function Contact() {
	var dc = "dc" + Math.floor( Math.random() * 1001 );
	var na = "na" + Math.floor( Math.random() * 1001 );
	var em = "em" + Math.floor( Math.random() * 1001 );
	var ty = "ty" + Math.floor( Math.random() * 1001 );
	var ms = "ms" + Math.floor( Math.random() * 1001 );

	document.write("<form action='contact.php' method='post'><input name='"+dc+"' value='1' type='hidden'><table style='color: #050; font-size: 11px;'><tbody><tr><td style='text-align: right;' width='50%'>Name &nbsp;</td><td width='50%'>&nbsp; <input name='"+na+"' type='text'></td></tr><tr><td style='text-align: right;' width='50%'>E-mail &nbsp;</td><td width='50%'>&nbsp; <input name='"+em+"' type='text'></td></tr><tr><td style='text-align: right;' width='50%'>Subject &nbsp;</td><td width='50%'>&nbsp; <select name='"+ty+"'><option>Set an Appointment</option><option>Banner Exchange</option><option>Other</option></select></td></tr><tr><td colspan='2'>Message:<br><textarea name='"+ms+"' style='width: 450px; height: 100px; font-family: Arial,Helvetica;'></textarea></td></tr><tr><td colspan='2' style='text-align: center;'><input value=' Send ' type='submit'><br></td></tr></tbody></table></form>");
}