document.write('<!-- phpForms.net form BEGIN -->');
document.write('<style>');
document.write('<!--');
document.write('.phpForms_pgtitle');
document.write('{');
document.write('    font-family : Arial;');
document.write('    font-size   : 18px;');
document.write('    color       : #1200d9;');
document.write('    font-weight : bold;');
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document.write('.phpForms_btn');
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document.write('    font-family         : Verdana, Arial, Helvetica, sans-serif;');
document.write('    color               : #000000;');
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document.write('</style>');
   var aIds_frm_98d1fec166 = Array( 'pg_5624b77966' );   var aId_frm_98d1fec166  = Array ();function ChangePage_frm_98d1fec166( to_hide, to_show ){   var tbl_hide = document.getElementById( aIds_frm_98d1fec166[to_hide] );   var tbl_show = document.getElementById( aIds_frm_98d1fec166[to_show] );   if ( typeof(tbl_hide)=='object' && tbl_hide!=null )    if ( typeof(tbl_show)=='object' && tbl_show!=null )    {       tbl_hide.style.display = 'none';       tbl_show.style.display = '';    }	}function NotEmpty( old_res, id, field_title ){   if ( old_res==0 )   {      var el = document.getElementById( id );      if ( typeof(el)=='object' && el!=null )        if ( el.value=='' )        {           alert( 'You should fill "' + field_title + '"' );           return 1;        }   }   return 0;}function Email_not_empty( old_res, id, field_title ){    if ( old_res==0 )   {      var el = document.getElementById( id );      if ( typeof(el)=='object' && el!=null  )      {         var re = /^[a-zA-Z0-9_\.\-]+@([a-zA-Z0-9][a-zA-Z0-9-]+\.)+[a-zA-Z]{2,6}$/;         if (el.value.search(re) != -1 )  return 0;         else         {            alert( '"'+field_title+'" must be email' );            return 1;         }      }   }   return 0;}function NumbersOnly( old_res, id, field_title ){   if ( old_res==0 )   {      var el = document.getElementById( id );      if ( typeof(el)=='object' && el!=null )      {         var re = /^[0-9]+$/;         if (el.value.search(re) == -1 )         {            alert( '"' + field_title + '" must be a number' );            return 1;         }      }   }   return 0;}document.write('<form name=\"frm_98d1fec166\" id=\"frm_98d1fec166\" method=\"POST\" enctype=\"multipart/form-data\" action=\"http://www.top-ten-website-marketing.com/phpforms/index.php?sid=0\" onSubmit=\"return false;\">');
document.write('<input type=\"hidden\" name=\"act\" value=\"idx\">');
document.write('<input type=\"hidden\" name=\"code\" value=\"01\">');
document.write('<input type=\"hidden\" name=\"fid\" value=\"98d1fec166\">');
function CheckPage_frm_98d1fec166_5624b77966(){   var nResult = 0;      nResult += NotEmpty( nResult, 'fld_86e1753b0a','Name:' );   nResult += Email_not_empty( nResult, 'fld_75098c3e90','Email:' );   nResult += NotEmpty( nResult, 'fld_df60e3674b','Phone:' );   nResult += NotEmpty( nResult, 'fld_1dadf9e738','Address:' );   nResult += NotEmpty( nResult, 'fld_b56578bec4','City:' );   nResult += NotEmpty( nResult, 'fld_839b5005d7','State:' );   nResult += NumbersOnly( nResult, 'fld_bb275098c1','Zip:' );   nResult += NotEmpty( nResult, 'fld_0bda050be6','Country:' );   if ( nResult == 0 )   {        document.getElementById('loading').style.display='inline';                                              document.getElementById('imgcode_code').style.display='none';											  if (arguments[0] == 1)											  {												window.temp = 'yes';											  } else												{													window.temp = 'no';												}											  CheckImg();											  return;                                                     if (1)      {         var el = document.getElementById( 'frm_98d1fec166' );         if ( typeof(el)=='object' && el != null )		 {			el.submit()		}      }      else         {            ChangePage_frm_98d1fec166( 0, 1 );            document.location.href="#";        }   } }function SetFDate(fld_id){	var cur_date = new Date();	var minutes = cur_date.getMinutes();	var hour= cur_date.getHours();	var day = cur_date.getDate();	var month = cur_date.getMonth();	var year = cur_date.getFullYear();	var eDay = document.getElementById('fld_d_' + fld_id);	if ( typeof(eDay )=='object' && eDay != null )	{		eDay.options[day].selected = 'selected';	}	var eHour= document.getElementById('fld_h_' + fld_id);	if ( typeof(eHour)=='object' && eHour != null )	{		eHour.options[hour].selected = 'selected';	}	var eMinutes = document.getElementById('fld_i_' + fld_id);	if ( typeof(eMinutes)=='object' && eMinutes != null )	{		eMinutes.options[minutes].selected = 'selected';	}	var eMonth = document.getElementById('fld_m_' + fld_id);	if ( typeof(eMonth)=='object' && eMonth != null )	{		eMonth.options[month].selected = 'selected';	}	var eYear = document.getElementById('fld_y_' + fld_id);	if ( typeof(eYear)=='object' && eYear != null )	{		for(i=0;i<eYear.length; i++)		{			if (eYear.options[i].value == year)			{				eYear.options[i].selected = 'selected';			}		}	}}document.write('     <!-- Page -->');
document.write('     <table id=\"pg_5624b77966\" border=\"0\" cellpadding=\"2\" cellspacing=\"1\" width=\"600\" bgcolor=\"#BCD2EE\" class=\"phpForms_main\" style=\"display:table;border: solid 1px #777777;\">');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Name:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_86e1753b0a\"  size=\"20\" id=\"fld_86e1753b0a\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Email:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_75098c3e90\"  size=\"20\" id=\"fld_75098c3e90\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Company:</span>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_9c25c15c57\"  size=\"30\" id=\"fld_9c25c15c57\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Phone:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_df60e3674b\"  size=\"20\" id=\"fld_df60e3674b\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Address:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_1dadf9e738\"  size=\"30\" id=\"fld_1dadf9e738\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">City:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_b56578bec4\"  size=\"20\" id=\"fld_b56578bec4\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">State:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_839b5005d7\"  size=\"20\" id=\"fld_839b5005d7\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Zip:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_bb275098c1\"  size=\"20\" id=\"fld_bb275098c1\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Country:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"text\" name=\"fld_0bda050be6\"  size=\"20\" id=\"fld_0bda050be6\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Comments:</span>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <textarea name=\"fld_9b2cb16008\" id=\"fld_9b2cb16008\" rows=\"5\" style=\"width:100%;\"></textarea>');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#BCD2EE\" valign=\"top\">');
document.write('             <span style=\"\">Letter Type:</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#BCD2EE\">');
document.write('             <input type=\"checkbox\" name=\"fld_ff0ae308a6[]\" id=\"c83adecd01\"   value=\"Product List\" style=\"\"><label for=\"c83adecd01\">Product List</label><br>');
document.write('<input type=\"checkbox\" name=\"fld_ff0ae308a6[]\" id=\"c331dc511b\"   value=\"Hot Deals\" style=\"\"><label for=\"c331dc511b\">Hot Deals</label><br>');
document.write('<input type=\"checkbox\" name=\"fld_ff0ae308a6[]\" id=\"f4889879f8\"   value=\"Closeout Deals\" style=\"\"><label for=\"f4889879f8\">Closeout Deals</label><br>');
document.write('<input type=\"checkbox\" name=\"fld_ff0ae308a6[]\" id=\"856e9820fe\"   value=\"Newsletter\" style=\"\"><label for=\"856e9820fe\">Newsletter</label>');
document.write('          </td>');
document.write('      </tr>');
document.write('<tr>');
document.write('    <td>');
document.write('     <img src=\"http://www.top-ten-website-marketing.com/phpforms/index.php?frm=98d1fec166&randm=\"+ randim + \"\" name=\"captcha\"><br>');
document.write('     <input type=\"hidden\" name=\"imgcode_id\" value=\'\'>');
document.write('     <a href=\"javascript:changeAccessCodeImg();\">Reload image</a>');
document.write('    </td>');
document.write('    <td>');
document.write('	 <img src=\"http://www.top-ten-website-marketing.com/phpforms/img-code/loading.gif\" id=\"loading\" name=\"loading\" style=\"display: none\"><br>');
document.write('	 <b>Enter the code you see on the image:</b><br />');
document.write('     <input type=\"text\" name=\"imgcode_code\" id=\"imgcode_code\" value=\'\' style=\"width:220px;\">');
document.write('    </td>	 ');
document.write('</tr>');
document.write('&nbsp;');
function changeAccessCodeImg(){   var randim = Math.random();   document.images.captcha.src = "http://www.top-ten-website-marketing.com/phpforms/index.php?frm=98d1fec166&randm="+ randim + "";   document.forms['frm_98d1fec166'].imgcode_id.value =+ randim + ""; } changeAccessCodeImg(); function CheckImg(){     var s = document.createElement('script');   s.setAttribute('type','text/javascript');   cl_code = document.getElementById('imgcode_code');   checimg = cl_code.value;   randim = document.forms['frm_98d1fec166'].imgcode_id.value;   document.documentElement.firstChild.appendChild(s);    ff_onload_called=false;	s.setAttribute('src', "http://www.top-ten-website-marketing.com/phpforms/index.php?frm=98d1fec166&chrandm=" + randim + "&checimg=" + checimg + "");	s.setAttribute('onload', "ff1()"); }var ff_onload_called=false;function ff1(){      if(ff_onload_called)        return;    ff_onload_called=true;       document.getElementById('loading').style.display='none';   document.getElementById('imgcode_code').style.display='';      if (ci == 3)    {      alert("Sorry, the code you've entered is invalid. Please try again.");      return 1;    }	    if (ci == 2 )    {         var el = document.getElementById('frm_98d1fec166');         if ( typeof(el)=='object' && el != null )         {            el.submit()         }    }	}document.write('&nbsp;');
document.write('<tr>');
document.write('          <td colspan=\"2\" align=\"center\" class=\"phpForms_main\">');
document.write('            ');
document.write('          </td>');
document.write('      </tr>');
document.write('<tr>');
document.write('          <td colspan=\"2\" align=\"center\" class=\"phpForms_main\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <!-- Buttons -->');
document.write('          <td colspan=\"2\" align=\"center\" class=\"phpForms_main\">');
document.write('<input type=\"button\" id=\"subbut\" value=\"Submit\" onClick=\'CheckPage_frm_98d1fec166_5624b77966(0);\' style=\"width:30%; background-color : #a2a2a2\" class=\"phpForms_btn\">');
document.write('          </td>');
document.write('      </tr>');
document.write('     </table>');
document.write('     <!-- /Page -->');
document.write('</form>');
document.write('<!-- /phpForms.net form END -->');