function writeJS(){
var str='';
str+='<form action="https:\/\/www.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8" method="POST">';
str+='<input type=hidden name="oid" value="00D600000006y7m">';
str+='<input type=hidden name="retURL" value="http:\/\/www.sterilizers.com\/otherequipment.html">';
str+='<input type="hidden" name="debug" value=0>';
str+='<input type="hidden" name="debugEmail" value="email@sterilizers.com">';
str+='<table class=inset>';
str+='<tr><td align=center colspan=2>';
str+='<h3>eMail us about your autoclave and sterilizer needs, issues, or  requirement.<\/h3>';
str+='<br><br>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='<input  id="00N60000001YkSV" maxlength="15" name="00N60000001YkSV" size="20" type="hidden" value="6">';
str+='<label for="first_name">First Name<\/label><\/td><td> <input  id="first_name" maxlength="40" name="first_name" size="20" type="text" \/><\/td><\/tr><tr><td ';
str+='align=right>';
str+='<label for="last_name">Last Name<\/label><\/td><td> <input  id="last_name" maxlength="40" name="last_name" size="20" type="text" \/><\/td><\/tr><tr><td ';
str+='align=right>';
str+='<label for="company">Company<\/label><\/td><td> <input  id="company" maxlength="40" name="company" size="20" type="text" \/><\/td><\/tr><tr><td align=right>';
str+='<label for="email">Email<\/label><\/td><td> <input  id="email" maxlength="80" name="email" size="20" type="text" \/><\/td><\/tr><tr><td align=right>';
str+='<label for="phone">Phone<\/label><\/td><td> <input  id="phone" maxlength="40" name="phone" size="20" type="text" \/><\/td><\/tr><tr><td align=right>';
str+='Country:<\/td><td>';
str+='<select  id="00N60000001ViRH" name="00N60000001ViRH" title="Country" onchange="ShowItem()">';
str+='<option value="USA">USA<\/option>';
str+='<option value="Afghanistan">Afghanistan<\/option>';
str+='<option value="Albania">Albania<\/option>';
str+='<option value="Algeria">Algeria<\/option>';
str+='<option value="American Samoa">American Samoa<\/option>';
str+='<option value="Andorra">Andorra<\/option>';
str+='<option value="Angola">Angola<\/option>';
str+='<option value="Anguilla">Anguilla<\/option>';
str+='<option value="Antarctica">Antarctica<\/option>';
str+='<option value="Antigua and Barbuda">Antigua and Barbuda<\/option>';
str+='<option value="Argentina">Argentina<\/option>';
str+='<option value="Armenia">Armenia<\/option>';
str+='<option value="Arctic Ocean">Arctic Ocean<\/option>';
str+='<option value="Aruba">Aruba<\/option>';
str+='<option value="Ashmore and Cartier Islands">Ashmore and Cartier Islands<\/option>';
str+='<option value="Atlantic Ocean">Atlantic Ocean<\/option>';
str+='<option value="Australia">Australia<\/option>';
str+='<option value="Austria">Austria<\/option>';
str+='<option value="Azerbaijan">Azerbaijan<\/option>';
str+='<option value="Bahamas">Bahamas<\/option>';
str+='<option value="Bahrain">Bahrain<\/option>';
str+='<option value="Baker Island">Baker Island<\/option>';
str+='<option value="Bangladesh">Bangladesh<\/option>';
str+='<option value="Barbados">Barbados<\/option>';
str+='<option value="Bassas da India">Bassas da India<\/option>';
str+='<option value="Belarus">Belarus<\/option>';
str+='<option value="Belgium">Belgium<\/option>';
str+='<option value="Belize">Belize<\/option>';
str+='<option value="Benin">Benin<\/option>';
str+='<option value="Bermuda">Bermuda<\/option>';
str+='<option value="Bhutan">Bhutan<\/option>';
str+='<option value="Bolivia">Bolivia<\/option>';
str+='<option value="Bosnia and Herzegovina">Bosnia and Herzegovina<\/option>';
str+='<option value="Botswana">Botswana<\/option>';
str+='<option value="Bouvet Island">Bouvet Island<\/option>';
str+='<option value="Brazil">Brazil<\/option>';
str+='<option value="British Virgin Islands">British Virgin Islands<\/option>';
str+='<option value="Brunei">Brunei<\/option>';
str+='<option value="Bulgaria">Bulgaria<\/option>';
str+='<option value="Burkina Faso">Burkina Faso<\/option>';
str+='<option value="Burundi">Burundi<\/option>';
str+='<option value="Cambodia">Cambodia<\/option>';
str+='<option value="Cameroon">Cameroon<\/option>';
str+='<option value="Canada">Canada<\/option>';
str+='<option value="Cape Verde">Cape Verde<\/option>';
str+='<option value="Cayman Islands">Cayman Islands<\/option>';
str+='<option value="Central African Republic">Central African Republic<\/option>';
str+='<option value="Chad">Chad<\/option>';
str+='<option value="Chile">Chile<\/option>';
str+='<option value="China">China<\/option>';
str+='<option value="Christmas Island">Christmas Island<\/option>';
str+='<option value="Clipperton Island">Clipperton Island<\/option>';
str+='<option value="Cocos Islands">Cocos Islands<\/option>';
str+='<option value="Colombia">Colombia<\/option>';
str+='<option value="Comoros">Comoros<\/option>';
str+='<option value="Cook Islands">Cook Islands<\/option>';
str+='<option value="Coral Sea Islands">Coral Sea Islands<\/option>';
str+='<option value="Costa Rica">Costa Rica<\/option>';
str+='<option value="Cote d\'Ivoire">Cote d\'Ivoire<\/option>';
str+='<option value="Croatia">Croatia<\/option>';
str+='<option value="Cuba">Cuba<\/option>';
str+='<option value="Cyprus">Cyprus<\/option>';
str+='<option value="Czech Republic">Czech Republic<\/option>';
str+='<option value="Denmark">Denmark<\/option>';
str+='<option value="Democratic Republic of the Congo">Democratic Republic of the Congo<\/option>';
str+='<option value="Djibouti">Djibouti<\/option>';
str+='<option value="Dominica">Dominica<\/option>';
str+='<option value="Dominican Republic">Dominican Republic<\/option>';
str+='<option value="East Timor">East Timor<\/option>';
str+='<option value="Ecuador">Ecuador<\/option>';
str+='<option value="Egypt">Egypt<\/option>';
str+='<option value="El Salvador">El Salvador<\/option>';
str+='<option value="Equatorial Guinea">Equatorial Guinea<\/option>';
str+='<option value="Eritrea">Eritrea<\/option>';
str+='<option value="Estonia">Estonia<\/option>';
str+='<option value="Ethiopia">Ethiopia<\/option>';
str+='<option value="Europa Island">Europa Island<\/option>';
str+='<option value="Falkland Islands (Islas Malvinas)">Falkland Islands (Islas Malvinas)<\/option>';
str+='<option value="Faroe Islands">Faroe Islands<\/option>';
str+='<option value="Fiji">Fiji<\/option>';
str+='<option value="Finland">Finland<\/option>';
str+='<option value="France">France<\/option>';
str+='<option value="French Guiana">French Guiana<\/option>';
str+='<option value="French Polynesia">French Polynesia<\/option>';
str+='<option value="French Southern and Antarctic Lands">French Southern and Antarctic Lands<\/option>';
str+='<option value="Gabon">Gabon<\/option>';
str+='<option value="Gambia">Gambia<\/option>';
str+='<option value="Gaza Strip">Gaza Strip<\/option>';
str+='<option value="Georgia">Georgia<\/option>';
str+='<option value="Germany">Germany<\/option>';
str+='<option value="Ghana">Ghana<\/option>';
str+='<option value="Gibraltar">Gibraltar<\/option>';
str+='<option value="Glorioso Islands">Glorioso Islands<\/option>';
str+='<option value="Greece">Greece<\/option>';
str+='<option value="Greenland">Greenland<\/option>';
str+='<option value="Grenada">Grenada<\/option>';
str+='<option value="Guadeloupe">Guadeloupe<\/option>';
str+='<option value="Guam">Guam<\/option>';
str+='<option value="Guatemala">Guatemala<\/option>';
str+='<option value="Guernsey">Guernsey<\/option>';
str+='<option value="Guinea">Guinea<\/option>';
str+='<option value="Guinea-Bissau">Guinea-Bissau<\/option>';
str+='<option value="Guyana">Guyana<\/option>';
str+='<option value="Haiti">Haiti<\/option>';
str+='<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands<\/option>';
str+='<option value="Honduras">Honduras<\/option>';
str+='<option value="Hong Kong">Hong Kong<\/option>';
str+='<option value="Howland Island">Howland Island<\/option>';
str+='<option value="Hungary">Hungary<\/option>';
str+='<option value="Iceland">Iceland<\/option>';
str+='<option value="India">India<\/option>';
str+='<option value="Indian Ocean">Indian Ocean<\/option>';
str+='<option value="Indonesia">Indonesia<\/option>';
str+='<option value="Iran">Iran<\/option>';
str+='<option value="Iraq">Iraq<\/option>';
str+='<option value="Ireland">Ireland<\/option>';
str+='<option value="Isle of Man">Isle of Man<\/option>';
str+='<option value="Israel">Israel<\/option>';
str+='<option value="Italy">Italy<\/option>';
str+='<option value="Jamaica">Jamaica<\/option>';
str+='<option value="Jan Mayen">Jan Mayen<\/option>';
str+='<option value="Japan">Japan<\/option>';
str+='<option value="Jarvis Island">Jarvis Island<\/option>';
str+='<option value="Jersey">Jersey<\/option>';
str+='<option value="Johnston Atoll">Johnston Atoll<\/option>';
str+='<option value="Jordan">Jordan<\/option>';
str+='<option value="Juan de Nova Island">Juan de Nova Island<\/option>';
str+='<option value="Kazakhstan">Kazakhstan<\/option>';
str+='<option value="Kenya">Kenya<\/option>';
str+='<option value="Kingman Reef">Kingman Reef<\/option>';
str+='<option value="Kiribati">Kiribati<\/option>';
str+='<option value="Kerguelen Archipelago">Kerguelen Archipelago<\/option>';
str+='<option value="Kuwait">Kuwait<\/option>';
str+='<option value="Kyrgyzstan">Kyrgyzstan<\/option>';
str+='<option value="Laos">Laos<\/option>';
str+='<option value="Latvia">Latvia<\/option>';
str+='<option value="Lebanon">Lebanon<\/option>';
str+='<option value="Lesotho">Lesotho<\/option>';
str+='<option value="Liberia">Liberia<\/option>';
str+='<option value="Libya">Libya<\/option>';
str+='<option value="Liechtenstein">Liechtenstein<\/option>';
str+='<option value="Lithuania">Lithuania<\/option>';
str+='<option value="Luxembourg">Luxembourg<\/option>';
str+='<option value="Macau">Macau<\/option>';
str+='<option value="Macedonia">Macedonia<\/option>';
str+='<option value="Madagascar">Madagascar<\/option>';
str+='<option value="Malawi">Malawi<\/option>';
str+='<option value="Malaysia">Malaysia<\/option>';
str+='<option value="Maldives">Maldives<\/option>';
str+='<option value="Mali">Mali<\/option>';
str+='<option value="Malta">Malta<\/option>';
str+='<option value="Marshall Islands">Marshall Islands<\/option>';
str+='<option value="Martinique">Martinique<\/option>';
str+='<option value="Mauritania">Mauritania<\/option>';
str+='<option value="Mauritius">Mauritius<\/option>';
str+='<option value="Mayotte">Mayotte<\/option>';
str+='<option value="Mexico">Mexico<\/option>';
str+='<option value="Micronesia">Micronesia<\/option>';
str+='<option value="Midway Islands">Midway Islands<\/option>';
str+='<option value="Moldova">Moldova<\/option>';
str+='<option value="Monaco">Monaco<\/option>';
str+='<option value="Mongolia">Mongolia<\/option>';
str+='<option value="Montenegro">Montenegro<\/option>';
str+='<option value="Montserrat">Montserrat<\/option>';
str+='<option value="Morocco">Morocco<\/option>';
str+='<option value="Mozambique">Mozambique<\/option>';
str+='<option value="Myanmar">Myanmar<\/option>';
str+='<option value="Namibia">Namibia<\/option>';
str+='<option value="Nauru">Nauru<\/option>';
str+='<option value="Navassa Island">Navassa Island<\/option>';
str+='<option value="Nepal">Nepal<\/option>';
str+='<option value="Netherlands">Netherlands<\/option>';
str+='<option value="Netherlands Antilles">Netherlands Antilles<\/option>';
str+='<option value="New Caledonia">New Caledonia<\/option>';
str+='<option value="New Zealand">New Zealand<\/option>';
str+='<option value="Nicaragua">Nicaragua<\/option>';
str+='<option value="Niger">Niger<\/option>';
str+='<option value="Nigeria">Nigeria<\/option>';
str+='<option value="Niue">Niue<\/option>';
str+='<option value="Norfolk Island">Norfolk Island<\/option>';
str+='<option value="North Korea">North Korea<\/option>';
str+='<option value="Northern Mariana Islands">Northern Mariana Islands<\/option>';
str+='<option value="Norway">Norway<\/option>';
str+='<option value="Oman">Oman<\/option>';
str+='<option value="Pacific Ocean">Pacific Ocean<\/option>';
str+='<option value="Pakistan">Pakistan<\/option>';
str+='<option value="Palau">Palau<\/option>';
str+='<option value="Palmyra Atoll">Palmyra Atoll<\/option>';
str+='<option value="Panama">Panama<\/option>';
str+='<option value="Papua New Guinea">Papua New Guinea<\/option>';
str+='<option value="Paracel Islands">Paracel Islands<\/option>';
str+='<option value="Paraguay">Paraguay<\/option>';
str+='<option value="Peru">Peru<\/option>';
str+='<option value="Philippines">Philippines<\/option>';
str+='<option value="Pitcairn Islands">Pitcairn Islands<\/option>';
str+='<option value="Poland">Poland<\/option>';
str+='<option value="Portugal">Portugal<\/option>';
str+='<option value="Puerto Rico">Puerto Rico<\/option>';
str+='<option value="Qatar">Qatar<\/option>';
str+='<option value="Reunion">Reunion<\/option>';
str+='<option value="Republic of the Congo">Republic of the Congo<\/option>';
str+='<option value="Romania">Romania<\/option>';
str+='<option value="Russia">Russia<\/option>';
str+='<option value="Rwanda">Rwanda<\/option>';
str+='<option value="Saint Helena">Saint Helena<\/option>';
str+='<option value="Saint Kitts and Nevis">Saint Kitts and Nevis<\/option>';
str+='<option value="Saint Lucia">Saint Lucia<\/option>';
str+='<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon<\/option>';
str+='<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines<\/option>';
str+='<option value="Samoa">Samoa<\/option>';
str+='<option value="San Marino">San Marino<\/option>';
str+='<option value="Sao Tome and Principe">Sao Tome and Principe<\/option>';
str+='<option value="Saudi Arabia">Saudi Arabia<\/option>';
str+='<option value="Senegal">Senegal<\/option>';
str+='<option value="Serbia">Serbia<\/option>';
str+='<option value="Seychelles">Seychelles<\/option>';
str+='<option value="Sierra Leone">Sierra Leone<\/option>';
str+='<option value="Singapore">Singapore<\/option>';
str+='<option value="Slovakia">Slovakia<\/option>';
str+='<option value="Slovenia">Slovenia<\/option>';
str+='<option value="Solomon Islands">Solomon Islands<\/option>';
str+='<option value="Somalia">Somalia<\/option>';
str+='<option value="South Africa">South Africa<\/option>';
str+='<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands<\/option>';
str+='<option value="South Korea">South Korea<\/option>';
str+='<option value="Spain">Spain<\/option>';
str+='<option value="Spratly Islands">Spratly Islands<\/option>';
str+='<option value="Sri Lanka">Sri Lanka<\/option>';
str+='<option value="Sudan">Sudan<\/option>';
str+='<option value="Suriname">Suriname<\/option>';
str+='<option value="Svalbard">Svalbard<\/option>';
str+='<option value="Swaziland">Swaziland<\/option>';
str+='<option value="Sweden">Sweden<\/option>';
str+='<option value="Switzerland">Switzerland<\/option>';
str+='<option value="Syria">Syria<\/option>';
str+='<option value="Taiwan">Taiwan<\/option>';
str+='<option value="Tajikistan">Tajikistan<\/option>';
str+='<option value="Tanzania">Tanzania<\/option>';
str+='<option value="Thailand">Thailand<\/option>';
str+='<option value="Togo">Togo<\/option>';
str+='<option value="Tokelau">Tokelau<\/option>';
str+='<option value="Tonga">Tonga<\/option>';
str+='<option value="Trinidad and Tobago">Trinidad and Tobago<\/option>';
str+='<option value="Tromelin Island">Tromelin Island<\/option>';
str+='<option value="Tunisia">Tunisia<\/option>';
str+='<option value="Turkey">Turkey<\/option>';
str+='<option value="Turkmenistan">Turkmenistan<\/option>';
str+='<option value="Turks and Caicos Islands">Turks and Caicos Islands<\/option>';
str+='<option value="Tuvalu">Tuvalu<\/option>';
str+='<option value="Uganda">Uganda<\/option>';
str+='<option value="Ukraine">Ukraine<\/option>';
str+='<option value="United Arab Emirates">United Arab Emirates<\/option>';
str+='<option value="United Kingdom">United Kingdom<\/option>';
str+='<option value="Uruguay">Uruguay<\/option>';
str+='<option value="Uzbekistan">Uzbekistan<\/option>';
str+='<option value="Vanuatu">Vanuatu<\/option>';
str+='<option value="Venezuela">Venezuela<\/option>';
str+='<option value="Viet Nam">Viet Nam<\/option>';
str+='<option value="Virgin Islands">Virgin Islands<\/option>';
str+='<option value="Wake Island">Wake Island<\/option>';
str+='<option value="Wallis and Futuna">Wallis and Futuna<\/option>';
str+='<option value="West Bank">West Bank<\/option>';
str+='<option value="Western Sahara">Western Sahara<\/option>';
str+='<option value="Yemen">Yemen<\/option>';
str+='<option value="Yugoslavia">Yugoslavia<\/option>';
str+='<option value="Zambia">Zambia<\/option>';
str+='<option value="Zimbabwe">Zimbabwe<\/option>';
str+='<\/select>';
str+='<\/td><\/tr><tr><td align=right>';
str+='<label for="street">Address<\/label><\/td><td> <textarea name="street"><\/textarea><\/td><\/tr><tr><td align=right>';
str+='<label for="city">City<\/label><\/td><td> <input  id="city" maxlength="40" name="city" size="20" type="text" \/><\/td><\/tr>';
str+='<tr><td align=right>';
str+='States\/Province:';
str+='<\/td><td>';
str+='<span id="Msg2" style={display="block";}>';
str+='<select  id="00N60000001VhjK" name="00N60000001VhjK" title="States">';
str+='<option value="">Select Your State<\/option>';
str+='<option value="AL">Alabama<\/option>';
str+='<option value="AK">Alaska<\/option>';
str+='<option value="AZ">Arizona<\/option>';
str+='<option value="AR">Arkansas<\/option>';
str+='<option value="CA">California<\/option>';
str+='<option value="CO">Colorado<\/option>';
str+='<option value="CT">Connecticut<\/option>';
str+='<option value="DE">Delaware<\/option>';
str+='<option value="DC">District of Columbia<\/option>';
str+='<option value="FL">Florida<\/option>';
str+='<option value="GA">Georgia<\/option>';
str+='<option value="HI">Hawaii<\/option>';
str+='<option value="ID">Idaho<\/option>';
str+='<option value="IL">Illinois<\/option>';
str+='<option value="IN">Indiana<\/option>';
str+='<option value="IA">Iowa<\/option>';
str+='<option value="KS">Kansas<\/option>';
str+='<option value="KY">Kentucky<\/option>';
str+='<option value="LA">Louisiana<\/option>';
str+='<option value="ME">Maine<\/option>';
str+='<option value="MD">Maryland<\/option>';
str+='<option value="MA">Massachusetts<\/option>';
str+='<option value="MI">Michigan<\/option>';
str+='<option value="MN">Minnesota<\/option>';
str+='<option value="MS">Mississippi<\/option>';
str+='<option value="MO">Missouri<\/option>';
str+='<option value="MT">Montana<\/option>';
str+='<option value="NE">Nebraska<\/option>';
str+='<option value="NV">Nevada<\/option>';
str+='<option value="NH">New Hampshire<\/option>';
str+='<option value="NJ">New Jersey<\/option>';
str+='<option value="NM">New Mexico<\/option>';
str+='<option value="NY">New York<\/option>';
str+='<option value="NC">North Carolina<\/option>';
str+='<option value="ND">North Dakota<\/option>';
str+='<option value="OH">Ohio<\/option>';
str+='<option value="OK">Oklahoma<\/option>';
str+='<option value="OR">Oregon<\/option>';
str+='<option value="PA">Pennsylvania<\/option>';
str+='<option value="RI">Rhode Island<\/option>';
str+='<option value="SC">South Carolina<\/option>';
str+='<option value="SD">South Dakota<\/option>';
str+='<option value="TN">Tennessee<\/option>';
str+='<option value="TX">Texas<\/option>';
str+='<option value="UT">Utah<\/option>';
str+='<option value="VT">Vermont<\/option>';
str+='<option value="VA">Virginia<\/option>';
str+='<option value="WA">Washington<\/option>';
str+='<option value="WV">West Virginia<\/option>';
str+='<option value="WI">Wisconsin<\/option>';
str+='<option value="WY">Wyoming<\/option>';
str+='<\/select>';
str+='<\/span>';
str+='<span id="Msg1" style={display="none";}>';
str+='<input  id="state" maxlength="20" name="state" size="20" type="text" \/>';
str+='<\/span>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='<label for="zip">Zip<\/label><\/td><td> <input  id="zip" maxlength="20" name="zip" size="20" type="text" \/><\/td><\/tr><tr><td align=right>';
str+='<font color=red>---><\/font><\/td><td>';
str+='<select  id="00N60000001VbeY" name="00N60000001VbeY" title="Type of Customer">';
str+='<option value="">Select Customer Type<\/option>';
str+='<option value="Beauty Salon">Beauty Salon<\/option>';
str+='<option value="Body Piercer">Body Piercer<\/option>';
str+='<option value="College">College<\/option>';
str+='<option value="Dealer (Dental)">Dealer (Dental)<\/option>';
str+='<option value="Dealer (Medical)">Dealer (Medical)<\/option>';
str+='<option value="Dealer (Veterinariy)">Dealer (Veterinariy)<\/option>';
str+='<option value="Dental profession (DDS, DMD, Orthodontist)">Dental profession (DDS, DMD, Orthodontist)<\/option>';
str+='<option value="Government">Government<\/option>';
str+='<option value="Laboratory">Laboratory<\/option>';
str+='<option value="manufacturer">manufacturer<\/option>';
str+='<option value="Medical Doctor (MD)">Medical Doctor (MD)<\/option>';
str+='<option value="Military">Military<\/option>';
str+='<option value="Municipal">Municipal<\/option>';
str+='<option value="Nail Salon">Nail Salon<\/option>';
str+='<option value="Other">Other<\/option>';
str+='<option value="Pharmacy">Pharmacy<\/option>';
str+='<option value="Podiatrist">Podiatrist<\/option>';
str+='<option value="Repair facility">Repair facility<\/option>';
str+='<option value="Tattoo shop">Tattoo shop<\/option>';
str+='<option value="University">University<\/option>';
str+='<option value="Vet">Vet<\/option>';
str+='<\/select><\/td><\/tr><tr><td align=right>';
str+='<font color=red>---><\/font><\/td><td>';
str+='<select  id="00N60000001Veqm" name="00N60000001Veqm" title="Type of sterilizer prospect has now">';
str+='<option value="">Select Sterilizer<\/option>';
str+='<option value="All American">All American<\/option>';
str+='<option value="Amsco">Amsco<\/option>';
str+='<option value="Anderson">Anderson<\/option>';
str+='<option value="Axis">Axis<\/option>';
str+='<option value="Barnstead">Barnstead<\/option>';
str+='<option value="Buxton">Buxton<\/option>';
str+='<option value="Castle">Castle<\/option>';
str+='<option value="Consolidated">Consolidated<\/option>';
str+='<option value="Cox">Cox<\/option>';
str+='<option value="CPac">CPac<\/option>';
str+='<option value="Dentronix">Dentronix<\/option>';
str+='<option value="Glass Beads">Glass Beads<\/option>';
str+='<option value="Harvey">Harvey<\/option>';
str+='<option value="Hirayama">Hirayama<\/option>';
str+='<option value="LabClave">LabClave<\/option>';
str+='<option value="Market Forge">Market Forge<\/option>';
str+='<option value="MDT">MDT<\/option>';
str+='<option value="Melag">Melag<\/option>';
str+='<option value="Midmark M11">Midmark M11<\/option>';
str+='<option value="Midmark M7">Midmark M7<\/option>';
str+='<option value="Midmark M9">Midmark M9<\/option>';
str+='<option value="Napco">Napco<\/option>';
str+='<option value="Pelton Crane Delta 10">Pelton Crane Delta 10<\/option>';
str+='<option value="Pelton Crane Delta 8">Pelton Crane Delta 8<\/option>';
str+='<option value="Pelton Crane Magnaclave">Pelton Crane Magnaclave<\/option>';
str+='<option value="Pelton Crane OCM">Pelton Crane OCM<\/option>';
str+='<option value="Pelton Crane OCR">Pelton Crane OCR<\/option>';
str+='<option value="Pelton Crane Sentry">Pelton Crane Sentry<\/option>';
str+='<option value="Pelton Crane Validator 10">Pelton Crane Validator 10<\/option>';
str+='<option value="Pelton Crane Validator 8">Pelton Crane Validator 8<\/option>';
str+='<option value="Porter">Porter<\/option>';
str+='<option value="Prestige front load">Prestige front load<\/option>';
str+='<option value="Prestige top load">Prestige top load<\/option>';
str+='<option value="Ritter">Ritter<\/option>';
str+='<option value="Sanyo">Sanyo<\/option>';
str+='<option value="SciCan">SciCan<\/option>';
str+='<option value="Sentry">Sentry<\/option>';
str+='<option value="Shinva">Shinva<\/option>';
str+='<option value="Statim">Statim<\/option>';
str+='<option value="Steri Dent">Steri Dent<\/option>';
str+='<option value="Systec">Systec<\/option>';
str+='<option value="Tomy">Tomy<\/option>';
str+='<option value="Tuttnauer 1730M">Tuttnauer 1730M<\/option>';
str+='<option value="Tuttnauer 2340E">Tuttnauer 2340E<\/option>';
str+='<option value="Tuttnauer 2340EK">Tuttnauer 2340EK<\/option>';
str+='<option value="Tuttnauer 2340M">Tuttnauer 2340M<\/option>';
str+='<option value="Tuttnauer 2340MK">Tuttnauer 2340MK<\/option>';
str+='<option value="Tuttnauer 2540E">Tuttnauer 2540E<\/option>';
str+='<option value="Tuttnauer 2540EK">Tuttnauer 2540EK<\/option>';
str+='<option value="Tuttnauer 2540M">Tuttnauer 2540M<\/option>';
str+='<option value="Tuttnauer 3850E">Tuttnauer 3850E<\/option>';
str+='<option value="Tuttnauer 3850M">Tuttnauer 3850M<\/option>';
str+='<option value="Tuttnauer 3870EA">Tuttnauer 3870EA<\/option>';
str+='<option value="Tuttnauer 3870M">Tuttnauer 3870M<\/option>';
str+='<option value="Vernitron">Vernitron<\/option>';
str+='<option value="Wayne">Wayne<\/option>';
str+='<option value="Wisconsin">Wisconsin<\/option>';
str+='<option value="~None">~None<\/option>';
str+='<\/select><\/td><\/tr><tr><td align=right>';
str+='<font color=red>---><\/font><\/td><td>';
str+='<select  id="00N60000001Vey2" name="00N60000001Vey2" title="Customer interested in?">';
str+='<option value="">Select Your Interest<\/option>';
str+='<option value="I am looking to purchase a new sterilizer">I am looking to purchase a new sterilizer<\/option>';
str+='<option value="I am looking to purchase a rebuild sterilizer">I am looking to purchase a rebuild sterilizer<\/option>';
str+='<option value="I am looking to repair my sterilizer">I am looking to repair my sterilizer<\/option>';
str+='<option value="I am looking to purchase a manual for my sterilizer">I am looking to purchase a manual for my sterilizer<\/option>';
str+='<option value="I am looking to purchase a part for my sterilizer">I am looking to purchase a part for my sterilizer<\/option>';
str+='<\/select><\/td><\/tr>';
str+='<tr><td align=right>';
str+='Comments:';
str+='<\/td><td>';
str+='<textarea  id="00N60000001Vh2k" name="00N60000001Vh2k" type="text" wrap="soft" rows=4><\/textarea>';
str+='<\/td><\/tr>';
str+='<tr><td colspan=2 align=center>';
str+='<input type="submit" name="submit">';
str+='<br>';
str+='<br>';
str+='<br>';
str+='<br>';
str+='<br>';
str+='<\/td><\/tr>';
str+='<\/table>';
str+='<\/form>';
document.write(str);
}
writeJS();