document.writeln("<form id=\"form1\" name=\"form1\" method=\"post\" action=\"feedback_js.php?action=save\">");
document.writeln("  <table width=\"100%\" border=\"0\" cellspacing=\"0\" cellpadding=\"5\" id=\"feedback\">");
document.writeln("    <tr>");
document.writeln("      <td align=\"right\">Содержание (тема) <\/td>");
document.writeln("      <td><textarea name=\"content\" cols=\"60\" rows=\"6\" id=\"content\"><\/textarea><\/td>");
document.writeln("    <\/tr>");
document.writeln("    <tr>");
document.writeln("    <tr>");
document.writeln("      <td align=\"right\">Название компании<\/td>");
document.writeln("      <td><input name=\"company\" type=\"text\" id=\"company\" size=\"40\" \/><\/td>");
document.writeln("    <\/tr>");
document.writeln("    <tr>");
document.writeln("      <td align=\"right\">Баше имя<\/td>");
document.writeln("      <td><input name=\"linkman\" type=\"text\" id=\"linkman\" size=\"20\" \/><\/td>");
document.writeln("    <\/tr>");
document.writeln("    <tr>");
document.writeln("      <td align=\"right\">Адрес<\/td>");
document.writeln("      <td><input name=\"address\" type=\"text\" id=\"address\" size=\"40\" \/><\/td>");
document.writeln("    <\/tr>");
document.writeln("    <tr>");
document.writeln("      <td align=\"right\">Телефон<\/td>");
document.writeln("      <td><input name=\"tel\" type=\"text\" id=\"tel\" size=\"20\" \/><\/td>");
document.writeln("    <\/tr>");
document.writeln("    <tr>");
document.writeln("      <td align=\"right\">E-mail<\/td>");
document.writeln("      <td><input name=\"email\" type=\"text\" id=\"email\" size=\"20\" \/><\/td>");
document.writeln("    <\/tr>");
document.writeln("    <tr>");
document.writeln("      <td align=\"right\">ICQ / Skype / MSN<\/td><td>");
document.writeln("<select name=\"imt\">");
document.writeln("<option value=\"MSN\">MSN<\/option>");
document.writeln("<option value=\"ICQ\">ICQ<\/option>");
document.writeln("<option value=\"Skype\">Skype<\/option>");
document.writeln("<\/select>")
document.writeln("      <input name=\"im\" type=\"text\" id=\"im\" size=\"15\" \/><\/td>");
document.writeln("    <\/tr>");

document.writeln("      <td>&nbsp;<\/td>");
document.writeln("      <td><input type=\"image\" name=\"imageField\" src=\"images\/otpr.gif\" \/><\/td>");
document.writeln("    <\/tr>");
document.writeln("  <\/table>");
document.writeln("<\/form>")