var output = ""
 output += "<form action='http://members.freewebz.com/formMail.jsp' method='post'>"
 output += "<input name='userid' value='6006990' type='hidden'>"
 output += "<input name='next' value='http://www.jacksonville-illinois.us/thank-you.html' type='hidden'>"
 output += "<input name='page' value='"
 output += document.title
 output += "' type='hidden'>"
 output += "<textarea name='Comments' maxlength='1000' rows='4' cols='50' align='top'>"
 output += " Have a comment about this place?  Add it right here, then press the button below..."
 output += "</textarea>"
 output += "<br>"
 output += "<input name='Submit' value='Share your comments' type='submit'>"
 output += "</form>"
 output += "<hr style='width: 90%; height: 1px;'>"
 output += "<b>"
 output += "Some of your comments may be displayed below:"
 output += "</b>"
document.write(output)