Here is the current form (this is an asp application): <%@ Language=VbScript %> <% pageid = 1 pagetitle = "Ride Request" metadesc = "" metakey = "" %> <!--#include file="head.asp"--> <div class="wrap"> <h3>Ride <span class="red">Request</span></h3> <center> <form method=post action="ride-request-02.asp" id=form1 name=form1> <TAbLE width="789"> <tr><td colspan="2"><strong><font size="+1">Information</font></strong></td></tr> <tr><td><b>First Name:</b></td><td><input name="text" name="Client_Fname" size="20" maxlength="20"></td></tr> <tr><td><b>Last Name:</b></td><td><input name="text" name="Client_Lname" size="25" maxlength="25"></td></tr> <tr><td><b>Pickup Time:</b></td><td><input name="text" name="Pickup_hour" size="2" maxlength="2"> <b>:</b> <select name="Pickup_min" size="0"><option selected><option>00am<option>15am<option>30am<option>45am<option>00pm<option>15pm<option>30pm<option>45pm</select> <I> Time format(00:00)</I></td></tr> <tr><td><b>Appointment Time:</b></td><td><input name="text" name="Appointment_hour" size="2" maxlength="2"> <b>:</b> <select name="Appointment_min" size="0"><option selected><option>00am<option>05am<option>10am<option>15am<option>20am<option>25am<option>30am<option>35am<option>40am<option>45am<option>50am<option>55am<option>00pm<option>05pm<option>10pm<option>15pm<option>20am<option>25am<option>30am<option>35pm<option>40pm<option>45pm<option>50pm<option>55pm</select> <I> Time format(00:00)</td></tr> <tr><td><b>Appointment Date:</b></td> <td><input name="text" name="Appointment_DATE" size="20" maxlength="20"><b> (MM/DD/YYYY)</b></td></tr> <tr><td width="138"><b>Client Phone Number:</b></td> <td width="439"><b>(</b><input name="text" name="Client_AREA_CODE" size="5" maxlength="5"><b>)</b><input name="text" name="Client_PHONE" size="8" maxlength="8"><b>Ext.</b><input name="text" name="Client_EXTENSION" size="4" maxlength="4"><I>(Area Code) Phone Number) Extension)</I><br /><I>(Numbers Only)</I></td></tr> <tr><td colspan="2"><br /><strong><font size="+1">Pickup Location</font></strong></td></tr> <tr><td width="138"><b>Name of Facility:</b></td> <td width="439"><input name="text" name="Name_of_Pickup_Location" size="20" maxlength="20"></td></tr> <tr><td width="138"><b>Room #</b></td> <td width="439"><input name="text" name="pickup_room_number" size="5" maxlength="5"></td></tr> <tr><td width="138"><b>Address:</b></td> <td width="439"><input name="text" name="pickup_Location_address" size="25" maxlength="25"></td></tr> <tr><td width="138"><b>City:</b></td> <td width="439"><input name="text" name="Pickup_location_CITY" size="30" maxlength="30"></td></tr> <tr><td width="138"><b>State:</b></td> <td width="439"><select name="Pickup_Location_State" size="1"><option selected> <option>Alabama<option>Alaska<option>Alberta, Canada<option>American Samoa<option>Arizona<option>Arkansas<option>Australian Capital Territory, Australia<option>british Columbia, Canada<option>California<option>Colorado<option>Connecticut<option>Delaware<option>District of Columbia<option>Florida<option>Foreign Country<option>Georgia<option>Guam<option>Hawaii<option>Idaho<option>Illinois<option>Indiana<option>Iowa<option>Kansas<option>Kentucky<option>Location Not Reported<option>Louisiana<option>Maine<option>Manitoba, Canada<option>Maryland<option>Massachusetts<option>Michigan<option>Minnesota<option>Minor Outlying Islands<option>Mississippi<option>Missouri<option>Montana<option>Nebraska<option>Nevada<option>New brunswick, Canada<option>New Hampshire<option>New Jersey<option>New Mexico<option>New South Wales, Australia<option>New York<option>Newfoundland, Canada<option>North Carolina<option>North Dakota<option>Northern Mariana Islands<option>Northern Territory, Australia<option>Northwest Territories, Canada<option>Nova Scotia, Canada<option>Nunavut, Canada<option>Ohio<option>Oklahoma<option>Ontario, Canada<option>Oregon<option>Pennsylvania<option>Prince Edward Island, Canada<option>Puerto Rico<option>Quebec, Canada<option>Queensland, Australia<option>Rhode Island<option>Saskatchewan, Canada<option>South Australia, Australia<option>South Carolina<option>South Dakota<option>Tasmania, Australia<option>Tennessee<option>Texas<option>Utah<option>Vermont<option>Victoria, Australia<option>Virgin Islands<option>Virginia<option>Washington<option>West Virginia<option>Western Australia, Australia<option>Wisconsin<option>Wyoming<option>Yukon, Canada</select></td></tr> <tr><td width="138"><b>Zip Code:</b></td> <td width="439"><input name="text" name="Pickup_location_ZIP" size="10" maxlength="10"></td></tr> <tr><td width="138"><b>Phone Number:</b></td> <td width="439"><b>(</b><input name="text" name="Pickup_location_AREA_CODE" size="5" maxlength="5"><b>)</b><input name="text" name="Pickup_location_PHONE" size="8" maxlength="8"><b>Ext.</b><input name="text" name="Pickup_location_EXTENSION" size="4" maxlength="4"><I>(Area Code) Phone Number) Extension)</I><br /><I>(Numbers Only)</I></td></tr> <tr><td colspan="2"><br /><strong><font size="+1">Destination Location</font></strong></td></tr> <tr><td><b>Name of Facility:</b></td> <td><input name="text" name="Name_of_destination_Facility" size="20" maxlength="20"></td></tr> <tr><td><b>Room #</b></td> <td><input name="text" name="destination_room_number" size="5" maxlength="5"></td></tr> <tr><td><b>Address:</b></td> <td><input name="text" name="destination_address" size="25" maxlength="25"></td></tr> <tr><td><b>City:</b></td> <td><input name="text" name="Destination_CITY" size="30" maxlength="30"></td></tr> <tr><td><b>State:</b></td> <td><select name="Destination_State" size="1"><option selected> <option>Alabama<option>Alaska<option>Alberta, Canada<option>American Samoa<option>Arizona<option>Arkansas<option>Australian Capital Territory, Australia<option>british Columbia, Canada<option>California<option>Colorado<option>Connecticut<option>Delaware<option>District of Columbia<option>Florida<option>Foreign Country<option>Georgia<option>Guam<option>Hawaii<option>Idaho<option>Illinois<option>Indiana<option>Iowa<option>Kansas<option>Kentucky<option>Location Not Reported<option>Louisiana<option>Maine<option>Manitoba, Canada<option>Maryland<option>Massachusetts<option>Michigan<option>Minnesota<option>Minor Outlying Islands<option>Mississippi<option>Missouri<option>Montana<option>Nebraska<option>Nevada<option>New brunswick, Canada<option>New Hampshire<option>New Jersey<option>New Mexico<option>New South Wales, Australia<option>New York<option>Newfoundland, Canada<option>North Carolina<option>North Dakota<option>Northern Mariana Islands<option>Northern Territory, Australia<option>Northwest Territories, Canada<option>Nova Scotia, Canada<option>Nunavut, Canada<option>Ohio<option>Oklahoma<option>Ontario, Canada<option>Oregon<option>Pennsylvania<option>Prince Edward Island, Canada<option>Puerto Rico<option>Quebec, Canada<option>Queensland, Australia<option>Rhode Island<option>Saskatchewan, Canada<option>South Australia, Australia<option>South Carolina<option>South Dakota<option>Tasmania, Australia<option>Tennessee<option>Texas<option>Utah<option>Vermont<option>Victoria, Australia<option>Virgin Islands<option>Virginia<option>Washington<option>West Virginia<option>Western Australia, Australia<option>Wisconsin<option>Wyoming<option>Yukon, Canada</select></td></tr> <tr><td><b>Zip Code:</b></td> <td><input name="text" name="Destination_ZIP" size="10" maxlength="10"></td></tr> <tr><td><b>Phone Number:</b></td> <td><b>(</b><input name="text" name="Destination_AREA_CODE" size="5" maxlength="5"><b>)</b><input name="text" name="Destination_PHONE" size="8" maxlength="8"><b>Ext.</b><input name="text" name="Destination_EXTENSION" size="4" maxlength="4"><I>(Area Code) Phone Number) Extension)</I><br /><I>(Numbers Only)</I></td></tr> <tr><td colspan="2"><br /><strong><font size="+1">Trip Information</font></strong></td></tr> <tr><td><b>Appointment Date:</b></td> <td><input name="text" name="Appointment_DATE" size="20" maxlength="20"><b> (MM/DD/YYYY)</b></td></tr> <tr><td><b>Round Trip:</b></td> <td><input type='radio' name="roundtrip_selection" value='yes'> Yes <input type='radio' name="roundtrip_selection" value='no'> No</td></tr> <tr><td><b>Is the client Ambulatory?</b></td> <td><input type='radio' name="ambulatory_selection" value='yes'> Yes <input type='radio' name="ambulatory_selection" value='no'> No</td></tr> <tr><td><b>Wheelchair Needed?</b></td> <td><input type='radio' name="wheelchair_selection" value='yes'> Yes <input type='radio' name="wheelchair_selection" value='no'> No</td></tr> <tr><td><b>"Ambulette"(strecher Van)?</b></td> <td><input type='radio' name="Ambulette_selection" value='yes'> Yes <input type='radio' name="Ambulette_selection" value='no'> No</td></tr> <tr bgcolor=#CCCCCC> <td colspan=4 align='right'><input name=submit type=submit id=submit value=Submit /></td> </tr> </table> </FORM> </center> </div> <!--#include file="foot.asp"--> Code (markup): I need javascript code created to prevent the form from being posted without every field being populated (other than room number) and I need the back end code to capture the data in asp and create an email message that sends the data in the same format so it is clearly readable. I need this ASAP! First reasonable offer gets the job.