var contactDisplay = document.getElementById('estimate-form');
contactDisplay.innerHTML = '<form action=\"mainstream-estimates.php\" method=\"POST\"><input type=\"hidden\" name=\"formtest\" value=\"test\"><table width=\"100%\"><tbody><tr><td width=\"40%\"  align=\"right\" valign=\"top\"><span class=\"SubHead\"><font color=\"#FF0000\"> * </font>Your Name:</span></td><td colspan=\"2\" valign=\"top\"><input class=\"form\" size=\"24\" name=inp_name></td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\"><font color=\"#FF0000\"> * </font>E-mail address:</span></td><td colspan=\"2\" valign=\"top\"><input class=\"form\" size=\"24\" name=inp_email></td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\"><font color=\"#FF0000\"> * </font>Street Address:</span></td><td colspan=\"2\" valign=\"top\"><textarea class=\"form\" name=inp_add rows=3 cols=24></textarea></td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\"><font color=\"#FF0000\"> * </font>City:</span></td><td colspan=\"2\" valign=\"top\"><input class=\"form\" size=\"24\" name=inp_city></td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\"><font color=\"#FF0000\"> * </font>State:</span></td><td colspan=\"2\" valign=\"top \"><select class=\"form\" size=1  name=inp_state><option value=\"IL\" selected>IL-Illinois</option><option value=\"IA\">IA-Iowa</option></select></td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\"><font color=\"#FF0000\"> * </font>Zip Code:</span></td><td colspan=\"2\" valign=\"top\"><input class=\"form\" maxlength=12 size=12 name=inp_zip></td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\"><font color=\"#FF0000\"> * </font>Daytime Phone #:</span></td><td colspan=\"2\" valign=\"top\"><input class=\"form\" size=\"24\" name=inp_phone></td></tr><tr><td colspan=\"3\" valign=\"top\" >&nbsp;</td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\"> Are you a past customer?:</span></td><td colspan=\"2\" valign=\"top\"><span class=\"SubHead2\">&nbsp;&nbsp;&nbsp;&nbsp;Yes<input type=\"radio\" name=\"pastpartner\" id=\"radio\"  value=\"Yes\">&nbsp;&nbsp;&nbsp;&nbsp;No<input type=\"radio\" name=\"pastpartner\" id=\"pastpartner\"  value=\"No\"></span> </td></tr><tr><td colspan=\"3\" valign=\"top\" >&nbsp;</td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\">When is the most convenient</span></td><td colspan=\"2\" valign=\"top\" ><span class=\"SubHead2\">Day&nbsp;&nbsp;&nbsp;<input class=\"form\" size=\"24\" name=convday></span></td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\">time to contact you?</span></td><td colspan=\"2\" valign=\"top\" ><span class=\"SubHead2\">Time&nbsp;<input class=\"form\" size=\"24\" name=convtime></span></td></tr><tr><td colspan=\"3\" valign=\"top\" >&nbsp;</td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\">What products are you interested in?:</span></td><td width=\"30%\" valign=\"top\" class=\"subhead2\">Vinyl Windows</td><td width=\"30%\" valign=\"top\" align=\"left\"><input name=\"interest1\" type=\"checkbox\" id=\"interest1\" value=\"Vinyl Windows\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Vinyl Siding</td><td valign=\"top\"><input name=\"interest2\" type=\"checkbox\" id=\"interest2\" value=\"Vinyl Siding\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Roofing</td><td valign=\"top\"><input name=\"interest3\" type=\"checkbox\" id=\"interest3\" value=\"Roofing\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Entry or Storms Doors</td><td valign=\"top\"><input name=\"interest4\" type=\"checkbox\" id=\"interest4\" value=\"Entry or Storms Doors\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Gutter Covers</td><td valign=\"top\"><input name=\"interest5\" type=\"checkbox\" id=\"interest5\" value=\"Gutter Covers\"></td></tr><tr><td colspan=\"3\" valign=\"top\" >&nbsp;</td></tr><tr><td valign=\"top\" align=\"right\"><span class=\"SubHead\">How did you hear about us?</span> </td><td valign=\"top\" class=\"subhead2\">Friend / Family</td><td valign=\"top\"><input name=\"hear1\" type=\"checkbox\" id=\"hear1\" value=\"Friend / Family\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Flyer</td><td valign=\"top\"><input name=\"hear2\" type=\"checkbox\" id=\"hear2\" value=\"Flyer\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Newspaper</td><td valign=\"top\"><input name=\"hear3\" type=\"checkbox\" id=\"hear3\" value=\"Newspaper\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Web Search</td><td valign=\"top\"> <input name=\"hear4\" type=\"checkbox\" id=\"hear4\" value=\"Web Search\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Phone Book</td><td valign=\"top\"><input name=\"hear5\" type=\"checkbox\" id=\"hear5\" value=\"Phone Book\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">McLeod</td><td valign=\"top\"><input name=\"hear6\" type=\"checkbox\" id=\"hear6\" value=\"McLeod\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Ameritech</td><td valign=\"top\"><input name=\"hear7\" type=\"checkbox\" id=\"hear7\" value=\"Ameritech\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Qwest Dex</td><td valign=\"top\"><input name=\"hear8\" type=\"checkbox\" id=\"hear8\" value=\"Qwest Dex\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Quad City Home Show</td><td valign=\"top\"><input name=\"hear9\" type=\"checkbox\" id=\"hear9\" value=\"Quad City Home Show\"></td></tr><tr><td valign=\"top\" align=\"right\">&nbsp;</td><td valign=\"top\" class=\"subhead2\">Other</td><td valign=\"top\"><input name=\"hear10\" type=\"checkbox\" id=\"hear10\" value=\"Other\"></td></tr></tbody></table><br><div align=\"center\"><input type=\"submit\" name=\"Submit\" value=\"Submit\" class=\"form\"> <input type=\"reset\" value=\"Reset Form\" class=\"form\"></div></form>';
