document.write("LI Cosmetic Dentistry Consult Request\n"); document.write("\n"); document.write("function TAMax( ta, countspan, maxlength ) {\n"); document.write(" if (ta.value.length > maxlength){\n"); document.write(" ta.value = ta.value.substring( 0, maxlength );\n"); document.write(" ta.blur();\n"); document.write(" ta.focus();\n"); document.write(" return false;\n"); document.write(" }\n"); document.write(" else {\n"); document.write(" countspan.innerHTML = maxlength - ta.value.length;\n"); document.write(" }\n"); document.write("}\n"); document.write("\n"); document.write("
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*First Name:
*Last Name:
Address:
City: State:
*Zip:
*Email:
*Telephone #1:\n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write("
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Telephone #2:\n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write(" \n"); document.write("
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Contact Method:  
Services Needed:  
Explanation:
900 characters remaining.
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