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document.writeln(" <hr size=\"1\">");
document.writeln("<form name=\"form1\" method=\"post\" action=\"mailing.asp\" onSubmit=\"return validate_form( );\">");
document.writeln("  <table width=\"376\" border=\"0\" align=\"center\" cellpadding=\"5\" cellspacing=\"2\">");
document.writeln("    <tr bgcolor=\"#FF9900\" class=\"content2\"> ");
document.writeln("      <td height=\"33\" colspan=\"2\"><div align=\"center\"><strong><font color=\"#FFFFFF\">Online ");
document.writeln("          Submission to Customer Service</font></strong></div></td>");
document.writeln("    </tr>");
document.writeln("    <tr class=\"content2\"> ");
document.writeln("      <td height=\"33\" colspan=\"2\"><br><strong>I want to </strong><br> <INPUT type=radio ");
document.writeln("                              value=TechSupport  name=support_type>");
document.writeln("        Ask Technical support <BR> <INPUT type=radio value=Feature ");
document.writeln("                              name=support_type>");
document.writeln("        Request a Feature<BR> <INPUT ");
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document.writeln("        Report a Problem <br>");
document.writeln("        <INPUT ");
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document.writeln("        Submit a Suggestion</td>");
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document.writeln("    <tr class=\"content2\"> ");
document.writeln("      <td width=130 height=\"33\"> <br>");
document.writeln("        Name* </td>");
document.writeln("      <td width=220> <br> <input name=\"LastName\" type=\"text\" id=\"LastName\" style=\"BACKGROUND-COLOR: #FFF9F9\" ></td>");
document.writeln("    </tr>");
document.writeln("    <tr class=\"content2\"> ");
document.writeln("      <td>Subscription No.</td>");
document.writeln("      <td><input name=\"subscriptionNo\" type=\"text\" id=\"subscriptionNo\" style=\"BACKGROUND-COLOR: #FFF9F9\"></td>");
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document.writeln("    <tr class=\"content2\"> ");
document.writeln("      <td>Address* </td>");
document.writeln("      <td><textarea name=\"Address\" rows=\"4\" id=\"Address\" style=\"BACKGROUND-COLOR: #FFF9F9\"></textarea></td>");
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document.writeln("      <td>Postal Code </td>");
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document.writeln("      <td>Phone Number* </td>");
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document.writeln("      <td>Comment* </td>");
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document.writeln("      <td>&nbsp;</td>");
document.writeln("      <td><div align=\"center\"> ");
document.writeln("          <input type=\"reset\" name=\"Reset\" value=\"Reset\">");
document.writeln("          &nbsp; &nbsp; &nbsp; ");
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document.writeln("</form>");
document.writeln("<span class=\"content2\"> &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp;  Note: Entries marked with <strong>*</strong> are required <br><br>We will only use your contact details in connection with the problem or issue you have identified. Contact details will not be used for marketing or provided to a third party.  ");
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