Please fill out all required fields.<br><br>

<!--
Do not modify the NAME value of any of the INPUT fields
the FORM action, or any of the hidden fields (eg. input type=hidden).
These are all required for this form to function correctly.
-->
<style>

	.myForm td, input, select, textarea, checkbox {
		font-family: tahoma;
		font-size: 12px;
	}

	.myForm {
		background-color: #E7EEF7;
		border: 1px solid #CCDCF2;
		padding: 10px;
	}

	.required {
		color: red;
	}

</style>
<form method="post" action="http://artrestaurant.co.nz/contacts/form.php?form=3" id="frmSS3" onSubmit="return CheckForm3(this);">
	<table border="0" cellpadding="2" class="myForm">
		<tr>
	<td><span class="required">*</span>
Full Name:</td>
	<td><input type="text" name="CustomFields[3]" id="CustomFields_3_3" value=""></td>
</tr><tr>
	<td><span class="required">*</span>
Phone Number:</td>
	<td><input type="text" name="CustomFields[4]" id="CustomFields_4_3" value=""></td>
</tr><tr>
	<td><span class="required">*</span>
Your email address:</td>
	<td><input type="text" name="email" value=""></td>
</tr><tr>
	<td><span class="required">*</span>
Booking for:</td>
	<td><select name="CustomFields[1]" id="CustomFields_1_3"><option value="">-- Please choose --</option><option value="Branch">Branch</option><option value="Lunch">Lunch</option><option value="Dinner">Dinner</option></select></td>
</tr><tr>
	<td><span class="required">*</span>
Number of people:</td>
	<td><input type="text" name="CustomFields[2]" id="CustomFields_2_3" value=""></td>
</tr><tr>
	<td><span class="required">*</span>
Date:</td>
	<td><select name="CustomFields[6][dd]" id="CustomFields[6][dd]"><option value="01">1</option><option value="02">2</option><option value="03">3</option><option value="04">4</option><option value="05">5</option><option value="06">6</option><option value="07">7</option><option value="08">8</option><option value="09">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select><select name="CustomFields[6][mm]" id="CustomFields[6][mm]"><option value="01">Jan</option><option value="02">Feb</option><option value="03">Mar</option><option value="04">Apr</option><option value="05">May</option><option value="06">Jun</option><option value="07">Jul</option><option value="08">Aug</option><option value="09">Sep</option><option value="10">Oct</option><option value="11">Nov</option><option value="12">Dec</option></select><select name="CustomFields[6][yy]" id="CustomFields[6][yy]"><option value="2010">2010</option><option value="2011">2011</option></select></td>
</tr><tr>
	<td><span class="required">*</span>
Time:</td>
	<td><select name="CustomFields[8]" id="CustomFields_8_3"><option value="">-- Please choose an option --</option><option value="10am">10am</option><option value="10.30am">10.30am</option><option value="11am">11am</option><option value="11.30am">11.30am</option><option value="12pm">12pm</option><option value="12.30pm">12.30pm</option><option value="1pm">1pm</option><option value="1.30pm">1.30pm</option><option value="2pm">2pm</option><option value="2.30pm">2.30pm</option><option value="3pm">3pm</option><option value="3.30pm">3.30pm</option><option value="4pm">4pm</option><option value="4.30pm">4.30pm</option><option value="5pm">5pm</option><option value="5.30pm">5.30pm</option><option value="6pm">6pm</option><option value="6.30pm">6.30pm</option><option value="7pm">7pm</option><option value="7.30pm">7.30pm</option><option value="8pm">8pm</option><option value="8.30pm">8.30pm</option><option value="9pm">9pm</option><option value="9.30pm">9.30pm</option><option value="10pm">10pm</option><option value="10.30pm">10.30pm</option><option value="11pm">11pm</option></select></td>
</tr><tr>
	<td>&nbsp;&nbsp;&nbsp;Special Request:</td>
	<td><label for="CustomFields[5_3]_Gluten-Free"><input type="checkbox" id="CustomFields[5_3]_Gluten-Free" name="CustomFields[5][]" value="Gluten-Free">Gluten-Free</label><br/><label for="CustomFields[5_3]_Vegitarian"><input type="checkbox" id="CustomFields[5_3]_Vegitarian" name="CustomFields[5][]" value="Vegitarian">Vegitarian</label><br/><label for="CustomFields[5_3]_Kids Menu"><input type="checkbox" id="CustomFields[5_3]_Kids Menu" name="CustomFields[5][]" value="Kids Menu">Kids Menu</label><br/><label for="CustomFields[5_3]_Diet"><input type="checkbox" id="CustomFields[5_3]_Diet" name="CustomFields[5][]" value="Diet">Diet</label><br/></td>
</tr><input type="hidden" name="format" value="h">
		<tr>
			<td>&nbsp;</td>
			<td><br><input type="submit" value="Subscribe">
			</td>
		</tr>
	</table>
</form>

<script language="javascript">

			function CheckMultiple3(frm, name) {
				for (var i=0; i < frm.length; i++)
				{
					fldObj = frm.elements[i];
					fldId = fldObj.id;
					if (fldId) {
						var fieldnamecheck=fldObj.id.indexOf(name);
						if (fieldnamecheck != -1) {
							if (fldObj.checked) {
								return true;
							}
						}
					}
				}
				return false;
			}
		function CheckForm3(f) {
			if (f.email.value == "") {
				alert("Please enter your email address.");
				f.email.focus();
				return false;
			}
		
			var fname = "CustomFields_3_3";
			var fld = document.getElementById(fname);
			if (fld.value == "") {
				alert("Please enter a value for field Full Name");
				fld.focus();
				return false;
			}
		
			var fname = "CustomFields_4_3";
			var fld = document.getElementById(fname);
		
				if (fld.value == "") {
					alert("Please enter a value for field Phone Number");
					fld.focus();
					return false;
				}
			
			CheckNum = parseInt(fld.value);
			if(fld.value != "" && isNaN(CheckNum)) {
				alert("Please enter a numeric value for field Phone Number");
				fld.select();
				fld.focus();
				return false;
			}
		
			var fname = "CustomFields_1_3";
			var fld = document.getElementById(fname);
			if (fld.selectedIndex == -1 || fld.selectedIndex == 0) {
				alert("Please choose an option for field Booking for");
				fld.focus();
				return false;
			}
		
			var fname = "CustomFields_2_3";
			var fld = document.getElementById(fname);
		
				if (fld.value == "") {
					alert("Please enter a value for field Number of people");
					fld.focus();
					return false;
				}
			
			CheckNum = parseInt(fld.value);
			if(fld.value != "" && isNaN(CheckNum)) {
				alert("Please enter a numeric value for field Number of people");
				fld.select();
				fld.focus();
				return false;
			}
		
			var fname = "CustomFields_8_3";
			var fld = document.getElementById(fname);
			if (fld.selectedIndex == -1 || fld.selectedIndex == 0) {
				alert("Please choose an option for field Time");
				fld.focus();
				return false;
			}
		
				return true;
			};
		
</script>