// valestimate.js

document.writeln('<form name="estimateform" onsubmit="return val_estform(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/estimate_confirm.htm>');
document.writeln('<input type=hidden name="subject" value="GCMPINC.com Request for Prevention Estimate">');
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="Title"> <strong>Title</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="FAX"> <strong>FAX 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('<span class="title3">Floor Square Feet<br></span>');
document.writeln('<input class="shadeform" size="5" type=text name="1stFloorSQFT"> <strong>How many square feet on First Floor?</strong><br>');
document.writeln('<input class="shadeform" size="5" type=text name="2ndFloorSQFT"> <strong>Second Floor?</strong><br>');
document.writeln('<input class="shadeform" size="5" type=text name="3rdFloorSQFT"> <strong>Third Floor?</strong><br>');
document.writeln('<br>');
document.writeln('<span class="title3">Select any of the following options that apply:</span>');
document.writeln('<br>');

document.writeln('<INPUT TYPE="checkbox" NAME="Option1" value="Ext. walls and interior wet areas">');
document.writeln('Option 1 - Ext. walls and interior wet areas<br>');

document.writeln('<INPUT TYPE="checkbox" NAME="Option2" value="Option 1 + all interior walls">');
document.writeln('Option 2 - Option 1 + all interior walls<br>');

document.writeln('<INPUT TYPE="checkbox" name="Option3" value="Option 1 + floor systems">');
document.writeln('Option 3- Option 1 + floor systems<BR>');

document.writeln('<INPUT TYPE="CHECKBOX" NAME="Option4" value="Option 1 and rafters">');
document.writeln('Option 4- Options 1 + rafters<BR>');

document.writeln('<INPUT TYPE="CHECKBOX" NAME="Option5" value="Options 2, 3, and 4">');
document.writeln('Option 5-&nbsp; Options 2,3 and 4<BR>');
document.writeln('<br>');
document.writeln('<B>Additional Comments/Questions:</B><BR>');
document.writeln('<TEXTAREA NAME="Additional_Comments" ROWS=5 COLS=35></TEXTAREA>');
document.writeln('<br><br>');

document.writeln('<strong>Enter the date when job would be ready: <br></strong>');
document.writeln('<INPUT TYPE=TEXT NAME="Date_when_job_would_be_ready" SIZE=25>');
document.writeln('<br><br>');

document.writeln('<strong>Location of the job site and directions.</strong><br><span class="copyright">(Plus additional comments, if any)</span><br>');
document.writeln('<TEXTAREA NAME="Location_of_job_site" ROWS=5 COLS=35></TEXTAREA>');

document.writeln('<br><br>');
document.writeln('<center>');
document.writeln('<input type="submit" value="Submit Estimate">&nbsp;&nbsp;&nbsp;<INPUT TYPE=RESET VALUE="Reset Form">');
document.writeln('</center>');
document.writeln('</form>');