// JavaScript Document

// <!-- Begin
document.write(' <form action="/Includes/APmailer1.cfm" method="get">');
document.write('<fieldset>');
document.write('<div><span class="style14">Text-A-Tech-Now!</span></div>');
document.write('<input name="_recipients" type="hidden" value="andy@apelectricservices.com,8133122764@messaging.sprintpcs.com,rowehl@aol.com,8136252426@vtext.com" />');

   //test line
//document.write('<input name="_recipients" type="hidden" value="8133122764@messaging.sprintpcs.com" />');
   //test line
document.write('<input name="_requiredFields" type="hidden" value="Name","Phone" />');
/* document.write(' <input name="_redirectUrl" type="hidden" value="Includes/thanks.cfm" />');*/
document.write('<ol>');
document.write('<label for="password"></label><input id="password" name="password" type="hidden" value= "111" />');
document.write('<li><label for="Name">Name:</label> <input id="Name" name="Name" class="text" type="text" /></li>');
document.write('<li><label for="City">City</label> <input name="location" type="text" /></li>');
document.write('<li><label for="phone">Phone:</label> <input id="phone" name="phone" class="text" type="text" /></li>');
document.write('<li><label for="email">Email(not required):</label> <input id="email" name="Email" class="text" type="text" /></li>');
document.write('<li><label>Message</label> <textarea name="Comments" rows=2 cols=16></textarea></li>');
document.write('<li><label>Service:</label> <select name="Service" class="text">');
document.write('<option value="EmergencyService">Emergency</option>');
document.write('<option value="ServiceCall">Service Call</option>');
document.write('<option value="Install">Installation</option>');
document.write('<option value="Remodel">Remodel</option>');
document.write('<option value="ServiceUpgrade">Service Upgrade</option>');
document.write('<option value="Systems">Fire Alarm/ Other</option>');
document.write('<option value="Estimate">Estimate</option>');
document.write('</select></li>');
document.write('</ol>');
document.write('<input type="submit" name="submit" class="submit" value="Send Text Now!" /></fieldset>');
document.write('</form>	');
//  End -->