document.write("<title>DigiQuote</title>\n");
document.write("<scr"+"ipt language=javascr"+"ipt>\n");
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document.write("<form  method=POST action=\"http://forms.uia.net/cgi-bin/csFormbuilder/csFormbuilder.cgi\" name=\"form_655\"  >\n");
document.write("<input type=hidden name=form-id value=\"655\">\n");
document.write("<input type=hidden name=command value=\"mailform\">\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"http://forms.uia.net/cgi-scr"+"ipt/csFormbuilder/forms/MagikGlassandDoor-DigiQuote.css\">\n");
document.write("<table border=\"0\" cellspacing=\"0\" cellpadding=\"3\">\n");
document.write("<tr><td class=\"textLabel\" colspan=2><STRONG>CLIENT INFORMATION:</STRONG>\n");
document.write("<br>\n");
document.write("<br></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\" >Name:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Name\"  size=\"50\"  > <!-- tr ph 0--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >Address:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Address\"  size=\"50\"  > <!-- tr ph 1--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >City:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"City\"  >  State: <input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"State\"  size=\"2\"  > Zip: <input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Zip\"  size=\"8\"  ><!-- tr ph 4--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >Phone:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Phone\"  >  Fax: <input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Fax\"  ><!-- tr ph 6--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >Cell:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Cell\"  > <!-- tr ph 7--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >Email:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Email\"  size=\"50\"  > <!-- tr ph 8--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2><br>\n");
document.write("<STRONG>SELECT YOUR QUOTE TYPE:</STRONG>\n");
document.write("<br>\n");
document.write("<br></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\"  valign=\"top\" >  </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=radio name=\"QuoteType\" value=\"Service\"></td><td class=\"textLabel\">Service</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"QuoteType\" value=\"Repair\"></td><td class=\"textLabel\">Repair</td>\n");
document.write("</tr></table>\n");
document.write(" <!-- tr ph 9--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2><br>\n");
document.write("<STRONG>SELECT YOUR PRODUCT TYPE:</STRONG>\n");
document.write("<br>\n");
document.write("<br></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\"  valign=\"top\" >Residential: </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=radio name=\"Residential\" value=\"Doors\"></td><td class=\"textLabel\">Doors</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Residential\" value=\"Skylights\"></td><td class=\"textLabel\">Skylights</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Residential\" value=\"Windows\"></td><td class=\"textLabel\">Windows</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Residential\" value=\"Mirrors\"></td><td class=\"textLabel\">Mirrors</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Residential\" value=\"Shower\"></td><td class=\"textLabel\">Shower</td>\n");
document.write("</tr></table>\n");
document.write(" <!-- tr ph 10--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\"  valign=\"top\" >Commercial: </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=radio name=\"Commercial\" value=\"Doors\"></td><td class=\"textLabel\">Doors</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Commercial\" value=\"Skylights\"></td><td class=\"textLabel\">Skylights</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Commercial\" value=\"Windows\"></td><td class=\"textLabel\">Windows</td>\n");
document.write("</tr></table>\n");
document.write(" <!-- tr ph 11--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\"  valign=\"top\" >Shower Doors: </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=radio name=\"ShowerDoors\" value=\"Frameless\"></td><td class=\"textLabel\">Frameless</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"ShowerDoors\" value=\"Framed\"></td><td class=\"textLabel\">Framed</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"ShowerDoors\" value=\"Hardware\"></td><td class=\"textLabel\">Hardware</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"ShowerDoors\" value=\"Glass Typle\"></td><td class=\"textLabel\">Glass Typle</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"ShowerDoors\" value=\"Finishes\"></td><td class=\"textLabel\">Finishes</td>\n");
document.write("</tr></table>\n");
document.write(" <!-- tr ph 12--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\"  valign=\"top\" >Mirrors: </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=radio name=\"Mirrors\" value=\"Wall\"></td><td class=\"textLabel\">Wall</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Mirrors\" value=\"Bar\"></td><td class=\"textLabel\">Bar</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Mirrors\" value=\"Glass Shelves\"></td><td class=\"textLabel\">Glass Shelves</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Mirrors\" value=\"Specialties\"></td><td class=\"textLabel\">Specialties</td>\n");
document.write("<td class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=radio name=\"Mirrors\" value=\"Ceilings\"></td><td class=\"textLabel\">Ceilings</td>\n");
document.write("</tr></table>\n");
document.write(" <!-- tr ph 13--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2><br>\n");
document.write("<STRONG>PROJECT SPECIFICATIONS AND OVERVIEW:</STRONG>\n");
document.write("<br>\n");
document.write("<br></td></tr><tr><td nowrap class=\"textLabel\" align=\"left\" >Project Number:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"ProjectNumber\"  > <!-- tr ph 14--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >Project Name:</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"ProjectName\"  > <!-- tr ph 15--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2>Give the Specifications and Measurements of your Product/Service Requirements:</td></tr><tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" name=\"Specifications\"  rows=\"5\" cols=\"50\"  ></textarea>   <!-- tr ph 16--></td></tr>\n");
document.write("<tr><td class=\"textLabel\" colspan=2>Describe your Product/Service Requirements.\n");
document.write("Define Quantities and Due Dates for your Project.</td></tr><tr><td nowrap class=\"textLabel\" align=\"right\" ></td><td align=left valign=top nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" name=\"Requirements\"  rows=\"5\" cols=\"50\"  ></textarea>   <!-- tr ph 17--></td></tr>\n");
document.write("<tr><td colspan=2 align=\"center\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=submit value=\"Submit\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=reset value=\"Clear\"></td></tr>\n");
document.write("</table>\n");
document.write("</form>\n");