<script>function validate_sub(){
             if(document.subscribeForm.email_address.value==''){
               alert('Please fill in your email address.');
               return false;
             }
             if(document.subscribeForm.firstname.value==''){
               alert('Please fill in your Firstname.');
               return false;
             }    
             if(document.subscribeForm.lastname.value==''){
               alert('Please fill in your Lastname.');
               return false;
             } 
             if(document.subscribeForm.confirm_send.checked==false){
               alert('If you would like us to send you this news Letter then please click the check box -> Send me your newsletter via email.');
               return false;
             }
document.subscribeForm.submit();
}</script>
<form action="http://www.tlabsystemslocal.co.za/admin/subscribe.php" name="subscribeForm">
    <input type="hidden" name="send_email" value="true" /> <input type="hidden" name="listsid" value="1" /> <input type="hidden" name="from_address" value="sales@teacup.co.za" />
    <table cellspacing="0" cellpadding="0" width="270" border="1">
        <tbody>
            <tr>
                <td>
                <table cellspacing="0" cellpadding="3" width="100%" border="0">
                    <tbody>
                        <tr>
                            <td align="center" colspan="2" height="53">Your email address will be kept secure and safe and will not be used with out your permission.</td>
                        </tr>
                        <tr>
                            <td width="44%">Email:</td>
                            <td width="56%"><input name="email_address" /></td>
                        </tr>
                        <tr>
                            <td>Re-Type Email:</td>
                            <td><input onblur="if(this.value!=this.form.email_address.value){alert(&quot;Your emails do not match!&quot;);this.focus();}" name="reemail_address" /></td>
                        </tr>
                        <tr>
                            <td>First Name:</td>
                            <td><input name="firstname" /></td>
                        </tr>
                        <tr>
                            <td>Last Name:</td>
                            <td><input name="lastname" /></td>
                        </tr>
                        <tr>
                            <td colspan="2"><input type="checkbox" name="confirm_send" value="1" /> Send me your newsletter via email.</td>
                        </tr>
                        <tr>
                            <td align="center" colspan="2" height="43">A confirmation email will be sent to the above address.</td>
                        </tr>
                        <tr>
                            <td align="center" colspan="2"><input onclick="validate_sub();" type="button" name="Submit" value="Suscribe to Newsletter Now" /></td>
                        </tr>
                    </tbody>
                </table>
                </td>
            </tr>
        </tbody>
    </table>
</form>