document.writeln('<form method="post" action="http://www.sitemason.com/feedback/h1e7wA/confirmation" target="_self">');
document.writeln('  <table border="0" cellspacing="0" cellpadding="0" width="400" align="center">');
document.writeln('    <tr>');
document.writeln('      <td bgcolor="#630030">');
document.writeln('        <table width="100%" border="0" cellspacing="1" cellpadding="3">');
document.writeln('          <tr>');
document.writeln('            <td bgcolor="#8A0043" align="center">');
document.writeln('              <font face="Verdana, Arial, Helvetica, sans-serif" size="2" color="#FFFFFF">');
document.writeln('                <b>Send Feedback</b>');
document.writeln('              </font>');
document.writeln('            </td>');
document.writeln('          </tr>');
document.writeln('          <tr>');
document.writeln('            <td align="center" bgcolor="#FFEAFB">');
document.writeln('              <table border="0" cellspacing="1" cellpadding="3" align="center">');
document.writeln('                <tr>');
document.writeln('                  <td align="right">');
document.writeln('                    <font face="Arial, Verdana, Helvetica, sans-serif" size="2" color="#000000">');
document.writeln('                      <b>Your Name:</b>');
document.writeln('                    </font>');
document.writeln('                  </td>');
document.writeln('                  <td align="left">');
document.writeln('                    <input name="from_name" type="text" maxlength="45" size="28" value="">');
document.writeln('                  </td>');
document.writeln('                </tr>');
document.writeln('                <tr>');
document.writeln('                  <td align="right">');
document.writeln('                    <font face="Arial, Verdana, Helvetica, sans-serif" size="2" color="#000000">');
document.writeln('                      <b>Your Email:</b>');
document.writeln('                    </font>');
document.writeln('                  </td>');
document.writeln('                  <td align="left">');
document.writeln('                    <input name="from_address" type="text" maxlength="45" size="28" value="">');
document.writeln('                  </td>');
document.writeln('                </tr>');
document.writeln('                <tr>');
document.writeln('                  <td align="center" colspan="2">');
document.writeln('                    <table>');
document.writeln('                      <tr>');
document.writeln('                        <td align="left">');
document.writeln('                          <font face="Arial, Verdana, Helvetica, sans-serif" size="2" color="#000000">');
document.writeln('                            <b>Comments:</b>');
document.writeln('                          </font>');
document.writeln('                          <br>');
document.writeln('                          <textarea name="content" rows="5" cols="40"></textarea>');
document.writeln('                          <br>');
document.writeln('                          <input type="hidden" name="referer" value="http://www.freewebs.com/darkonsb/">');
document.writeln('                        </td>');
document.writeln('                      </tr>');
document.writeln('                    </table>');
document.writeln('                  </td>');
document.writeln('                </tr>');
document.writeln('                <tr>');
document.writeln('                  <td colspan="2" align="center">');
document.writeln('                    <input type="submit" name="send" value="Send Feedback">');
document.writeln('                  </td>');
document.writeln('                </tr>');
document.writeln('              </table>');
document.writeln('            </td>');
document.writeln('          </tr>');
document.writeln('        </table>');
document.writeln('      </td>');
document.writeln('    </tr>');
document.writeln('  </table>');
document.writeln('</form>');