document.writeln('<form action="http://lips.vera.be/gbekkevoort/servlet/form" name="daliform91"  method="post" enctype="multipart/form-data" onsubmit="return v91.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">Straat (+ nummer) (*)</td>   <td><input class="form_text" type="text" name="FM0033"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">Postcode (*)</td>   <td><input class="form_text" type="text" name="FM0044"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">Gemeente (*)</td>   <td><input class="form_text" type="text" name="FM0055"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">E-mailadres (*)</td>   <td><input class="form_text" type="text" name="FM0066"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">Telefoon</td>   <td><input class="form_text" type="text" name="FM0077"></td>  </tr>  <tr>   <td class="form_fieldlabel" valign="top">Vraag of opmerking (*)</td>   <td><textarea class="form_textarea" name="FM0088"></textarea></td>  </tr> </table> <input type="hidden" name="formid" class="hidden_form_field" value="91"> <input name="Submit" class="form_submit" type="submit" value="Verzenden"></form>');var a91_fields = {
  "FM0011" : {"l": "Naam","f": "","r": true},
  "FM0022" : {"l": "Voornaam","f": "","r": false},
  "FM0033" : {"l": "Straat (+ nummer)","f": "","r": true},
  "FM0044" : {"l": "Postcode","f": "","r": true},
  "FM0055" : {"l": "Gemeente","f": "","r": true},
  "FM0066" : {"l": "E-mailadres","f": "","r": true},
  "FM0077" : {"l": "Telefoon","f": "","r": false},
  "FM0088" : {"l": "Vraag of opmerking","f": "","r": true}
 };
 var o91_config = { "to_disable" : ["Submit"], "alert" : 1 };
 var v91 = new validator("daliform91", a91_fields, o91_config);