document.write("<div align=right>"+
				   "<form name=info method=post action=corporate_info.php onSubmit='return check();'>"+
					"<table width=230 border=0 cellspacing=0 cellpadding=0>"+
					  "<tr>"+ 
						"<td bgcolor=#0099CC height=30>"+ 
						  "<div align=center><b><font color=#FFFFFF>Call Back Request</font></b></div>"+
						"</td>"+
					  "</tr>"+
					  "<tr>"+
						"<td bgcolor=EBEBEB height=106>"+ 
						  "<div align=center>If you would like more information<br>"+
							"about any of our services, please<br>"+
							"fill in the brief form below and a<br>"+
							"member of our team will call be in<br>"+
							"touch to provide further information.</div>"+
						"</td>"+
					  "</tr>"+
					  "<tr> "+
						"<td bgcolor=EBEBEB height=50>"+
						  "<div align=center>"+
							"<table width=210 border=0 cellspacing=0 cellpadding=0>"+
							  "<tr valign=middle>"+ 
								"<td height=22 width=58><b>Name</b></td>"+
								"<td height=22 width=152>"+ 
								  "<input type=text name=name id=name size=18>"+
								"</td>"+
							  "</tr>"+
							  "<tr valign=middle>"+ 
								"<td height=22 width=58><b>Phone</b></td>"+
								"<td height=22 width=152>"+ 
								  "<input type=text name=phone id=phone size=18>"+
								"</td>"+
							  "</tr>"+
							  "<tr valign=middle>"+ 
								"<td height=22 width=58><b>Email</b></td>"+
								"<td height=22 width=152>"+ 
								  "<input type=text name=email id=email size=18 onBlur='IsValid(this);'>"+
								"</td>"+
							  "</tr>"+
							  "<tr valign=middle>"+ 
								"<td height=22 width=58><b>Mobile</b></td>"+
								"<td height=22 width=152>"+
								  "<input type=text name=mobile id=mobile size=18>"+
								"</td>"+
							  "</tr>"+
							  "<tr>"+ 
								"<td height=28 colspan=2>"+ 
								  "<div align=center><b><font color=#0066CC>Services"+ 
									"Of Interest</font></b></div>"+
								"</td>"+
							  "</tr>"+
							  "<tr>"+
								"<td height=23 colspan=2>"+ 
								  "<input type=checkbox name=imt value='International Money Transfer'>International Money Transfer</td>"+
							  "</tr>"+
							  "<tr>"+ 
								"<td height=23 colspan=2>"+ 
								  "<input type=checkbox name=fmd value='Foreign Money Drafts'>Foreign Money Drafts</td>"+
							  "</tr>"+
							  "<tr>"+ 
								"<td height=23 colspan=2>"+ 
								  "<input type=checkbox name=fc value='Foreign Currency'>Foreign Currency</td>"+
							  "</tr>"+
							  "<tr>"+ 
								"<td height=23 colspan=2>"+ 
								  "<input type=checkbox name=fa value='Foreign Accounts'>Foreign Accounts</td>"+
							  "</tr>"+
							  "<tr>"+ 
								"<td height=23 colspan=2>"+ 
								  "<input type=checkbox name=ps value='Postal Service'>"+
								  "Postal Service</td>"+
							  "</tr>"+
							  "<tr>"+ 
								"<td height=23 colspan=2>"+ 
								  "<input type=checkbox name=tpc value='Third Party Cheques'>Third Party Cheques</td>"+
							  "</tr>"+
							  "<tr>"+ 
								"<td height=23 colspan=2>"+ 
								  "<input type=checkbox name=tc value='Travellers Cheques'>Travellers Cheques</td>"+
							  "</tr>"+
							  "<tr>"+ 
								"<td height=20 width=58>&nbsp;</td>"+
								"<td height=20 width=152>&nbsp;</td>"+
							  "</tr>"+
							"</table>"+
							"<input type=submit name=submit value=Submit Call Back Request>"+
						  "</div>"+
						"</td>"+
					  "</tr>"+
					  "<tr>"+ 
						"<td bgcolor=EBEBEB height=25>&nbsp;</td>"+
					  "</tr>"+
					  "<tr>"+ 
						"<td bgcolor=#FFFFFF height=25>&nbsp;</td>"+
					  "</tr>"+
					"</table>"+
					"</form>"+
				  "</div>");
			
			function check(){
				if(document.info.name.value==''){
     			alert("Please enter first name.");
	 			document.info.name.focus();
	 			return false;
   				}
				if(document.info.phone.value==''){
     			alert("Please enter phone.");
	 			document.info.phone.focus();
	 			return false;
   				}
				if(document.info.email.value==''){
     			alert("Please enter Email.");
	 			document.info.email.focus();
	 			return false;
   				}
				if(document.info.mobile.value==''){
     			alert("Please enter Mobile.");
	 			document.info.mobile.focus();
	 			return false;
   				}
			}
			function IsValid( oField)
			{
			text = oField.value;
    		if (text!=""){
        	re = /^(([a-z\._\-0-9])+\@([a-z\._\-0-9])+\.([a-z])+)?$/i;
        	$sMsg = "E-Mail is invalid. E-Mail should be in user@domain.com format."
    		}
   			if (!re.test(oField.value)){
        	alert( $sMsg );
        	oField.value = '';
        	oField.focus();
          return false;
    }
}