{form->rootpath_script}
{form->basepath_script}

<script type="text/javascript">
$(document).ready(function(){
	//alert($('#hidImageCaptchaCode').val());
	$('#hidImageCaptchaCode').css('visibility', 'hidden');
});
</script>
          {form->start name="formRunaproduct" method="post" action="page/runAProduct/"} <a name="formFocus"></a>
           {*form->hidden name="businessstatehidValue"*}
              <h3 class="bord-bottom-dot mrgT10">{$language.lblContactInformation}</h3>
              <fieldset class="form-field04  ">
             <ul class="form1">
            <li class="clearfix">
            <div class="col-md-12">
             <div class="clearfix"> <div class="label clearfix">
                <label>{$language.lblFirstName} </label>
                <span class="mndty">*</span></div>
              <div class="field"> {form->textbox id="businessReqFirstName" name="businessReqFirstName"  maxlength="100"  class="form-control" validate="required" validate_event="submit" error=$language.errFirstName} </div>
              </div>
             </div>
              <div class="col-md-12">
              	<div class="clearfix">
                 <div class="label clearfix">
                <label>{$language.lblLastName} </label>
                <span class="mndty">*</span></div>
              <div class="field">{form->textbox name="businessReqLastName" maxlength="100"  class="form-control" validate_event="submit"   validate="required" error=$language.errLastName}</div>
                </div>
              </div>
            </li>
             <li class="clearfix">
            <div class="col-md-12">
             <div class="clearfix"> 
             <div class="label clearfix">
                <label>{$language.lblAddressLine1} </label>
                <span class="mndty">*</span></div>
              <div class="field"> {form->textbox name="businessReqAddress1"  maxlength="100"  class=" form-control"  validate="required" validate_event="submit" error=$language.errBusAddress1}</div>
              </div>
             </div>
              <div class="col-md-12">
              	<div class="clearfix">
                <div class="label clearfix">
                <label>{$language.lblAddressLine2}</label>
                </div>
              <div class="field"> {form->textbox name="businessReqAddress2" maxlength="100"  class=" form-control"}</div>
                </div>
              </div>
            </li>
            
            <li class="clearfix">
            <div class="col-md-12">
             <div class="clearfix"> 
             <div class="label clearfix">
                <label>{$language.lblCity}</label>
                <span class="mndty">*</span></div>
              <div class="field">{form->textbox name="businessReqCity"  maxlength="100"  class=" form-control" validate="required"  validate_event="submit" error=$language.errBusCity}  </div>
              </div>
             </div>
              <div class="col-md-12">
              	<div class="clearfix">
                <div class="label clearfix">
                <label>{$language.lblCountry} </label>
                <span class="mndty">*</span></div>
              <div class="field"> {form->select id="businessReqCountryID" maxlength="50" name="businessReqCountryID" caption="->{$language.lblSelect}" options=$resListCountry  class=" listbox" validate="required" validate_event="submit" error=$language.errBusCountry}</div>
                </div>
              </div>
            </li>
            <li class="clearfix">
            <div class="col-md-12">
             <div class="clearfix"> 
             <div class="label clearfix">
                <label>{$language.lblStateProvince}</label>
                <span class="mndty">*</span></div>
               <div class="field"> <span id="spanState"> {form->select id="businessReqStateID" name="businessReqStateID" class=" form-control"  caption="->{$language.lblSelect}"  maxlength="100" validate="stateSelectedType->isequal->state~*required"  validate_event="submit" error=$language.errBusState} </span> <span id="spanStateProvince" style="display:none;"> {form->textbox id="stateProvince"  name="businessReqProvince"  class=" form-control"  maxlength="50" validate="stateSelectedType->isequal->province~*required" validate_event="submit"  error=$language.errBusProvince} </span> 
                       {form->hidden id="stateSelectedType"  name="stateSelectedType" value=""}
                 {form->hidden id="stateSelectedID"  name="stateSelectedID"}    </div>
              </div>
             </div>
              <div class="col-md-12">
              	<div class="clearfix">
                <div class="label clearfix">
                <label>{$language.lblZipPostalCode} </label> <span class="mndty">*</span>
                </div>
               <div class="field"> {form->textbox name="businessReqZip"  maxlength="10"  class="form-control" validate="required"  validate_event="submit" error=$language.errBusZip} </div>
                </div>
              </div>
            </li>
             <li class="clearfix">
            <div class="col-md-12">
             <div class="clearfix"> 
             <div class="label clearfix">
                <label>{$language.lblPhoneNumber}</label>
                <span class="mndty">*</span></div>
               <div class="field"> {form->textbox name="businessReqPhone" maxlength="20"  class=" form-control" validate="required"  validate_event="submit" error=$language.errPhone} </div>
              </div>
             </div>
              <div class="col-md-12">
              	<div class="clearfix">
                <div class="label clearfix">
                <label>{$language.lblWebsite} </label>
               </div>
            <div class="field"> {form->textbox name="businessReqWebsite"  maxlength="255"  class=" form-control" validate="isUrl" validate_event="submit" error=$language.errInvalidUrl} </div>
                </div>
              </div>
            </li>
             <li class="clearfix">
            <div class="col-md-12">
             <div class="clearfix"> 
             <div class="label clearfix">
                <label>{$language.lblEmail}</label>
                <span class="mndty">*</span></div>
            <div class="field"> {form->textbox name="businessReqEmail"  maxlength="50"  class="form-control" validate="required~*email" validate_event="submit" error=$language.errEmailID|cat:'~*'|cat:$language.errValidEmail} </div>
              </div>
             </div>
              
            </li>
            
            </ul>
              </fieldset>
            <div  class="top-spacing">
              <h3 class="bord-bottom-dot mrgT10">{$language.lblBusinessInformation}</h3>
              <fieldset>
              <div>
              <ul class="form1">
            <li class="clearfix">
            <div class="column flt-left">
             <div class="clearfix"> <div class="label clearfix">
                <label>{$language.lblNameBusiness} </label>
                <span class="mndty">*</span></div>
              <div class="field"> {form->textbox name="businessReqName" maxlength="100"  class=" textbox"  validate="required"  validate_event="submit" error=$language.errBusName} </div>
              </div>
             </div>
              <div class="column flt-right">
              	<div class="clearfix">
                 <div class="label clearfix">
                <label>{$language.lblBusinessDuration} </label>
                </div>
              <div class="field"> {form->textbox name="PeriodofBusiness"  maxlength="20"  class=" textbox"} </div>
                </div>
              </div>
            </li>
             <li class="clearfix">
            <div class="column flt-left">
             <div class="clearfix"> 
             <div class="label clearfix">
                <label>{$language.lblTypeBusiness} </label>
                <span class="mndty">*</span></div>
              <div class="field"><span id="spanBusiness"> {form->select id="businessTypeID" name="businessTypeID" class=" listbox"  caption="->{$language.lblSelect}"  width="15" content=$resListBusinessType  validate="required"  validate_event="submit" error=$language.errBusinessType}</span> <span id="spanBusinessOthers" style="display:none;"> {$language.lblPleaseSpecify}
                      
                      {form->textbox id="businessTypeOther" name="businessTypeOther" class=" textbox" maxlength="50" validate="businessTypeID->isequal->0~*required" validate_event="submit" error=$language.errBusinessTypeOther} </span> {form->hidden id="businessSelectedType"  name="businessSelectedType"} </div>
              </div>
             </div>
              <div class="column flt-right">
              	<div class="clearfix">
                <div class="label clearfix">
                <label>{$language.lblHearAboutUs} </label>
                </div>
             <div class="field"> {form->select id="hearAbout" name="hearAbout" class=" listbox"  caption="->{$language.lblSelect}" options="E mail->{$language.lblEmail}~*Google->{$language.lblGoogle}~*Word of Mouth->{$language.lblWordMouth}~*Flyer->{$language.lblFlyer}~*Newspaper/Magazine->{$language.lblNewspaperMagazine}~*MSN->{$language.lblMSN}~*Seen around Towns->{$language.lblSeenTowns}" width="15" maxlength="100"} </div>
                </div>
              </div>
            </li>
            
            <li class="clearfix">
            <div class="column flt-left">
             <div class="clearfix"> 
             <div class="label clearfix">
                <label>{$language.lblBusinessProfile} </label>
                </div>
              <div class="field">  {form->textarea  name="businessReqComments" cols="5" rows="5"  class=" textarea01"}  </div>
              </div>
             </div>{if $enable_captcha}

              <div class="column flt-right">
              	<div class="clearfix">
                <div class="label clearfix">
                <label>{$language.lblSecurityCode} </label>
                <span class="mndty">*</span></div>
              <div class="field captcha"> 
              <div class="column-inner flt-left">
                      <img id="captchaCode"/>
                      </div>  <div class="column-inner flt-left" >&nbsp; 
                      <img id="reload_icon_captcha" src="{$view_images}/reload_icon_captcha.png" style="cursor:pointer;"  marginheight="0px" marginwidth="0px"  vspace="19"/> &nbsp;
                     </div>
              {form->textbox id="businessRequestSecurityCode" autocomplete="off" name="businessRequestSecurityCode"  class="form-control flt-left" maxlength="12" validate="required~*hidImageCaptchaCode->compare->value" validate_event="submit" error=$language.errBusSecurityCode|cat:'~*'|cat:$language.errSecurityCode}&nbsp; &nbsp; 
                      <span style="display:none">
                      {form->textbox id="hidImageCaptchaCode"   name="hidImageCaptchaCode" class="hidden-variable"}</span>
                      
                     <div class="clear"></div>
                     
                     </div>
                </div>
              </div>
              {/if}
            </li>
            <li class="clearfix">
            <div class="label clearfix"></div>
              <div class="dot"></div>
              <div class="field"> 
            {form->submit name="submitForms" id="button" class="btn btn-primary btn-block" form="formRunaproduct" validate_submit="yes"  value="{$language.lblSubmit}"}
            </div>
            </li>
            </ul>
                
                <div class="clear"></div>
              </div>
              </fieldset>
            </div>
            {form->close}
<script type="text/javascript">
    var lblSelect 	= '{$language.lblSelect}';
	var lblHtmltags	= "{$language.lblHtmltags}";
</script>
{html->script_group_start name="{$compiled_js_path}/contentrunadeal.js"}
  {html->script src="{$common_frontend_js}/captcha.page.js"}
  {html->script src="{$common_frontend_js}/forms.page.js"}
{html->script_group_end}
<script type="text/javascript">
$(document).ready(function(){
	$('#formRunaproduct').bind("submit",function ()
	{	
		if($("#captchaCode").length>0 && $('.hid_err_formRunaproduct_validations[value=1]').length>0)
		{
			setCapcha();
		}	
	});
});
 </script> 
{form->validate_script form="formRunaproduct"}

