document.write('<h2>To join Cliftons mailing list, please complete the following form:</h2>');
document.write('<strong>* <font size="1">Indicates a required field</font></strong>');
document.write('<form name="theForm" onsubmit="javascript:return checkWholeForm(this);" action="/main/" method="post">');
document.write('<input type="hidden" name="c" value="sb">');
document.write('<input type="hidden" name="sb_task" value="form_submit">');
document.write('<input type="hidden" name="form_type" value="newsletter">');
document.write('<input type="hidden" name="destination" value="/page/thankyou.html">');
document.write('<table cellspacing="1" cellpadding="4" width="100%" border="0">');
document.write('<tr>');
document.write('<td style="width: 22%" bgcolor="#f9f9f9"><strong>Name:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="name" type="text"> *</strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td style="width: 25%" bgcolor="#f9f9f9"><strong>Company:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="company" type="text"> *</strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td style="width: 25%" bgcolor="#f9f9f9"><strong>Title:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="title" type="text"> *</strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td style="width: 25%" bgcolor="#f9f9f9"><strong>Phone:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="phone_number" type="text"> *</strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td bgcolor="#f9f9f9"><strong>Email:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="email" type="text"> *</strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td bgcolor="#f9f9f9"><strong>Address:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="address1" type="text"> </strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td bgcolor="#f9f9f9">&nbsp;</td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="address2" type="text"> </strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td bgcolor="#f9f9f9"><strong>City:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="city" type="text"> </strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td bgcolor="#f9f9f9"><strong>State:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" size="4" name="state" type="text"> *</strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td bgcolor="#f9f9f9"><strong>Postcode:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" size="4" name="postcode" type="text"> </strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td bgcolor="#f9f9f9"><strong>Country:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><input style="font: 10px verdana,arial,helvetica" name="country" type="text"> </strong></td>');
document.write('</tr>');
document.write('</table>');
document.write('<p>&nbsp;</p>');
document.write('<table cellspacing="1" cellpadding="4" width="100%" border="0">');
document.write('<tr>');
document.write('<td style="width: 25%" valign="top"><strong>Additional Comments:</strong></td>');
document.write('<td bgcolor="#f9f9f9"><strong><textarea name="comments" rows="4" cols="40"></textarea> </strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td style="width: 25%" valign="top"><strong><input class="noborder" type="checkbox" name="additional_material" value="yes"> </strong>');
document.write('</td>');
document.write('<td><strong>Please check this box if you do not wish to receive additional material from Cliftons:</strong></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td style="width: 25%" valign="top">&nbsp;</td>');
document.write('<td><input class="noborder" type="image" src="/persistent/templateimages/btn_submit.gif" name="Submit" value="Submit"></td>');
document.write('</tr>');
document.write('</table>');
document.write('</form><p>We will respect your privacy and promise that your personal information will remain confidential. We will only contact you based upon your requests for information above. <br /><br />');
document.write('Please click <a href="/page/auto/1146191329:31658:26186:48086038.html" mce_href="/page/auto/1146191329:31658:26186:48086038.html">here</a> to view our privacy policy. </p>');