var HTML ='<h3>Contact Us</h3>' +
				  '<form action="http://www.chupachupz.it/nbny/mail/send.php" method="post" id="contactform">'+
				  '<p>' +
				  '<label for="number">Phone:</label> <br />' +
				  '&nbsp;&nbsp;&nbsp;Francesca: 07793938065 <br />' +
				  '&nbsp;&nbsp;&nbsp;Paul: 07841419216 <br />' +
					'<label for="name">Your Name*</label><br />' +
					'<input class="text-box" id="name" name="name" value="" type="text" tabindex="1"/>' +
					'<label for="email">Your Email Address*</label><br />' +
					'<input id="email" name="email" value="" type="text" tabindex="2"/>' +
					'<label for="number">Your Number</label><br />' +
					'<input id="number" name="number" value="" type="text" tabindex="3"/>' +
					'<label for="message">Your Message</label><br />' +
					'<textarea id="message" name="message" rows="5" cols="10" tabindex="4"></textarea>' +
					'<img src="images/captcha/c1.jpg" width="32" height="32" />' +
				  '<img src="images/captcha/c2.jpg" width="32" height="32" />' +
				  '<img src="images/captcha/c3.jpg" width="32" height="32" />' +
				  '<img src="images/captcha/c4.jpg" width="32" height="32" />' +
				  '<label for="captcha">Enter the characters shown in the image *</label><br />' +
					'<input id="captcha" name="captcha" value="" type="text" tabindex="5" />' +
				'</p>' +
				'<p class="post-info">* Must be filled in.</p>	' +
				'<p class="no-border">' +
					'<input id="subject" name="subject" value=".:: NBNY Request Contact :.." type="hidden"/>' +
					'<input id="type" name="type" value="contact" type="hidden"/>' +
					'<input class="button" type="submit" value="Submit" tabindex="6" />' +
         	'<input class="button" type="reset" value="Reset" tabindex="7" />	' +
				'</p>' +
			'</form>';
			
document.write(HTML);