document.write("<form  method=POST action=\"http://www.maplecreekgc.com/cgi-bin/csFormbuilder/csFormbuilder.pl\" name=\"form_12\"  >\n");
document.write("<input type=hidden name=form-id value=\"12\">\n");
document.write("<input type=hidden name=command value=\"mailform\">\n");
document.write("<link rel=\"stylesheet\" type=\"text/css\" href=\"http://www.maplecreekgc.com/cgi-bin/csFormbuilder/forms/ten_dollars_off.css\">\n");
document.write("<table border=\"0\" cellspacing=\"0\" cellpadding=\"3\">\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*First & Last Name:</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"Name\"  size=\"50\"   maxlength=\"50\" ></td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 0--></td></tr>\n");
document.write("<tr><td nowrap class=\"textLabel\" align=\"left\" ></td><td align=left valign=top nowrap class=\"textLabel\"><table align=left border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\" align=\"left\">*Email Address:</td>\n");
document.write("</tr>\n");
document.write("<tr>\n");
document.write("<td nowrap class=\"textLabel\"><input onfocus=\"className='textFieldFocus'\" onblur=\"className='textField'\" class=\"textField\" type=\"text\" name=\"email\"  size=\"50\"  ></td>\n");
document.write("</tr>\n");
document.write("</table> <!-- tr ph 1--></td></tr>\n");
document.write("<tr><td colspan=2 align=\"center\"><input onmouseover=\"className='buttonfieldFocus'\" onmouseout=\"className='buttonfield'\" class=\"buttonfield\" type=submit value=\"Submit\"></td></tr>\n");
document.write("</table>\n");
document.write("</form>\n");