// 

document.write('<form name="eform" action="/wp-content/themes/s2n-4/s/rc/emjs.php" method="post" onSubmit="return validateStandard(this, \'error\');">');
document.write('<table align="center" border="0" cellspacing="8" cellpadding="0">');
document.write('<tr>');
document.write('<td align="right" class="mandatory">Name:</td>');
document.write('<td><input id="name" name="name" type="text" size="27" maxlength="30" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="right">Company:</td>');
document.write('<td><input name="company" type="text" size="27" maxlength="30" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="right">Address:</td>');
document.write('<td><input name="address" type="text" size="52" maxlength="50" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="right">City:</td>');
document.write('<td>');
document.write('<input name="city" type="text" size="20" maxlength="30" /> State: ');
document.write('<input name="state" type="text" size="3" maxlength="20" /> Zip: ');
document.write('<input name="zip" type="text" size="5" maxlength="10" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="right">Country:</td>');
document.write('<td><input maxlength="20" size="10" value="usa" name="country" type="text" /> ');
document.write('<span class="v10"> (change if other)</span></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="right">Phone:</td>');
document.write('<td><input name="phone type="text" size="20"" maxlength="30" />');
document.write('<span class="v10">&nbsp;&nbsp;&nbsp;&nbsp; Best time to call: </span>');
document.write('<input name="time" type="text" size="6" maxlength="10" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="right">Fax:</td>');
document.write('<td><input name="fax" type="text" size="20" maxlength="30" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="right" class="mandatory">Email:</td>');
document.write('<td><input id="email" name="email" type="text" size="27" maxlength="30" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="right">Message:</td>');
document.write('<td><textarea name="message" rows="6" cols="41"></textarea></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="v10">&nbsp;</td>');
document.write('<td align="center"><input type="submit" value="submit" /></td>');
document.write('</tr>');
document.write('</table>');
document.write('</form>');