document.write('<form method="post" action="http://www.promergence.com/sendstudionx/form.php?form=17" id="frmSS17" onSubmit="return CheckForm17(this);"><input type="hidden" name="format" value="t" /><div id="sd-container"><div class="labels">First Name:<div><div class="ipt-3"><input type="text" name="CustomFields[1]" id="CustomFields_1_17" value=""  class="ipt-sidebar" /></div><div class="labels">Last Name:</div><div class="ipt-3"><input type="text" name="CustomFields[2]" id="CustomFields_2_17" value="" class="ipt-sidebar" /></div><div class="labels">Title:</div><div class="ipt-3"><input type="text" name="CustomFields[4]" id="CustomFields_4_17" value="" class="ipt-sidebar" /></div><div class="labels">Company:</div><div class="ipt-3"><input type="text" name="CustomFields[3]" id="CustomFields_3_17" value="" class="ipt-sidebar" /></div><div class="labels">Email:</div><div class="ipt-3"><input type="text" name="email" value="" class="ipt-sidebar" /></div><div class="bb"><input type="submit" value="Get Report" class="form-button-sb" /></div><br /><div class="bb"><input type="reset" value="Reset Text" class="form-button-sb" /></div></div></div></div></form><script type="text/javascript">function CheckMultiple17(frm, name) {for (var i=0; i < frm.length; i++){fldObj = frm.elements[i];fldId = fldObj.id;if (fldId) {var fieldnamecheck=fldObj.id.indexOf(name);if (fieldnamecheck != -1) {if (fldObj.checked) {return true;}}}}return false;}function CheckForm17(f) {if (f.email.value == "") {alert("Please enter your email address.");f.email.focus();return false;}var fname = "CustomFields_1_17";var fld = document.getElementById(fname);if (fld.value == "") {alert("Please enter a value for field First Name");fld.focus();return false;}var fname = "CustomFields_2_17";var fld = document.getElementById(fname);if (fld.value == "") {alert("Please enter a value for field Last Name");fld.focus();return false;}var fname = "CustomFields_4_17";var fld = document.getElementById(fname);if (fld.value == "") {alert("Please enter a value for field Title");fld.focus();return false;}var fname = "CustomFields_3_17";var fld = document.getElementById(fname);if (fld.value == "") {alert("Please enter a value for field Company");fld.focus();return false;}return true;}</script>')