document.writeln('<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>');
document.writeln('<div class=small><div id=fdiv><form method=post action="/feedback.php?token=c916b28614b7e3a0ef3f528583e3ef4b&fdiv=fdiv" target=_irs onsubmit="return _fbcheck(this)"><table style="font-size:1em">');
document.writeln('<tr><td><div align=right>Name:</div></td><td><input name=n size=50 value=""></td></tr>');
document.writeln('<tr><td><div align=right>Email:</div></td><td><input name=e size=30 value=""></td></tr>');
document.writeln('<tr><td><div align=right>Contact No.:</div></td><td><input name=t size=30 value=""></td></tr>');
document.writeln('<tr><td valign=top><div align=right">Message:</div></td><td><textarea name=c rows=10 cols=50></textarea></td></tr>');
document.writeln('<tr><td colspan=2 align=center><input type=submit value="Send"></td></tr>');
document.writeln('</table></form></div></div><div style="display:none"><iframe width=1 height=1 name=_irs></iframe></div>');