document.write('<!-- phpForms.net form BEGIN -->');document.write('<style>');document.write('<!--');document.write('.phpForms_pgtitle');document.write('{');document.write('    font-family : Arial;');document.write('    font-size   : 18px;');document.write('    color       : #1200d9;');document.write('    font-weight : bold;');document.write('}');document.write('.phpForms_btn');document.write('{');document.write('    border-top-width    : 1px;');document.write('    border-left-width   : 1px;');document.write('    border-bottom-width : 1px;');document.write('    border-right-width  : 1px;');document.write('    border-top-color    : #e4e4e4;');document.write('    border-left-color   : #e4e4e4;');document.write('    border-right-color  : #c1c1c1;');document.write('    border-bottom-color : #c1c1c1;');document.write('    font                : Verdana, Arial, Helvetica, sans-serif;');document.write('    color               : 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value="73d74b0f36">');function CheckPagebd5efea5b1(){   var nResult = 0;      nResult += LettersOnly( nResult, 'fld_2f909e20fc','Your Name:' );   nResult += Email( nResult, 'fld_e97e08d83a','Your Email:' );   nResult += NotEmpty( nResult, 'fld_24705b3dd9','Message:' );   if ( nResult == 0 )   {        document.getElementById('loading').style.display='inline';                                              document.getElementById('imgcode_code').style.display='none';                                              CheckImg(arguments[0]);                                              return;      if (1)      {         var el = document.getElementById( 'frm_73d74b0f36' );         if ( typeof(el)=='object' && el != null ) el.submit();      }      else ChangePage( 0, 1 );   }}document.write('     <!-- Page -->');document.write('     <table id="pg_bd5efea5b1" border="0" cellpadding="2" cellspacing="1" width="475" bgcolor="#EED8AE" class="phpForms_main" style="display:;border: solid 1px #777777;">');document.write('      <tr>');document.write('          <td width="30%" align="left" bgcolor="#EED8AE" valign="top">');document.write('             <span style="">Please select the Law Area where you need assistance:</span>');document.write('          </td>');document.write('          <td width="70%" align="left" bgcolor="#EED8AE">');document.write('             <input type="radio" name="fld_7cf752c1ea" id="1caa64995e"   value="DUI" style=""><label for="1caa64995e">DUI</label><br>');document.write('<input type="radio" name="fld_7cf752c1ea" id="f45ac85e10"   value="Criminal Law" style=""><label for="f45ac85e10">Criminal Law</label><br>');document.write('<input type="radio" name="fld_7cf752c1ea" id="c0e4ce4921"   value="Family Law" style=""><label for="c0e4ce4921">Family Law</label><br>');document.write('<input type="radio" name="fld_7cf752c1ea" id="16a0a95e5d"   value="Bankruptcy" style=""><label for="16a0a95e5d">Bankruptcy</label><br>');document.write('<input type="radio" name="fld_7cf752c1ea" id="c151965acb"   value="Personal inj/workers comp" style=""><label for="c151965acb">Personal Injury / Workers Comp.</label><br>');document.write('<input type="radio" name="fld_7cf752c1ea" id="87cef0880c"   value="other" style=""><label for="87cef0880c">Other</label>');document.write('          </td>');document.write('      </tr>');document.write('      <tr>');document.write('          <td width="30%" align="left" bgcolor="#EED8AE" valign="top">');document.write('             <span style="">If you have an Attorney preference please select one:</span>');document.write('          </td>');document.write('          <td width="70%" align="left" bgcolor="#EED8AE">');document.write('             <select name="fld_2dd894b71e" id="fld_2dd894b71e" style="width:100%;">');document.write('  <option value=\'John\'>John Weddle</option>');document.write('<option value=\'Mark\'>Mark Nickels</option>');document.write('<option value=\'Angela\'>Angela Brooks</option>');document.write('<option value=\'Kim\'>Kimberly Brown</option>');document.write('</select>');document.write('          </td>');document.write('      </tr>');document.write('      <tr>');document.write('          <td width="30%" align="left" bgcolor="#EED8AE" valign="top">');document.write('             <span style="">Your Name:</span>&nbsp;<font color=\'red\'>*</font>');document.write('          </td>');document.write('          <td width="70%" align="left" bgcolor="#EED8AE">');document.write('             <input type="text" name="fld_2f909e20fc"   id="fld_2f909e20fc" value="" style="width:100%;">');document.write('          </td>');document.write('      </tr>');document.write('      <tr>');document.write('          <td width="30%" align="left" bgcolor="#EED8AE" valign="top">');document.write('             <span style="">Your Email:</span>&nbsp;<font color=\'red\'>*</font>');document.write('          </td>');document.write('          <td width="70%" align="left" 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 <td width="70%" align="left" bgcolor="#EED8AE">');document.write('             <textarea name="fld_24705b3dd9" id="fld_24705b3dd9" rows="0" style="width:100%;">Please give us a brief description of your situation.</textarea>');document.write('          </td>');document.write('      </tr>');document.write('<tr><td colspan="2" bgcolor="#cdcdcd">');document.write('Please enter the security code below & click Submit to complete the form. If you can not read the image click on the reload image icon for a new code.');document.write('</td></tr>');document.write('<tr>');document.write('    <td>');document.write('     <img src="http://bogwebdesign.com/phpForms/index.php?frm=73d74b0f36&randm="+ randim + "" name="captcha"><br>');document.write('     <input type="hidden" name="imgcode_id" value=\'\'>');document.write('     <a href="javascript:changeAccessCodeImg();">Reload image</a>');document.write('    </td>');document.write('    <td>');document.write('	 <img src="http://bogwebdesign.com/phpForms/img-code/loading.gif" id="loading" name="loading" style="display: none"><br>');document.write('     <input type="text" name="imgcode_code" id="imgcode_code" value=\'\' style="width:220px;">');document.write('    </td>	 ');document.write('</tr>');document.write('&nbsp;');function changeAccessCodeImg(){   var randim = Math.random();   document.images.captcha.src = "http://bogwebdesign.com/phpForms/index.php?frm=73d74b0f36&randm="+ randim + "";   document.forms['frm_73d74b0f36'].imgcode_id.value =+ randim + ""; } changeAccessCodeImg(); function CheckImg(){     arg_ff1=arguments[0];   var s = document.createElement('script');   s.setAttribute('type','text/javascript');   cl_code = document.getElementById('imgcode_code');   checimg = cl_code.value;   randim = document.forms['frm_73d74b0f36'].imgcode_id.value;   document.documentElement.firstChild.appendChild(s);    ff_onload_called=false;    s.setAttribute('src', "http://bogwebdesign.com/phpForms/index.php?frm=73d74b0f36&chrandm=" + randim + "&checimg=" + checimg + "");    s.setAttribute('onload', "ff1()"); }var ff_onload_called=false;var arg_ff1;function ff1(){      if(ff_onload_called)        return;            ff_onload_called=true;       document.getElementById('loading').style.display='none';   document.getElementById('imgcode_code').style.display='';      if (ci == 3)    {      alert("Sorry, the code you've entered is invalid. Please try again.");      return 1;    }    if (ci == 2 )    {               var el = document.getElementById('frm_73d74b0f36');         if ( typeof(el)=='object' && el != null )         {            el.submit()         }    }}document.write('&nbsp;');document.write('<tr>');document.write('          <td colspan="2" align="center" class="phpForms_main">');document.write('            ');document.write('          </td>');document.write('      </tr>');document.write('<tr>');document.write('          <td colspan="2" align="center" class="phpForms_main">');document.write('          </td>');document.write('      </tr>');document.write('      <tr>');document.write('          <!-- Buttons -->');document.write('          <td colspan="2" align="center" class="phpForms_main">');document.write('<input type="button" id="subbut" value="Submit" onClick=\'CheckPagebd5efea5b1();\' style="width:30%; background-color : #a2a2a2" class="phpForms_btn">');document.write('          </td>');document.write('      </tr>');document.write('     </table>');document.write('     <!-- /Page -->');document.write('</form>');document.write('<!-- /phpForms.net form END -->');