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Form JavaScript

I need a form javascript which does the following:

Form fields: zipcode (textbox), insured yes or no (option button)

Validation:

- "zipcode" field should validate that entry is 5 numeric digits - if not, alert "Please enter a valid 5 digit zip code."

Functionality:

When the "submit" button is hit, the form should redirect to "http://url-2.com&zip=xxxxx&insured=X" in a new "full" window. This should be compatible with all browsers. Notice that the zipcode and insured are added as url parameters.

In addition, the form should also pass source=xxxxx&afftrack=xx&affsub=xx&campid=xx which should be obtained from the landing page url.

For example, if the form is on [url removed, login to view] and the visitor lands with:

[url removed, login to view];campid=ppc&afftrack=3020&affsub=05

And if, the visitor enters zipcode "91710", selects insured "Yes" and hits go, the visitor should be redirected in a "new full window" to:

[url removed, login to view];insured=Y&source=google&campid=ppc&afftrack=3020&affsub=05

Thanks

Habilidades: Javascript

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Acerca do Empregador:
( 26 comentários ) pomona, United States

ID do Projeto: #593517

Premiar a:

peruvianmaster

hello I can provide this form, check your pmb please

$30 USD em 0 dias
(4 Avaliações)
3.7