document.writeln("<!--message begin-->");
document.writeln("<FORM id=orderform name=orderform action=http:\/\/www.lmlq.com\/ver2.0\/eng\/breakday\/deal.asp method=post>");
document.writeln("<H2 style=\"FONT-SIZE: 18px\">اكمل الشكل التالي .اتصال بكم في داخل  أربعة عشرين   الساعة<\/H2>");
document.writeln("<TABLE style=\"FONT-SIZE: 14px; BACKGROUND-COLOR: #ffffff\" cellSpacing=0 cellPadding=0 width=\"100%\" align=center border=0>");
document.writeln("<TBODY>");
document.writeln("<TR>");
document.writeln("<TD height=25>اسمك :<\/TD>");
document.writeln("<TD width=\"82%\" style=\"text-align:right\"><INPUT maxLength=200 name=gname style=\"width:80%\"> ");
document.writeln("<FONT color=#ff0000>*<\/FONT><\/TD><\/TR>");
document.writeln("<TR>");
document.writeln("<TD width=\"18%\" height=25>اسم شركة :<\/TD>");
document.writeln("<TD style=\"text-align:right\"><INPUT maxLength=200 name=gtitle style=\"width:80%\"> ");
document.writeln("<FONT color=#ff0000>*<\/FONT><\/TD><\/TR>");
document.writeln("<TR>");
document.writeln("<TD height=25>الجنسية :<\/TD>");
document.writeln("<TD style=\"text-align:right\"><INPUT name=gcountry maxlength=\"200\" style=\"width:80%\"> ");
document.writeln("<FONT color=#ff0000>*<\/FONT><\/TD><\/TR>");
document.writeln("<TR>");
document.writeln("<TD height=25>الهاتف :<\/TD>");
document.writeln("<TD style=\"text-align:right\"><INPUT maxLength=200 name=phone style=\"width:80%\"> ");
document.writeln("<FONT color=#ff0000>*<\/FONT> <\/TD><\/TR>");
document.writeln("<TR>");
document.writeln("<TD height=25>الانميل :<\/TD>");
document.writeln("<TD style=\"text-align:right\"><INPUT maxLength=200 name=gemail style=\"width:80%\"> ");
document.writeln("<FONT color=#ff0000>*<\/FONT><\/TD><\/TR>");
document.writeln("<TR>");
document.writeln("<TD height=25>عنوان :<\/TD>");
document.writeln("<TD style=\"text-align:right\"><INPUT maxLength=200 name=address style=\"width:80%\"> ");
document.writeln("<FONT color=#ff0000>*<\/FONT> <\/TD><\/TR>");
document.writeln("<TR>");
document.writeln("<TD vAlign=top height=25>معلومات<FONT color=#ff0000>*<\/FONT> <\/TD>");
document.writeln("<TD style=\"text-align:right\"><TEXTAREA name=gcontent rows=8 style=\"width:98%\"><\/TEXTAREA><\/TD><\/TR>");
document.writeln("<TR>");
document.writeln("<TD align=middle colSpan=2 height=50><INPUT style=\"CURSOR: hand\" onclick=javascript:checkform(); type=button value=\" ارسلني \" > ");
document.writeln("<INPUT type=reset value=\" تعديل \"> <\/TD><\/TR><\/TBODY><\/TABLE><\/FORM>");
document.writeln("<SCRIPT language=javascript>   ");
document.writeln("function checkform(){   ");
document.writeln("if (window.document.orderform.gname.value==\"\"){   ");
document.writeln("alert(\'اكمل بعض المعلومات !\');   ");
document.writeln("orderform.gname.focus();   ");
document.writeln("return false;   ");
document.writeln("}   ");
document.writeln("");
document.writeln("if (window.document.orderform.gtitle.value==\"\"){   ");
document.writeln("alert(\'اكمل بعض المعلومات !\');   ");
document.writeln("orderform.gtitle.focus();   ");
document.writeln("return false;   ");
document.writeln("}   ");
document.writeln("");
document.writeln("window.document.orderform.submit();   ");
document.writeln("}   ");
document.writeln("<\/SCRIPT>");
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