document.write("\
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			<div id=\"mailSpicerHaartForPropertyForm\"> \
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<div class=\"MailForm_Formatting\" onclick=\"initValidation_spicer();\">\
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		<p class=\"small\">The information you provide in this form is forwarded to the agent and not sent to any other organisation.</p>\
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	\
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		<form name=\"contactagentform\" action=\"/uk-property-to-rent/mailBranch/\" id=\"contactagentform_spicer\" onsubmit=\"return contactAgent(this,contactGateway);\" class=\"form_form_page\">\
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			<input name=\"panelId\" value=\"\" type=\"hidden\" />\
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			<input name=\"resultId\" value=\"\" type=\"hidden\" />\
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			<input name=\"formId\" value=\"\" type=\"hidden\" />\
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	\
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		<input name=\"formType\" value=\"spicerHaart\" type=\"hidden\" />\
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		<input name=\"formContactAgentSource\" value=\"uk-property-to-rent.details\" type=\"hidden\" />\
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		<input name=\"referenceID\" value=\"\" type=\"hidden\" />\
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		<input name=\"agentCode\" value=\"\" type=\"hidden\" />\
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		\
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			<input name=\"formContactAgentType\" value=\"\" type=\"hidden\" />\
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		\
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		<p><strong>Required information marked with an *</strong></p>\
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<div class=\"full_width\">\
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		<span id=\"spryselect_senderTitle_spicer\">\
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			<label class=\"leftlabel\" for=\"senderTitle_spicer\">\
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				title *\
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				<span class=\"selectRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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			</label>\
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			<select name=\"senderTitle\" id=\"senderTitle_spicer\">\
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				<option value=\"\">Select...</option>\
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				<option value=\"Mr\">Mr</option> <option value=\"Mrs\">Mrs</option> <option value=\"Ms\">Ms</option> <option value=\"Miss\">Miss</option> <option value=\"Dr\">Dr</option> \
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			</select>\
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		</span>\
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</div>\
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<div class=\"full_width\">\
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        <span id=\"sprytextfield_senderFirstname_spicer\">\
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            <label class=\"leftlabel\" for=\"senderFirstname_spicer\">\
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            first name *\
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            <span class=\"textfieldRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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            </label>\
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        <input name=\"senderFirstname\" id=\"senderFirstname_spicer\" value=\"\" type=\"text\" maxlength=\"49\"  class=\"leftinputs_text\"class=\"leftinputs_text\"/>\
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        </span>\
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</div>\
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<div class=\"full_width\">\
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		<span id=\"sprytextfield_senderLastname_spicer\">\
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	 		<label class=\"leftlabel\" for=\"senderLastname_spicer\">\
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		 		last name *\
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				<span class=\"textfieldRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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		 	</label>\
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			<input name=\"senderLastname\" id=\"senderLastname_spicer\" value=\"\" type=\"text\" maxlength=\"49\"  class=\"leftinputs_text\"/>\
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		</span>\
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</div>\
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<div class=\"full_width\">\
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		<span id=\"sprytextfield_senderEmail_spicer\">\
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			<label class=\"leftlabel\" for=\"senderEmail_spicer\">\
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				email *\
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				<span class=\"textfieldInvalidFormatMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> invalid email</span>\
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				<span class=\"textfieldRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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			</label>\
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			<input name=\"senderEmail\" id=\"senderEmail_spicer\" value=\"\" type=\"text\" maxlength=\"49\"  class=\"leftinputs_text\"/>\
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		</span>\
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</div>\
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<div class=\"full_width\">\
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		<strong>address</strong>\
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		<br />\
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</div>\
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<div class=\"full_width\">\
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		<span id=\"sprytextfield_senderAddressHouseNumber_spicer\">\
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			<label class=\"leftlabel\" for=\"senderAddressHouseNumber_spicer\">\
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				house name/number *\
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				<span class=\"textfieldRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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			</label>\
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			<input name=\"senderAddressHouseNumber\" id=\"senderAddressHouseNumber_spicer\" value=\"\" type=\"text\" maxlength=\"49\"  class=\"leftinputs_text\"/>\
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		</span>\
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</div>\
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<div class=\"full_width\">\
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		<span id=\"sprytextfield_senderAddressStreet_spicer\">\
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			<label class=\"leftlabel\" for=\"senderAddressStreet_spicer\">\
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				street *\
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				<span class=\"textfieldRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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			</label>\
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			<input name=\"senderAddressStreet\" id=\"senderAddressStreet_spicer\" value=\"\" type=\"text\" maxlength=\"49\"  class=\"leftinputs_text\"/>\
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		</span>\
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</div>\
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<div class=\"full_width\">	\
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		<label class=\"leftlabel\" for=\"senderAddressLocality_spicer\">locality</label>\
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		<input name=\"senderAddressLocality\" id=\"senderAddressLocality_spicer\" value=\"\" type=\"text\" maxlength=\"49\" class=\"leftinputs_text\"/>\
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</div>\
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<div class=\"full_width\">	\
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		<span id=\"sprytextfield_senderAddressTown_spicer\">\
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			<label class=\"leftlabel\" for=\"senderAddressTown_spicer\">\
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				town *\
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				<span class=\"textfieldRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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			</label>\
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			<input name=\"senderAddressTown\" id=\"senderAddressTown_spicer\" value=\"\" type=\"text\" maxlength=\"49\"  class=\"leftinputs_text\"/>\
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		</span>\
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</div>\
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<div class=\"full_width\">	\
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    <label class=\"leftlabel\" for=\"senderAddressCounty_spicer\">county</label>\
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    <input name=\"senderAddressCounty\" id=\"senderAddressCounty_spicer\" value=\"\" type=\"text\" maxlength=\"49\" class=\"leftinputs_text\"/>\
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</div>\
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<div class=\"full_width\">\
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    <span id=\"sprytextfield_senderAddressPostCode_spicer\">\
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    <label class=\"leftlabel\" for=\"senderAddressPostCode_spicer\">postcode *\
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    <span class=\"textfieldRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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    </label>\
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    <input name=\"senderAddressPostCode\" id=\"senderAddressPostCode_spicer\" value=\"\" type=\"text\" maxlength=\"49\"  class=\"leftinputs_text\"/>\
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    </span>\
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</div>\
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<div class=\"full_width\">	\
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<span id=\"sprytextfield_senderTelephoneNumber_spicer\">\
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        <label class=\"leftlabel\" for=\"senderTelephoneNumber_spicer\">telephone number *\
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        <span class=\"textfieldRequiredMsg\"><img src=\"/images/SHimg/sitewide/icons/form_alerts/alert_error.gif\" alt=\"required\" /> required</span>\
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        </label>\
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        <input name=\"senderTelephoneNumber\" id=\"senderTelephoneNumber_spicer\" value=\"\" type=\"text\" maxlength=\"49\"  class=\"leftinputs_text\"/>\
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        </span>\
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</div>\
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        \
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<div class=\"full_width\">\
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    <label for=\"senderValuationRequested_spicer\" class=\"leftlabel_checkbox\">would you like your property valued ?</label>\
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        <input  name=\"senderValuationRequested\"  \
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                id=\"senderValuationRequested_spicer\" \
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                type=\"checkbox\" value=\"1\"  \
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                class=\"leftinputs_checkbox\"/>\
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</div>\
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        \
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<div class=\"full_width\">\
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        <label for=\"senderFSRequested_spicer\" class=\"leftlabel_checkbox\">do you require mortgage advice ?</label>    \
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        <input 	name=\"senderFSRequested\" \
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        id=\"senderFSRequested_spicer\" \
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        type=\"checkbox\" value=\"1\"  \
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        class=\"leftinputs_checkbox\" />\
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</div>\
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		\
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<div class=\"full_width\">\
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        <label for=\"senderPropToSell_spicer\" class=\"leftlabel_checkbox\">do you have a property to sell ?</label>\
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        <input name=\"senderPropToSell\"  id=\"senderPropToSell_spicer\" type=\"checkbox\" value=\"1\"  /class=\"leftinputs_checkbox\">\
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</div>\
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    \
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<div class=\"full_width\">\
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        <label for=\"senderFTB_spicer\" class=\"leftlabel_checkbox\">are you a first time buyer ?</label>\
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        <input  name=\"senderFTB\" id=\"senderFTB_spicer\" type=\"checkbox\" value=\"1\"   class=\"leftinputs_checkbox\"/>\
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</div>\
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        \
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<div class=\"full_width\">\
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        <span id=\"sprytextarea_senderMessage_spicer\">\
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        <label class=\"leftlabel\" for=\"senderMessage_spicer\">\
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        <strong>message</strong>\
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        <br />\
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        </label>\
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        <textarea name=\"senderMessage\" id=\"senderMessage_spicer\" rows=\"4\"></textarea>\
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        </span>\
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</div>\
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        \
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		\
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            \
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            <div class=\"full_width\">\
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			<input type=\"hidden\" id=\"p_reg_spicer\" name=\"p_reg\" value=\"\"/>\
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			<label for=\"show_reg_spicer\" class=\"leftlabel_checkbox\">\
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			Register with Primelocation.com to have your contact information prefilled next time you contact an agent?\
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			</label>\
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			<input type=\"checkbox\" id=\"show_reg_spicer\" name=\"show_reg\" value=\"true\" checked=\"checked\" class=\"leftinputs_checkbox\"/>\
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			</div>\
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		\
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         <div class=\"full_width\">\
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		<input type=\"submit\" name=\"send\" value=\"send\" class=\"formbutton\" />\
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      	</div>			\
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	</form>\
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</div>\
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</div>\
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		");


function initValidation_spicer(){
	if(typeof validation_spicer=="undefined"){
		var spryselect_senderTitle_spicer = new Spry.Widget.ValidationSelect("spryselect_senderTitle_spicer",{validateOn:["blur"],invalidValue:""});
		var sprytextfield_senderFirstname_spicer = new Spry.Widget.ValidationTextField("sprytextfield_senderFirstname_spicer", "none", {validateOn:["blur"]});
		var sprytextfield_senderLastname_spicer = new Spry.Widget.ValidationTextField("sprytextfield_senderLastname_spicer", "none", {validateOn:["blur"]});
		var sprytextfield_senderEmail_spicer = new Spry.Widget.ValidationTextField("sprytextfield_senderEmail_spicer", "email", {validateOn:["blur"]});
		var sprytextfield_senderAddressHouseNumber_spicer = new Spry.Widget.ValidationTextField("sprytextfield_senderAddressHouseNumber_spicer", "none", {validateOn:["blur"]});
		var sprytextfield_senderAddressStreet_spicer = new Spry.Widget.ValidationTextField("sprytextfield_senderAddressStreet_spicer", "none", {validateOn:["blur"]});
		var sprytextfield_senderAddressTown_spicer = new Spry.Widget.ValidationTextField("sprytextfield_senderAddressTown_spicer", "none", {validateOn:["blur"]});
		var sprytextfield_senderAddressPostCode_spicer = new Spry.Widget.ValidationTextField("sprytextfield_senderAddressPostCode_spicer", "none", {validateOn:["blur"]});
		var sprytextfield_senderTelephoneNumber_spicer = new Spry.Widget.ValidationTextField("sprytextfield_senderTelephoneNumber_spicer", "none", {validateOn:["blur"]});
		var sprytextarea_senderMessage_spicer = new Spry.Widget.ValidationTextarea("sprytextarea_senderMessage_spicer",{validateOn:["blur"],isRequired:false,maxChars:2000});
	}
	validation_spicer = true;
}