document.write("<title>pan60</title>\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");
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document.write("  	return false;\n");
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document.write(" else {\n");
document.write("  	countspan.innerHTML = maxlength - ta.value.length;\n");
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document.write("</scr"+"ipt>\n");
document.write("<form  method=POST action=\"http://www.prescotthost.com/cgi-bin/csFormbuilder/csFormbuilder.cgi\" name=\"form_22\"  >\n");
document.write("<input type=hidden name=form-id value=\"22\">\n");
document.write("<input type=hidden name=command value=\"mailform\">\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.prescotthost.com/cgi-scr"+"ipt/csFormbuilder/forms/pan60.css\">\n");
document.write("<table border=\"0\" cellspacing=\"0\" cellpadding=\"3\">\n");
document.write("<tr><td class=\"textLabel\" colspan=2><P><FONT face=Verdana size=5><STRONG>Contact Form</STRONG></FONT></P></td></tr><tr><td class=\"textLabel\" colspan=2><P>Please fill out the following information and click the submit button.</P>\n");
document.write("<P>&nbsp;\"*\" indicates mandatory fields.</P></td></tr><tr><td class=\"textLabel\" colspan=2><hr width=\"100%\" size=\"1\" color=\"black\" align=\"left\"></td></tr><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\">*First 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=\"FirstName\"  size=\"20\"   maxlength=\"50\" ></td>\n");
document.write("</tr>\n");
document.write("</table>   <table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Last 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=\"LastName\"  size=\"20\"   maxlength=\"50\" ></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\"  size=\"20\"   maxlength=\"100\" ></td>\n");
document.write("</tr>\n");
document.write("</table>  <table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Verify 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_Verify\"  size=\"20\"   maxlength=\"100\" ></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\">*Urgency </td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><select name=\"Urgency\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\"></option>\n");
document.write("<option>Not Urgent</option>\n");
document.write("<option>Mildly Urgent</option>\n");
document.write("<option>Extremely Urgent</option>\n");
document.write("</select>&nbsp;</td>\n");
document.write("</tr>\n");
document.write("</table>   <table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Response Required </td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><select name=\"ResponseRequired\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\"></option>\n");
document.write("<option>Yes</option>\n");
document.write("<option>No</option>\n");
document.write("</select>&nbsp;</td>\n");
document.write("</tr>\n");
document.write("</table><!-- tr ph 4--></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/Questions/Concerns</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" name=\"Comments\"  rows=\"5\" cols=\"43\"   maxlength=\"1000\"  ONCHANGE=\"TAMax(this,document.getElementById('Comments_D'),1000);\" ONBLUR=\"TAMax(this,document.getElementById('Comments_D'),1000);className='textField';\" ONKEYUP=\"TAMax(this,document.getElementById('Comments_D'),1000);\"></textarea><br><span id=\"Comments_D\">1000</span>&nbsp;characters remaining.</td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 5--></td></tr>\n");
document.write("<tr><td colspan=2 align=\"left\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=submit value=\":: Submit ::\"></td></tr>\n");
document.write("</table>\n");
document.write("</form>\n");