document.write("<form method=\"get\" action=\"/quote.html\" id=\"gtlform\" onsubmit=\"return checkMini()\"><div class=\"mini-one\"><h3>1. Type of loan</h3><table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" id=\"radios\"><tr><td><input type=\"radio\" name=\"service\" value=\"REFI\" checked=\"checked\" /></td><td>Mortgage Refinance</td></tr><tr><td><input type=\"radio\" name=\"service\" value=\"DEBTCON\" /></td><td>Debt Consolidation</td></tr><tr><td><input type=\"radio\" name=\"service\" value=\"HOMEEQ\" /></td><td>Home Equity Loan or Line</td></tr><tr><td><input type=\"radio\" name=\"service\" value=\"NEWHOME\" /></td><td>New Home Loan</td></tr></table><h3>2. State</h3><select name=\"propertyStateCode\" size=\"1\"><option value=\"\">-- Select One --</option><option value=\"AL\">Alabama</option><option value=\"AK\">Alaska</option><option value=\"AZ\">Arizona</option><option value=\"AR\">Arkansas</option><option value=\"CA\">California</option><option value=\"CO\">Colorado</option><option value=\"CT\">Connecticut</option><option value=\"DE\">Delaware</option><option value=\"DC\">District of Columbia</option><option value=\"FL\">Florida</option><option value=\"GA\">Georgia</option><option value=\"HI\">Hawaii</option><option value=\"ID\">Idaho</option><option value=\"IL\">Illinois</option><option value=\"IN\">Indiana</option><option value=\"IA\">Iowa</option><option value=\"KS\">Kansas</option><option value=\"KY\">Kentucky</option><option value=\"LA\">Louisiana</option><option value=\"ME\">Maine</option><option value=\"MD\">Maryland</option><option value=\"MA\">Massachusetts</option><option value=\"MI\">Michigan</option><option value=\"MN\">Minnesota</option><option value=\"MS\">Mississippi</option><option value=\"MO\">Missouri</option><option value=\"MT\">Montana</option><option value=\"NE\">Nebraska</option><option value=\"NV\">Nevada</option><option value=\"NH\">New Hampshire</option><option value=\"NJ\">New Jersey</option><option value=\"NM\">New Mexico</option><option value=\"NY\">New York</option><option value=\"NC\">North Carolina</option><option value=\"ND\">North Dakota</option><option value=\"OH\">Ohio</option><option value=\"OK\">Oklahoma</option><option value=\"OR\">Oregon</option><option value=\"PA\">Pennsylvania</option><option value=\"RI\">Rhode Island</option><option value=\"SC\">South Carolina</option><option value=\"SD\">South Dakota</option><option value=\"TN\">Tennessee</option><option value=\"TX\">Texas</option><option value=\"UT\">Utah</option><option value=\"VT\">Vermont</option><option value=\"VA\">Virginia</option><option value=\"WA\">Washington</option><option value=\"WV\">West Virginia</option><option value=\"WI\">Wisconsin</option><option value=\"WY\">Wyoming</option></select></div><div class=\"mini-two\"><h3>3. Property type</h3>    <select name=\"propertyDesc\" size=\"1\"><option value=\"\">-- Select One --</option><option value=\"0\" selected=\"selected\">Single family residence</option><option value=\"1\">Multi-family residence</option><option value=\"2\">Condominium</option><option value=\"3\">Mobile home</option><option value=\"4\">Manufactured home</option></select><h3>4. What is your<br />&nbsp;&nbsp;&nbsp;&nbsp;credit rating?</h3><select name=\"credit_rating\"><option value=\"0\">Excellent</option><option selected=\"selected\" value=\"1\">Good</option><option value=\"2\">Fair</option><option value=\"3\">Poor</option></select><br /><br /><input type=\"image\" src=\"/images/btn-continue.gif\"></div></form>");