document.write("<title>Newman</title>\n");
document.write("Fill out the following information and click 'Submit'.<br>\n");
document.write("<scr"+"ipt language=javascr"+"ipt>\n");
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document.write("</scr"+"ipt>\n");
document.write("<form  method=POST action=\"http://www.mediamessiah.com/cgi-scr"+"ipt/csFormbuilder/csFormbuilder.cgi\" name=\"form_17\"  >\n");
document.write("<input type=hidden name=form-id value=\"17\">\n");
document.write("<input type=hidden name=command value=\"mailform\">\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.mediamessiah.com/cgi-scr"+"ipt/csFormbuilder/forms/newman.css\">\n");
document.write("<table border=\"0\" cellspacing=\"0\" cellpadding=\"3\">\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\" >*First Name</td><td align=left valign=top nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" name=\"firstname\"  rows=\"1\" cols=\"50\"  ></textarea>   <!-- tr ph 0--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\" >*Last Name</td><td align=left valign=top nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" name=\"lastname\"  rows=\"1\" cols=\"50\"  ></textarea>   <!-- tr ph 1--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\" >*Phone:</td><td align=left valign=top nowrap class=\"textLabel\">\n");
document.write("	      <table border=\"0\" cellspacing=\"0\" align=left>\n");
document.write("	        <tr>\n");
document.write("	          <td valign=\"middle\" align=\"center\" class=\"textLabel\" nowrap>(</td>\n");
document.write("	          <td valign=\"middle\" align=\"center\" class=\"textLabel\" nowrap><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Phone_1\" size=\"3\" maxlength=\"3\"></td>\n");
document.write("	          <td valign=\"middle\" align=\"center\" class=\"textLabel\" nowrap>)</td>\n");
document.write("	          <td valign=\"middle\" align=\"center\" class=\"textLabel\" nowrap>&nbsp;</td>\n");
document.write("	          <td valign=\"middle\" align=\"center\" class=\"textLabel\" nowrap><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Phone_2\" size=\"3\" maxlength=\"3\"></td>\n");
document.write("	          <td valign=\"middle\" align=\"center\" class=\"textLabel\" nowrap>-</td>\n");
document.write("	          <td valign=\"middle\" align=\"center\" class=\"textLabel\" nowrap><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Phone_3\" size=\"4\" maxlength=\"4\"><input type=hidden name=\"Phone\" value=\"1\"></td>\n");
document.write("	        </tr>\n");
document.write("      </table>\n");
document.write("       <!-- tr ph 2--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\" >*Email:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Email\"  > <!-- tr ph 3--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\"  valign=\"top\" >*Question regarding </td><td align=left valign=top nowrap class=\"textLabel\"><table border=0 cellspacing=2 cellpadding=0><tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"regarding\" value=\"Buying\"></td><td class=\"textLabel\">Buying</td></tr>\n");
document.write("<tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"regarding\" value=\"Selling\"></td><td class=\"textLabel\">Selling</td></tr>\n");
document.write("<tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"regarding\" value=\"Renting\"></td><td class=\"textLabel\">Renting</td></tr>\n");
document.write("<tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"regarding\" value=\"Construction / Maintenance\"></td><td class=\"textLabel\">Construction / Maintenance</td></tr>\n");
document.write("</table>\n");
document.write(" <!-- tr ph 4--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\"  valign=\"top\" >*Town(s) of interest </td><td align=left valign=top nowrap class=\"textLabel\"><table border=0 cellspacing=2 cellpadding=0><tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"towns\" value=\"Fair Harbor\"></td><td class=\"textLabel\">Fair Harbor</td></tr>\n");
document.write("<tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"towns\" value=\"Saltaire\"></td><td class=\"textLabel\">Saltaire</td></tr>\n");
document.write("<tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"towns\" value=\"Dunewood\"></td><td class=\"textLabel\">Dunewood</td></tr>\n");
document.write("<tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"towns\" value=\"Lonelyville\"></td><td class=\"textLabel\">Lonelyville</td></tr>\n");
document.write("<tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"towns\" value=\"Kismet\"></td><td class=\"textLabel\">Kismet</td></tr>\n");
document.write("<tr><td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=checkbox name=\"towns\" value=\"Seaview\"></td><td class=\"textLabel\">Seaview</td></tr>\n");
document.write("</table>\n");
document.write(" <!-- tr ph 5--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\" >Bedroom # </td><td align=left valign=top nowrap class=\"textLabel\"><select name=\"bednumber\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\">-= Select =-</option>\n");
document.write("<option>2</option>\n");
document.write("<option>3</option>\n");
document.write("<option>4</option>\n");
document.write("<option>5+</option>\n");
document.write("</select>&nbsp; <!-- tr ph 6--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\" >Bathroom # </td><td align=left valign=top nowrap class=\"textLabel\"><select name=\"bathnumber\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\">-= Select =-</option>\n");
document.write("<option>1</option>\n");
document.write("<option>2</option>\n");
document.write("<option>3+</option>\n");
document.write("</select>&nbsp; <!-- tr ph 7--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"right\" >Comments/Questions/Concerns</td><td align=left valign=top nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" name=\"comments\"  rows=\"5\" cols=\"50\"  ></textarea>   <!-- tr ph 8--></td></tr>\n");
document.write("<tr><td colspan=2 align=\"right\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=button value=\"Back\" onClick=\"history.back();\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=submit value=\"Submit\"></td></tr>\n");
document.write("</table>\n");
document.write("</form>\n");