function show(){
	var myWin= open("http://www.claimhelpline.co.uk/claims/items.php",  "displayWindow", "width=600,height=500,scrollbars=yes,resizable=yes,status=no,toolbar=no,menubar=no");
}
function print(str){
	document.getElementById('form').innerHTML =  responseText;
}
function sendScriptRequest(url, httpParams, callback, callbackArgsArray) {
var currentScript = document.createElement("SCRIPT");
if (httpParams)
httpParams="?rand=" + Math.random() + "&" + httpParams;
else
httpParams="?rand=" + Math.random();
currentScript.ajax_readyState = false;
currentScript.onload = scriptCallback(currentScript, callback, callbackArgsArray);
currentScript.onreadystatechange = scriptCallback(currentScript, callback, callbackArgsArray);
currentScript.src = url + httpParams;
document.getElementsByTagName("script")[0].parentNode.appendChild(currentScript);
}function scriptCallback(currentScript, callback, callbackArgsArray){
return function() {
if (currentScript.ajax_readyState)
return;
if (! currentScript.readyState || currentScript.readyState == "loaded" || currentScript.readyState == "complete") {
currentScript.ajax_readyState = true;
callback.apply(currentScript, callbackArgsArray)
currentScript.parentNode.removeChild(currentScript);
}
}
}

var str=new String;
var pl=new String;
var ty=new String;
function send() {
	str= 'other=';
	var q=1;
	if (document.getElementById('place').value!="" && document.getElementById('type').value!=""){	pl='place='+document.getElementById('place').value;
		ty='type='+document.getElementById('type').value;
		var j=0;
		var f=0;
		if ( document.getElementById( 'Your Full Name:' ).value != "" ) str = str + 'Your Full Name:'  + '-' + document.getElementById( 'Your Full Name:' ).value + '_' ; else { if(1 == 1) f++; }if ( document.getElementById( 'Your Phone Number:' ).value != "" ) str = str + 'Your Phone Number:'  + '-' + document.getElementById( 'Your Phone Number:' ).value + '_' ; else { if(1 == 1) f++; }if ( document.getElementById( 'Your email address:' ).value != "" ) str = str + 'Your email address:'  + '-' + document.getElementById( 'Your email address:' ).value + '_' ; else { if(0 == 1) f++; }if ( document.getElementById( 'Briefly describe what happened to you:' ).value != "" ) str = str + 'Briefly describe what happened to you:'  + '-' + document.getElementById( 'Briefly describe what happened to you:' ).value + '_' ; else { if(0 == 1) f++; }if ( document.getElementById( 'Best time to contact you:' ).value != "" ) str = str + 'Best time to contact you:'  + '-' + document.getElementById( 'Best time to contact you:' ).value + '_' ; else { if(0 == 1) f++; }         if (f>0)document.getElementById('capt').innerHTML='Please fill all required fields (marked with *)'; else {
         	if (document.getElementById('check').checked == false){
         		document.getElementById('capt').innerHTML='You should accept terms and conditions before submiting the form';
         	}else{
         	document.getElementById('capt').innerHTML='';
         	sendScriptRequest("http://www.claimhelpline.co.uk/claims//user.php?", str+'&'+pl+'&'+ty,print, ["test123"]);
         	}
         }

}else { document.getElementById('capt').innerHTML = 'You need to fill in both location and type'; }}
document.write('<div id="all"><div id="capt"></div><div id="form"></div></div>');
sendScriptRequest("http://www.claimhelpline.co.uk/claims/uform.php", "a=1&b=2",print, ["test123"]);