tengo este codigo:
Código PHP:
<link rel="stylesheet" href="../../css/style.css" type="text/css" />
<!--[if IE]><link rel="stylesheet" href="/css/ie/styleIE.css" type="text/css" /><![endif]-->
<script src="/js/site.js" type="text/javascript"></script>
<script type="text/JavaScript">
var incomes = Array();
<?php foreach($_DATA["statuses"] as $s){ ?>
incomes[<?=$s['id']?>] = '<?=format_money($s['income_limit'])?>';
<?php } ?>
function clear_income() {
$('mainform').income.options.length = 1;
}
function fill_income()
{
var f = $('mainform');
if(f.status.selectedIndex>0)
{
var bound = incomes[ f.status.options[f.status.selectedIndex].value ];
if(f.income.options.length==1)
{
f.income.options[1]=new Option("Please select your status first","lt");
f.income.options[2]=new Option("Please select your status first","gt");
}
f.income.options[1].text="under $"+bound;
f.income.options[2].text="over $"+bound;
f.income.options[1].value="under $"+bound;
f.income.options[2].value="over $"+bound;
if (arguments.length>0) {
if (arguments[0]=="under $"+bound) {
f.income.selectedIndex = 1;
}
if (arguments[0]=="over $"+bound) {
f.income.selectedIndex = 2;
}
}
}
else
{
f.income.options[2]=null;
f.income.options[1]=null;
clear_income();
}
}
function check_form(){
var f = $('mainform');
if( f.county.options[f.county.selectedIndex].value=='' ){
alert('Please select county');
f.county.focus();
return false;
}
if( !(f.status.selectedIndex > 0) ){
alert('Please select status');
f.status.focus();
return false;
}
if( !(f.income.selectedIndex > 0) ){
alert('Please select income');
f.income.focus();
return false;
}
return true;
}
</script>
</head>
<body>
<div id="popupWin"></div>
<div id="page">
<div id="popup">
<div class="ptitle"></div>
<div class="pcontent"></div>
</div>
<div id="skipNav">
<ul title="Accessibility options">
<li><a href="#content">Skip to main content</a></li>
</ul>
</div>
<!-- header -->
<div id="navBarTop">
<ul>
<li><a href="/newsletter/">Newsletter Sign-up</a></li>
<li><a href="/carriers/">Carriers</a></li>
<li><a href="/learning_center/">Learning Center</a></li>
<li><a href="/legal_notice/">Privacy Policy</a></li>
<li><a href="/testimonials/">Testimonials</a></li>
<li><a href="/faq/">FAQ</a></li>
<li><a href="/about_us/">About Us</a></li>
<li><a href="/contact_us/">Contact Us</a></li>
<li class="last"><a href="/sitemap/">Site Map</a></li>
</ul>
</div>
<div id="header"><div class="headerImg">
<h1><a href="/">VISTA Health Solutions</a></h1>
<div>
<h3>NEW YORK</h3>
<h2>Self-Employed Health Insurance</h2>
</div>
</div></div>
<!-- end header -->
<!-- steps -->
<div id="stepsBar">
<h4>3 Easy Steps</h4>
<ul>
<li class="step1"><?if(empty($_SITEMAP["step"])){?><b><?}?>1. Make your Selection<?if(empty($_SITEMAP["step"])){?></b><?}?></li>
<li class="step2"><?if($_SITEMAP["step"]=='2'){?><b><?}?>2. Compare Plans<?if($_SITEMAP["step"]=='2'){?></b><?}?></li>
<li class="step3"><?if($_SITEMAP["step"]=='3'){?><b><?}?>3. Apply<?if($_SITEMAP["step"]=='3'){?></b><?}?></li>
</ul>
</div>
<!-- end steps -->
<? if (empty($_SITEMAP["quoteform"])) { ?>
<div class="selBar"><div class="selBarL"><div class="selBarR">
<form method="post" action="/forms/quote/select/do" id="mainform" onsubmit="return check_form();" autofill="disabled">
<?php
// agregado por lucas
if(isset($_REQUEST["referrer"]) && trim(strtolower($_REQUEST["referrer"])) == 'healthyny') {?>
<select name="county" style="margin-left:100px;">
<option value="">Select your county</option>
<option value="">-----------------</option>
<?php /* $prev=0; foreach($_DATA["counties"] as $c){ ?>
<?php if($prev <> $c['position']){ ?>
<option value="">-----------------</option>
<?php } ?>
<?php $prev = $c['position']; ?>
<option <?if($_SESSION["county"]==$c["id"]){?> selected="selected"<? } ?> value="<?=$c['id']?>"><?=$c['name']?></option>
<?php } */?>
<option value="7">Bronx</option>
<option value="8">Kings</option>
<option value="29">New York</option>
<option value="59">Queens</option>
<option value="3">Richmond</option>
</select><?php
}
else {?>
<select name="county">
<option value="">Select your county</option>
<option value="">-----------------</option>
<?php $prev=0; foreach($_DATA["counties"] as $c){ ?>
<?php if($prev <> $c['position']){ ?>
<option value="">-----------------</option>
<?php } ?>
<?php $prev = $c['position']; ?>
<option <?if($_SESSION["county"]==$c["id"]){?> selected="selected"<? } ?> value="<?=$c['id']?>"><?=$c['name']?></option>
<?php } ?>
</select><?php
}?>
<select name="status" onchange="fill_income();" style="width: auto;">
<option value="">Select your status</option>
<?php foreach($_DATA["statuses"] as $s){ ?>
<option <?if($_SESSION["status"]==$s["id"]){?> selected="selected"<? } ?> value="<?=$s['id']?>"><?=$s['status']?></option>
<?php } ?>
</select>
<select name="income">
<option value="">Select your annual income</option>
</select>
<? if (/*$_SITEMAP["step"]!=2 && */!empty($_SESSION["status"])) { ?><script type="text/JavaScript">fill_income('<?=$_SESSION["income"]?>');</script><? } ?>
<a href="#" onclick="show_popup(event,this,' ','We\'re asking for Your adjusted gross income (line 37 of your 2007 1040 tax forms) to see if You may qualify for healthy NY. A low cost health insurance plan now made available to the self employed.',310,70); return false;" class="icoQuestion">?</a>
<? if ($_SITEMAP["step"]!=2) { ?>
<a class="btnRBarrow" onclick="if (check_form()) $('mainform').submit(); return false;" href="/">GET INSTANT QUOTE</a>
<? } else { ?>
<input class="bthFlRight" type="submit" value="Change Your Selection" />
<? } ?>
<!-- <input type="image" src="/images/buttons/btnBgRB_arrow.gif">-->
</form>
<? if ($_SITEMAP["step"]==2) { ?>
<script type="text/JavaScript">
//$('mainform').county.selectedIndex = 0;
//$('mainform').status.selectedIndex = 0;
</script>
<? }
?>
</div></div></div> puede ver lo que estoy armando aca http://www.nyhealthinsurer.com/?referrer=healthyny
desde ya muchas gracias
