document.write('<form id=\"signupForm2572\" action=\"https://www.intouchcrm.co.uk/app/api/dc/default.aspx?s=4420C2FA-8F2E-4847-94D3-74266DD86759\" method=\"post\" onsubmit=\"return validateSignUpForm2572();\">\r\n<table>\r\n\t<tr><td><label for=\"EmailAddress\">Email Address *</label></td><td><input name=\"EmailAddress\" type=\"text\" maxlength=\"250\" /></td></tr>\r\n\t<tr><td><label for=\"Firstname\">Name *</label></td><td><input name=\"Firstname\" type=\"text\" maxlength=\"250\" /></td></tr>\r\n\t<tr><td><label for=\"Mobile\">Mobile</label></td><td><input name=\"Mobile\" type=\"text\" maxlength=\"250\" /></td></tr>\r\n\t<tr><td><label for=\"CompanyName\">Company Name</label></td><td><input name=\"CompanyName\" type=\"text\" maxlength=\"1000\" /></td></tr>\r\n\t<tr><td><label for=\"CommsEMail\">Send Me The Newsletter</label></td><td><input name=\"CommsEMail\" type=\"checkbox\" /></td></tr>\r\n<span style=\"display:none;\"><input type=\"input\" id=\"trap\">&nbsp; Leave me blank</span>\r\n\t<tr><td></td><td>* = Required Field</td></tr></table>\r\n<input type=\"reset\" value=\"Clear\">&nbsp;\r\n<input type=\"submit\" value=\"Subscribe\" />\r\n</form>\r\n<script type=\"text/javascript\">\r\n\r\nvar signupForm2572 = document.getElementById(\'signupForm2572\');\r\nvar reg = /^([A-Za-z0-9_\\-\\.])+\\@([A-Za-z0-9_\\-\\.])+\\.([A-Za-z]{2,4})$/;\r\n\r\nfunction validateSignUpForm2572() {\r\nif (signupForm2572[\'EmailAddress\'].value == \'\') { alert(\'Email Address is required.\'); signupForm2572[\'EmailAddress\'].focus(); return false; }\r\nif(reg.test(signupForm2572[\'EmailAddress\'].value) == false) { alert(\'Invalid Email Address format.\'); return false; }if (signupForm2572[\'Firstname\'].value == \'\') { alert(\'Name is required.\'); signupForm2572[\'Firstname\'].focus(); return false; }\r\nif (signupForm2572[\'trap\'].value != \'\') { return false; }\r\nreturn true;\r\n}\r\n</script>\r\n');