//<script LANGUAGE="JAVASCRIPT">

				document.writeln('<p>');
						
				document.writeln('</p>');

				document.writeln('<scr' + 'ipt language="javascript" src="/js/incWsPafLookup.js"></sc' + 'ript>');
				
				document.writeln('		<scr'+'ipt language="Javascript">');
				document.writeln('	  		//Status for PAF Function');
				document.writeln('			function funPAFLookupStatus(sStatus){');
				document.writeln('				if (sStatus == "BEGIN") {');
				document.writeln('					document.getElementById("btnPostCodeLookup").value = "Please wait..";');
				document.writeln('				}');
				document.writeln('				else if (sStatus == "ERROR") {');
				document.writeln('					document.getElementById("btnPostCodeLookup").value = " Error.";');
				document.writeln('				}');
				document.writeln('				else {');
				document.writeln('					document.getElementById("btnPostCodeLookup").value = "Lookup Address";');
				document.writeln('				}');
				document.writeln('			}');
				document.writeln('			</scr'+'ipt>');						
				
				document.writeln('<form name="customForm17414" action="/CustomFormProcess.asp" method="post" onsubmit="return ValidateCustomForm(this,0)">');
				document.writeln('<input type="hidden" name="Title" value="Contact Us" class="hidden" />');
				document.writeln('<input type="hidden" name="ID" value="17414" class="hidden" />');
				document.writeln('<input type="hidden" name="nConfirmationNum" value="100" class="hidden" />');
			 	document.writeln('<input type="hidden" name="NumQuestions" value="-1" class="hidden" />');
			 	document.writeln('<input type="hidden" name="NumFields" value="0" class="hidden" />');
				document.writeln('<fieldset class="custom_form">');
				
			//</script>	 	
			document.writeln('<p>');
document.writeln('  <label for="TO">Nature of your inquiry</label>');
document.writeln('  <select id="TO" NAME="TO" class="">');
document.writeln('<option value="5825">Comments: DJs and Shows</option>');
document.writeln('<option value="6759">Enquiries about Xfm.co.uk</option>');
document.writeln('<option value="10657">Problems Listening Online</option>');
document.writeln('<option value="10522">Problems Registering/Logging In</option>');
document.writeln('<option value="5826">Enquiries about Xfm\'s playlist</option>');
document.writeln('<option value="12824">Got a query about a competition or promotion?</option>');
document.writeln('</select>');
document.writeln('</p>');	 

					//<script LANGUAGE="JAVASCRIPT">
					  document.writeln('	<p>');
					  //display friend's email only for these 4 field questions for RAF
					  
						document.writeln('	<label for="cf_Field0answer">Comments:</label>');
					 
					  
					//</script>		
							
					//<script LANGUAGE="JAVASCRIPT">		
					  document.writeln('<span class="">*</span>');
					//</script>		
							
					//<script LANGUAGE="JAVASCRIPT">		
					  document.writeln('	<input type="hidden" name="Field0" value="Comments:" class="hidden" />');
					  document.writeln('	<input type="hidden" name="FieldRequired0" value="1" class="hidden" />');
					  document.writeln('	<input type="hidden" name="FieldID0" value="33" class="hidden" />');
					  
					//</script>	
				document.writeln('<textarea class="" name="Field0answer" id="cf_Field0answer" cols=30 rows="5"></textarea>');
						document.writeln('</p>');
					document.writeln('</fieldset>');
document.writeln('<fieldset class="personal_details">');

document.writeln('	  <p>');

document.writeln('<input type="hidden" name="FirstNameRequired" class="hidden" />');

		    document.writeln('  <label for="cf_FirstName">*First Name:</label>');
			document.writeln('       <input type="text" id="cf_FirstName" name="txtFirstName" value=""  class="" maxLength="80" />');
		
document.writeln('    <input type="hidden" name="FirstNameLabel" value="First Name" class="hidden" />');

document.writeln('	  </p>');

document.writeln('	  <p>');

document.writeln('<input type="hidden" name="LastNameRequired" class="hidden" />');

			document.writeln('  <label for="cf_LastName">*Surname:</label>');
			document.writeln('       <input type="text" id="cf_LastName" name="txtLastName" value=""  class="" maxLength="80" />');
		
document.writeln('    <input type="hidden" name="LastNameLabel" value="Surname" class="hidden" />');

document.writeln('	  </p>');

document.writeln('	  <p>');

document.writeln('<input type="hidden" name="EmailRequired" class="hidden" />');

			document.writeln('  <label for="cf_Email">*Email address:</label>');
			document.writeln('       <input type="text" id="cf_Email" name="txtEmail" class="" maxLength="80" />');
		
document.writeln('    <input type="hidden" name="EmailLabel" value="Email address" class="hidden" />');

document.writeln('	  </p>');

document.writeln('	  <p>');


document.writeln('      <label for="BirthDay">Date of Birth:</label>');
document.writeln('<span class="custom-form-select">');
document.writeln('  	<select name="BirthDay" id="BirthDay"><option value>Day<option value="1">1<option value="2">2<option value="3">3<option value="4">4<option value="5">5<option value="6">6<option value="7">7<option value="8">8<option value="9">9<option value="10">10<option value="11">11<option value="12">12<option value="13">13<option value="14">14<option value="15">15<option value="16">16<option value="17">17<option value="18">18<option value="19">19<option value="20">20<option value="21">21<option value="22">22<option value="23">23<option value="24">24<option value="25">25<option value="26">26<option value="27">27<option value="28">28<option value="29">29<option value="30">30<option value="31">31</select>');
document.writeln('  	<select name="BirthMonth"><option value>Month<option value="1">Jan<option value="2">Feb<option value="3">Mar<option value="4">Apr<option value="5">May<option value="6">Jun<option value="7">Jul<option value="8">Aug<option value="9">Sep<option value="10">Oct<option value="11">Nov<option value="12">Dec</select>');
document.writeln('      <select name="BirthYear" size="1">');
document.writeln('       <option value>Year</option>');
  		
document.writeln('	      <option value="2009">2009</option>');
  		
document.writeln('	      <option value="2008">2008</option>');
  		
document.writeln('	      <option value="2007">2007</option>');
  		
document.writeln('	      <option value="2006">2006</option>');
  		
document.writeln('	      <option value="2005">2005</option>');
  		
document.writeln('	      <option value="2004">2004</option>');
  		
document.writeln('	      <option value="2003">2003</option>');
  		
document.writeln('	      <option value="2002">2002</option>');
  		
document.writeln('	      <option value="2001">2001</option>');
  		
document.writeln('	      <option value="2000">2000</option>');
  		
document.writeln('	      <option value="1999">1999</option>');
  		
document.writeln('	      <option value="1998">1998</option>');
  		
document.writeln('	      <option value="1997">1997</option>');
  		
document.writeln('	      <option value="1996">1996</option>');
  		
document.writeln('	      <option value="1995">1995</option>');
  		
document.writeln('	      <option value="1994">1994</option>');
  		
document.writeln('	      <option value="1993">1993</option>');
  		
document.writeln('	      <option value="1992">1992</option>');
  		
document.writeln('	      <option value="1991">1991</option>');
  		
document.writeln('	      <option value="1990">1990</option>');
  		
document.writeln('	      <option value="1989">1989</option>');
  		
document.writeln('	      <option value="1988">1988</option>');
  		
document.writeln('	      <option value="1987">1987</option>');
  		
document.writeln('	      <option value="1986">1986</option>');
  		
document.writeln('	      <option value="1985">1985</option>');
  		
document.writeln('	      <option value="1984">1984</option>');
  		
document.writeln('	      <option value="1983">1983</option>');
  		
document.writeln('	      <option value="1982">1982</option>');
  		
document.writeln('	      <option value="1981">1981</option>');
  		
document.writeln('	      <option value="1980">1980</option>');
  		
document.writeln('	      <option value="1979">1979</option>');
  		
document.writeln('	      <option value="1978">1978</option>');
  		
document.writeln('	      <option value="1977">1977</option>');
  		
document.writeln('	      <option value="1976">1976</option>');
  		
document.writeln('	      <option value="1975">1975</option>');
  		
document.writeln('	      <option value="1974">1974</option>');
  		
document.writeln('	      <option value="1973">1973</option>');
  		
document.writeln('	      <option value="1972">1972</option>');
  		
document.writeln('	      <option value="1971">1971</option>');
  		
document.writeln('	      <option value="1970">1970</option>');
  		
document.writeln('	      <option value="1969">1969</option>');
  		
document.writeln('	      <option value="1968">1968</option>');
  		
document.writeln('	      <option value="1967">1967</option>');
  		
document.writeln('	      <option value="1966">1966</option>');
  		
document.writeln('	      <option value="1965">1965</option>');
  		
document.writeln('	      <option value="1964">1964</option>');
  		
document.writeln('	      <option value="1963">1963</option>');
  		
document.writeln('	      <option value="1962">1962</option>');
  		
document.writeln('	      <option value="1961">1961</option>');
  		
document.writeln('	      <option value="1960">1960</option>');
  		
document.writeln('	      <option value="1959">1959</option>');
  		
document.writeln('	      <option value="1958">1958</option>');
  		
document.writeln('	      <option value="1957">1957</option>');
  		
document.writeln('	      <option value="1956">1956</option>');
  		
document.writeln('	      <option value="1955">1955</option>');
  		
document.writeln('	      <option value="1954">1954</option>');
  		
document.writeln('	      <option value="1953">1953</option>');
  		
document.writeln('	      <option value="1952">1952</option>');
  		
document.writeln('	      <option value="1951">1951</option>');
  		
document.writeln('	      <option value="1950">1950</option>');
  		
document.writeln('	      <option value="1949">1949</option>');
  		
document.writeln('	      <option value="1948">1948</option>');
  		
document.writeln('	      <option value="1947">1947</option>');
  		
document.writeln('	      <option value="1946">1946</option>');
  		
document.writeln('	      <option value="1945">1945</option>');
  		
document.writeln('	      <option value="1944">1944</option>');
  		
document.writeln('	      <option value="1943">1943</option>');
  		
document.writeln('	      <option value="1942">1942</option>');
  		
document.writeln('	      <option value="1941">1941</option>');
  		
document.writeln('	      <option value="1940">1940</option>');
  		
document.writeln('	      <option value="1939">1939</option>');
  		
document.writeln('	      <option value="1938">1938</option>');
  		
document.writeln('	      <option value="1937">1937</option>');
  		
document.writeln('	      <option value="1936">1936</option>');
  		
document.writeln('	      <option value="1935">1935</option>');
  		
document.writeln('	      <option value="1934">1934</option>');
  		
document.writeln('	      <option value="1933">1933</option>');
  		
document.writeln('	      <option value="1932">1932</option>');
  		
document.writeln('	      <option value="1931">1931</option>');
  		
document.writeln('	      <option value="1930">1930</option>');
  		
document.writeln('	      <option value="1929">1929</option>');
  		
document.writeln('	      <option value="1928">1928</option>');
  		
document.writeln('	      <option value="1927">1927</option>');
  		
document.writeln('	      <option value="1926">1926</option>');
  		
document.writeln('	      <option value="1925">1925</option>');
  		
document.writeln('	      <option value="1924">1924</option>');
  		
document.writeln('	      <option value="1923">1923</option>');
  		
document.writeln('	      <option value="1922">1922</option>');
  		
document.writeln('	      <option value="1921">1921</option>');
  		
document.writeln('	      <option value="1920">1920</option>');
  		
document.writeln('	      <option value="1919">1919</option>');
  		
document.writeln('	      <option value="1918">1918</option>');
  		
document.writeln('	      <option value="1917">1917</option>');
  		
document.writeln('	      <option value="1916">1916</option>');
  		
document.writeln('	      <option value="1915">1915</option>');
  		
document.writeln('	      <option value="1914">1914</option>');
  		
document.writeln('	      <option value="1913">1913</option>');
  		
document.writeln('	      <option value="1912">1912</option>');
  		
document.writeln('	      <option value="1911">1911</option>');
  		
document.writeln('	      <option value="1910">1910</option>');
  		
document.writeln('	      <option value="1909">1909</option>');
  		
document.writeln('      </select> ');
document.writeln('</span>');
  
document.writeln('    <input type="hidden" name="BirthdateLabel" value="Date of Birth" class="hidden" />');

document.writeln('	  </p>');

document.writeln('	  <p>');

			document.writeln('  <label for="cf_DayPhone">Daytime Phone:</label>');
			document.writeln('       <input type="text" id="cf_DayPhone" name="txtDayPhone" class="" maxLength="15" />');
		
document.writeln('    <input type="hidden" name="DayPhoneLabel" value="Daytime Phone" class="hidden" />');

document.writeln('	  </p>');
document.writeln('</fieldset>');

		
				//<script LANGUAGE="JAVASCRIPT">
					
				//</script>
				
				//<script LANGUAGE="JAVASCRIPT">

			document.writeln('  <p class="submit_holder"><button name="submitButton" type="submit">submit</button></p>');
			document.writeln('</fieldset>');			
			document.writeln('</form>');
			//</script>