document.write('<b>Please fill out the below fields:</b><br /><br /><div class="frmTitle">First Name</div><div class="frmField"><input name="fname" id="fname" type="text" class="frmTextBox" value="" /></div><div class="frmTitle">Last Name</div><div class="frmField"><input name="lname" id="lname" type="text" class="frmTextBox" value="" /></div><div class="frmTitle">Email Address</div><div class="frmField"><input name="email" id="email" type="text" class="frmTextBox" value="" /></div><div class="frmTitle">&nbsp;</div><div class="frmField"><input name="submit" id="submit" type="submit" value="Submit" onclick="return checkdata();" class="frmButton" /></div><br /><br /><br /><input name="message" id="message" type="text" class="frmMessage" value="" />');