function verifyForm(form) {
    var affiliate_claim_number = form.affiliate_claim_number.value;
    var client_name = form.client_name.value;
    var insured_name1 = form.insured_name1.value;
    var incident_desc = form.incident_desc.value;
    var payment_amount1 = form.payment_amount1.value;
    var deductible_amount = form.deductible_amount.value;
    var claim_state_code = form.claim_state_code.value;
	var assigning_adjuster_name=form.outside_examiner.value;
	var assigning_adjuster_email=form.radjuster_email.value;
	var assigning_adjuster_phone = form.radjuster_phone.value;
	var success = 1;

	
	if (!assigning_adjuster_phone) {
        form.radjuster_phone.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.radjuster_phone.style.backgroundColor = "";
        form.radjuster_phone.style.border = "";
    }
	
	
	if (!assigning_adjuster_email) {
        form.radjuster_email.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.radjuster_email.style.backgroundColor = "";
        form.radjuster_email.style.border = "";
    }
	
	
	if (!assigning_adjuster_name) {
        form.outside_examiner.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.outside_examiner.style.backgroundColor = "";
        form.outside_examiner.style.border = "";
    }
	
	
    if (!deductible_amount) {
        form.deductible_amount.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.deductible_amount.style.backgroundColor = "";
        form.deductible_amount.style.border = "";
    }


    if (!payment_amount1) {
        form.payment_amount1.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.payment_amount1.style.backgroundColor = "";
        form.payment_amount1.style.border = "";
    }


    if (!incident_desc) {
        form.incident_desc.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.incident_desc.style.backgroundColor = "";
        form.incident_desc.style.border = "";
    }

    if (!insured_name1) {
        form.insured_name1.style.backgroundColor = "yellow";
        success = 0;
    }

    else {
        form.insured_name1.style.backgroundColor = "";
        form.insured_name1.style.border = "";
    }


    if (!affiliate_claim_number) {
        form.affiliate_claim_number.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.affiliate_claim_number.style.backgroundColor = "";
        form.affiliate_claim_number.style.border = "";
    }

    if (!client_name) {
        form.client_name.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.client_name.style.backgroundColor = "";
        form.client_name.style.border = "";
    }

    var deliveryMethodCode = form.method_code.value;
    if (deliveryMethodCode == "0") {
        form.method_code.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.method_code.style.backgroundColor = "";
        form.method_code.style.border = "";
    }

    if (claim_state_code == "") {
        form.claim_state_code.style.backgroundColor = "yellow";
        success = 0;
    }
    else {
        form.claim_state_code.style.backgroundColor = "";
        form.claim_state_code.style.border = "";
    }


    if (!success) {
        alert("The form is incomplete.  Please populate the highlighted fields.");
        return false;
    }
    else {
        return true;
    }
}