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<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">


<script type="text/javascript">


var areadb = new Object()
areadb["sa"] = [{value:"a", text:"Gauteng"},
		{value:"b", text:"Free State"},
                {value:"c", text:"Western Cape"},
                {value:"d", text:"Eastern Cape"},
		{value:"e", text:"Northern Cape"},
		{value:"f", text:"Kwazulu-Natal"},
		{value:"g", text:"North West"},
		{value:"h", text:"Limpopo"},
		{value:"i", text:"Mpumalanga"}];

areadb["swaz"] = [{value:"as", text:"Swaziland"}];

areadb["bots"] = [{value:"ab", text:"Gaborone"},
				  {value:"abb", text:"Francistown"}];

var detailsdb = new Object()
detailsdb["a"] = [{value:"", text:"East London"}];


function setCities(chooser) {
    var newElem;
    var where = (navigator.appName == "Microsoft Internet Explorer") ? -1 : null;
    var cityChooser = chooser.form.elements["country"];
    while (cityChooser.options.length) {
        cityChooser.remove(0);
    }
    var choice = chooser.options[chooser.selectedIndex].value;
    var db = countrydb[choice];
    newElem = document.createElement("option");
    newElem.text = "Choose a Country:";
    newElem.value = "";
    cityChooser.add(newElem, where);
    if (choice != "") {
        for (var i = 0; i < db.length; i++) {
            newElem = document.createElement("option");
            newElem.text = db[i].text;
            newElem.value = db[i].value;
            cityChooser.add(newElem, where);
        }
    }
}

function setRegion(chooser) {
    var newElem;
    var where = (navigator.appName == "Microsoft Internet Explorer") ? -1 : null;
    var cityChooser = chooser.form.elements["area"];
    while (cityChooser.options.length) {
        cityChooser.remove(0);
    }
    var choice = chooser.options[chooser.selectedIndex].value;
    var db = areadb[choice];
    newElem = document.createElement("option");
    newElem.text = "Choose an Area:";
    newElem.value = "";
    cityChooser.add(newElem, where);
    
    if (choice != "") {
        for (var i = 0; i < db.length; i++) {
            newElem = document.createElement("option");
            newElem.text = db[i].text;
            newElem.value = db[i].value;
            cityChooser.add(newElem, where);
        }
    }
}


function setDetails(chooser) {
   
    var newElem;
    var where = (navigator.appName == "Microsoft Internet Explorer") ? -1 : null;
    //var cityChooser = chooser.form.elements["details"];
 
    var choice = chooser.options[chooser.selectedIndex].value;
  //alert (choice); 
    var db = detailsdb[choice];
    
//	cityChooser.text = "";

    if (choice != "") 
    {
	if(choice=="a")
	{
		document.getElementById('G2').style.display="block";
		document.getElementById('GP').style.display="none";
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		if(choice=="b")
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		if(choice=="c")
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		if(choice=="d")
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		document.getElementById('GP').style.display="block";
		document.getElementById('G2').style.display="none";
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		if(choice=="e")
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		document.getElementById('GP').style.display="block";
		document.getElementById('G2').style.display="none";
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		if(choice=="f")
	{
		document.getElementById('GP').style.display="block";
		document.getElementById('G2').style.display="none";

	}
    }
}

/**********
  DOM LEVEL 0 ALTERNATE
 **********
function setCities(chooser) {
    var cityChooser = chooser.form.elements["city"];
    // empty previous settings
    cityChooser.options.length = 0;
    // get chosen value to act as index to regiondb hash table
    var choice = chooser.options[chooser.selectedIndex].value;
    var db = regiondb[choice];
    // insert default first item
    cityChooser.options[0] = new Option("Choose a City:", "", true, false);
    if (choice != "") {
        // loop through array of the hash table entry, and populate options
        for (var i = 0; i < db.length; i++) {
            cityChooser.options[i + 1] = new Option(db[i].text, db[i].value);
        }
    }
}
**********/

</script>

<!-- InstanceEndEditable -->
<link href="css/styles_payd.css" rel="stylesheet" type="text/css" />
<script src="nav_css/jquery.js" type="text/javascript"></script>
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</head>
<body>
       <script language="javascript">

           function checkform() {

               var o_name = document.getElementById("name");
               var o_surname = document.getElementById("surname");
               var o_contact = document.getElementById("number");
               var o_email = document.getElementById("email");
               var o_message = document.getElementById("Message");

               if (o_name.value == '') {
                   alert("Please enter a valid name")

                   return false;
               }

               if (o_surname.value == '') {
                   alert("Please enter a valid surname")

                   return false;
               }

               if (o_contact.value == '') {
                   alert("Please enter a valid contact number")

                   return false;
               }

               if (o_email.value == '') {
                   alert("Please enter a valid email address")

                   return false;
               }

               return true;


           }

           function checkform1() {

               var o_name = document.getElementById("name");
               var o_surname = document.getElementById("surname");
               var o_contact = document.getElementById("number");
               var o_email = document.getElementById("email");
               var o_message = document.getElementById("Message");

               if (o_name.value == '') {
                   alert("Please enter a valid name")

                   return false;
               }

               if (o_surname.value == '') {
                   alert("Please enter a valid surname")

                   return false;
               }

               if (o_contact.value == '') {
                   alert("Please enter a valid contact number")

                   return false;
               }

               if (o_email.value == '') {
                   alert("Please enter a valid email address")

                   return false;
               }

               return true;


           }
       
       </script>
       <div id="content">
    <div><br />
      <strong> </strong>
      <ul>
        <li>Please call <strong>0861 360&nbsp;360</strong> for <strong>sales </strong>related enquiries (see business hours below)</li>
        <li>To have a sales agent call you, please SMS* “<strong>Web</strong>” to <strong>41363</strong> or call <strong>0861 360&nbsp;360</strong></li>
        <li>You can also e-mail any enquiries or suggestions to <a href="paydcommunications@hollard.co.za">paydcommunications@hollard.co.za</a></li>
      </ul>
      <p><strong><br />
      Sales Contact Centre hours</strong></p>
      <blockquote>
        <p>08:00 to 20:00 Monday to Thursday<br />
          08:00 to 18:30 Friday<br />
          08:00 to 13:00 Saturday</p>
      </blockquote>
      <p><strong>Request a Phone Call from Us</strong></p>
      <blockquote>
        <p>Please complete and submit the following form and we will phone you:<br />
          <br />
        </p>
        <table width="557" border="0" cellspacing="0" cellpadding="0">
        <tr>
          <td width="4" height="30" align="left" valign="top">&nbsp;</td>
          <td width="106" height="30" align="left" valign="top">Requirement:</td>
          <td width="447" align="left" valign="top"><select name="select2" id="select2" onchange="setDetails(this)">
            <option selected="selected">Please select</option>
            <option value="a">Sales Consultant</option>
            <option value="b">Client Services Consultant</option>
            <option value="c">Claim Consultant</option>
            <option value="d">Complaint</option>
            <option value="e">Compliment</option>
            <option value="f">Other</option>
          </select></td>
        </tr>
      </table>
      <p><br />
        <br />
      <div id="GP" style="display:none;">
        <form action="contact.aspx" method="post" name="General Form" id="General Form">
          <br />
          <fieldset>
            <br />
            <label for="textfield4">First Name</label>
            <input type="text" name="name" id="name" />
            <br />
            <label for="textfield4">Surname</label>
            <input type="text" name="Surname" id="Surname" />
            <br />
            <label for="textfield4">Mobile</label>
            <input type="text" name="number" id="number" />
            <br />
            <label for="textfield4">Email Address</label>
            <input type="text" name="email" id="email" />
            <br />
            <label for="textfield5">Policy Number</label>
            <input type="text" name="policy" id="policy" />
            <br />
            <label for="textfield6">Message</label>
            <textarea name="Message" rows="4" id="Message"></textarea>
            <br />
            <br />
            <label for="kludge2"></label>
            <input name="HTTP_r" type="hidden"  class="input" id="HTTP_r" value="Google" />
				        <input name="FromForm" type="hidden"  class="input" id="FromForm" value="ContactUS" />
				        <input name="TTRCode" type="hidden"  class="input" id="TTRCode" value="0" />
            <input type="submit" value="Send" id="submit2" tabindex="5" onclick="javascript:return checkform();" />
            <input type="reset" id="reset2" tabindex="6" />
          </fieldset>
          <br />
        </form>
      </div>
      </p>
      <div id="G2" style="display:none;">
        <form action="sales.php" method="post" name="Sales Consultant Form" id="Sales Consultant Form">
          <br />
          <fieldset>
            <label for="textfield2">First Name</label>
            <input type="text" name="name" id="name" />
            <br />
            <label for="textfield2">Surname</label>
            <input type="text" name="surname" id="surname" />
            <br />
            <label for="textfield2">Mobile</label>
            <input type="text" name="number" id="number" />
            <br />
            <label for="textfield2">Email Address</label>
            <input type="text" name="email" id="email" />
            <br />
            <label for="firstname4" accesskey="f">Are you older than <br />
              25 years?</label>
            <select name="age" class="select" id="age">
              <option value="-">Make Selection</option>
              <option value="yes">Yes</option>
              <option value="no">No</option>
            </select>
            <br />
            <label for="surname4" accesskey="l">Have you had your driver's license for <br />
              more than 12 months?</label>
            <select name="license" class="select" id="km5">
              <option value="-">Make Selection</option>
              <option value="yes">Yes</option>
              <option value="no">No</option>
            </select>
            </select>
            </label>
            <br />
            <label for="email4" accesskey="e">Do you drive LESS than 1500 km PER MONTH</label>
            <select name="kms" class="select" id="km6">
              <option value="-">Make Selection</option>
              <option value="yes">Yes</option>
              <option value="no">No</option>
            </select>
            <br />
            <br />
            <label for="kludge3"></label>
            <input name="HTTP_r" type="hidden"  class="input" id="HTTP_r" value="Google" />
				        <input name="FromForm" type="hidden"  class="input" id="FromForm" value="ContactUS" />
				        <input name="TTRCode" type="hidden"  class="input" id="TTRCode" value="0" />
            <input type="submit" value="Send" id="submit3" tabindex="5" />
            <input type="reset" id="reset3" tabindex="6" />
            <br />
          </fieldset>
          <br />
        </form>
      </div>
      <br />
      <p><strong>Hollard Insurance Physical Address</strong></p>
      <blockquote>
        <p>22 Oxford Road<br />
          Entrance off Federation Road<br />
          Parktown<br />
          Johannesburg<br />
          2193<br />
          *Charged at standard network rates.</p>
      </blockquote>
      <table width="681" border="0" cellpadding="0" cellspacing="0">
        <tr>
          <td width="681" height="100" align="center" bgcolor="#4A2984" class="whitebig"><strong>Emergency Assistance</strong> <span class="whitesmaller"><br />
            <br />
            For 24 hour assistance with <strong>Towing</strong> or <strong>Roadside Assistance</strong> <br />
            or <strong>Medical Assistance</strong> call <strong>0861 000&nbsp;911</strong>.</span></td>
        </tr>
      </table>
      <br />
</div>
  </div>
</body>
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