Notes

<div class="main">


<script language="Javascript">
$.ajaxSetup(
{
type: "POST",
error: function (req,status,error)
{
alert("An error occurred while processing your request. Please try again later.");
},
success: function (responseXML,status,xhr)
{
if(xhr.getResponseHeader("content-type").search(/text/html/i)>=0)
{
xhr.statusText=(responseXML.search(/efficenter login screen/i)>=0)?"Your request could not be processed as your session has expired. Please re-login and try again.":"An error occurred while processing your request.";
xhr.status="Error";
alert(xhr.statusText);
}
}
}
);
</script>
<style>
.calendarTitle
{
background-color: #6ab2e2;
width: 100%;
height: 35px;
text-align: center;
width: 131px;
font-family: "Roboto", sans-serif;
font-size: 12px;
font-weight: bold;
color: white;
}
.calTL
{
/*border-top-left-radius: 2px;*/
}
.calTR
{
/*border-top-right-radius: 2px;*/
}
.calArrow
{
width: 22px;
text-align:center;
cursor: pointer;
}
.calWeekdays
{
color: black;
font-weight: bold;
width: 100%;
height: 25px;
text-align:center;

}
.calDays
{
line-height: 25px;
}
.calWeekday
{
font-size: 11px;
font-family: "Roboto", sans-serif;
float: left;
width: 30px;
height: 30px;
line-height: 25px;
text-align: center;
padding-top: 2px;
border-bottom: 1px solid #E9E9E9;
border-right: 1px solid #E9E9E9;
}
.calDay,
.calDay2,
.calDaySel,
.calDayDisabled
{
font-size: 11px;
font-family: "Roboto", sans-serif;
float:left;
width: 30px;
height: 30px;
line-height: 28px;
text-align: center;
cursor: pointer;
border-bottom: 1px solid #E9E9E9;
border-right: 1px solid #E9E9E9;
}
.calDayDisabled
{
color: #cccccc;
}
.calDay2
{
cursor: auto;
}
.calDaySel
{
width: 30px;
height: 30px;
line-height: 28px;
color: white;
background-color: #6ab2e2;
}
.calendar
{
position: absolute;
display:none;
width: 211px;
z-index: 99999;
background-color: #dcdcdc;
/*border-radius: 2px;*/
/*padding-bottom: 4px;*/
}
</style>



<script language="Javascript">
var _calMonths=new Array('January','February','March','April','May','June','July','August','September','October','November','December');
var _calField="";
var _calCurDate="";
var _calOrigDate="";
var _calCallBack=null;
var _calSundayOnly=false;

function _calEvtResponse(e)
{
var temp=(e.target||window.event.srcElement);


if(temp &&
(
(temp.id!=null && temp.id.search!=null && temp.id.search('_cal')>=0) ||
(temp.parentNode && temp.parentNode.id && temp.parentNode.id.search!=null && temp.parentNode.id.search('_cal')>=0)
)
)
{
//clicked inside the calendar.
cancelEvent(e||window.event);

if(temp.className=="calDayDisabled")
return false;

temp=temp.id.match(/^_calDay(d+)$/);
if(temp && temp.length>1)
{


_closeCal();
var tempMonth=_calCurDate.getMonth()+1;
if(tempMonth<10){ tempMonth="0"+tempMonth; }
if(temp[1] < 10){ temp[1]="0"+temp[1]; }
_calField.value=tempMonth+"/"+temp[1]+"/"+_calCurDate.getFullYear();
if(_calCallBack!=null)
{
_calCallBack();
}
}
}
else
{
_closeCal();
}

}

function _closeCal()
{
removeEvent(document,"onmouseup",_calEvtResponse);
$('#_calendar').stop();
var calTop=document.getElementById('_calendar').style.top.replace(/px/i,'');
$('#_calendar').animate({opacity: 0, top: calTop-25},150,"", function(){document.getElementById('_calendar').style.display="none";});
}
function showCal(field,properties)
{
var properties=(properties!=null)?properties:{};
_calSundayOnly=(properties.sundayOnly!=null)?properties.sundayOnly:false;

var margin={};
margin.top=(properties.marginTop!=null)?properties.marginTop+''.replace("px","")*1:0;
margin.left=(properties.marginLeft!=null)?properties.marginLeft+''.replace("px","")*1:0;
_calCallBack=(properties.callBack!=null)?properties.callBack:null;

_calField=(typeof(field)=="string")?document.getElementById(field):field;
_calPos=$(_calField).offset();

var fieldHeight=_calField.offsetHeight?_calField.offsetHeight:0;
var calTop=_calPos.top+margin.top+fieldHeight;
$('#_calendar').stop();
document.getElementById('_calendar').style.display="block";
document.getElementById('_calendar').style.top=calTop+"px";
document.getElementById('_calendar').style.left=(_calPos.left+margin.left)+"px";
$('#_calendar').animate({opacity: 0,top: calTop-25},0);
$('#_calendar').animate({opacity: 1,top: calTop},250);


_calDate=new Date(_calField.value);
if(_calDate.toString().search(/nan|invalid/i)==0)
{
_calDate=new Date();
}
_calOrigDate=new Date(_calDate.valueOf());
_calCurDate=new Date(_calDate.valueOf());
_calDisplayDate(_calDate);
removeEvent(document,"onmouseup",_calEvtResponse);
setTimeout(_trackCalEvt,1);
}
function _trackCalEvt()
{
trackEvent(document,"onmouseup",_calEvtResponse);
}
function _calPrevMonth()
{
_calCurDate.setDate(1);
_calCurDate.setMonth(_calCurDate.getMonth()-1);
_calDisplayDate(_calCurDate);
}
function _calNextMonth()
{
_calCurDate.setDate(1);
_calCurDate.setMonth(_calCurDate.getMonth()+1);
_calDisplayDate(_calCurDate);
}
function _calDisplayDate(date)
{
document.getElementById("_calDays").innerHTML="";
var temp=new Date(date.valueOf());
temp.setDate(1);
var days=0;

document.getElementById("_calTitle").innerHTML=_calMonths[temp.getMonth()]+' '+temp.getFullYear().toString()+'';

for(i=0;i<temp.getDay();i++)
{
days++;
document.getElementById("_calDays").innerHTML+='<div class="calDay2">&nbsp;</div>n';
}

temp.setMonth(temp.getMonth()+1);
temp.setDate(0);

tempOut=""
for(i=0;i<temp.getDate();i++)
{
days++;
var divClass="calDay";

if(_calSundayOnly && days%7!=1)
divClass="calDayDisabled";

tempOut+='<div id="_calDay'+(i+1)+'" class="'+divClass+'">'+(i+1)+'</div>n';
}
document.getElementById("_calDays").innerHTML+=tempOut;

for(i=0;i<6-temp.getDay();i++)
{
days++;
document.getElementById("_calDays").innerHTML+='<div class="calDay2">&nbsp;</div>n';
}

if(!_calSundayOnly && _calOrigDate.getMonth()==temp.getMonth() && _calOrigDate.getFullYear()==temp.getFullYear())
{
document.getElementById('_calDay'+_calOrigDate.getDate()).className="calDaySel";
}
}

$('#_calendar').appendTo('body');
</script>
<script language="Javascript" src="/efficenter/includes/js/sForm.js?55"></script>
<script language="Javascript" src="/efficenter/includes/js/validations.js?55"></script>




<script language="Javascript">
var _toolTipAnimation=true;
function showTooltip(obj,text,properties)
{
if(typeof(jQuery)=="function"){ $("#_tooltip").stop(true); }
var properties=properties==null?{}:properties;
var text=text==null?"":text;
var padding=properties.padding==null?"8px 8px 8px 8px":properties.padding;
var positionAdjustX=properties.positionAdjustX==null?0:properties.positionAdjustX;
var marginTop=properties.marginTop==null?0:properties.marginTop+''.replace("px","")*1;
var topPosition=properties.position==null?true:((properties.position=='top')?true:false);
_toolTipAnimation=properties.animate==null?true:properties.animate;
var docwidth=document.body.clientWidth;
var objHeight=obj.clientHeight>0?obj.clientHeight:obj.offsetHeight;
var objWidth=obj.clientWidth>0?obj.clientWidth:obj.offsetWidth;
var objPos=$(obj).offset();

var triangle=topPosition?'_tooltipTriangle2':'_tooltipTriangle';
var tipParent=document.getElementById('_tooltip').parentNode;

document.getElementById('_tooltipTriangle2').style.display="none";
document.getElementById('_tooltipTriangle').style.display="none";
document.getElementById('_tooltipContent').style.padding=padding;

tipParent.style.display="block";
tipParent.style.position="absolute";
tipParent.style.top="0px";
tipParent.style.left="0px";
tipParent.style.width="100%";

document.getElementById('_tooltipContent').innerHTML=text;

var tipHeight=document.getElementById('_tooltip').clientHeight+10;
var tipWidth=$('#_tooltip').outerWidth()+1;

tipParent.style.height=tipHeight+'px';
tipParent.style.width=tipWidth+'px';

if((objPos.top-tipHeight-marginTop)<0)
{
topPosition=false;
}
if(topPosition)
{
tipParent.style.top=objPos.top-tipHeight-marginTop+'px';
document.getElementById('_tooltipTriangle2').style.display="";
}
else
{
tipParent.style.top=(objPos.top+objHeight+marginTop)+'px';
document.getElementById('_tooltipTriangle').style.display="";
}

var rightAlign=(objPos.left+tipWidth > docwidth);
var offset=(objWidth < 29)?(objWidth/2)+3:0;

tipParent.style.left=rightAlign?((objPos.left+objWidth)-tipWidth)+offset-positionAdjustX+'px':objPos.left-offset+positionAdjustX+'px';

document.getElementById(triangle).align=rightAlign?"right":"left";

if(typeof(jQuery)=="function" && _toolTipAnimation)
{
//document.getElementById('_tooltip').style.top=tipHeight*(topPosition?1:-1)+"px";
$("#_tooltip").css({opacity: 0, top: topPosition?40:-40});
$("#_tooltip").animate({ top: 0, opacity: 1 },{queue: false, duration: 250 });
}
}
function hideTooltip()
{
var topPosition=document.getElementById('_tooltipTriangle2').style.display=="";
var tipDiv=document.getElementById('_tooltip');

if(typeof(jQuery)=="function" && _toolTipAnimation)
{
//$("#_tooltip").animate({ top: (topPosition?tipDiv.clientHeight+1:(tipDiv.clientHeight*-1)+"px") },150,hideTooltipNow);
$("#_tooltip").animate({ top: topPosition?40:-40, opacity: 0},200,hideTooltipNow);
}
else
{
hideTooltipNow();
}
}
function hideTooltipNow()
{
document.getElementById('_tooltip').parentNode.style.display="none";
document.getElementById('_tooltipContent').innerHTML="";
}
function tooltip(obj,text,properties)
{
this.obj=(typeof(obj)=="string")?document.getElementById(obj):obj;
this.text=text==null?"":text;
this.properties=properties==null?"":properties;
this.func=functionCallerTT(this,"showTooltip");
trackEvent(this.obj,"onmouseover",this.func);
trackEvent(this.obj,"onmouseout",hideTooltip);
}
tooltip.prototype.showTooltip=function()
{
showTooltip(this.obj,this.text,this.properties);
}
tooltip.prototype.removeTooltip=function()
{
removeEvent(this.obj,"onmouseover",this.func);
removeEvent(this.obj,"onmouseout",hideTooltip);
}
function functionCallerTT(object,functionName)
{
return function (e) {
if(e==null)
{ e=window.event; }
object[functionName](e,this);
};
}
$('#_tooltipParent').appendTo('body');
</script>



<script language="Javascript" src="/efficenter/includes/js/events.js?44444"></script>

<script language="Javascript" src="/efficenter/includes/js/ajax.js?44444"></script>




<div id="backdropBoxHolder" style="display:none">
<div onclick="closeBackDropWindow()" id="backdropLoadingDiv" class="plaintext cta" style="color: white; font-size: 20px"><span class="spinner100White"></span><br><br>Loading...</div>
<div id="anContentDiv"></div></div>

<script language="javascript">
var allowCloseAcWindow=true;
var parentAllowCloseAcWindow=true;
var minBdHeight=0;
var defaultBdWidth=550;
var lastBackDropId="";
var lastBackDropPadding=0;
var backWindowIsOpen=false;
var bdTimeout="";
var lastBackDropBlur=true;
var lastiFrame="";

function backDropBlurTitleBar()
{
document.getElementById('backdropTitleBar').className="backdropTitleBar backdropTitleBarBlur";
}
function backDropUnBlurTitleBar()
{
document.getElementById('backdropTitleBar').className="backdropTitleBar";
}
function backDropLoadURL(params)
{
document.getElementById(lastBackDropId).innerHTML="";
var iframe=document.createElement("iframe");
iframe.height=params.height;
iframe.width=params.width;
iframe.id=params.frameName;
iframe.frameBorder=0;
iframe.style.display=(params.loading?"none":"");
iframe.style.position="relative";

var cfwin=document.getElementById(lastBackDropId);
cfwin.innerHTML="";
cfwin.style.fontSize="1px";
cfwin.appendChild(iframe);
if(params.loading)
{
cfwin.innerHTML+="<div style='height: "+(params.height-10)+"px; line-height: "+(params.height-10)+"px; width: "+params.width+"; text-align: center; position:relative;' id='_"+lastBackDropId+"BackDropFrameLoading'><div class='spinner"+((params.height < 300)?"50":"100")+"'></div></div>";
$('#'+params.frameName).animate({"opacity": 0, "top": -100},0);
}
}
function backDropURLLoaded()
{
if(document.getElementById('_'+lastBackDropId+"BackDropFrameLoading"))
{
$('#_'+lastBackDropId+"BackDropFrameLoading").animate({"opacity": 0, "top": -100},200,
function()
{
var frameName="_"+lastBackDropId+"BackDropFrame";
$('#'+frameName).show();
$('#'+frameName).animate({"opacity": 1, "top": 0},200);
$(this).hide();
}
);
}
}
function backDropWindowLoaded()
{
backDropURLLoaded();
}
function showBox(id,title,noTemplate,urlParams)
{
if(lastiFrame.length > 0)
{
document.getElementById(lastiFrame).innerHTML="";
lastiFrame="";
}

lastBackDropId=id;
if(!document.getElementById(id))
{
alert("No elements with ID ""+id+"" were found.");
return false;
}
var noTemplate=(noTemplate===undefined)?false:noTemplate;
var urlParams=(urlParams===undefined)?{url: ''}:urlParams;

if(!("backDropBlur" in urlParams))
urlParams.backDropBlur=true;
if(!("url" in urlParams))
urlParams.url="";
if(!("height" in urlParams))
urlParams.height=500;
if(!("width" in urlParams))
urlParams.width="100%";
else
{
urlParams.width=urlParams.width.toString();
if(urlParams.width.search('%')<0 && urlParams.width.search(/px/i) < 0)
{
urlParams.width=urlParams.width+'px';
}
}

if(!("loading" in urlParams))
urlParams.loading=false;
if(!("margin" in urlParams))
urlParams.margin=20;

if(urlParams.url!="")
{
lastiFrame=id;
urlParams.title=title;
urlParams.frameName="_"+lastBackDropId+"BackDropFrame";
backDropLoadURL(urlParams);
document.getElementById('backdropContentBox').style.padding=urlParams.margin+"px";
lastBackDropPadding=urlParams.margin;
}
else
{
document.getElementById('backdropContentBox').style.padding="20px";
lastBackDropPadding=20;
}

lastBackDropBlur=urlParams.backDropBlur;


if(title.charAt(0)=="/")
title="";

document.getElementById('popTitle').innerHTML=(title!=null && title.length>0)?title:'';

if(document.getElementById('backdropContentBox').getElementsByTagName('div').length>0)
{
document.getElementById('backdropBoxHolder').appendChild(document.getElementById('backdropContentBox').getElementsByTagName('div')[0]);
}
document.getElementById("backdropContentBox").appendChild(document.getElementById(id));

document.getElementById('backDropErrorBox').style.display="none";
$('#backdropTitleBar').css("display",((noTemplate)?"none":""));
$('#backdropPanel').css('background-color',((noTemplate)?"transparent":"white"));

$('#backdropContent').height('auto');
$('#backdropPanel').width(defaultBdWidth);
$('#backdropFooter').html('');

backDropUnBlurTitleBar();
showBackDropWindow();


try
{
if(parent!=self && parent.backWindowIsOpen && noTemplate==false)
{
parentAllowCloseAcWindow=parent.allowCloseAcWindow;
parent.backDropBlurTitleBar();
parent.preventBackDropClose();
}
}
catch(e)
{
//do nothing
}
if(urlParams.url!="" && urlParams.width.search('%') < 0)
{
bdTimeout=setTimeout(
function()
{
var windowWidth=$('#backdropContent').width();
var windowHeight=$('#backdropContent').height();
var frameWidth=$('#'+urlParams.frameName).width();
var frameHeight=$('#'+urlParams.frameName).height();

if(windowWidth < frameWidth)
{
var adj=urlParams.width-windowWidth;
document.getElementById(urlParams.frameName).style.width=(windowWidth)+'px';
}
if(windowHeight-5 < frameHeight)
{
var adj=urlParams.height-windowHeight;
document.getElementById(urlParams.frameName).style.height=(windowHeight-5)+'px';
}
},2000);
}
$('#backdropWinCloseButton').css("display","");
var bdHeight=$('#backdropPanel').height();
if(bdHeight < minBdHeight)
$('#backdropFiller').height(minBdHeight-bdHeight);

if(urlParams.url!="")
document.getElementById(urlParams.frameName).src=urlParams.url;
}
function showBoxLoading()
{
showBox('backdropLoadingDiv','-',true);
}
function hideBackDropCloseButton()
{
$('#backdropWinCloseButton').css("display","none");
}
function showBackDropMessage(message,className)
{
if(typeof message==="undefined" || message.length==0)
{
hideBackDropMessage();
return false;
}
document.getElementById('backDropErrorBox').style.display='';
$('#backDropErrorBox').slideUp(0);
document.getElementById('backDropErrorBox').innerHTML="<span class='plaintext'>"+message+"</span>";
document.getElementById('backDropErrorBox').className=(className===undefined)?"alertBox":className;

/*$('#backDropErrorBox').animate({'top': '-20px', 'opacity': 0 },0);
$('#backDropErrorBox').animate({'top': '0px', 'opacity': 1 },500);*/
$('#backDropErrorBox').slideDown(300);
}
function hideBackDropMessage()
{
if(document.getElementById('backDropErrorBox').style.display=="none")
return false;

$('#backDropErrorBox').slideUp(200,
function()
{
$(this).css({'display': 'none'});
$(this).html('');
}
);
}
function showBackDropWindow()
{
if(backWindowIsOpen)
{
sizeBackDropWindow();
return false;
}

backWindowIsOpen=true;
//Hide just incase window is open
$('#backdrop').css("opacity","0");
$('#backdropWindow').css("opacity","0");
$('.backdropPanel').removeClass("backdropScaleUp");
$('.backdropPanel').addClass("backdropScaleDown");

$('#backdrop').show();
$('#backdropWindow').show();
var defaultOpacity=0.5;
if(!lastBackDropBlur)
{
defaultOpacity=0.20;
}

$('#backdrop').animate({ "opacity": defaultOpacity },150,
function()
{
$('#backdropWindow').animate({ "opacity": 1 },400);
$('.backdropPanel').removeClass('backdropScaleDown');
$('.backdropPanel').addClass('backdropScaleUp');
sizeBackDropWindow();
setTimeout(function(){$('.backdropPanel').removeClass('backdropScaleUp');},300);

}
);

if(lastBackDropBlur)
{
$("header").addClass('backdropBlur');
$(".content").addClass('backdropBlur');
$(".mainBody").addClass('backdropBlur');
}
}

function sizeBackDropWindow()
{
var bdPanelHeight=$('#backdropPanel').height();
var bdFooterHeight=$('#backdropFooter').height();
var windowHeight=$(window).height();

if(bdPanelHeight+bdFooterHeight > windowHeight)
$('#backdropContent').height(windowHeight-bdFooterHeight-150);


var bdContentWidth=$('#backdropContent')[0].scrollWidth;
var bdPanelWidth=$('#backdropPanel').width();
var windowWidth=$(window).width()-150;

if(bdContentWidth > bdPanelWidth)
{
var newWidth=bdContentWidth+lastBackDropPadding;
if(newWidth > windowWidth)
newWidth=windowWidth;

$('#backdropPanel').width(newWidth);

}
}
function preventBackDropClose()
{
document.getElementById('backdropWinCloseButton').style.display="none";
allowCloseAcWindow=false;
}
function allowBackDropClose()
{
document.getElementById('backdropWinCloseButton').style.display="";
allowCloseAcWindow=true;
}
function onBackDropClose(boxId)
{
return true;
}
function closeBackDropWindow(forceClose)
{
if(forceClose!==undefined && forceClose)
allowBackDropClose();

if(allowCloseAcWindow)
{
var retVal=onBackDropClose(lastBackDropId);

if (typeof retVal !== "undefined" && retVal==false)
return false;

$('#backdrop').animate({"opacity": 0},200,function(){ $(this).hide(); });
$('#backdropWindow').animate({"opacity": 0},200,function(){ $(this).hide(); });
$('#backDropWindow').hide();
$('.backdropPanel').animate({"top": "-100px"},200);

$("header").removeClass('backdropBlur');
$(".content").removeClass('backdropBlur');
$(".mainBody").removeClass('backdropBlur');
try
{
if(parent!=self && parent.backWindowIsOpen)
{
parent.backDropUnBlurTitleBar();
if(parentAllowCloseAcWindow)
parent.allowBackDropClose();
}
}
catch(e)
{
//do nothing
console.log(e);
}
clearTimeout(bdTimeout);
backWindowIsOpen=false;
}
}
$('#backdropWindow').appendTo('body');
$('#backdrop').appendTo('body');
$('#backDropErrorBox').css("min-height","auto");
</script>


<script language="Javascript" src="/efficenter/includes/js/addressNormalization.js?44444"></script>
<div class="title titlePadding"><img src="/efficenter/images/person2-flat.svg" class="titleIcon" align="absmiddle"> &nbsp;Personal Info</div>

<style>
.flw
{
width: 80px;
}
.flw2
{
width: 100px;
}
.spacer
{
text-align: right;
padding-right: 10px;
box-sizing: border-box;
}
</style>


<form name="form" id="form" action="mi-updaddr.cfm" method="post">
<br><br>
<div class="subtitle">
<img src="/efficenter/images/person-outline.cfm?color=ffffff" class="subTitleIcon"> Maryemily Louise Moore
</div>
<br>
<div class="formLabel ib flw">SSN</div> <span class="plaintext" id="ssnBox"><a class="link hand" onclick="viewSSN()">Click here to view</a></span>
<br><br>
<div class="formLabel ib flw">Address</div>
<input type="text" tabindex="1" name="addr1" id="addr1" value="4116 Winkler Way" size="40" class="required textbox" onchange="address_onChangeEvent(this);"><img id="warnform|addr1" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">
<div class="formLabel ib flw spacer">Address 2</div>
<input type="text" tabindex="2" name="addr2" id="addr2" value="" size="15" class="textbox" onchange="address_onChangeEvent(this);">

<br><br>

<div class="formLabel ib flw">City</div>
<input type="text" name="city" id="city" tabindex="3" value="Gainesville" class="textbox required" onchange="address_onChangeEvent(this);"><img id="warnform|city" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">
<div class="formLabel ib flw spacer">State</div>
<input type="text" name="state" id="state" maxlength="2" tabindex="4" size="4" value="GA" class="textbox required" onchange="address_onChangeEvent(this);"><img id="warnform|state" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">
<div class="formLabel ib flw spacer">Zip</div>
<input type="text" name="zip" id="zip" tabindex="5" size="12" value="30506-5382" class="textbox required" onchange="address_onChangeEvent(this);"><img id="warnform|zip" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">

<br><br>

<div class="formLabel ib flw">Email</div>
<input type="text" tabindex="7" id="emailaddress" name="emailaddress" value="[email protected]" maxlength="50" size="35" class="textbox required"><img id="warnform|emailaddress" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">


<br><br><br><br>



<div class="subtitle"><img src="/efficenter/images/phone-outline.cfm?color=ffffff" class="subTitleIcon"> Phone Numbers</div>
<br>

<div class="formLabel ib flw">Home</div>
<input type="text" tabindex="6" id="home_phone" name="home_phone" value="678-338-6481" maxlength="14" size="20" class="textbox"><img id="warnform|home_phone" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">

<div class="formLabel ib flw spacer">Mobile</div>
<input type="text" tabindex="6" id="phone1" name="phone1" value="678-338-6481" maxlength="14" size="20" class="textbox"><img id="warnform|phone1" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">
<br><br>
<div class="formLabel ib flw">Other</div>
<input type="text" tabindex="6" id="phone2" name="phone2" value="" maxlength="14" size="20" class="textbox"><img id="warnform|phone2" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">

<div class="formLabel ib flw spacer">Other 2</div>
<input type="text" tabindex="6" id="phone3" name="phone3" value="" maxlength="14" size="20" class="textbox"><img id="warnform|phone3" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">

<br><br>
<div class="formLabel ib flw">Preferred</div>
<select class="menu" name="preferredPhone">
<option value=""></option>
<option value="Home Phone">Home Phone</option>

<option value="Mobile">Mobile</option>

<option value="Other">Other</option>

<option value="Other 2">Other 2</option>

</select>


<br><br><br><br>
<div class="subtitle"><img src="/efficenter/images/notification-outline.cfm?color=ffffff" class="subTitleIcon"> Emergency Contact Info</div>
<br>
<div class="formLabel ib flw2">Contact Name</div>
<input type="text" id="emer_contact" name="emer_contact" value="Ethan Moore" maxlength="36" size="35" class="textbox">
<div class="formLabel ib flw spacer">Phone</div>
<input type="text" id="emer_phone" name="emer_phone" value="770-298-5295" maxlength="14" size="20" class="textbox"><img id="warnform|emer_phone" src="/efficenter/images/16x16spacer.gif" align="absmiddle" style="margin-left: 4px; height: 22px; width: 22px;">

<br><br>

<div class="formLabel ib flw2">Relationship</div>
<input type="text" id="EMER_REL" name="EMER_REL" value="Fiancé" size="50" maxlength="12" class="textbox">


<br><br>
<input class="button" type="submit" value="Submit" name="Submit" id="Submit">


<input type="hidden" name="action" id="action" value="submit">
<input type="hidden" name="normalizedAddress" id="normalizedAddress" value="false">
</form>

<script language="Javascript">

myform=new sForm('form');
myform.required("addr1,emailaddress,city,state,zip",true);
myform.mustBeEmail("emailaddress");
myform.mustBePhone("home_phone,emer_phone,phone1,phone2,phone3",true);

myform.setFieldNames(
"addr1: Address 1",
"emailaddress: Email Address",
"home_phone: Home Phone",
"phone1: Mobile",
"phone2: Other",
"phone3: Other 2",
"emer_phone: Emergency Phone",
"emer_contact: Emergency Contact"

);


myform.bind("emer_phone","emer_contact");
</script>

<script language="Javascript">
//turn the forceValid flag to true to force validation by default.
var forceValid = true;
var forceValidCnt = 0;

myform.onBeforeSubmit=function()
{
//after 2 tries to edit the address, the force validation is to be turned off to allow user to user address as-is
if(forceValidCnt == 2)
forceValid = false;
forceValidCnt++;

return validateAddress(document.getElementById('form'),forceValid,
'9290',
'302512',
'9',
'2158',
'www.adamskeegan.com/efficenter/myinfo/mi-updaddr.cfm',
'3.228.203.229');
}
</script>


<script language="javascript">
var xmlObj2=new requestObj();
function viewSSN(response)
{
if(response===undefined)
{
document.getElementById('ssnBox').innerHTML="<div class='spinner25'></div>";
xmlObj2.sendRequest("POST","mi-updaddr.cfm","action=getSSN",function(){ viewSSN(1); },true);
}
else
{
document.getElementById('ssnBox').innerHTML=atob(getElement(xmlObj2.getContent()[0],"ssn"));
}
}
</script>

</div>