Code-Bin #853 - Sign up Form

HTML Code

<div id="SignUp">
<table width="260" class="signupframe" border="0" cellspacing="0" cellpadding="5">
	<tr>
      <td valign=top align=right>
        <span class="required">*</span> Email
      </td>
      <td align=left>
        <input type=text name="fields_email">
      </td>
    </tr>
	<tr>
      <td valign=top align=right>
         First Name
      </td>
      <td align=left>
        <input type=text name="fields_fname">
      </td>
    </tr>
	<tr>
      <td valign=top align=right>
         Last Name
      </td>
      <td align=left>
        <input type=text name="fields_lname">
      </td>
    </tr>
    <input type=hidden name="listid" value="10548">
    <input type=hidden name="specialid:10548" value="ZXO6">

<input type=hidden name=clientid value="661189">
    <input type=hidden name=formid value="3216">
    <input type=hidden name=reallistid value="1">
    <input type=hidden name=doubleopt value="0">
    <tr>
      <td> </td>
      <td><span class="required">*</span> = Required Field</td>
    </tr>
    <tr>
      <td> </td>
      <td><input type="submit" name="Submit" value="Submit"></td>
    </tr>
    </table>
</div>
</form>
<script type="text/javascript">

var icpForm3216 = document.getElementById('icpsignup3216');

if (document.location.protocol === "https:")

icpForm3216.action = "https://app.icontact.com/icp/signup.php";
function verifyRequired3216() {
  if (icpForm3216["fields_email"].value == "") {
    icpForm3216["fields_email"].focus();
    alert("The Email field is required.");
    return false;
  }

return true;
}
</script>
<span class="link"><a href="http://www.icontact.com">Email Marketing</a> You Can Trust</span>

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