function writeJS(){
var str='';
str+='<form name=\"form1\" method=\"post\" action=\"http:\/\/www.mcssl.com\/app\/contactsave.asp\">';
str+='<input name=\"merchantid\" type=\"hidden\" id=\"merchantid\" value=\"61769\">';
str+='<input name=\"ARThankyouURL\" type=\"hidden\" id=\"ARThankyouURL\" value=\"http:\/\/www.prhotsheet.com\/pr-case-studies.php\">';
str+='<input name=\"copyarresponse\" type=\"hidden\" id=\"copyarresponse\" value=\"1\">';
str+='<input name=\"custom\" type=\"hidden\" id=\"custom\" value=\"0\">';
str+='<input name=\"defaultar\" type=\"hidden\" id=\"defaultar\" value=\"171050\">';
str+='<input name=\"allowmulti\" type=\"hidden\" id=\"allowmulti\" value=\"1\">';
str+='<input name=\"visiblefields\" type=\"hidden\" id=\"visiblefields\" value=\"Name,Email1\">';
str+='<input name=\"requiredfields\" type=\"hidden\" id=\"requiredfields\" value=\"Name,Email1\">';
str+='<table border=\"0\" cellpadding=\"5\">';
str+='    <tr>';
str+='      <td>Full name:<\/td>';
str+='      <td><input name=\"Name\" type=\"text\"><\/td>';
str+='    <\/tr>';
str+='    <tr>';
str+='      <td>Email address: <\/td>';
str+='      <td><input name=\"Email1\" type=\"text\">';
str+='      <input type=\"Submit\" name=\"cmdSubmit\" value=\"Submit\"><\/td>';
str+='    <\/tr>';
str+='  <\/table>';
str+='<\/form>';
document.write(str);
}
writeJS();