document.write("<title>pubdirectcontactus</title>\n");
document.write("Fill out the following information and click 'Submit'.<br>\n");
document.write("<scr"+"ipt language=javascr"+"ipt>\n");
document.write("function TAMax( ta, countspan, maxlength ) {\n");
document.write(" if (ta.value.length > maxlength){\n");
document.write(" 	ta.value = ta.value.substring( 0, maxlength );\n");
document.write("  	ta.blur();\n");
document.write("  	ta.focus();\n");
document.write("  	return false;\n");
document.write(" 	}\n");
document.write(" else {\n");
document.write("  	countspan.innerHTML = maxlength - ta.value.length;\n");
document.write(" 	}\n");
document.write("}\n");
document.write("</scr"+"ipt>\n");
document.write("<form  method=POST action=\"http://www.bndreammakers.com/cgi-scr"+"ipt/csFormbuilder/csFormbuilder.cgi\" name=\"form_191\"  >\n");
document.write("<input type=hidden name=form-id value=\"191\">\n");
document.write("<input type=hidden name=command value=\"mailform\">\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.bndreammakers.com/cgi-scr"+"ipt/csFormbuilder/forms/PuBDirect-ContactUs.css\">\n");
document.write("<table border=\"0\" cellspacing=\"0\" cellpadding=\"3\">\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Full Name:</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"FullName\"  ></td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 0--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Phone:</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td 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("      </td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 1--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Email:</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Email\"  ></td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 2--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">Comments:</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" name=\"Comments\"  rows=\"5\" cols=\"50\"  ></textarea></td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 3--></td></tr>\n");
document.write("<tr><td colspan=2 align=\"left\"><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");