document.write('<div style="float:left">');
document.write('<input type="hidden" name="react_form" value="wealth_jazz" size="40" maxlength="40" />');
document.write('YOUR NAME:<br />');
document.write('<input type="text" name="first_name" id="first_name" size="30" maxlength="150" value="" />');
document.write('<br />');
document.write('E-MAIL:<br />');
document.write('<input type="text" name="client_email" id="client_email" size="30" maxlength="150" value="" />');
document.write('<br />');
document.write('PHONE NUMBER:<br />');
document.write('<input type="text" name="phone" id="phone" size="30" maxlength="150" value="" /><br />');
document.write('<br />');
document.write('<select name="service_type" size="1">');
document.write('<option value="">-Select A Service-</option>');
document.write('<option value="WebDesign">Web Design</option>');
document.write('<option value="Games">Flash Development</option>');
document.write('<option value="Imaging">Graphic Design</option>');
document.write('</select>');
document.write('</div>');
document.write('<div style="float:right">');
document.write('DETAILS OF PROJECT:WHAT WOULD YOU LIKE DONE?<br />');
document.write('<textarea name="body_area" id="body_area" rows="5" cols="42"></textarea>');
document.write('<br /><br />');
document.write('</div>');
document.write('<div align="right" style="float:right">');
document.write('<input type="reset" name="clear_form" id="clear_form" value="CLEAR" />');
document.write('<input type="submit" name="submit" id="submit" value="SUBMIT" />');
document.write('</div>');