Online Member Form Draft

function validateForm() { var x=document.forms[“myPayPal”][“os0″].value if (x==null || x==””) { alert(“Please enter a patient account number”); return false; } if (!(x.length == 6)) { alert(“Please enter a six digit account number”); return false; } var y=document.forms[“myPayPal”][“os1″].value if (y==null || y==””) { alert(“Please enter a patient name”); return false; } var z=document.forms[“myPayPal”][“amount”].value if (z==null || z==””) { alert(“Please enter a payment amount”); return false; } }

Patient Account Number:

Patient Full Name:

Amount: