d=self.document;

d.write("<form method='post' action='http://www.insights-for-life.com/forMail.php'><input type='hidden' name='recipients' value='marthahypnotherapyinsights-for-life.com' /><input type='hidden' name='mail_options' value='KeepLines' /><input type='hidden' name='required' value='realname:Your name,email:Your email address,message:Message' /><input type='hidden' name='good_url' value='http://www.insights-for-life.com/thanks.php' /><input type='hidden' name='bad_url' value='http://www.insights-for-life.com/error.php' />");

d.write("<table align='center' cellspacing='0' cellpadding='0' border='0'><tr><td valign='top' style='padding-right: 8px;'><p style='margin-bottom: 0;'>Your Name:</p><input type='text' name='realname' size='29' /><p style='margin-bottom: 0;'>Your Email:</p><input type='text' name='email' size='29' /><p style='margin-bottom: 0;'>Subject:</p><input type='text' name='subject' size='29' /></td>");

d.write("<td valign='top'><p style='margin-bottom: 0;'>Message:</p><textarea name='message' cols='31' rows='10'></textarea><br /><input type='reset' value='Reset' name='reset' style='cursor: hand;' /><input type='submit' value='Submit' name='submit' style='cursor: hand;' /><br /><p style='font-weight: bold; margin: 0;'>Please press \"Submit\" only once!</p><p class='R'><span class='credit'>Visit <a href='http://www.tectite.com/' target='_blank' title='www.tectite.com' style='font-weight: normal;'>www.tectite.com</a> for free FormMail software.</span></p></td></tr></table></form>");