function Validate()
{
	var txtPhNo = document.getElementById("txtPhNo");
	var txtName = document.getElementById("txtName");
	var ddlCity = document.getElementById("ddlCity");
	if(txtName.value == "")
	{
		alert("Please Enter Valid Name");	
		txtName.focus();
		return false;
	}
	
	if(txtPhNo.value == "")
	{
		alert("Please Enter Valid Phone No");	
		txtPhNo.focus();
		return false;
	}
	if(ddlCity.value == "0")
	{
		alert("Please Select City");	
		ddlCity.focus();
		return false;
	}
	else
	{
		if(!IsNumeric(txtPhNo.value))
		{
			alert("Please Enter Valid Phone No");	
			txtPhNo.focus();
			return false;	
		}
	}
	
	return true;
}

function IsNumeric(strString)
{
   var strValidChars = "0123456789";
   var strChar;
   var blnResult = true;

   if (strString.length == 0) return false;

   //  test strString consists of valid characters listed above
   for (i = 0; i < strString.length && blnResult == true; i++)
	  {
	  strChar = strString.charAt(i);
	  if (strValidChars.indexOf(strChar) == -1)
		 {
		 blnResult = false;
		 }
	  }
   return blnResult;
}
document.writeln('<div id="somediv" style="display:none">');
document.writeln('<div style="position:relative; width:350px;">');
document.writeln('<form id="form1" name="form1" method="post" action="http://www.dhfl.com/thank_you_callback.asp">');
document.writeln('<table width="330" border="0" cellpadding="0" cellspacing="0" class="tbl-pad-popup-call">');
document.writeln('<tr>');
document.writeln('<td colspan="2" align="left" valign="top" class="bg-header-popup"><img src="'+ _gRootPath +'images/i_logo_dhfl_popup.gif" width="186" height="64" border="0" /></td>');
document.writeln('</tr>');
document.writeln('<tr>');
document.writeln('<td colspan="2" align="left" valign="top">Thank you. To speak with a DHFL Home Loan Counselor please enter your phone / mobile number below and we will call you back soon.</td>');
document.writeln('</tr>');
document.writeln('<tr>');
document.writeln('<td width="125" align="left" valign="top"><strong>Name </strong></td>');
document.writeln('<td width="205" align="left" valign="top">');
document.writeln('<label>');
document.writeln('<input type="text" name="txtName" id="txtName" class="input" />');
document.writeln('</label></td>');
document.writeln('</tr>');
document.writeln('<tr>');
document.writeln('<td width="125" align="left" valign="top"><strong>Phone Number </strong></td>');
document.writeln('<td width="205" align="left" valign="top">');
document.writeln('<label>');
document.writeln('<input type="text" name="txtPhNo" id="txtPhNo" class="input" /><br />(ISD-STD-No.)');
document.writeln('</label></td>');
document.writeln('</tr>');
document.writeln('<tr>');
document.writeln('<td width="125" align="left" valign="top"><strong>City </strong></td>');
document.writeln('<td width="205" align="left" valign="top">');
document.writeln('<select id="ddlCity" name="ddlCity" style="width: 160px;" class="input-field">');
document.writeln('<option value="0">Select a City </option>');
document.writeln('<optgroup value="0" label="Metros" style="color: White; background-color: SlateGray; font-style: normal; font-weight: bold;"></optgroup>');
document.writeln('<option value="Bangalore">Bangalore</option>');
document.writeln('<option value="Chennai">Chennai</option>');
document.writeln('<option value="Faridabad">Faridabad</option>');
document.writeln('<option value="Ghaziabad">Ghaziabad</option>');
document.writeln('<option value="Gurgaon">Gurgaon</option>');
document.writeln('<option value="Howrah">Howrah</option>');
document.writeln('<option value="Hyderabad">Hyderabad</option>');
document.writeln('<option value="Kolkata">Kolkata</option>');
document.writeln('<option value="Mumbai">Mumbai</option>');
document.writeln('<option value="Navi Mumbai">Navi Mumbai</option>');
document.writeln('<option value="New Delhi">New Delhi</option>');
document.writeln('<option value="Noida">Noida</option>');
document.writeln('<option value="Pune">Pune</option>');
document.writeln('<option value="Secunderabad">Secunderabad</option>');
document.writeln('<option value="Thane">Thane</option>');
document.writeln('<optgroup value="0" label="Other Cities" style="color: White; background-color: SlateGray; font-style: normal; font-weight: bold;"></optgroup>');
document.writeln('<option value="Agra">Agra</option>');
document.writeln('<option value="Ahmedabad">Ahmedabad</option>');
document.writeln('<option value="Ahmednagar">Ahmednagar</option>');
document.writeln('<option value="Ajmer">Ajmer</option>');
document.writeln('<option value="Akola">Akola</option>');
document.writeln('<option value="Alappuzha">Alappuzha</option>');
document.writeln('<option value="Aligarh">Aligarh</option>');
document.writeln('<option value="Allahabad">Allahabad</option>');
document.writeln('<option value="Alleppey">Alleppey</option>');
document.writeln('<option value="Aluva">Aluva</option>');
document.writeln('<option value="Alwar">Alwar</option>');
document.writeln('<option value="Ambala">Ambala</option>');
document.writeln('<option value="Amravati">Amravati</option>');
document.writeln('<option value="Amritsar">Amritsar</option>');
document.writeln('<option value="Anand">Anand</option>');
document.writeln('<option value="Anantapur">Anantapur</option>');
document.writeln('<option value="Anantnag">Anantnag</option>');
document.writeln('<option value="Ankleshwar">Ankleshwar</option>');
document.writeln('<option value="Arakkonam">Arakkonam</option>');
document.writeln('<option value="Asansol">Asansol</option>');
document.writeln('<option value="Aurangabad">Aurangabad</option>');
document.writeln('<option value="Avadi">Avadi</option>');
document.writeln('<option value="Baddi">Baddi</option>');
document.writeln('<option value="Bagalkot">Bagalkot</option>');
document.writeln('<option value="Bangalore">Bangalore</option>');
document.writeln('<option value="Bardoli">Bardoli</option>');
document.writeln('<option value="Bareilly">Bareilly</option>');
document.writeln('<option value="Barkathpura">Barkathpura</option>');
document.writeln('<option value="Baroda">Baroda</option>');
document.writeln('<option value="Batala">Batala</option>');
document.writeln('<option value="Beawar">Beawar</option>');
document.writeln('<option value="Belgaum">Belgaum</option>');
document.writeln('<option value="Bellary">Bellary</option>');
document.writeln('<option value="Berhampur">Berhampur</option>');
document.writeln('<option value="Bharuch">Bharuch</option>');
document.writeln('<option value="Bhatinda">Bhatinda</option>');
document.writeln('<option value="Bhavnagar">Bhavnagar</option>');
document.writeln('<option value="Bhilai">Bhilai</option>');
document.writeln('<option value="Bhilwara">Bhilwara</option>');
document.writeln('<option value="Bhimavaram">Bhimavaram</option>');
document.writeln('<option value="Bhiwandi">Bhiwandi</option>');
document.writeln('<option value="Bhopal">Bhopal</option>');
document.writeln('<option value="Bhubaneshwar">Bhubaneshwar</option>');
document.writeln('<option value="Bhuj">Bhuj</option>');
document.writeln('<option value="Bidar">Bidar</option>');
document.writeln('<option value="Bijapur">Bijapur</option>');
document.writeln('<option value="Bikaner">Bikaner</option>');
document.writeln('<option value="Bilaspur">Bilaspur</option>');
document.writeln('<option value="Boisar">Boisar</option>');
document.writeln('<option value="Bokaro">Bokaro</option>');
document.writeln('<option value="Calicut">Calicut</option>');
document.writeln('<option value="Chandigarh">Chandigarh</option>');
document.writeln('<option value="Chandrapur">Chandrapur</option>');
document.writeln('<option value="Changanacherry">Changanacherry</option>');
document.writeln('<option value="Chankheda">Chankheda</option>');
document.writeln('<option value="Chennai">Chennai</option>');
document.writeln('<option value="Chidambaram">Chidambaram</option>');
document.writeln('<option value="Chitradurga">Chitradurga</option>');
document.writeln('<option value="Chokodi">Chokodi</option>');
document.writeln('<option value="Cochin">Cochin</option>');
document.writeln('<option value="Coimbatore">Coimbatore</option>');
document.writeln('<option value="Cuddalore">Cuddalore</option>');
document.writeln('<option value="Cuttack">Cuttack</option>');
document.writeln('<option value="Dahanu">Dahanu</option>');
document.writeln('<option value="Dahej">Dahej</option>');
document.writeln('<option value="Daman">Daman</option>');
document.writeln('<option value="Dausa">Dausa</option>');
document.writeln('<option value="Davangere">Davangere</option>');
document.writeln('<option value="Dehradun">Dehradun</option>');
document.writeln('<option value="Delhi">Delhi</option>');
document.writeln('<option value="Derabassi">Derabassi</option>');
document.writeln('<option value="Dewas">Dewas</option>');
document.writeln('<option value="Dhanbad">Dhanbad</option>');
document.writeln('<option value="Dharwad">Dharwad</option>');
document.writeln('<option value="Dhule">Dhule</option>');
document.writeln('<option value="Dindigul">Dindigul</option>');
document.writeln('<option value="Durg">Durg</option>');
document.writeln('<option value="Durgapur">Durgapur</option>');
document.writeln('<option value="Eluru">Eluru</option>');
document.writeln('<option value="Ernakulam">Ernakulam</option>');
document.writeln('<option value="Erode">Erode</option>');
document.writeln('<option value="Faizabad">Faizabad</option>');
document.writeln('<option value="Faridabad">Faridabad</option>');
document.writeln('<option value="Firozabad">Firozabad</option>');
document.writeln('<option value="Gandhidham">Gandhidham</option>');
document.writeln('<option value="Gandhinagar">Gandhinagar</option>');
document.writeln('<option value="Gangtok">Gangtok</option>');
document.writeln('<option value="Ghaziabad">Ghaziabad</option>');
document.writeln('<option value="Goa">Goa</option>');
document.writeln('<option value="Gokak">Gokak</option>');
document.writeln('<option value="Gorakhpur">Gorakhpur</option>');
document.writeln('<option value="Gulbarga">Gulbarga</option>');
document.writeln('<option value="Guntur">Guntur</option>');
document.writeln('<option value="Gurgaon">Gurgaon</option>');
document.writeln('<option value="Guwahati">Guwahati</option>');
document.writeln('<option value="Gwalior">Gwalior</option>');
document.writeln('<option value="Haldwani">Haldwani</option>');
document.writeln('<option value="Hapur">Hapur</option>');
document.writeln('<option value="Haridwar">Haridwar</option>');
document.writeln('<option value="Harpanahalli">Harpanahalli</option>');
document.writeln('<option value="Hassan">Hassan</option>');
document.writeln('<option value="Haveri">Haveri</option>');
document.writeln('<option value="Hazirabagh">Hazirabagh</option>');
document.writeln('<option value="Himmatnagar">Himmatnagar</option>');
document.writeln('<option value="Hissar">Hissar</option>');
document.writeln('<option value="Hoshiarpur">Hoshiarpur</option>');
document.writeln('<option value="Hospet">Hospet</option>');
document.writeln('<option value="Hosur">Hosur</option>');
document.writeln('<option value="Howrah">Howrah</option>');
document.writeln('<option value="Hubli">Hubli</option>');
document.writeln('<option value="Hyderabad">Hyderabad</option>');
document.writeln('<option value="Idukki">Idukki</option>');
document.writeln('<option value="Indore">Indore</option>');
document.writeln('<option value="Jabalpur">Jabalpur</option>');
document.writeln('<option value="Jaipur">Jaipur</option>');
document.writeln('<option value="Jalandhar">Jalandhar</option>');
document.writeln('<option value="Jalgaon">Jalgaon</option>');
document.writeln('<option value="Jalna">Jalna</option>');
document.writeln('<option value="Jammu">Jammu</option>');
document.writeln('<option value="Jamnagar">Jamnagar</option>');
document.writeln('<option value="Jamshedpur">Jamshedpur</option>');
document.writeln('<option value="Jhansi">Jhansi</option>');
document.writeln('<option value="Jodhpur">Jodhpur</option>');
document.writeln('<option value="Junagadh">Junagadh</option>');
document.writeln('<option value="Kadappa">Kadappa</option>');
document.writeln('<option value="Kakinada">Kakinada</option>');
document.writeln('<option value="Kalka">Kalka</option>');
document.writeln('<option value="Kallakurichi">Kallakurichi</option>');
document.writeln('<option value="Kalyan">Kalyan</option>');
document.writeln('<option value="Kancheepuran">Kancheepuran</option>');
document.writeln('<option value="Kankroli">Kankroli</option>');
document.writeln('<option value="Kannur">Kannur</option>');
document.writeln('<option value="Kanpur">Kanpur</option>');
document.writeln('<option value="Kanyakumari">Kanyakumari</option>');
document.writeln('<option value="Kapurthala">Kapurthala</option>');
document.writeln('<option value="Karad">Karad</option>');
document.writeln('<option value="Karaikudi">Karaikudi</option>');
document.writeln('<option value="Karimnagar">Karimnagar</option>');
document.writeln('<option value="Karnal">Karnal</option>');
document.writeln('<option value="Karur">Karur</option>');
document.writeln('<option value="Karwar">Karwar</option>');
document.writeln('<option value="Kasaragode">Kasaragode</option>');
document.writeln('<option value="Katni">Katni</option>');
document.writeln('<option value="Khammam">Khammam</option>');
document.writeln('<option value="Khandwa">Khandwa</option>');
document.writeln('<option value="Khanna">Khanna</option>');
document.writeln('<option value="Khargone">Khargone</option>');
document.writeln('<option value="Kolar">Kolar</option>');
document.writeln('<option value="Kolhapur">Kolhapur</option>');
document.writeln('<option value="Kolkata">Kolkata</option>');
document.writeln('<option value="Kollam">Kollam</option>');
document.writeln('<option value="Kota">Kota</option>');
document.writeln('<option value="Kottayam">Kottayam</option>');
document.writeln('<option value="Kovilatti">Kovilatti</option>');
document.writeln('<option value="Kozhikode">Kozhikode</option>');
document.writeln('<option value="Kumbakonam">Kumbakonam</option>');
document.writeln('<option value="Kurnool">Kurnool</option>');
document.writeln('<option value="Kurukshetra">Kurukshetra</option>');
document.writeln('<option value="Lathur">Lathur</option>');
document.writeln('<option value="Lucknow">Lucknow</option>');
document.writeln('<option value="Ludhiana">Ludhiana</option>');
document.writeln('<option value="Madurai">Madurai</option>');
document.writeln('<option value="Mahabubnagar">Mahabubnagar</option>');
document.writeln('<option value="Mahad">Mahad</option>');
document.writeln('<option value="Malappuram">Malappuram</option>');
document.writeln('<option value="Mandya">Mandya</option>');
document.writeln('<option value="Mangalore">Mangalore</option>');
document.writeln('<option value="Mangan">Mangan</option>');
document.writeln('<option value="Manipal">Manipal</option>');
document.writeln('<option value="Manjeri">Manjeri</option>');
document.writeln('<option value="Mansarovar">Mansarovar</option>');
document.writeln('<option value="Mapusa">Mapusa</option>');
document.writeln('<option value="Mathura">Mathura</option>');
document.writeln('<option value="Mavelikara">Mavelikara</option>');
document.writeln('<option value="Meerut">Meerut</option>');
document.writeln('<option value="Mehsana">Mehsana</option>');
document.writeln('<option value="Moga">Moga</option>');
document.writeln('<option value="Mohali">Mohali</option>');
document.writeln('<option value="Morvi">Morvi</option>');
document.writeln('<option value="Mudhol">Mudhol</option>');
document.writeln('<option value="Mumbai">Mumbai</option>');
document.writeln('<option value="Mysore">Mysore</option>');
document.writeln('<option value="Nabha">Nabha</option>');
document.writeln('<option value="Nadiad">Nadiad</option>');
document.writeln('<option value="Nagercoil">Nagercoil</option>');
document.writeln('<option value="Nagpur">Nagpur</option>');
document.writeln('<option value="Nanded">Nanded</option>');
document.writeln('<option value="Nandyal">Nandyal</option>');
document.writeln('<option value="Narsipatnam">Narsipatnam</option>');
document.writeln('<option value="Nashik">Nashik</option>');
document.writeln('<option value="Navi Mumbai">Navi Mumbai</option>');
document.writeln('<option value="Navsari">Navsari</option>');
document.writeln('<option value="Neelamangala">Neelamangala</option>');
document.writeln('<option value="Nellore">Nellore</option>');
document.writeln('<option value="New Delhi">New Delhi</option>');
document.writeln('<option value="Nizamabad">Nizamabad</option>');
document.writeln('<option value="Noida">Noida</option>');
document.writeln('<option value="Nokha">Nokha</option>');
document.writeln('<option value="Other City">Other City</option>');
document.writeln('<option value="Ongole">Ongole</option>');
document.writeln('<option value="Palakkad">Palakkad</option>');
document.writeln('<option value="Palanpur">Palanpur</option>');
document.writeln('<option value="Palghar">Palghar</option>');
document.writeln('<option value="Pali">Pali</option>');
document.writeln('<option value="Panchkulla">Panchkulla</option>');
document.writeln('<option value="Panipat">Panipat</option>');
document.writeln('<option value="Panjim">Panjim</option>');
document.writeln('<option value="Panvel">Panvel</option>');
document.writeln('<option value="Parbhani">Parbhani</option>');
document.writeln('<option value="Patalganga">Patalganga</option>');
document.writeln('<option value="Pathanamthitta">Pathanamthitta</option>');
document.writeln('<option value="Pathankot">Pathankot</option>');
document.writeln('<option value="Patiala">Patiala</option>');
document.writeln('<option value="Patna">Patna</option>');
document.writeln('<option value="Pen">Pen</option>');
document.writeln('<option value="Phagwara">Phagwara</option>');
document.writeln('<option value="Pithampur">Pithampur</option>');
document.writeln('<option value="Pollachi">Pollachi</option>');
document.writeln('<option value="Ponda">Ponda</option>');
document.writeln('<option value="Pondichery">Pondichery</option>');
document.writeln('<option value="Porbunder">Porbunder</option>');
document.writeln('<option value="Poruru">Poruru</option>');
document.writeln('<option value="Porvorim">Porvorim</option>');
document.writeln('<option value="Pudukottai">Pudukottai</option>');
document.writeln('<option value="Pune">Pune</option>');
document.writeln('<option value="Raichur">Raichur</option>');
document.writeln('<option value="Raigarh">Raigarh</option>');
document.writeln('<option value="Raipur">Raipur</option>');
document.writeln('<option value="Rajkot">Rajkot</option>');
document.writeln('<option value="Rajmundry">Rajmundry</option>');
document.writeln('<option value="Rajnandgaon">Rajnandgaon</option>');
document.writeln('<option value="Rajpura">Rajpura</option>');
document.writeln('<option value="Ranchi">Ranchi</option>');
document.writeln('<option value="Ranipet">Ranipet</option>');
document.writeln('<option value="Ratlam">Ratlam</option>');
document.writeln('<option value="Ratnagiri">Ratnagiri</option>');
document.writeln('<option value="Rewari">Rewari</option>');
document.writeln('<option value="Rohtak">Rohtak</option>');
document.writeln('<option value="Ropar">Ropar</option>');
document.writeln('<option value="Rourkela">Rourkela</option>');
document.writeln('<option value="Rudrapur">Rudrapur</option>');
document.writeln('<option value="Saharanpur">Saharanpur</option>');
document.writeln('<option value="Salem">Salem</option>');
document.writeln('<option value="Sangareddy">Sangareddy</option>');
document.writeln('<option value="Sangli">Sangli</option>');
document.writeln('<option value="Sangrur">Sangrur</option>');
document.writeln('<option value="Satara">Satara</option>');
document.writeln('<option value="Secunderabad">Secunderabad</option>');
document.writeln('<option value="Shimla">Shimla</option>');
document.writeln('<option value="Shimoga">Shimoga</option>');
document.writeln('<option value="Sikar">Sikar</option>');
document.writeln('<option value="Silchar">Silchar</option>');
document.writeln('<option value="Siliguri">Siliguri</option>');
document.writeln('<option value="Silvassa">Silvassa</option>');
document.writeln('<option value="Sirsa">Sirsa</option>');
document.writeln('<option value="Sitapur">Sitapur</option>');
document.writeln('<option value="Sivakasi">Sivakasi</option>');
document.writeln('<option value="Sohana">Sohana</option>');
document.writeln('<option value="Solan">Solan</option>');
document.writeln('<option value="Solapur">Solapur</option>');
document.writeln('<option value="Sonepat">Sonepat</option>');
document.writeln('<option value="Sri Ganganagar">Sri Ganganagar</option>');
document.writeln('<option value="Srikakulam">Srikakulam</option>');
document.writeln('<option value="Srinagar">Srinagar</option>');
document.writeln('<option value="Surat">Surat</option>');
document.writeln('<option value="Swargate">Swargate</option>');
document.writeln('<option value="Tadepalligudem">Tadepalligudem</option>');
document.writeln('<option value="Tamilnadu">Tamilnadu</option>');
document.writeln('<option value="Tanjore">Tanjore</option>');
document.writeln('<option value="Thane">Thane</option>');
document.writeln('<option value="Thanjavur">Thanjavur</option>');
document.writeln('<option value="Theni">Theni</option>');
document.writeln('<option value="Thiruvananthapuram">Thiruvananthapuram</option>');
document.writeln('<option value="Thiruvannamalai">Thiruvannamalai</option>');
document.writeln('<option value="Thripunithura">Thripunithura</option>');
document.writeln('<option value="Thrissur">Thrissur</option>');
document.writeln('<option value="Tirunelveli">Tirunelveli</option>');
document.writeln('<option value="Tirupathi">Tirupathi</option>');
document.writeln('<option value="Tirupur">Tirupur</option>');
document.writeln('<option value="Tiruvalla">Tiruvalla</option>');
document.writeln('<option value="Tonk">Tonk</option>');
document.writeln('<option value="Trichur">Trichur</option>');
document.writeln('<option value="Trichy">Trichy</option>');
document.writeln('<option value="Trivandrum">Trivandrum</option>');
document.writeln('<option value="Tumkur">Tumkur</option>');
document.writeln('<option value="Udaipur">Udaipur</option>');
document.writeln('<option value="Udupi">Udupi</option>');
document.writeln('<option value="Ujjain">Ujjain</option>');
document.writeln('<option value="Unjha">Unjha</option>');
document.writeln('<option value="Valsad">Valsad</option>');
document.writeln('<option value="Vapi">Vapi</option>');
document.writeln('<option value="Varanasi">Varanasi</option>');
document.writeln('<option value="Vastral">Vastral</option>');
document.writeln('<option value="Vellore">Vellore</option>');
document.writeln('<option value="Veraval">Veraval</option>');
document.writeln('<option value="Vijayawada">Vijayawada</option>');
document.writeln('<option value="Villupuram">Villupuram</option>');
document.writeln('<option value="Virudhachalam">Virudhachalam</option>');
document.writeln('<option value="Virudhunagar">Virudhunagar</option>');
document.writeln('<option value="Vizag">Vizag</option>');
document.writeln('<option value="Warangal">Warangal</option>');
document.writeln('<option value="Wardha">Wardha</option>');
document.writeln('<option value="Yamunanagar">Yamunanagar</option>');
document.writeln('<option value="Yavatmal">Yavatmal</option>');
document.writeln('<option value="Yelanka">Yelanka</option>');
document.writeln('<option value="Zirakpur">Zirakpur</option>');
document.writeln('</select>');
document.writeln('</td>');
document.writeln('</tr>');


//document.writeln('<tr>');
//document.writeln('<td width="46%" align="left" valign="top"><strong>State </strong></td>');
//document.writeln('<td width="46%" align="left" valign="top"><select name="ddlState" id="ddlState" class="input-field">');
//document.writeln('<option value="0">Select Your State</option>');
//document.writeln('<option value="Andaman and Nicobar Islands">Andaman and Nicobar Islands</option>');
//document.writeln('<option value="Andhra Pradesh">Andhra Pradesh</option>');
//document.writeln('<option value="Arunachal Pradesh">Arunachal Pradesh</option>');
//document.writeln('<option value="Assam">Assam</option>');
//document.writeln('<option value="Bihar">Bihar</option>');
//document.writeln('<option value="Chandigarh">Chandigarh</option>');
//document.writeln('<option value="Chhattisgarh">Chhattisgarh</option>');
//document.writeln('<option value="Dadra and Nagar Haveli">Dadra and Nagar Haveli</option>');
//document.writeln('<option value="Daman and Diu">Daman and Diu</option>');
//document.writeln('<option value="Delhi">Delhi</option>');
//document.writeln('<option value="Goa">Goa</option>');
//document.writeln('<option value="Gujarat">Gujarat</option>');
//document.writeln('<option value="Haryana">Haryana</option>');
//document.writeln('<option value="Himachal Pradesh">Himachal Pradesh</option>');
//document.writeln('<option value="Jammu and Kashmir">Jammu and Kashmir</option>');
//document.writeln('<option value="Jharkhand">Jharkhand</option>');
//document.writeln('<option value="Karnataka">Karnataka</option>');
//document.writeln('<option value="Kerala">Kerala</option>');
//document.writeln('<option value="Lakshadweep">Lakshadweep</option>');
//document.writeln('<option value="Madhya Pradesh">Madhya Pradesh</option>');
//document.writeln('<option value="Maharashtra">Maharashtra</option>');
//document.writeln('<option value="Manipur">Manipur</option>');
//document.writeln('<option value="Meghalaya">Meghalaya</option>');
//document.writeln('<option value="Mizoram">Mizoram</option>');
//document.writeln('<option value="Nagaland">Nagaland</option>');
//document.writeln('<option value="Orissa">Orissa</option>');
//document.writeln('<option value="Puducherry">Puducherry</option>');
//document.writeln('<option value="Punjab">Punjab</option>');
//document.writeln('<option value="Rajasthan">Rajasthan</option>');
//document.writeln('<option value="Sikkim">Sikkim</option>');
//document.writeln('<option value="Tamil Nadu">Tamil Nadu</option>');
//document.writeln('<option value="Tripura">Tripura</option>');
//document.writeln('<option value="Uttarakhand">Uttarakhand</option>');
//document.writeln('<option value="Uttar Pradesh">Uttar Pradesh</option>');
//document.writeln('<option value="West Bengal">West Bengal</option>');
//document.writeln('<OPTION value="Others">Others</OPTION>');
//document.writeln('</select></td>');
//document.writeln('</tr>');
document.writeln('<tr>');
document.writeln('<td width="125" align="left" valign="top">&nbsp;</td>');
document.writeln('<td width="205" align="left" valign="top"><label>');
document.writeln('<input src="'+ _gRootPath +'images/b_go.gif" type="image" name="button" id="button" value="Submit" style="border:none;" onclick = "javascript:return Validate();" />');
document.writeln('</label></td>');
document.writeln('</tr>');
document.writeln('</table>');
document.writeln('</form>');
document.writeln('</div>');
document.writeln('<div style="position:relative; width:350px; text-align:right; font:12px Verdana, Arial, Helvetica, sans-serif bold; color:#999999;">');
document.writeln('<a href="javascript:divwin.close()" style="text-decoration:none; color:#999999; font-weight:bold; line-height:22px; padding-right:10px;"><img src="'+ _gRootPath +'images/popup_call_back/close.gif" width="16" height="14" border="0" style="vertical-align:middle; padding-bottom:1px;"/> Close</a>');
document.writeln('</div>');
document.writeln('</div>');