document.write("<div id='accident-lawyer'><h1><strong>Consulta Gratis</strong></h1><form action='../scripts/contact-spanish/contact2.php' method='post' id='form1' name='myform'><p>Nombre:<em class='spanish'>Tel&eacute;fono:</em></p><input name='name_from' maxlength='30' style='width:100px;margin-right:7px;' type='text' /><input name='phone' maxlength='16' onkeydown='__FormatPhoneNumber(event, this)' onkeyup='__FormatPhoneNumber(event, this)' type='text' style='width:106px;margin-top:-3px;' /><p>Correo Electrónico:</p><input name='email_from' maxlength='255' type='text' style='width:220px;' /><p>Comentarios:</p><textarea name='comments' style='width:216px;height:50px;'></textarea><p>C&oacute;digo: <a href='#ref' onclick='document.getElementById(&#39;captcha&#39;).src = document.getElementById(&#39;captcha&#39;).src + &#39;?&#39; + (new Date()).getMilliseconds()' style='font-size:12px;color:#fff;text-decoration:none;'>&#8595;</a><img src='../scripts/contact-spanish/captcha-image.php' style='margin-top:2px;padding-left:6px;' alt='Security Image' name='captcha' align='right' width='90' height='18' id='captcha' /><input style='float:right;margin-top:2px;width:51px;' type='text' name='security_code' value='' maxlength='6' id='security_code'></p><input type='submit' class='submit' value='Enviar' /></form></div>");