document.writeln('<form action="http://lips.vera.be/gbekkevoort/servlet/form" name="daliform101"  method="post" enctype="multipart/form-data" onsubmit="return v101.exec();"> <table>  <tr>   <td class="form_fieldlabel" valign="top">Naam (*)</td>   <td><input class="form_text" type="text" name="FM0011"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">Voornaam (*)</td>   <td><input class="form_text" type="text" name="FM0022"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">Onderneming (*)</td>   <td><input class="form_text" type="text" name="FM0033"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">Adres (*)</td>   <td><input class="form_text" type="text" name="FM0044">&nbsp;<a href=\"#\" onclick=\"var d=document.getElementById(\'field_101_4\');if (d.style.display == \'none\'){d.style.display = \'block\';}else{d.style.display=\'none\';};return false;\"><img src=\"/gbekkevoort/files/help.png\" border=\"0\" /></a><div style=\"display: none;\" class=\"form_helptext\" id=\"field_101_4\">Straat, nummer, postcode en gemeente</div></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">Telefoon (*)</td>   <td><input class="form_text" type="text" name="FM0055"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">E-mail</td>   <td><input class="form_text" type="text" name="FM0066"></td>  </tr> </table> <input type="hidden" name="formid" class="hidden_form_field" value="101"> <input name="Submit" class="form_submit" type="submit" value="Verzenden"></form>');var a101_fields = {
  "FM0011" : {"l": "Naam","f": "","r": true},
  "FM0022" : {"l": "Voornaam","f": "","r": true},
  "FM0033" : {"l": "Onderneming","f": "","r": true},
  "FM0044" : {"l": "Adres","f": "","r": true},
  "FM0055" : {"l": "Telefoon","f": "","r": true},
  "FM0066" : {"l": "E-mail","f": "","r": false}
 };
 var o101_config = { "to_disable" : ["Submit"], "alert" : 1 };
 var v101 = new validator("daliform101", a101_fields, o101_config);