<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Application Form</title>
<style type="text/css">
#container #mainbody {
	width: 960px;
	margin-right: auto;
	margin-left: auto;
}
#container #mainbody #dheader {
	float: left;
	height: 160px;
	width: 960px;
}
#container #mainbody #contd {
	float: left;
	width: 960px;
}
body {
	background-image: url(images/body-bg.png);
	background-repeat: repeat;
}
</style>
<script type="text/javascript">
function MM_validateForm() { //v4.0
  if (document.getElementById){
    var i,p,q,nm,test,num,min,max,errors='',args=MM_validateForm.arguments;
    for (i=0; i<(args.length-2); i+=3) { test=args[i+2]; val=document.getElementById(args[i]);
      if (val) { nm=val.name; if ((val=val.value)!="") {
        if (test.indexOf('isEmail')!=-1) { p=val.indexOf('@');
          if (p<1 || p==(val.length-1)) errors+='- '+nm+' must contain an e-mail address.\n';
        } else if (test!='R') { num = parseFloat(val);
          if (isNaN(val)) errors+='- '+nm+' must contain a number.\n';
          if (test.indexOf('inRange') != -1) { p=test.indexOf(':');
            min=test.substring(8,p); max=test.substring(p+1);
            if (num<min || max<num) errors+='- '+nm+' must contain a number between '+min+' and '+max+'.\n';
      } } } else if (test.charAt(0) == 'R') errors += '- '+nm+' is required.\n'; }
    } if (errors) alert('The following error(s) occurred:\n'+errors);
    document.MM_returnValue = (errors == '');
} }
</script>
</head>

<body>
<div id="container">
  <div id="mainbody">
    <div id="dheader"><img src="images/header.png" width="960" height="158" usemap="#Map" border="0" />
<map name="Map" id="Map">
        <area shape="rect" coords="489,47,543,147" href="http://www.frontierfinanceventuresltd.com" />
        <area shape="rect" coords="557,51,632,146" href="http://www.frontierfinanceventuresltd.com/index.php/features" />
        <area shape="rect" coords="639,51,713,145" href="http://www.frontierfinanceventuresltd.com/index.php/services" />
        <area shape="rect" coords="720,46,809,145" href="http://www.frontierfinanceventuresltd.com/index.php/products" />
        <area shape="rect" coords="813,52,873,145" href="http://www.frontierfinanceventuresltd.com/apply.php" />
        <area shape="rect" coords="879,52,961,144" href="http://www.frontierfinanceventuresltd.com/contact.php" />
</map>
    </div>
    <div id="contd">
      <p><strong>Application Form</strong></p>
      <form action="formtoemail.php" method="post" name="form1" id="form1" onsubmit="MM_validateForm('LastName','','R','FirstName','','R','date_of_birth','','R','Phone','','R','Employer','','R','Department','','R','designation','','R','Id_number','','R','date_of_Employment','','R','retirement_date','','R','gradelevel','','R','Netsalary','','R','Loans','','R','Loan_Company','','R','Purpose','','R','Loan_amount','','R','duration','','R','residential_address','','R','home_address','','R','state_LGA','','R','employee_address','','R','actual_employee_address','','R');return document.MM_returnValue">
        <table width="500" border="0" align="left" cellpadding="5" cellspacing="5">
          <tr>
            <td width="177" scope="col">Applicant's LastName </td>
            <td width="288" scope="col"><label for="LastName"></label>
            <input name="LastName" type="text" id="LastName" size="32" /></td>
          </tr>
          <tr>
            <td>Applicant's FirstName </td>
            <td><input name="FirstName" type="text" id="FirstName" size="32" /></td>
          </tr>
          <tr>
            <td>Applicant's MiddleName </td>
            <td><input name="MiddleName" type="text" id="MiddleName" size="32" /></td>
          </tr>
          <tr>
            <td>Residential Address            </td>
            <td><label for="residential_address"></label>
            <textarea name="residential_address" id="residential_address" cols="28" rows="5"></textarea></td>
          </tr>
          <tr>
            <td>Home Town Address</td>
            <td><textarea name="home_address" id="home_address" cols="28" rows="5"></textarea></td>
          </tr>
          <tr>
            <td>State and LGA</td>
            <td><textarea name="state_LGA" id="state_LGA" cols="28" rows="5"></textarea></td>
          </tr>
          <tr>
            <td>Date of Birth</td>
            <td><label for="date_of_birth"></label>
            <input name="date_of_birth" type="text" id="date_of_birth" size="32" /></td>
          </tr>
          <tr>
            <td>Marital Status</td>
            <td><label for="Marital_status"></label>
            <input name="Marital_status" type="text" id="Marital_status" size="32" /></td>
          </tr>
          <tr>
            <td>Telephone Numbers</td>
            <td><label for="Phone"></label>
            <input name="Phone" type="text" id="Phone" size="32" /></td>
          </tr>
          <tr>
            <td>Employer</td>
            <td><label for="Employer"></label>
            <input name="Employer" type="text" id="Employer" size="32" /></td>
          </tr>
          <tr>
            <td>Employer's Address</td>
            <td><textarea name="employee_address" id="employee_address" cols="28" rows="5"></textarea></td>
          </tr>
          <tr>
            <td>Department</td>
            <td><label for="Department"></label>
            <input name="Department" type="text" id="Department" size="32" /></td>
          </tr>
          <tr>
            <td>Actual Employment Address</td>
            <td><textarea name="actual_employee_address" id="actual_employee_address" cols="28" rows="5"></textarea></td>
          </tr>
          <tr>
            <td>Position/ Designation</td>
            <td><label for="designation"></label>
            <input name="designation" type="text" id="designation" size="32" /></td>
          </tr>
          <tr>
            <td>ID No</td>
            <td><label for="Id_number"></label>
            <input name="Id_number" type="text" id="Id_number" size="32" /></td>
          </tr>
          <tr>
            <td>Date of Employment</td>
            <td><label for="date_of_Employment"></label>
            <input name="date_of_Employment" type="text" id="date_of_Employment" size="32" /></td>
          </tr>
          <tr>
            <td>Expected Year of Retirement</td>
            <td><label for="retirement_date"></label>
            <input name="retirement_date" type="text" id="retirement_date" size="32" /></td>
          </tr>
          <tr>
            <td>Grade Level</td>
            <td><label for="gradelevel"></label>
            <input name="gradelevel" type="text" id="gradelevel" size="32" /></td>
          </tr>
          <tr>
            <td>Net Salary Per Month</td>
            <td><label for="Netsalary"></label>
            <input name="Netsalary" type="text" id="Netsalary" size="32" /></td>
          </tr>
          <tr>
            <td>Other Deductions(Loans)</td>
            <td><label for="Loans"></label>
            <input name="Loans" type="text" id="Loans" size="32" /></td>
          </tr>
          <tr>
            <td>Loan Companies</td>
            <td><label for="Loan_Company"></label>
            <input name="Loan_Company" type="text" id="Loan_Company" size="32" />              <label for="Purpose"></label></td>
          </tr>
          <tr>
            <td>Purpose of Loan &amp; Credit</td>
            <td><input name="Purpose" type="text" id="Purpose" size="32" /></td>
          </tr>
          <tr>
            <td>Loan Amount of Request</td>
            <td><label for="Loan_amount"></label>
            <input name="Loan_amount" type="text" id="Loan_amount" size="32" /></td>
          </tr>
          <tr>
            <td>Duration/Tenure of Credit</td>
            <td><label for="duration"></label>
            <input name="duration" type="text" id="duration" size="32" /></td>
          </tr>
          <tr>
            <td>Agreed Monthly Deduction in Favour of F.F.V.Ltd</td>
            <td><label for="monthly_deduction"></label>
            <input name="monthly_deduction" type="text" id="monthly_deduction" size="32" /></td>
          </tr>
          <tr>
            <td>&nbsp;</td>
            <td><input type="submit" name="button" id="button" value="Submit" /></td>
          </tr>
        </table>
      </form>
    </div>
  </div>
</div>
</body>
</html>