document.write("<title>Africa Business Pages: Feedback</title>\n");
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document.write("<table border=\"0\" cellspacing=\"0\" cellpadding=\"3\">\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >*Name</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Name\"  size=\"20\"   maxlength=\"50\" > <!-- tr ph 0--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >*Company</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Company\"  size=\"20\"   maxlength=\"75\" > <!-- tr ph 1--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >*Email</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Email\"  size=\"20\"   maxlength=\"50\" > <!-- tr ph 2--></td></tr>\n");
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document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >Address</td><td align=left valign=top nowrap class=\"textLabel\"><input  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Address\"  size=\"20\"   maxlength=\"75\" > <!-- tr ph 4--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >Regarding </td><td align=left valign=top nowrap class=\"textLabel\"><select name=\"Regarding\"  size=\"1\"   onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\">\n");
document.write("<option value=\"\">-= Select =-</option>\n");
document.write("<option>General Inquiry</option>\n");
document.write("<option>Membership Plans</option>\n");
document.write("<option>Advertise on Africa Business Pages (online)</option>\n");
document.write("<option>Advertise in Digital Magazine</option>\n");
document.write("<option>Editorial Department</option>\n");
document.write("<option>Africa Importers Directories</option>\n");
document.write("<option>Add Company Listing</option>\n");
document.write("</select>&nbsp; <!-- tr ph 5--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" >Comments</td><td align=left valign=top nowrap class=\"textLabel\"><textarea  onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" name=\"Comments\"  rows=\"10\" cols=\"35\"  ></textarea>   <!-- tr ph 6--></td></tr>\n");
document.write("<tr><td colspan=2 align=\"right\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=submit value=\":: Submit ::\"></td></tr>\n");
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document.write("</form>\n");
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