function check_email(es)
{
	var s = trim(es);
	var a = false;
	var res = false;
	if (typeof(RegExp) == 'function') {
		var b = new RegExp('abc');
		if (b.test('abc') == true) {
			a = true;
		}
	}

	if (a == true) {
		reg = new RegExp('^([a-zA-Z0-9\\-\\.\\_]+)'+'(\\@)([a-zA-Z0-9\\-\\.]+)'+'(\\.)([a-zA-Z]{2,4})$');
		res = (reg.test(s));
	} else {
		res = ( s.search('@') >= 1 && s.lastIndexOf('.') > s.search('@') && s.lastIndexOf('.') >= s.length-5 );
	}

	return(res);
}

function trim(TRIM_VALUE)
{
	if (TRIM_VALUE.length < 1) {
		return "";
	}
	TRIM_VALUE = RTrim(TRIM_VALUE);
	TRIM_VALUE = LTrim(TRIM_VALUE);
	if(TRIM_VALUE=="") {
		return "";
	} else {
		return TRIM_VALUE;
	}
}

function RTrim(VALUE)
{
	var w_space = String.fromCharCode(32);
	var v_length = VALUE.length;
	var strTemp = "";
	if(v_length < 0) {
		return "";
	}
	var iTemp = v_length -1;

	while (iTemp > -1) {
		if (VALUE.charAt(iTemp) == w_space) {
		} else {
			strTemp = VALUE.substring(0,iTemp +1);
			break;
		}
		iTemp = iTemp-1;
	}

	return strTemp;
}

function LTrim(VALUE)
{
	var w_space = String.fromCharCode(32);
	if (v_length < 1) {
		return "";
	}
	var v_length = VALUE.length;
	var strTemp = "";

	var iTemp = 0;

	while (iTemp < v_length) {
		if (VALUE.charAt(iTemp) == w_space) {
		} else {
			strTemp = VALUE.substring(iTemp,v_length);
			break;
		}
		iTemp = iTemp + 1;
	}

	return strTemp;
}

function is_number(VALUE)
{
	return ( isNaN(VALUE) ? false : true );
}

function check_form(){
	var fm = document.forms['PKVFORM'];
	var fehler = new Array();

	if (fm.elements['f1name5'].value.length < 2){
		fehler[fehler.length] = 'Vorname';
		}
	if (fm.elements['f1name11'].value.length < 2){
		fehler[fehler.length] = 'Nachname';
		}
	if (fm.elements['f1name43'].value.length < 2){
		fehler[fehler.length] = 'Strasse';
		}
	if (fm.elements['f1name49'].value.length < 1){
		fehler[fehler.length] = 'Hausnummer';
		}
	if (fm.elements['f1name55'].value.length != 5){
		fehler[fehler.length] = 'PLZ (5-stellige Zahl)';
		}
	else if (isNaN(fm.elements['f1name55'].value)){
		fehler[fehler.length] = 'PLZ (nur Ziffern erlaubt)';
		}
	if (fm.elements['f1name61'].value.length < 2){
		fehler[fehler.length] = 'Stadt';
		}
	if (fm.elements['f1name67'].value.length < 2){
		fehler[fehler.length] = 'Telefon';
		}
	if (fm.elements['f1name17[day]'].value == '0'){
		fehler[fehler.length] = 'Geburtsdatum (Tag)';
	}
	if (fm.elements['f1name17[month]'].value == '00'){
		fehler[fehler.length] = 'Geburtsdatum (Monat)';
	}
	if (fm.elements['f1name17[year]'].value == '0000'){
		fehler[fehler.length] = 'Geburtsdatum (Jahr)';
	}
	if (fm.elements['f1name79'].value.length < 7){
		fehler[fehler.length] = 'Email-Adresse';
		}
	else if (check_email(fm.elements['f1name79'].value) == false){
		fehler[fehler.length] = 'gültige Email-Adresse';
		}
	if (fm.elements['f1name85'].checked == false){
		fehler[fehler.length] = 'Jahreseinkommen';
		}
	if (fm.elements['f1name37'].value == 'Angestellter' && fm.elements['f1name85'].value != 'ueber BBG'){
		fehler[fehler.length] = 'Jahreseinkommen (liegt unter Beitragsbemessungsgrenze für Angestellte)';
		}
	if (fm.elements['f1name117'].checked == false){
		fehler[fehler.length] = 'Datenschutz zustimmen';
		}
	if (fehler.length >0){
		alert('Bitte folgende Felder korrekt ausfüllen:' + "\n - " + fehler.join("\n - "));
		return false;
		}
	else {
		return true;
		}
	}


	function Geld_WM_SetRedirect(view){
		if (typeof redirectURL == 'undefined'){
			params = document.location.search.replace(/\?/,'');;
			data=params.split("&");
			for (i=0;i<data.length;i++){
				sResult = data[i].search(/redirectURL=/);
				if (sResult != -1) {
					data1 = data[i].split("=");
					redirectURL = unescape(data1[1]);
				}
			}
		}
		if (typeof document.getElementsByName(view+'[redirect]')[0] != 'undefined'){
			document.getElementsByName(view+'[redirect]')[0].value = redirectURL;
		}else{
			document.write('<input type="hidden" name="'+view+'[redirect]" value="'+redirectURL+'" />');
		}
	}
document.write('<style type="text/css">');
document.write('/* <![CDATA[ */');
document.write('#geld_de_form_pkv1 label, #geld_de_form_pkv1 a {');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('}');
document.write('#geld_de_form_pkv1 form {');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('display: inline;');
document.write('}');
document.write('#geld_de_form_pkv1 form input, #geld_de_form_pkv1 form select{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('font-size: 12px;');
document.write('}');
document.write('/* formulares leadsystem */');
document.write('#geld_de_form_pkv1{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('color: #000000;');
document.write('margin: 0;');
document.write('padding: 10px;');
document.write('text-align: center;');
document.write('}');
document.write('#geld_de_form_pkv1 input, #geld_de_form_pkv1 select, #geld_de_form_pkv1 option, #geld_de_form_pkv1 textarea{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('font-size: 13px;');
document.write('margin: 2px;');
document.write('vertical-align: middle;');
document.write('}');
document.write('#geld_de_form_pkv1 textarea{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('width: 225px;');
document.write('}');
document.write('#geld_de_form_pkv1 table{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('color: #000000;');
document.write('font-size: 12px;');
document.write('background: #EDF4FE;');
document.write('text-align: left;');
document.write('border-right: 1px solid #9EC5F9;');
document.write('border-bottom: 1px solid #9EC5F9;');
document.write('}');
document.write('#geld_de_form_pkv1 table td{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('width: 50%;');
document.write('height: 25px;');
document.write('padding: 0px 3px 0px 3px;');
document.write('border-top: 1px solid #9EC5F9;');
document.write('border-left: 1px solid #9EC5F9;');
document.write('}');
document.write('#geld_de_form_pkv1 table td.blue{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('font-size: 13px;');
document.write('font-weight: bold;');
document.write('color: #000;');
document.write('border-top: 1px solid #9EC5F9;');
document.write('border-left: 1px solid #9EC5F9;');
document.write('}');
document.write('#geld_de_form_pkv1 table td.blue_footer{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('font-size: 13px;');
document.write('color: #000;');
document.write('background: #9EC5F9;');
document.write('}');
document.write('#geld_de_form_pkv1 table td.blue_header{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('color: #ffffff;');
document.write('font-size: 14px;');
document.write('line-height: 25px;');
document.write('font-weight: bold;');
document.write('background: #9EC5F9;');
document.write('}');
document.write('#geld_de_form_pkv1 input.button_compare{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('width: 100px;');
document.write('font-size: 13px;');
document.write('margin: 5px;');
document.write('}');
document.write('#geld_de_form_pkv1 .hint{');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('color: #CC0033;');
document.write('}');
document.write('#geld_de_form_pkv1 .footerHint {');
document.write('font-family: Arial, Helvetica, sans-serif;');
document.write('color:#CC0033;');
document.write('font-size:11px;');
document.write('font-weight: bold;');
document.write('}');
document.write('/* ]]> */');
document.write('</style>');
document.write('<div id="geld_de_form_pkv1">');
document.write('<table cellpadding="0" cellspacing="0">');
document.write('<form name="PKVFORM" method="post" action="http://leadsystem.geld.de/packages/leadsystem/index.php" onsubmit="return check_form();">');
document.write('<tr>');
document.write('<td colspan="2" class="blue_header">Private Krankenversicherung</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="24">Vorname<span class="hint">*</span></td>');
document.write('<td><input type="text" name="f1name5" value="" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="24">Nachname<span class="hint">*</span></td>');
document.write('<td><input type="text" name="f1name11" value="" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="27">Geburtsdatum<span class="hint">*</span></td>');
document.write('<td><select name="f1name17[day]">');
document.write('<option value="0" selected="selected">--</option>');
document.write('<option value="1">01</option>');
document.write('<option value="2">02</option>');
document.write('<option value="3">03</option>');
document.write('<option value="4">04</option>');
document.write('<option value="5">05</option>');
document.write('<option value="6">06</option>');
document.write('<option value="7">07</option>');
document.write('<option value="8">08</option>');
document.write('<option value="9">09</option>');
document.write('<option value="10">10</option>');
document.write('<option value="11">11</option>');
document.write('<option value="12">12</option>');
document.write('<option value="13">13</option>');
document.write('<option value="14">14</option>');
document.write('<option value="15">15</option>');
document.write('<option value="16">16</option>');
document.write('<option value="17">17</option>');
document.write('<option value="18">18</option>');
document.write('<option value="19">19</option>');
document.write('<option value="20">20</option>');
document.write('<option value="21">21</option>');
document.write('<option value="22">22</option>');
document.write('<option value="23">23</option>');
document.write('<option value="24">24</option>');
document.write('<option value="25">25</option>');
document.write('<option value="26">26</option>');
document.write('<option value="27">27</option>');
document.write('<option value="28">28</option>');
document.write('<option value="29">29</option>');
document.write('<option value="30">30</option>');
document.write('<option value="31">31</option>');
document.write('</select>');
document.write('-');
document.write('<select name="f1name17[month]">');
document.write('<option value="00" selected="selected">--</option>');
document.write('<option value="01">01</option>');
document.write('<option value="02">02</option>');
document.write('<option value="03">03</option>');
document.write('<option value="04">04</option>');
document.write('<option value="05">05</option>');
document.write('<option value="06">06</option>');
document.write('<option value="07">07</option>');
document.write('<option value="08">08</option>');
document.write('<option value="09">09</option>');
document.write('<option value="10">10</option>');
document.write('<option value="11">11</option>');
document.write('<option value="12">12</option>');
document.write('</select>');
document.write('-');
document.write('<select name="f1name17[year]">');
document.write('<option value="1905">1905</option>');
document.write('<option value="1906">1906</option>');
document.write('<option value="1907">1907</option>');
document.write('<option value="1908">1908</option>');
document.write('<option value="1909">1909</option>');
document.write('<option value="1910">1910</option>');
document.write('<option value="1911">1911</option>');
document.write('<option value="1912">1912</option>');
document.write('<option value="1913">1913</option>');
document.write('<option value="1914">1914</option>');
document.write('<option value="1915">1915</option>');
document.write('<option value="1916">1916</option>');
document.write('<option value="1917">1917</option>');
document.write('<option value="1918">1918</option>');
document.write('<option value="1919">1919</option>');
document.write('<option value="1920">1920</option>');
document.write('<option value="1921">1921</option>');
document.write('<option value="1922">1922</option>');
document.write('<option value="1923">1923</option>');
document.write('<option value="1924">1924</option>');
document.write('<option value="1925">1925</option>');
document.write('<option value="1926">1926</option>');
document.write('<option value="1927">1927</option>');
document.write('<option value="1928">1928</option>');
document.write('<option value="1929">1929</option>');
document.write('<option value="1930">1930</option>');
document.write('<option value="1931">1931</option>');
document.write('<option value="1932">1932</option>');
document.write('<option value="1933">1933</option>');
document.write('<option value="1934">1934</option>');
document.write('<option value="1935">1935</option>');
document.write('<option value="1936">1936</option>');
document.write('<option value="1937">1937</option>');
document.write('<option value="1938">1938</option>');
document.write('<option value="1939">1939</option>');
document.write('<option value="1940">1940</option>');
document.write('<option value="1941">1941</option>');
document.write('<option value="1942">1942</option>');
document.write('<option value="1943">1943</option>');
document.write('<option value="1944">1944</option>');
document.write('<option value="1945">1945</option>');
document.write('<option value="1946">1946</option>');
document.write('<option value="1947">1947</option>');
document.write('<option value="1948">1948</option>');
document.write('<option value="1949">1949</option>');
document.write('<option value="1950">1950</option>');
document.write('<option value="1951">1951</option>');
document.write('<option value="1952">1952</option>');
document.write('<option value="1953">1953</option>');
document.write('<option value="1954">1954</option>');
document.write('<option value="1955">1955</option>');
document.write('<option value="1956">1956</option>');
document.write('<option value="1957">1957</option>');
document.write('<option value="1958">1958</option>');
document.write('<option value="1959">1959</option>');
document.write('<option value="0000" selected="selected">----</option>');
document.write('<option value="1960">1960</option>');
document.write('<option value="1961">1961</option>');
document.write('<option value="1962">1962</option>');
document.write('<option value="1963">1963</option>');
document.write('<option value="1964">1964</option>');
document.write('<option value="1965">1965</option>');
document.write('<option value="1966">1966</option>');
document.write('<option value="1967">1967</option>');
document.write('<option value="1968">1968</option>');
document.write('<option value="1969">1969</option>');
document.write('<option value="1970">1970</option>');
document.write('<option value="1971">1971</option>');
document.write('<option value="1972">1972</option>');
document.write('<option value="1973">1973</option>');
document.write('<option value="1974">1974</option>');
document.write('<option value="1975">1975</option>');
document.write('<option value="1976">1976</option>');
document.write('<option value="1977">1977</option>');
document.write('<option value="1978">1978</option>');
document.write('<option value="1979">1979</option>');
document.write('<option value="1980">1980</option>');
document.write('<option value="1981">1981</option>');
document.write('<option value="1982">1982</option>');
document.write('<option value="1983">1983</option>');
document.write('<option value="1984">1984</option>');
document.write('<option value="1985">1985</option>');
document.write('<option value="1986">1986</option>');
document.write('<option value="1987">1987</option>');
document.write('<option value="1988">1988</option>');
document.write('<option value="1989">1989</option>');
document.write('<option value="1990">1990</option>');
document.write('<option value="1991">1991</option>');
document.write('<option value="1992">1992</option>');
document.write('<option value="1993">1993</option>');
document.write('<option value="1994">1994</option>');
document.write('<option value="1995">1995</option>');
document.write('<option value="1996">1996</option>');
document.write('<option value="1997">1997</option>');
document.write('<option value="1998">1998</option>');
document.write('<option value="1999">1999</option>');
document.write('<option value="2000">2000</option>');
document.write('<option value="2001">2001</option>');
document.write('<option value="2002">2002</option>');
document.write('<option value="2003">2003</option>');
document.write('<option value="2004">2004</option>');
document.write('<option value="2005">2005</option>');
document.write('</select>');
document.write('</td>');
document.write('</tr>');
document.write('<tr >');
document.write('<td>Geschlecht<span class="hint">*</span></td>');
document.write('<td><input type="radio" name="f1name21" value="m" id="f1name27" checked="checked" />');
document.write('m&auml;nnlich');
document.write('<input type="radio" name="f1name21" value="w" id="f1name31" />');
document.write('weiblich </td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="27">Beruf<span class="hint">*</span></td>');
document.write('<td><select name="f1name37" id="f1name37">');
document.write('<option value="Angestellter">Angestellte(r)</option>');
document.write('<option value="Selbststaendiger">Selbstst&auml;ndige(r)</option>');
document.write('<option value="Freiberufler">Freiberufler(in)</option>');
document.write('<option value="Beamter">Beamte(r)</option>');
document.write('<option value="Beamtenanwaerter">Beamtenanw&auml;rter(in)</option>');
document.write('<option value="Hausfrau">Hausfrau</option>');
document.write('<option value="Student">Student(in)</option>');
document.write('<option value="Schueler">Sch&uuml;ler(in)</option>');
document.write('<option value="nicht berufstaetig">nicht berufst&auml;tig</option>');
document.write('<option value="Rentner">Rentner(in)</option>');
document.write('<option value="Azubi">Azubi</option>');
document.write('</select>');
document.write('</td>');
document.write('</tr>');
document.write('<tr >');
document.write('<td height="24">Strasse<span class="hint">*</span></td>');
document.write('<td><input type="text" name="f1name43" value="" id="f1name43" maxlength="100" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr >');
document.write('<td height="24">Hausnummer<span class="hint">*</span></td>');
document.write('<td><input type="text" name="f1name49" value="" id="f1name49" maxlength="100" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>PLZ<span class="hint">*</span></td>');
document.write('<td><input type="text" name="f1name55" value="" id="f1name55" maxlength="10" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="24">Stadt<span class="hint">*</span></td>');
document.write('<td><input type="text" name="f1name61" value="" id="f1name61" maxlength="50" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>Telefon <span class="hint">*');
document.write('<br />');
document.write('<strong>Ihre Anfrage kann nur mit korrekter Telefonnummer bearbeitet werden!</strong></span> </td>');
document.write('<td><input type="text" name="f1name67" value="" id="f1name67" maxlength="50" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="24">Telefon tags&uuml;ber (bzw. Handy)</td>');
document.write('<td><input type="text" name="f1name73" value="" id="f1name73" maxlength="50" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td height="24">Email<span color="<?=$styles[\'hintColor\']?>">*</span></td>');
document.write('<td><input type="text" name="f1name79" value="" id="f1name79" maxlength="50" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>Jahreseinkommen <span class="hint">*');
document.write('<br />');
document.write('<strong>Aufgrund der Beitragsbemessungsgrenze ist die Angabe des Jahreseinkommens wichtig!</strong></span> </td>');
document.write('<td><select name="f1name85" id="f1name85">');
document.write('<option value="">-- bitte ausw&auml;hlen --</option>');
document.write('<option value="bis 15000">bis 15.000,- Euro</option>');
document.write('<option value="bis 30000">bis 30.000,- Euro</option>');
document.write('<option value="bis BBG">bis 49.950,- Euro</option>');
document.write('<option value="ueber BBG">ab 49.950,- Euro</option>');
document.write('</select>');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="2" class="blue_header">Angaben zu Ihrer gew&uuml;nschten Versicherung</td>');
document.write('</tr>');
document.write('<tr >');
document.write('<td>Wie sind Sie derzeit versichert?</td>');
document.write('<td><select name="f1name95" id="f1name95">');
document.write('<option value="privat versichert">privat versichert</option>');
document.write('<option value="freiwillig gesetzlich versichert">freiwillig gesetzlich versichert</option>');
document.write('<option value="gar nicht versichert">gar nicht versichert</option>');
document.write('</select>');
document.write('</td>');
document.write('</tr>');
document.write('<tr >');
document.write('<td>Gew&uuml;nschte Selbstbeteiligung (SB):</td>');
document.write('<td><select name="f1name101" id="f1name101">');
document.write('<option value="ohne SB">ohne SB</option>');
document.write('<option value="beitragsoptimiert">beitragsoptimiert</option>');
document.write('<option value="bis 150 Euro">bis 150 Euro</option>');
document.write('<option value="bis 300 Euro">bis 300 Euro</option>');
document.write('<option value="bis 500 Euro">bis 500 Euro</option>');
document.write('<option value="bis 600 Euro">bis 600 Euro</option>');
document.write('<option value="bis 700 Euro">bis 700 Euro</option>');
document.write('<option value="bis 800 Euro">bis 800 Euro</option>');
document.write('<option value="bis 900 Euro">bis 900 Euro</option>');
document.write('<option value="bis 1000 Euro">bis 1000 Euro</option>');
document.write('<option value="bis 1250 Euro">bis 1250 Euro</option>');
document.write('<option value="bis 5000 Euro">bis 5000 Euro</option>');
document.write('</select>');
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