTML = '&nbsp;<div class="required">&bull;</div>Required Fields';
	document.getElementById('validation_image').src='img/server.php?'+Math.random();
}
function clearAll(){
	init();
	document.getElementById('name').value='';
	document.getElementById('address').value='';
	document.getElementById('city').value='';
	document.getElementById('hphone').value='';
	document.getElementById('wphone').value='';
	document.getElementById('email').value='';
}
function diseaseDetails(status){
	switch(status){
		case 1:
			document.getElementById('disease_more').style.display='block';
		break;
		default:
			document.getElementById('disease_more').style.display='none';
		break;
	}
}

function getHTTPObject(){
if (window.ActiveXObject) return new ActiveXObject("Microsoft.XMLHTTP");
	else if (window.XMLHttpRequest) return new XMLHttpRequest();
	else {
		alert("Your browser does not support AJAX.");
		return null;
	}
}
function process(){
	scroll(0,0);
	document.getElementById('response').innerHTML = '<div style="float:left">&nbsp;Validating Form</div><img src="img/LoadingProgressBar.gif" style="float:right">';
	document.getElementById('buttons').style.display='none';
	var httpObject = null;
	httpObject = getHTTPObject();
	if (httpObject != null) {
		var querystring='inc/process/life.php?';
		querystring+='name=' + document.getElementById('name').value;
		querystring+='&address=' + document.getElementById('address').value;
		querystring+='&city=' + document.getElementById('city').value;
		querystring+='&hphone=' + document.getElementById('hphone').value;
		querystring+='&wphone=' + document.getElementById('wphone').value;
		querystring+='&email=' + document.getElementById('email').value;
		querystring+='&dob=' + document.getElementById('dob_month').options[document.getElementById('dob_month').selectedIndex].value + '/' + document.getElementById('dob_day').options[document.getElementById('dob_day').selectedIndex].value + '/' + document.getElementById('dob_year').options[document.getElementById('dob_year').selectedIndex].value;
		if(document.getElementById('male').checked==true){
			querystring+='&gender=male'
		}
		if(document.getElementById('female').checked==true){
			querystring+='&gender=female'
		}
		querystring+='&height=' + document.getElementById('feet').options[document.getElementById('feet').selectedIndex].value + '\'' + document.getElementById('inches').options[document.getElementById('inches').selectedIndex].value + '"';
		querystring+='&weight=' + document.getElementById('weight').value;
		querystring+='&type=' + document.getElementById('type').options[document.getElementById('type').selectedIndex].value
		querystring+='&amount=' + document.getElementById('amount').options[document.getElementById('amount').selectedIndex].value
		querystring+='&coverage=' + document.getElementById('coverage').options[document.getElementById('coverage').selectedIndex].value
		if(document.getElementById('ty').checked==true){
			querystring+='&tobacco=yes';
		}else{
			querystring+='&tobacco=no';
		}
		if(document.getElementById('dy').checked==true){
			querystring+='&disease=yes';
			querystring+='&disease_extra='+document.getElementById('disease_extra').value;
		}else{
			querystring+='&disease=no';
		}
		if(document.getElementById('hy').checked==true){
			querystring+='&hazardous=yes';
		}else{
			querystring+='&hazardous=no';
		}
		querystring+='&product=' + document.getElementById('product').options[document.getElementById('product').selectedIndex].value;
		querystring+='&validation=' + document.getElementById('validation').value;
		httpObject.open("GET", querystring, true);
		httpObject.send(null);
		httpObject.onreadystatechange = function(){
			if(httpObject.readyState == 4){
				if(httpObject.responseText!='valid'){
					document.getElementById('response').innerHTML = '<div class="required">&nbsp;'+httpObject.responseText+'</div>';
					document.getElementById('buttons').style.display='block';	
					document.getElementById('validation_image').src='img/server.php?'+Math.random();		
				}else{
					document.getElementById('response').innerHTML = '<div style="color:#006600">Thank you for your inquiry. We will be contacting you shortly.</div>';
					setTimeout("clearAll()", 7000);
				}
			}
		};
	}
}