document.write('<form name="form1" id="form1" method="post" action="/includes/mail.php">Name:<br /><input name="Name" type="text" id="Name" class="spaced" style="background-color: #000; color: #fff; border: 0px solid #fff; font-family: arial; font-size: 14px;" /><br /><br />Email:<br /><input name="Email" type="text" id="Email" class="spaced" style="background-color: #000; color: #fff; border: 0px solid #fff; font-family: arial; font-size: 14px;" /><br /><br />Comments:<br /><textarea name="Comments" id="Comments" cols="40" rows="7" style="background-color: #000; color: #fff; border: 0px solid #fff; overflow: auto; font-family: arial; font-size: 14px;"></textarea><br /><input type="submit" name="Submit" value="Submit" /><input type="reset" name="Reset" value="Reset" /><input name="recipient" type="hidden" value="jazzloud@gmail.com" /><input name="subject" type="hidden" value="Jay Aldrich.com - Visitor Contacting" /><input name="required" type="hidden" value="Name,Email,Comments" /><input name="errorpage" type="hidden" value="/error.php" /><input name="redirect" type="hidden" value="/success.php" /></form>');