// JavaScript Document
document.write('<form method="post" action="http://www.prokarlift.com/quick-contact.php" name="form" onSubmit="return checkFields();">');
document.write('<table width="200" border="0" cellspacing="0" cellpadding="0">');
document.write('<tr>');
document.write('<td bgcolor="#FFFF00" class="toll">Call Us Toll Free<br />');
document.write('1-866-602-0888</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>&nbsp;</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="titles border-top">Quick Contact</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>&nbsp;</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="lables">Name:</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="left" valign="top"><label>');
document.write('<input name="name" type="text" id="name" size="33" />');
document.write('</label></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="lables">Email:</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="left" valign="top"><input name="email" type="text" id="email" size="33" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="lables">Phone:</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="left" valign="top"><input name="phone" type="text" id="phone" size="33" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="lables">Shipping Address:</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="left" valign="top"><input name="shipping" type="text" id="shipping" size="33" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="lables">Inquiry:</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="left" valign="top"><label>');
document.write('<textarea name="inquiry" id="inquiry" cols="26" rows="5"></textarea>');
document.write('</label></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td class="spacing">&nbsp;</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="2" align="left" valign="top" class="main"><img src="http://www.prokarlift.com/CaptchaSecurityImages.php?width=100&height=35&characters=4" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="2" align="left" valign="top" class="lables">');
document.write('<label for="security_code"><strong>Security Code:</strong> </label>');           
document.write('<input id="security_code" name="security_code" type="text" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="2" align="left" valign="top"></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td align="left" valign="top" class="titles border-bottom"><label>');
document.write('<input type="submit" name="submit" id="submit" value="Submit" />');
document.write('</label></td>');
document.write('</tr>');
document.write('</table>');
document.write('</form>');