document.write('<table border="0" cellspacing="0" cellpadding="0">');
document.write('				   <tr>');
document.write('				   		<td width="7">&nbsp;</td>');
document.write('				        <td colspan="2" align="center"><div class="quotehead">Request a Brochure of our Capabilities</div></td> 		        ');
document.write('                   </tr>');
document.write('                   <tr>');
document.write('				   		<td >&nbsp;</td>');
document.write('				        <td>Name</td>                  ');
document.write('				        <td><label for="cname"><input type="text" name="cname" id="cname" size="20" /></label></td>');
document.write('                   </tr>');
document.write('				   ');
document.write('				   <tr>');
document.write('				   		<td>&nbsp;</td>');
document.write('				        <td >Phone &nbsp;</td>                  ');
document.write('				        <td><label for="phone"><input type="text" name="phone" id="phone" size="20" /></label></td>');
document.write('                   </tr>');
document.write('<tr>');
document.write('				   		<td>&nbsp;</td>');
document.write('				        <td >Email &nbsp;</td>                  ');
document.write('				        <td><label for="email"><input type="text" name="email" id="email" size="20" /></label></td>');
document.write('                   </tr>');
document.write('<tr>');
document.write('				   		<td>&nbsp;</td>');
document.write('				        <td >Address &nbsp;</td>                  ');
document.write('				        <td><label for="address"><textarea cols="15" rows="1" name="address" id="address"></textarea></label></td>');
document.write('                   </tr>');

document.write('');
document.write('				   <tr>');
document.write('				   		<td>&nbsp;</td>');
document.write('						<td colspan="2" align="right" class="submitquote">');
document.write('							<input type="submit" name="submit" id="submit" value="Submit" />');
document.write('						</td>');
document.write('				   </tr>');
document.write('<tr>');
document.write('				   	                  ');
document.write('				        <td colspan="3" class="questions"><label for="questions"><input type="hidden"  name="questions" id="questions" /></label></td>');
document.write('                   </tr>');
document.write('				   ');
document.write('				   </table>');