document.write('<table style="border: 1px solid #AEAEAE;" width=190px border=0 cellpadding =0 cellspacing=0><form action="submitcomments.php4" method=post >');
document.write('<tr><td style="padding: 5 5 5 5 ;" class=blacktext>Comments or questions about the site or products? Leave us a message.</td></tr>');
document.write('<tr><td style="padding: 1 5 1 5 ;" class=blacktext>name <input class=inputtext type=text name="username" style="width: 143px"/></td></tr>');
document.write('<tr><td style="padding: 1 5 1 5 ;" class=blacktext><nobr>email / tel no. <input class=inputtext type=text name="email" style="width:102px"/></nobr></td></tr>');
document.write('<tr><td style="padding: 1 5 1 5 ;" class=blacktext>message<br><textarea class=inputtext multiline=true name="message" style="width:178px; height: 100px"></textarea></td></tr>');
document.write('<tr><td style="padding: 1 5 1 5 ;" class=blacktext><select name="inquiry" class=inputtext style="width: 178px">');
document.write('<option value=\'General Inquiry\'>General Inquiry</option>');
document.write('<option value=\'Wholesale Inquiry\'>Wholesale Inquiry</option>');
document.write('<option value=\'Specific Product Questions\'>Specific Product Questions</option>');
document.write('<option value=\'Comments on the Website\'>Comments on the Website</option>');
document.write('<option value=\'Others\'>Other</option>');
document.write('</select>');
document.write('<script lang=javascript>');
document.write("document.write('<input  type=hidden value='+document.URL+' id=url name=url />');");
document.write('</script>');
document.write('</td></tr>');
document.write('<tr><td style="padding: 1 5 5 5 ;" class=blacktext><input type=submit value=submit class=inputtext></td></tr>');
document.write('</table></form>');