\n");
document.write(" | First Name: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Last Name: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Company: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Address 1: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Address 2: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | City: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | State/Province: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Zip Code: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Country: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Web Site: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Email Address: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Verify Email: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Home Phone: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Business Phone: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Fax: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Toll Free Number: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | What Year Was Your Business Started: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" How many employees did you have when you started, please explain: | \n");
document.write(" | \n");
document.write("
\n");
document.write("| \n");
document.write("Was this a home based business to start: | \n");
document.write("\n");
document.write("Yes \n");
document.write("No \n");
document.write(" |
\n");
document.write(" | What really made you fee that success was yours to be had: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | What separates you from your competition: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" What are you hours Please list something like M-F 8:00am - 5:00pm EST: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | What is your main product line: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | What is your contact information: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Any special offers or deals currently offered: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" Please list links to particular images or logos you would like have used in your article: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" Send your $300 payment via paypal to chris@sellersdock.com\n");
document.write("or\n");
document.write(" Send your check or money order for $300 to TodaysSmallBiz.com\n");
document.write(" 6771 Forest Hill Lane\n");
document.write(" Hamilton OH 45011\n");
document.write("\n");
document.write("Please allow 10 business days for your article to be created.\n");
document.write(" For Front Page and Main Category Feature please add $75.00. \n");
document.write(" Please allow 24-hours for your placement. Visit http://www.todayssmallbiz.com \n");
document.write(" |
\n");
document.write("\n");
document.write(" | Special Code: | \n");
document.write(" | \n");
document.write("
\n");
document.write(" | Contact Required: | \n");
document.write(" Yes No | \n");
document.write("
\n");
document.write("