document.write('<form method=POST action="http://www.surface-renew.com/cgi-bin/FormMail.pl"target="_top">');
document.write('<INPUT TYPE="HIDDEN" NAME="recipient" VALUE="ryan@surface-renew.com">');
document.write('<INPUT TYPE="HIDDEN" NAME="subject"  VALUE="Website mail"> ');
document.write('<INPUT TYPE="HIDDEN" NAME="redirect" VALUE="http://www.surface-renew.com/index.htm">');
document.write('<INPUT TYPE="HIDDEN" NAME="required" VALUE="first_name,last_name,phone_home, email"> ');
document.write('<INPUT TYPE="HIDDEN" NAME="sort" value="through,first_name,last_name,phone_home,email,comments">');
document.write('<TABLE BORDER="0" cellpadding="0" cellspacing="0" width="100%">');

document.write('</td><td valign="top" align="30%">First Name<br>');
document.write('<INPUT TYPE="TEXT" NAME="first_name" SIZE="20" class="shadeform">');

document.write('</td><td valign="top" align="30%">Last Name<br>');
document.write('<INPUT TYPE="TEXT" NAME="last_name" SIZE="20" class="shadeform">');


document.write('</td></tr><tr><td align="30%">Phone<br>');
document.write('<INPUT TYPE="TEXT" NAME="phone_home" SIZE="20" class="shadeform">');


document.write('</td><td valign="top" align="30%">E-Mail<br>');
document.write('<INPUT TYPE="TEXT" NAME="email" SIZE="20" class="shadeform">');

document.write('</td></tr><tr><td align="30%">How did you find the site?<br>');
document.write('<select name="through" class="dropdown">');
document.write('<option selected value="None selected">Please Select One ----></option>');
document.write('<option value="AOL">America Online</option>');
document.write('<option value="AOLFind">AOLFind</option>');
document.write('<option value="Ask_Jeeves">Ask Jeeves</option>');
document.write('<option value="Excite">Excite</option>');
document.write('<option value="Google">Google</option>');
document.write('<option value="Go">Go</option>');
document.write('<option value="Goto">Goto</option>');
document.write('<option value="Hotbot">Hotbot</option>');
document.write('<option value="Infoseek">Infoseek</option>');
document.write('<option value="Lycos">Lycos</option>');
document.write('<option value="MSN">MSN</option>');
document.write('<option value="yahoo">Yahoo</option>');
document.write('<option value="Banner-Ad">Banner Ad</option>');
document.write('<option value="Friend">Friend</option>');
document.write('<option value="website">Website</option>');
document.write('<option value="Magazine Newspaper">Magazine/Newspaper</option>');
document.write('<option value="Radio">Radio</option>');
document.write('<option value="other">Other</option>');
document.write('</select><br><br>');

document.write('</td></tr><tr><td align="middle"><br>Questons and/or Comments<br>');
document.write('<TEXTAREA NAME="comments" ROWS="5" COLS="30" wrap="soft" class="textarea"></TEXTAREA><p>');
document.write('<input type=submit value="Submit Information" onmouseover="this.className=\'buttonon\'" onmouseout="this.className=\'button\'" class="button">');
document.write('</FORM>');

document.write('</td></tr></table>');