MM6F input form

gistfile1.html

<form action="http://www.networkcycle.com/leads/addlead" name="leadfrm" id="leadfrm-1col" class="form-wrapper" method="post">
		<input type="hidden" value="[hash code1]" name="brand_id">
		<input type="hidden" value="[hash code 2]" name="site_id">
		<input type="hidden" value="[hash code 3]" name="verify_string">
		<input type="hidden" id="redirect" value="thank-you-page/" name="redirect">
	
	<div class="1colform-content">
		<fieldset id="user-details-1col">
			<label for="firstName-l">First Name*:</label>	
				<input type="text" value="" maxlength="200" id="firstName" name="firstName" />
				<div class="fieldError" id="fnameerr"></div> 
			<label for="lastName-l">Last Name*:</label>
				<input type="text" value="" maxlength="200" id="lastName" name="lastName" />
				<div class="<fielderror-1col></fielderror-1col>" id="lnameerr"></div>
			<label for="Email-l">Email Address*:</label>
				<input type="text" value="" maxlength="200" id="email" name="email" />
				<div class="fieldError" id="emailerr"></div> 
			<label for="Mobile-l">Mobile*:</label>
				<input type="text" value="" maxlength="25" id="mobile" name="mobile" />
				<div class="fieldError" id="mobileerr"></div> 
		</fieldset><!--end user details-->
		
		
		<fieldset id="region-details-1col">
			<label for="Address-l">Address:</label>
				<input type="text" value="" maxlength="100" id="address1" name="address" />
				<div class="fieldError" id="adderr"></div>
			<label for="state-l">State:</label>
				<input type="hidden" name="countryID" id="form-countryID" value="254" />
				<select name="regionID" id="form-regionID">
					<option value="" selected="selected" class="">Select 

					</option>
					<option value="122" class="">Alabama</option>
					<option value="123" class="">Alaska</option>
					<option value="124" class="">Arizona</option>
					<option value="125" class="">Arkansas</option>
					<option value="126" class="">California</option>
					<option value="127" class="">Colorado</option>
					<option value="128" class="">Connecticut</option>
					<option value="129" class="">Delaware</option>
					<option value="130" class="">District of Columbia</option>
					<option value="131" class="">Florida</option>
					<option value="132" class="">Georgia</option>
					<option value="133" class="">Hawaii</option>
					<option value="134" class="">Idaho</option>
					<option value="135" class="">Illinois</option>
					<option value="136" class="">Indiana</option>
					<option value="137" class="">Iowa</option>
					<option value="138" class="">Kansas</option>
					<option value="139" class="">Kentucky</option>
					<option value="140" class="">Louisiana</option>
					<option value="141" class="">Maine</option>
					<option value="142" class="">Maryland</option>
					<option value="143" class="">Massachusetts</option>
					<option value="144" class="">Michigan</option>
					<option value="145" class="">Minnesota</option>
					<option value="146" class="">Mississippi</option>
					<option value="147" class="">Missouri</option>
					<option value="148" class="">Montana</option>
					<option value="149" class="">Nebraska</option>
					<option value="150" class="">Nevada</option>
					<option value="151" class="">New Hampshire</option>
					<option value="152" class="">New Jersey</option>
					<option value="153" class="">New Mexico</option>
					<option value="154" class="">New York</option>
					<option value="155" class="">North Carolina</option>
					<option value="156" class="">North Dakota</option>
					<option value="157" class="">Ohio</option>
					<option value="158" class="">Oklahoma</option>
					<option value="159" class="">Oregon</option>
					<option value="160" class="">Pennsylvania</option>
					<option value="161" class="">Rhode Island</option>
					<option value="162" class="">South Carolina</option>
					<option value="163" class="">South Dakota</option>
					<option value="164" class="">Tennessee</option>
					<option value="165" class="">Texas</option>
					<option value="166" class="">Utah</option>
					<option value="167" class="">Virginia</option>
					<option value="168" class="">Washington</option>
					<option value="169" class="">West Virginia</option>
					<option value="170" class="">Wisconsin</option>
					<option value="171" class="">Wyoming</option>
					<option value="172" class="">Vermont</option>
					<option value="792" class="">US Minor Outlying Islands</option>
				</select>

					<!-- <div class="fieldError" id="stateerr"></div> -->
					<label for="city-l">City:</label>
						<input type="text" name="cityID" id="form-cityID" maxlength="100" value="" /><br />
					<!-- <div class="fieldError" id="cityerr"></div> -->
					<label for="postal-l">Postal Code:</label>
						<input type="text" value="" maxlength="10" id="postcode" name="postcode" />
					<!-- <div class="fieldError" id="postcodeerr"></div> -->
		</fieldset><!--end region details-->
		
		<fieldset id="message-details-1col">
				<label for="postal-l">How did you find us?:</label>
					<input type="text" value="" maxlength="100" id="findus-1col" name="findus" />
				<div class="fieldError" id="finduserr"></div>	
					
				<label class="textAreaLabel" for="postal-l">Tell us about yourself:</label>
					<textarea id="tellabout-1col" name="tellabout" rows="3" cols="17"></textarea>
				<div class="fieldError" id="tellerr"></div>
					
				<label class="ypcm" for="postal-l">Please contact me</label>
					<input type="checkbox" value="1" id="optin" name="optin" checked="checked" />		  
					<input type="submit" class="submit" value="Submit" id="formComplete" name="button" />   
				<div class="fieldError" id="optinerr"></div>	
		</fieldset>		
	
	</div><!--end form content -->	

</form><!--end contact-form -->