document.write('<div id="lavina_form_8">');
document.write('In order to subscribe to GOmotion free newsletter, please fill in the following form:');

document.write('<div class="errorExplanation" id="lavina_form_errors_8">');
document.write('</div>')

document.write('<form method="post">');

errors = false;                      


	document.write('<div>');
	document.write('<label>e-mail  *</label>');
	
		document.write('<input type="text" id="lavina_field_8_0" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Name: *</label>');
	
		document.write('<input type="text" id="lavina_field_8_1" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Surname:</label>');
	
		document.write('<input type="text" id="lavina_field_8_2" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Title:   </label>');
	
		document.write('<input type="text" id="lavina_field_8_3" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Address:  </label>');
	
		document.write('<input type="text" id="lavina_field_8_4" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label></label>');
	
		document.write('<input type="text" id="lavina_field_8_5" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Telephone No:  </label>');
	
		document.write('<input type="text" id="lavina_field_8_6" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Comapny name: </label>');
	
		document.write('<input type="text" id="lavina_field_8_7" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Country: </label>');
	
		document.write('<input type="text" id="lavina_field_8_8" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Age: </label>');
	
		document.write('<input type="text" id="lavina_field_8_9" class="text" style="width:50px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Occupation: </label>');
	
		document.write('<input type="text" id="lavina_field_8_10" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

document.write('<input type="submit" value="Send" onclick="lavina_form_submit_8();return false;"/>');
document.write('</form>');
document.write('</div>');

lavina_form_submit_8 = function() {    
	lavina_uri = ''
	for (i = 0; i < 11; i++) {
		lavina_uri += '&f['+i+']=' + unescape(document.getElementById('lavina_field_8_'+i).value);
	}
  $.getScript("http://software.alfa.javatech.com.pl/lavina/8/form.js?save=yes"+lavina_uri, function(){  
	if (errors == 0) document.getElementById("lavina_form_8").innerHTML = lavina_form_html_8;
	else document.getElementById("lavina_form_errors_8").innerHTML = lavina_form_html_8
  });
};