<!--Table starts here -->
document.write("<form name='Support' ACTION='http://www.hostvip.co.za/cgi-bin/suppform.pl' onSubmit='return validateForm(Support)' method='post' class='table'><input type=hidden name='redirect' value='http://www.hostvip.biz/thankyou.htm'><table BORDER='0' CELLPADDING='10' CELLSPACING='0' class='table' width='100%'><tr><td valign='top' width='178'></td><td width='408' ><p class='table'><b>*Please fill in the required fields</b></td></tr><tr><td valign='top' width='178' bgcolor='#658393' class='sidetable2'></td><td width='408' bgcolor='#658393' class='sidetable2' ><b>Hosting Details</b></td></tr><tr><td valign='middle' width='178'><p class='table' align='right'>*http://</td><td width='408' ><p class='table'><input TYPE='text' name='Domain' class='table' size='36'><br>Domain Name</td></tr><tr><td valign='top' width='178' bgcolor='#658393' class='sidetable2'></td><td width='408' bgcolor='#658393' class='sidetable2'><b>Account Owner Details</b></td></tr><tr><td valign='top' width='178'><p align='right' class='table' style='word-spacing: 0; line-height: 200%; text-indent: 0; margin: 0'>Name*:<BR>Surname*:</p></td><td width='408' ><p class='table'><input TYPE='text' name='Name' class='table'> <BR><input TYPE='text' name='Surname' class='table'></p></td></tr><tr><td width='178' valign='top'><p class='table' align='right' style='word-spacing: 0; text-indent: 0; line-height: 200%; margin: 0'>Tel*:<BR>Mobile*:<br>Email*:<br>Confirm/Alt Email*:</p></td><td width='408'><p class='table' style=line-height: '200%'><input type='text' name='Tel' class='table'> <BR><input type='text' name='Mobile' class='table'><BR><input type='text' name='email' class='table' size='36' ><br><input type='text' name='Email' class='table' size='36' ><br>i.e. bv. address@host.ext</p></td></tr><tr><td valign='top' width='178' bgcolor='#658393' class='sidetable2'></td><td width='408' bgcolor='#658393' class='sidetable2'><b>Support Needed</b></td></tr><tr><td COLSPAN='2' width='608'><p class='table' align='center'> <!--webbot bot='Validation' B-Value-Required='TRUE' B-Disallow-First-Item='TRUE' --> <select name='subject' size='1' class='table' ><option>Select One</option><option>Accounts Support</option><option>Dial-up Support</option><option>Domain Registration Support</option><option>Domain Transfer Support</option><option>Hosting Support</option><option>Webmail Support</option><option>I would like to be a Reseller</option><option>Other</option></select></p><p class='table' align='center'> *Comments, questions, suggestions, broken links..</p><p class='table' align='center'> <textarea name='CommentsSuggestions' COLS='50' ROWS='6'></textarea></p></td></tr></table><div align='center'><table><tr><td align='center'><p align='left'><input TYPE='submit' VALUE='Send Form' style='font-size: 8pt'><input type='reset' value='Clear Form' style='font-size: 8pt'></p></td></tr></table></div></form>")
