document.write('<span class="formtitles2">&nbsp;&nbsp;&nbsp;&nbsp;Request a Free Quote</span>');
document.write('<form method="POST" action="mailer.php">');
document.write('<span class="formtitles">Name:</span> <input type="text" name="name" size="20" class="formbg"><br />');
document.write('<span class="formtitles">Company:</span> <input type="text" name="company" size="20" class="formbg"><br />');
document.write('<span class="formtitles">E-Mail:</span> <input type="text" name="email" size="20" class="formbg"><br />');
document.write('<span class="formtitles">Phone:</span> <input type="text" name="phone" size="20" class="formbg"><br />');
document.write('<br />');
document.write('<div align="center"><input type="submit" value="Submit" name="submit"></div>');
document.write('</form>');