// valcontact.js

document.writeln('<form name="contactform" onsubmit="return val_contactform(this);" method=post action=http://www.gcmpinc.com/cgi-bin/liammrof.pl>');
document.writeln('<input type="hidden" name="recipient" value=angie@gcmpinc.com>');
document.writeln('<input type="hidden" name="redirect" value=http://gcmpinc.com/contact_confirm.htm>');
document.writeln('<input type=hidden name="subject" value="Web Site Contact Form (gcmpinc.com)">');
document.writeln('<input type=hidden name="required" value="email">');
document.writeln('<input type=hidden name="print_blank_fields" value="1">');

document.writeln('<input class="shadeform" type=text size="35" name="realname"> <strong>Your Name</strong><br>');
document.writeln('<input class="shadeform" type=text size="35" name="Organization"> <strong>Organization</strong><br>');
document.writeln('<input class="shadeform" type=text size="35" name="Phone"> <strong>Phone Number</strong><br>');
document.writeln('<input class="shadeform" type=text size="35" name="email"><span class="nobreak"> <strong>E-Mail&nbsp;Address</strong>&nbsp;(required)</span><br>');
document.writeln('<br>');



document.writeln('<b>Please provide the following product information:</b><br>');
document.writeln('<EM>Product Name:</EM> <SELECT NAME="Wants_Product_Info_for"><OPTION SELECTED>Forticel<OPTION>Bioguard<OPTION>Other</SELECT>');
document.writeln('<br><br>');
document.writeln('<strong>Please enter any additional comments you might have.</strong>');
document.writeln('<TEXTAREA NAME="Additional_Comments" ROWS=5 COLS=35></TEXTAREA>');
document.writeln('<BR><br>');
document.writeln('<strong>Enter the time that is best to contact you:</strong>');
document.writeln('<br><INPUT TYPE=TEXT NAME="Best_time_to_contact" SIZE=35>');
document.writeln('<BR><br>');
document.writeln('<center>');
document.writeln('<INPUT TYPE=submit VALUE="Submit Form">&nbsp;&nbsp;&nbsp;<INPUT TYPE=RESET VALUE="Reset Form">');
document.writeln('</center>');
document.writeln('</form>');