document.write('<div id="lavina_form_14">');
document.write('');

document.write('<div class="errorExplanation" id="lavina_form_errors_14">');
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_14_0" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Anrede: *</label>');
	
	  
	  document.write('<select id="lavina_field_14_1" class="text" style="width:100px;" ><option selected="selected" value=""></option><option value="Herr">Herr</option><option value="Frau">Frau</option></select>');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Vorname: *</label>');
	
		document.write('<input type="text" id="lavina_field_14_2" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Nachname *</label>');
	
		document.write('<input type="text" id="lavina_field_14_3" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Straße</label>');
	
		document.write('<input type="text" id="lavina_field_14_4" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>PLZ:</label>');
	
		document.write('<input type="text" id="lavina_field_14_5" class="text" style="width:50px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Ort:</label>');
	
		document.write('<input type="text" id="lavina_field_14_6" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Land</label>');
	
		document.write('<input type="text" id="lavina_field_14_7" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Telefon:</label>');
	
		document.write('<input type="text" id="lavina_field_14_8" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Fax:</label>');
	
		document.write('<input type="text" id="lavina_field_14_9" class="text" style="width:300px;" />');
	
	document.write('</div>');
	

	document.write('<div>');
	document.write('<label>Kommentar: *</label>');
	
  	document.write('<textarea id="lavina_field_14_10" class="text" style="width:300px;height:250px;" ></textarea>');
	
	document.write('</div>');
	

document.write('<input type="submit" value="Senden" onclick="lavina_form_submit_14();return false;"/>');
document.write('</form>');
document.write('</div>');

lavina_form_submit_14 = function() {    
	lavina_uri = ''
	for (i = 0; i < 11; i++) {
		lavina_uri += '&f['+i+']=' + unescape(document.getElementById('lavina_field_14_'+i).value);
	}
  $.getScript("http://software.alfa.javatech.com.pl/lavina/14/form.js?save=yes"+lavina_uri, function(){  
	if (errors == 0) document.getElementById("lavina_form_14").innerHTML = lavina_form_html_14;
	else document.getElementById("lavina_form_errors_14").innerHTML = lavina_form_html_14
  });
};