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;');
document.write('}');
document.write('.phpForms_btn');
document.write('{');
document.write('    border-top-width    : 1px;');
document.write('    border-left-width   : 1px;');
document.write('    border-bottom-width : 1px;');
document.write('    border-right-width  : 1px;');
document.write('    border-top-color    : #e4e4e4;');
document.write('    border-left-color   : #e4e4e4;');
document.write('    border-right-color  : #c1c1c1;');
document.write('    border-bottom-color : #c1c1c1;');
document.write('    font-family         : Verdana, Arial, Helvetica, sans-serif;');
document.write('    color               : #000000;');
document.write('}');
document.write('-->');
document.write('</style>');
   var aIds_frm_e717c57a4f = Array( 'pg_72a7aa1edc' );   var aId_frm_e717c57a4f  = Array ();function ChangePage_frm_e717c57a4f( to_hide, to_show ){   var tbl_hide = document.getElementById( aIds_frm_e717c57a4f[to_hide] );   var tbl_show = document.getElementById( aIds_frm_e717c57a4f[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;}document.write('<form name=\"frm_e717c57a4f\" id=\"frm_e717c57a4f\" 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=\"e717c57a4f\">');
function CheckPage_frm_e717c57a4f_72a7aa1edc(){   var nResult = 0;      nResult += NotEmpty( nResult, 'fld_5776ff12f1','First Name' );   nResult += NotEmpty( nResult, 'fld_fabec7015e','Last Name' );   nResult += NotEmpty( nResult, 'fld_48d734fb4e','Phone Number' );   nResult += NotEmpty( nResult, 'fld_efe8b04463','Email' );   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_e717c57a4f' );         if ( typeof(el)=='object' && el != null )		 {			el.submit()		}      }      else         {            ChangePage_frm_e717c57a4f( 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_72a7aa1edc\" border=\"0\" cellpadding=\"2\" cellspacing=\"1\" width=\"550\" bgcolor=\"#0A0A0A\" class=\"phpForms_main\" style=\"display:table;border: solid 1px #777777;\">');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">First Name</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <input type=\"text\" name=\"fld_5776ff12f1\"  size=\"30\" id=\"fld_5776ff12f1\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">Last Name</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <input type=\"text\" name=\"fld_fabec7015e\"  size=\"30\" id=\"fld_fabec7015e\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">Phone Number</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <input type=\"text\" name=\"fld_48d734fb4e\"  size=\"30\" id=\"fld_48d734fb4e\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">Email</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <input type=\"text\" name=\"fld_efe8b04463\"  size=\"30\" id=\"fld_efe8b04463\" value=\"\" style=\"\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">DOB</span>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <input type=\"text\" name=\"fld_5f718c44ba\"   id=\"fld_5f718c44ba\" value=\"\" style=\"30\">');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">How did you find us?</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <select name=\"fld_38a1094df7\" id=\"fld_38a1094df7\" style=\"30\">');
document.write('  <option value=\'Choose one\'>Choose one</option>');
document.write('<option value=\'Google Search\'>Google Search</option>');
document.write('<option value=\'Yahoo Search\'>Yahoo Search</option>');
document.write('<option value=\'MSN Search\'>MSN Search</option>');
document.write('<option value=\'Recommendation\'>Recommendation</option>');
document.write('<option value=\'Radio\'>Radio</option>');
document.write('<option value=\'Newspaper\'>Newspaper</option>');
document.write('</select>');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">Best time to call you?</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <select name=\"fld_8acffcd858\" id=\"fld_8acffcd858\" style=\"60\">');
document.write('  <option value=\'9:00am - 12:00pm\'>9:00am - 12:00pm</option>');
document.write('<option value=\'12:00pm - 3:00pm\'>12:00pm - 3:00pm</option>');
document.write('<option value=\'3:00pm - 6:00pm\'>3:00pm - 6:00pm</option>');
document.write('<option value=\'6:00pm - 9:00pm\'>6:00pm - 9:00pm</option>');
document.write('</select>');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">Best means to contact you?</span>&nbsp;<font color=\'red\'>*</font>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <select name=\"fld_e7c2f36da2\" id=\"fld_e7c2f36da2\" style=\"60\">');
document.write('  <option value=\'Email\'>Email</option>');
document.write('<option value=\'Phone\'>Phone</option>');
document.write('</select>');
document.write('          </td>');
document.write('      </tr>');
document.write('      <tr>');
document.write('          <td width=\"30%\" align=\"left\" bgcolor=\"#0A0A0A\" valign=\"top\">');
document.write('             <span style=\"\">Message</span>');
document.write('          </td>');
document.write('          <td width=\"70%\" align=\"left\" bgcolor=\"#0A0A0A\">');
document.write('             <textarea name=\"fld_547eec2eb2\" id=\"fld_547eec2eb2\" rows=\"5\" style=\"65\"></textarea>');
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=e717c57a4f&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=e717c57a4f&randm="+ randim + "";   document.forms['frm_e717c57a4f'].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_e717c57a4f'].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=e717c57a4f&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_e717c57a4f');         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_e717c57a4f_72a7aa1edc(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 -->');