Faster Claims Reporting

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	<html lang="en"> <head> <title>Faster Claims Reporting</title> <base href="http://www.fasterclaims.com"> <meta name="MSSmartTagsPreventParsing" content="TRUE"> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> <meta http-equiv="Keywords" content="automotive, claims, ias, theft, avert, phantom footprints, gap, ezlease, ez, lease, window etch, body part marking"> <meta http-equiv="Description" content="Filing a claim with IAS has never been easier. You can now file and check the status of your claim online. Submit your Gap, Tire, Theft, Paint / Fabric / Wear, and Red Alert / Daytime Running Lights claims faster, at FasterClaims.com."> <SCRIPT Language="Javascript" src="/theme/scripts.js"></script> <link rel="stylesheet" href="/theme/styles.css"> </head> <body bgcolor="#FFFFFF" text="#333366" leftmargin="0" topmargin="0" marginwidth="0" marginheight="0" link="#333366" vlink="#990000"> <table border="0" cellpadding="10" cellspacing="0"><tr><td> <script language="Javascript"> <!-- function validate2() { var strTemp1=document.FrontPage_Form1.Claim_Type; var strTemp2=document.FrontPage_Form1.Date_of_Loss.value; if ((strTemp1[0].checked\|\|strTemp1[1].checked\|\|strTemp1[2].checked)&&strTemp2=='') { alert("Please enter a Date of Loss."); document.FrontPage_Form1.Date_of_Loss.focus(); return (false); } } //--> </script> <script Language="JavaScript" Type="text/javascript"><!-- function FrontPage_Form1_Validator(theForm) { if (theForm.Contract_Number.value == "") { alert("Please enter a value for the \"Contract_Number\" field."); theForm.Contract_Number.focus(); return (false); } if (theForm.VIN_Number.value == "") { alert("Please enter a value for the \"VIN_Number\" field."); theForm.VIN_Number.focus(); return (false); } if (theForm.VIN_Number.value.length < 17) { alert("Please enter at least 17 characters in the \"VIN_Number\" field."); theForm.VIN_Number.focus(); return (false); } if (theForm.VIN_Number.value.length > 17) { alert("Please enter at most 17 characters in the \"VIN_Number\" field."); theForm.VIN_Number.focus(); return (false); } if (theForm.Name_on_Warranty.value == "") { alert("Please enter a value for the \"Name_on_Warranty\" field."); theForm.Name_on_Warranty.focus(); return (false); } if (theForm.Current_Mailing_Address.value == "") { alert("Please enter a value for the \"Current_Mailing_Address\" field."); theForm.Current_Mailing_Address.focus(); return (false); } if (theForm.City.value == "") { alert("Please enter a value for the \"City\" field."); theForm.City.focus(); return (false); } if (theForm.State.selectedIndex < 0) { alert("Please select one of the \"State\" options."); theForm.State.focus(); return (false); } if (theForm.State.selectedIndex == 0) { alert("The first \"State\" option is not a valid selection. Please choose one of the other options."); theForm.State.focus(); return (false); } if (theForm.Zip_Code.value == "") { alert("Please enter a value for the \"Zip_Code\" field."); theForm.Zip_Code.focus(); return (false); } if (theForm.Zip_Code.value.length < 5) { alert("Please enter at least 5 characters in the \"Zip_Code\" field."); theForm.Zip_Code.focus(); return (false); } if (theForm.Zip_Code.value.length > 15) { alert("Please enter at most 15 characters in the \"Zip_Code\" field."); theForm.Zip_Code.focus(); return (false); } var checkOK = "0123456789--() \t\r\n\f"; var checkStr = theForm.Zip_Code.value; var allValid = true; var validGroups = true; for (i = 0; i < checkStr.length; i++) { ch = checkStr.charAt(i); for (j = 0; j < checkOK.length; j++) if (ch == checkOK.charAt(j)) break; if (j == checkOK.length) { allValid = false; break; } } if (!allValid) { alert("Please enter only digit, whitespace and \"-()\" characters in the \"Zip_Code\" field."); theForm.Zip_Code.focus(); return (false); } if (theForm.Home_Phone.value == "") { alert("Please enter a value for the \"Home_Phone\" field."); theForm.Home_Phone.focus(); return (false); } if (theForm.Home_Phone.value.length < 10) { alert("Please enter at least 10 characters in the \"Home_Phone\" field."); theForm.Home_Phone.focus(); return (false); } if (theForm.Home_Phone.value.length > 15) { alert("Please enter at most 15 characters in the \"Home_Phone\" field."); theForm.Home_Phone.focus(); return (false); } var checkOK = "0123456789-(xxx)xxx-xxxx \t\r\n\f"; var checkStr = theForm.Home_Phone.value; var allValid = true; var validGroups = true; for (i = 0; i < checkStr.length; i++) { ch = checkStr.charAt(i); for (j = 0; j < checkOK.length; j++) if (ch == checkOK.charAt(j)) break; if (j == checkOK.length) { allValid = false; break; } } if (!allValid) { alert("Please enter only digit, whitespace and \"(xxx)xxx-xxxx\" characters in the \"Home_Phone\" field."); theForm.Home_Phone.focus(); return (false); } if (theForm.Daytime_Phone.value == "") { alert("Please enter a value for the \"Daytime_Phone\" field."); theForm.Daytime_Phone.focus(); return (false); } if (theForm.Dealer_Purchased_From.value == "") { alert("Please enter a value for the \"Dealer_Purchased_From\" field."); theForm.Dealer_Purchased_From.focus(); return (false); } if (theForm.Year.value == "") { alert("Please enter a value for the \"Year\" field."); theForm.Year.focus(); return (false); } if (theForm.Make.value == "") { alert("Please enter a value for the \"Make\" options."); theForm.Make.focus(); return (false); } if (theForm.Model.value == "") { alert("Please enter a value for the \"Model\" options."); theForm.Model.focus(); return (false); } if (theForm.Date_of_Purchase.value == "") { alert("Please enter a value for the \"Date_of_Purchase\" field."); theForm.Date_of_Purchase.focus(); return (false); } if (theForm.Current_Mileage.value == "") { alert("Please enter a value for the \"Current_Mileage\" field."); theForm.Current_Mileage.focus(); return (false); } var radioSelected = false; for (i = 0; i < theForm.Claim_Type.length; i++) { if (theForm.Claim_Type[i].checked) radioSelected = true; } if (!radioSelected) { alert("Please select one of the \"Claim_Type\" options."); return (false); } return (true); } //--></script><form method="POST" action="/content/mailhandler.asp" onsubmit="return FrontPage_Form1_Validator(this)" language="JavaScript" name="FrontPage_Form1" target="_top"> <input type="hidden" name="Fields" value="Contract_Number;VIN_Number;Name_on_Warranty;Current_Mailing_Address;Address_Line_2;City;State;Zip_Code;Home_Phone;Daytime_Phone;Email;Dealer_Purchased_From;Year;Make;Model;Date_of_Purchase;Current_Mileage;Date_of_Loss;Claim_Type"><input type="hidden" name="Subject" value="Claim Request"> <table border="0" cellpadding="2" cellspacing="0" width="60%"> <tr> <td valign="top" colspan="3"> <p> The following information is required in order to initiate the claims process, be it online or via the telephone. Please ensure that this information is accurate before proceeding. Once this form has been completed and submitted, you can expect a call from an IAS representative within 1-2 business days.<br>  </td> </tr> <tr> <td valign="top" nowrap> </td> <td valign="top" nowrap colspan="2"><font color="#FF0000">* </font> Required items are marked with a red star.</td> </tr> <tr> <td valign="top" nowrap>Contract Number:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Contract_Number" size="20"></td> </tr> <tr> <td valign="top" nowrap>VIN Number:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td> <input type="text" name="VIN_Number" size="20" maxlength="17"></td> </tr> <tr> <td valign="top" nowrap>Name as printed on warranty:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Name_on_Warranty" size="20"></td> </tr> <tr> <td valign="top" nowrap>Current Mailing Address:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Current_Mailing_Address" size="20"></td> </tr> <tr> <td valign="top" nowrap> </td> <td valign="top" nowrap> </td> <td><input type="text" name="Address_Line_2" size="20"></td> </tr> <tr> <td align="right" valign="top" nowrap>City:</td> <td align="right" valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="City" size="20"></td> </tr> <tr> <td align="right" valign="top" nowrap>State:</td> <td align="right" valign="top" nowrap><font color="#FF0000"></font></td> <td> <select size="1" name="State"> <option selected>Please Choose</option> <option>Alabama</option> <option>Alaska</option> <option>Arizona</option> <option>Arkansas</option> <option>California</option> <option>Colorado</option> <option>Connecticut</option> <option>Delaware</option> <option>Florida</option> <option>Georgia</option> <option>Hawaii</option> <option>Idaho</option> <option>Illinois</option> <option>Indiana</option> <option>Iowa</option> <option>Kansas</option> <option>Kentucky</option> <option>Louisiana</option> <option>Maine</option> <option>Maryland</option> <option>Massachusetts</option> <option>Michigan</option> <option>Minnesota</option> <option>Mississippi</option> <option>Missouri</option> <option>Montana</option> <option>Nebraska</option> <option>Nevada</option> <option>New Hampshire</option> <option>New Jersey</option> <option>New Mexico</option> <option>New York</option> <option>North Carolina</option> <option>North Dakota</option> <option>Ohio</option> <option>Oklahoma</option> <option>Oregon</option> <option>Pennsylvania</option> <option>Rhode Island</option> <option>South Carolina</option> <option>South Dakota</option> <option>Tennessee</option> <option>Texas</option> <option>Utah</option> <option>Vermont</option> <option>Virginia</option> <option>Washington</option> <option>Washington, D.C.</option> <option>West Virginia</option> <option>Wisconsin</option> <option>Wyoming</option> </select></td> </tr> <tr> <td align="right" valign="top" nowrap>Zip:</td> <td align="right" valign="top" nowrap><font color="#FF0000"></font></td> <td> <input type="text" name="Zip_Code" size="10" maxlength="15"></td> </tr> <tr> <td valign="top" nowrap>Home Phone:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td> <input type="text" name="Home_Phone" size="15" maxlength="15"></td> </tr> <tr> <td valign="top" nowrap>Daytime Phone:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Daytime_Phone" size="15"></td> </tr> <tr> <td valign="top" nowrap>Email Address:</td> <td valign="top" nowrap> </td> <td><input type="text" name="Email" size="20"></td> </tr> <tr> <td valign="top" nowrap>Dealer purchased from:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Dealer_Purchased_From" size="20"></td> </tr> <tr> <td valign="top" nowrap>Vehicle Year:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Year" size="4"></td> </tr> <tr> <td valign="top" nowrap>Vehicle Make:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" value="" name="Make" size="20" /></td> </tr> <tr> <td valign="top" nowrap>Vehicle Model:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" value="" name="Model" size="20" /></td> </tr> <tr> <td valign="top" nowrap>Date of Purchase:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Date_of_Purchase" size="20"></td> </tr> <tr> <td valign="top" nowrap>Current Mileage:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Current_Mileage" size="20"></td> </tr> <tr> <td valign="top" nowrap>Date of Loss:</td> <td valign="top" nowrap><font color="#FF0000"></font></td> <td><input type="text" name="Date_of_Loss" size="20"><br> (Required for GAP, Tire, and Theft claim types.)</td> </tr> <tr> <td valign="top" nowrap>Type of Claim:</td> <td valign="top" nowrap><font color="#FF0000">*</font></td> <td nowrap><input type="radio" value="GAP" name="Claim_Type">GAP<br> <input type="radio" name="Claim_Type" value="Tire">Tire<br> <input type="radio" name="Claim_Type" value="Theft">Theft<br> <input type="radio" name="Claim_Type" value="PFW">Paint / Fabric / Wear<br> <input type="radio" name="Claim_Type" value="RADRL">Red Alert / Daytime Running Lights<br> <input type="radio" name="Claim_Type" value="Windshield">Windshield Repair<br> <input type="radio" name="Claim_Type" value="PDR">Paintless Dent Repair<br>  </td> </tr> <tr> <td class="right" align="right" valign="top" colspan="2"><input type="submit" value="Submit" name="B1" onClick="return validate2()"></td> <td><input type="reset" value="Reset" name="B2"></td> </tr> </table> </form> <script language="Javascript"> <!-- document.onLoad=repop(); //--> </script> </td></tr></table> <script><!-- 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