function formserialize(frmRequest){
		clearMMLForm();
		document.getElementById("apiFirstName").value=frmRequest.first_name.value;
		document.getElementById("apiLastName").value=frmRequest.last_name.value;
		document.getElementById("apiAddress").value=frmRequest.address.value;
		document.getElementById("apiCity").value=frmRequest.city.value;
		document.getElementById("apiStateCode").value=frmRequest.state.value;
		document.getElementById("apiZipCode").value=frmRequest.zip.value;
		document.getElementById("apiPhone").value=frmRequest.area_code.value+frmRequest.three_digit.value+frmRequest.four_digit.value;
		document.getElementById("apiEmail").value=frmRequest.email.value;
		document.getElementById("apiBestTimeToCall").value=frmRequest.contact_time.value+' '+frmRequest.contact_me.value;
		document.getElementById("apiComment").value=frmRequest.describe_problem.value;
		
		var ans,AdditionalFields;
		
		AdditionalFields="";
		
		if(frmRequest.years_old[1].checked){
			ans="No";
		}else{
			ans="Yes";
		}
		AdditionalFields="Are you at least 18 years old?#"+ans;
		if(frmRequest.glasses_or_contacts[1].checked){
			ans="No";
		}else{
			ans="Yes";
		}
		if(AdditionalFields==""){
			AdditionalFields=AdditionalFields+"Do you require glasses or contacts to drive?#"+ans;	
		}else{
			AdditionalFields=AdditionalFields+"~Do you require glasses or contacts to drive?#"+ans;
		}
		
		document.getElementById("apiAdditionalFields").value=AdditionalFields; 
		document.getElementById("apiTranKey").value='4319D180-6D87-481C-BDD4-F50401211F4B-ACCNT1561'; 
		document.getElementById("apiRedirectPath").value='http://www.westonlaser.com/apithanks.html';
		
		if(frmRequest.first_name.value!="" && frmRequest.last_name.value!="" && frmRequest.address.value!="" && frmRequest.city.value!="" && frmRequest.state.value!="" && frmRequest.zip.value!="" && frmRequest.email.value!="" && frmRequest.contact_time.value!="" && APIvalidateEmail(frmRequest.email.value)){
			window.open("blank.html","MMLBlankPage","width=5,height=5,top=5000,left=5000");
			document.mmlform.submit();
		}
	
	}	
	
	function APIvalidateEmail(fieldValue) {
		if (fieldValue == "") return true;
		return /\w{1,}[@][\w\-]{1,}([.]([\w\-]{1,})){1,3}$/.test(fieldValue);
	}

	function clearMMLForm(){
		document.getElementById("apiFirstName").value="";
		document.getElementById("apiLastName").value="";
		document.getElementById("apiGender").value="";
		document.getElementById("apiAddress").value="";
		document.getElementById("apiCity").value="";
		document.getElementById("apiStateCode").value="";
		document.getElementById("apiZipCode").value="";
		document.getElementById("apiPhone").value="";
		document.getElementById("apiEmail").value="";
		document.getElementById("apiSergeryType").value="";
		document.getElementById("apiBestTimeToCall").value="";
		document.getElementById("apiHearSource").value="";
		document.getElementById("apiComment").value="";
		document.getElementById("apiAdditionalFields").value="";
		document.getElementById("apiTranKey").value="";
		document.getElementById("apiRedirectPath").value="";
	}

	var mmlForm="";
	mmlForm="<form name=\"mmlform\" action=\"http://mymedleads.com/jquery_api_form.asp\" method=\"post\" style=\"padding:0;margin:0;\" target=\"MMLBlankPage\">";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiFirstName\" id=\"apiFirstName\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiLastName\" id=\"apiLastName\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiGender\" id=\"apiGender\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiAddress\" id=\"apiAddress\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiCity\" id=\"apiCity\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiStateCode\" id=\"apiStateCode\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiZipCode\" id=\"apiZipCode\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiPhone\" id=\"apiPhone\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiEmail\" id=\"apiEmail\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiSergeryType\" id=\"apiSergeryType\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiBestTimeToCall\" id=\"apiBestTimeToCall\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiHearSource\" id=\"apiHearSource\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiComment\" id=\"apiComment\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiAdditionalFields\" id=\"apiAdditionalFields\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiTranKey\" id=\"apiTranKey\" value=\"\" />";
	mmlForm=mmlForm + "<input type=\"hidden\" name=\"apiRedirectPath\" id=\"apiRedirectPath\" value=\"\" />";
	mmlForm=mmlForm + "</form>";
	document.write(mmlForm);