// JavaScript Document
document.write('<form action="http://formmail.dreamhost.com/cgi-bin/formmail.cgi" method="POST" targe="_top">');
document.write('<input type="hidden" name="recipient" value="marques@trilliummed.com">');
document.write('<input type="hidden" name="subject"  value="Trilliummed.com Email Form">');
document.write('<input type="hidden" name="redirect" value="http://www.trilliummed.com/thanks.htm">');
document.write('<input type=hidden name="missing_fields_redirect" value="http://www.trilliummed.com/error.htm">');
document.write('<input type="hidden" name="required" value="Email,Name, Body"> ');
document.write('<input type=hidden name="sort" value="order:Name,Phone,Email,Body">');

document.write('<table width="650" align="left">');
document.write('<tr>');
document.write('<td width="130" align="left">');
document.write('<span class="paragraph">');
document.write('Name *');
document.write('</span>');
document.write('</td>');
document.write('<td>');
document.write('<input type="text" name="Name" size="50">');
document.write('</td>');
document.write('</tr>');			
				
document.write('<tr>');
document.write('<td width="130" align="left">');
document.write('<span class="paragraph">');
document.write('Phone Number');
document.write('</span>');
document.write('</td>');
document.write('<td>');
document.write('<input type="text" name="Phone" size="50">');
document.write('</td>');
document.write('</tr>');		
				
document.write('<tr>');
document.write('<td width="130" align="left">');
document.write('<span class="paragraph">');
document.write('Email Address *');
document.write('</span>');
document.write('</td>');
document.write('<td>');
document.write('<input type="text" name="Email" size="50">');
document.write('</td>');
document.write('</tr>');
				
document.write('<tr>');
document.write('<td width="130" align="left">');
document.write('<span class="paragraph">');
document.write('Comments *');
document.write('</span>');
document.write('</td>');
document.write('<td>');
document.write('<textarea name="Body" rows="6" cols="50" wrap=soft></textarea>');
document.write('</td>');
document.write('</tr>');
	
document.write('<tr>');
document.write('<td width="130" background="images/spacer.gif">');
document.write('</td>');
document.write('<td>');
document.write('<input type="submit" value="Send Information" class="formbutton">');
document.write('<input type=reset value="Clear Form" class="formbutton">');
document.write('</td>');
document.write('</tr>');		
document.write('<tr>');
document.write('<td width="130" background="images/spacer.gif">');
document.write('</td>');
document.write('<td align="right">');
document.write('<span class="paragraph">');
document.write('* Required Fields');
document.write('</span>');
document.write('</td>');
document.write('</tr>');
document.write('</table>');
				
document.write('</form>');