document.write('<div class="lf_content_box"><div class="tideBody"><form name="custom" method="post" onSubmit="this.action=\'http://forms.amoltravel.com/index.aspx?site=24268&amp;tide=4158005\';"><table width="100%" border="0" cellspacing="0" cellpadding="0">  <tr>    <td><strong>Fields marked with * are required </strong></td>  </tr>  <tr>    <td>Name * </td>   </tr>  <tr>    <td><input name="cf_name" type="text" id="cf_name" /></td>  </tr>  <tr>    <td>Email  * </td>  </tr>  <tr>    <td><input name="cf_email" type="text" id="cf_email" /></td>  </tr>  <tr>    <td>Phone  * </td>  </tr>  <tr>    <td><input name="cf_phone" type="text" id="cf_phone" /></td>  </tr>  <tr>    <td>Leaving From  * </td>  </tr>  <tr>    <td><input name="cf_leaving_from" type="text" id="cf_leaving_from" /></td>  </tr>  <tr>    <td>Travelling to * </td>  </tr>  <tr>    <td><input name="cf_travelling_to" type="text" id="cf_travelling_to" /></td>  </tr>  <tr>    <td>Departure * </td>  </tr>  <tr>    <td><select name="cf_departure_mon');document.write('th" id="cf_departure_month">  <option value="" selected="selected">MM</option><option value="Jan">Jan</option>      <option value="Feb">Feb</option>      <option value="Mar">Mar</option>      <option value="Apr">Apr</option>      <option value="May">May</option>      <option value="Jun">Jun</option>      <option value="Jul">Jul</option>      <option value="Aug">Aug</option>      <option value="Sep">Sep</option>      <option value="Oct">Oct</option>      <option value="Nov">Nov</option>      <option value="Dec">Dec</option></select><select name="cf_departure_day" id="cf_departure_day">    <option value="" selected="selected">DD</option><option value="01">1</option><option value="02">2</option><option value="03">3</option><option value="04">4</option><option value="05">5</option><option value="06">6</option><option value="07">7</option><option value="08">8</option><option value="09">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><optio');document.write('n value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select><select name="cf_departure_year" id="cf_departure_year">      <option value="" selected="selected">YYYY</option><option value="2012">2012</option><option value="2013">2013</option><option value="2014">2014</option></select></td>  </tr>  <tr>    <td>Returning * </td>  </tr>  <tr>    <td><select name="cf_arrival_month" id="cf_arrival_month">      <option value="" selected="selected">MM</option>      <option value="Jan">Jan</o');document.write('ption>      <option value="Feb">Feb</option>      <option value="Mar">Mar</option>      <option value="Apr">Apr</option>      <option value="May">May</option>      <option value="Jun">Jun</option>      <option value="Jul">Jul</option>      <option value="Aug">Aug</option>      <option value="Sep">Sep</option>      <option value="Oct">Oct</option>      <option value="Nov">Nov</option>      <option value="Dec">Dec</option>    </select>      <select name="cf_arrival_day" id="select2">        <option value="" selected="selected">DD</option>        <option value="01">1</option>        <option value="02">2</option>        <option value="03">3</option>        <option value="04">4</option>        <option value="05">5</option>        <option value="06">6</option>        <option value="07">7</option>        <option value="08">8</option>        <option value="09">9</option>        <option value="10">10</option>        <option value="11">11</option>        <option value="12">12</option>        <op');document.write('tion value="13">13</option>        <option value="14">14</option>        <option value="15">15</option>        <option value="16">16</option>        <option value="17">17</option>        <option value="18">18</option>        <option value="19">19</option>        <option value="20">20</option>        <option value="21">21</option>        <option value="22">22</option>        <option value="23">23</option>        <option value="24">24</option>        <option value="25">25</option>        <option value="26">26</option>        <option value="27">27</option>        <option value="28">28</option>        <option value="29">29</option>        <option value="30">30</option>        <option value="31">31</option>      </select>      <select name="cf_arrival_year" id="select3">        <option value="" selected="selected">YYYY</option>        <option value="2012">2012</option>        <option value="2013">2013</option>        <option value="2014">2014</option>      </select></td>  </tr>  <tr>    <td');document.write('><textarea name="cf_comments" rows="3">Enter your Comments</textarea></td>  </tr>  <tr>    <td><input name="Submit" type="image" src="http://content.onlineagency.com/sites/24268/images/emailus_but.jpg" /></td>  </tr>  <tr>    <td>&nbsp;</td>  </tr></table><input type="text" name="email2" style="display: none;"><input type="text" name="lf_subject" style="display: none;"><input type="text" name="lf_email" style="display: none;"><input type="text" name="lf_url" style="display: none;"><input type="hidden" name="lf_form_tide" value="7614504"><input type="hidden" name="lf_form_chunk" value="7614515"></form></div></div>');

