document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub12.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=985477274&formid=3817&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:985477274:12:3817\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Contact Bennecelli (Jim Bennett)</div></div> <div class=\"bn-form-desc\"><p>I appreciate your interest and look forward to hearing from you.</p></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Your Name <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"Your first and last name.\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">City/Country </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-162863048993656\" placeholder=\"Please enter the city and country where you reside\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Email Address <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"Please enter a valid email address so I may reply.\" validator=\"email\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Enter Your Message </span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"Enter your message here.\" validator=\"\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"Thank you. I will reply as soon as possible.\"> <input type=\"hidden\" name=\"subject\" value=\"Bennecelli Contact Form\"><div class=\"bn-form-submit\"><button type=\"submit\" class=\"formbtn\">SEND</button></div> <style type=\"text/css\">.bnet-form ::-webkit-input-placeholder {');
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