document.writeln('<div id=fdiv>\r\n\r\n<script>function _fbcheck(f) { if (f.n.value==\"\") { alert(\"Please enter your Name\"); f.n.focus(); return false; } if (f.t.value==\"\") { alert(\"Please enter your Contact No\"); f.t.focus(); return false; } return true; }<\/script>\r\n\r\n* = required field\r\n<form method=\"post\" action=\"/feedback.php?form=feedback\" target=\"_irs\" onsubmit=\"return _fbcheck(this)\">\r\n<table style=\"font-size: 1em\">\r\n<tr><td><b>Name<\/b>*<\/td><td><input style=\"width:250px;\" name=\"n\" size=\"50\" value=\"\"><\/td><\/tr>\r\n<tr><td><b>Email<\/b><\/td><td><input style=\"width:250px;\" name=\"e\" size=\"30\" value=\"\"><\/td><\/tr>\r\n<tr><td><b>Contact No.<\/b>*<\/td><td><input style=\"width:250px;\" name=\"t\" size=\"30\" value=\"\"><\/td><\/tr>\r\n<tr><td colspan=\"2\"><b>Comments/Message<\/b><br><textarea name=\"c\" rows=\"10\" cols=\"50\"><\/textarea><\/td><\/tr>\r\n<tr><td colspan=\"2\" align=\"center\"><input value=\"Send\" type=\"submit\"><\/td><\/tr>\r\n<\/table>\r\n\r\n</div><div style="display:none"><iframe width=1 height=1 name=_irs></iframe></div>');