function writeJS(){
var str='';
str+='<form action="https:\/\/www.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8" method="POST">';
str+='<input type="hidden" name="debug" value=0>';
str+='<input type="hidden" name="debugEmail" value="email@sterilizers.com">';
str+='<input type=hidden name="oid" value="00D600000006y7m">';
str+='<input type=hidden name="retURL" value="http:\/\/www.sterilizers.com">';
str+='<input  id="00N60000001YkSV" maxlength="15" name="00N60000001YkSV" size="20" type="hidden" value="8">';
str+='<tr><td align=right>';
str+='<label for="first_name">First Name<\/label>';
str+='<\/td><td>';
str+='<input  id="first_name" maxlength="40" name="first_name" size="20" type="text" \/>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='<label for="last_name">Last Name<\/label>';
str+='<\/td><td><input  id="last_name" maxlength="40" name="last_name" size="20" type="text" \/>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='<label for="email">Email<\/label>';
str+='<\/td><td>';
str+='<input  id="email" maxlength="80" name="email" size="20" type="text" \/>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='<label for="phone">Phone<\/label>';
str+='<\/td><td>';
str+='<input  id="phone" maxlength="40" name="phone" size="20" type="text" \/>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='Type of Customer:';
str+='<\/td><td>';
str+='<select  id="00N60000001VbeY" name="00N60000001VbeY" title="Type of Customer">';
str+='<option value="">--None--<\/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 (Nail or Beauty)">Dealer (Nail or Beauty)<\/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>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='Type of sterilizer prospect has now:';
str+='<\/td><td>';
str+='<select  id="00N60000001Veqm" name="00N60000001Veqm" title="Type of sterilizer prospect has now">';
str+='<option value="">--None--<\/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>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='Serial No:';
str+='<\/td><td><input  id="00N60000001Vh2l" maxlength="50" name="00N60000001Vh2l" size="20" type="text" \/>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='How urgent is this repair job:';
str+='<\/td><td>';
str+='<input  id="00N60000001Vh3i" maxlength="255" name="00N60000001Vh3i" size="20" type="text" \/>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='What is your sterilizer mfg name:';
str+='<\/td><td>';
str+='<input  id="00N60000001Vh3s" maxlength="100" name="00N60000001Vh3s" size="20" type="text" \/>';
str+='<\/td><\/tr>';
str+='<tr><td align=right>';
str+='Comments:';
str+='<\/td><td>';
str+='<textarea  id="00N60000001Vh2k" name="00N60000001Vh2k" type="text" wrap="soft" cols=40 rows=3><\/textarea>';
str+='<\/td><\/tr>';
str+='<tr><td align=center colspan=2>';
str+='<input type="submit" name="submit">';
str+='<\/td><\/tr>';
str+='<\/table>';
str+='<\/form>';
document.write(str);
}
writeJS();