function validEmail(txt)
{
return refind("(^([A-Za-z0-9_\-\.])+\@([A-Za-z0-9_\-\.])+\.([A-Za-z]{2,4})$)",txt);
}
function trimNonNumbers(txt){
return rereplace(txt,'(\D)', '',"ALL");
}
function isValidPhone(txt){
var stripped = trimNonNumbers(txt);
if (not isNumeric(stripped) OR len(stripped) neq 10)
return false;
return true;
}
Online Application:
*************** Submittor Information ***************
Personal Information
First Name: #form.firstname#
M.I.: #form.middle#
Last Name: #form.lastname#
SSN: #form.SSN#
Birth Date: #form.birthdate#
Email: #form.email#
Primary Address: #form.address#
City: #form.city#
State: #form.state#
Zip: #form.zip#
Primary Phone: #form.phone#
Fax: #form.fax#
Case Information
Date of Event: #form.eventdate#
Case Type: #form.casetype#
State Your Case Is In: #form.casestate#
Has this case been settled? #form.beensettled#
Have you taken prior funding on this case? #form.priorfunding#
Do you plan to apply with other funding sources? #form.plantoapply#
Case Description: #form.casedescription#
Damages/Injuries Sustained: #form.injuries#
Do you have any other cases pending? #form.pendingcases#
Attorney Info
First Name: #form.afname#
Last Name: #form.alname#
City: #form.acity#
State: #form.astate#
Phone: #form.aphone#
SSN: #form.SSN#
Email: #form.aemail#
Requset Information
Amount of money being requested: #form.requestedmoney#
Authorization to Contact Attorney
Signature: #form.authname#
Today's Date: #form.authdate#
Records Release Authorization: YesNoOnline Litigation Funding Application - Covered Bridge Capital, LLC
The following form errors have been found:
#errors#
You have successfully submitted your application.
Proud sponsor and Hero Partner of the Pennsylvania Association for Justice (formerly, Pennsylvania Trial Lawyers Association)
