document.write('<style type="text/css">'+
'#text_select_form_expo	{color: #3674A7; font-size: 10px; }'+
'</style>'+
''+
'<table width="100%" border="0" cellPadding=2 cellSpacing=0 >'+
' <form name="form1" method="post" action="" target=send>'+
' <tr>'+
'  <td width="30%"><b>Ваше имя</b><font color=red>*</font></td>'+
'  <td width="70%"><input name=NAME size=35 id=tdxb style="width: 190px; "></td></tr>'+
' <tr>'+
'  <td width="30%"><b>Название организации</b></td>'+
'  <td width="70%"><input name=FIRM_NAME size=35 id=tdxb style="width: 190px; "></td></tr>'+
' <tr>'+
'  <td width="30%"><b>Контактные телефоны</b><font color=red>*</font></td>'+
'  <td width="70%"><input name=TELEFON size=35 id=tdxb style="width: 190px; "></td></tr>'+
' <tr>'+
'  <td width="30%"><b>Контактный e-mail</b><font color=red>*</font></td>'+
'  <td width="70%"><input name=MAIL size=35 id=tdxb style="width: 190px; "></td></tr>'+
' <tr>'+
'  <td width="30%"><b>Текст сообщения</b><font color=red>*</font></td>'+
'  <td width="70%"><textarea cols=50 name=NOTE rows=8 id=tdxb style="width: 190px; "></textarea></tr>'+
' <tr>'+
'  <td width="50%" id=tdx><input type="Submit" name="Submit" value="Отправить"></td>'+
'  <td width="50%" id=tdx>&nbsp;</td>'+
'</tr>'+
' </form>'+
'</table>'+
''+
 ' ');