// <!---------------  Home Information ---------------->
document.write("    <tr>");
document.write("	 <td width='100%' colspan='8' class='tbHeader'>");
document.write("	   Home Information");
document.write("	 </td>");
document.write("    </tr>");
//        <!-- data here -->
//	<!-- Explanation field -->
//	 <!-- Construction field -->
document.write("     <tr>");   
document.write("       <td colspan='2'>Construction Style</td>");
document.write("       <td>");
document.write("	    <select name='ddstyle' value='1 story'>");
document.write("		<option value='onestory'>1 Story");
document.write("		<option value='twostory'>2 Story");
document.write("		<option value='split'>Split level");
document.write("	    </select>");
document.write("       </td><td>&nbsp;</td>");
//       
document.write("        <td>Dwelling Type</td>");
document.write("        <td>");
document.write("	    <select name='dddwelltype' value='Single Family'>");
document.write("		<option value='singlefamily'>Single Family");
document.write("		<option value='duplex'>Duplex");
document.write("		<option value='triplex'>Triplex");
document.write("		<option value='other'>Other");
document.write("	    </select>");
document.write("       </td>");
document.write("      </tr>");
//	 <!-- Construction Yearfield -->
document.write("     <tr>");
document.write("       <td colspan='2'>Construction Year</td>");
document.write("       <td><input type='text' name='txtconstyear' VALUE size='4'></td>");
document.write("       <td>&nbsp;</td>");
//       
document.write("        <td>Square footage</td>");
document.write("        <td><input type='text' name='txtconstfootage' VALUE size='10'></td>");
//
document.write("      </tr>");
//
document.write("     <tr>");
document.write("        <td colspan='2'>Basement</td>");
document.write("        <td>");
document.write("	    <select name='ddbasement' value='Yes'>");
document.write("		<option value='yesbase'>Yes");
document.write("		<option value='nobase'>No");
document.write("	    </select>");
document.write("	</td><td>&nbsp;</td>");
//       <!-- If yes, basement square footage field -->
document.write("       <td>If yes, basement square footage</td>");
document.write("       <td><input type='text' name='txtbasefootage' VALUE size='10'></td>");
//       
document.write("      <tr><td>Percent of Basement Finished</td>");
document.write("        <td><td><input type='text' name='txtpercentbasefinish' VALUE size='10'></td>");
document.write("      </tr>");
//
document.write("	<tr>");
//
document.write("	</tr");
//
document.write("     <tr>");
//       <!-- Garage Type field -->
document.write("       <td colspan='2'>Garage Type</td>");
document.write("       <td>");
document.write("	    <select name='ddgaragetype' value='None'>");
document.write("		<option value='None'>None");
document.write("		<option value='onecar'>1-Car");
document.write("		<option value='twocar'>2-Car");
document.write("		<option value='threecar'>3-Car");
document.write("		<option value='fourcar'>4-Car");
document.write("	    </select>");
document.write("       </td><td>&nbsp;</td>");
//       
document.write("        <td>Garage construction</td>");
document.write("        <td>");
document.write("	    <select name='ddgarageconst' value='N/A'>");
document.write("		<option value='na'>N/A");
document.write("		<option value='attached'>Attached");
document.write("		<option value='detached'>Detached");
document.write("	    </select>");
document.write("       </td>");
//
//
document.write("     <tr>");
//       <!-- Age of roof field -->
document.write("       <td colspan='2'>Age of roof</td>");
document.write("       <td><input type='text' name='txtageroof' VALUE size='10'></td>");
document.write("       <td>&nbsp;</td>");
//
document.write("        <td>Roof material</td>");
document.write("        <td>");
document.write("	    <select name='ddroofmaterial' value='Asphalt Shingle'>");
document.write("		<option value='asphalt'>Asphalt Shingle");
document.write("		<option value='wood'>Wood Shingle/Shake");
document.write("		<option value='spanish'>Spanish Tile");
document.write("		<option value='rock'>Rock");
document.write("		<option value='synthetic'>Synthetic");
document.write("		<option value='concrete'>Concrete");
document.write("	    </select>");
document.write("	</td>");
//       
//       <!-- Central A/C field -->
//
document.write("     <tr>");
document.write("       <td colspan='2'>Central A/C</td>");
document.write("       <td>");
document.write("	   <select name='ddcentralac' value='Yes'>");
document.write("		<option value='yesac'>Yes");
document.write("		<option value='noac'>No");
document.write("	   </select>");
document.write("       </td>");
document.write("       <td>&nbsp;</td>");
//
//

document.write("     <tr>");
//
document.write("       <tr>");
document.write("        <td colspan='2'># of Full Bathrooms</td>");
document.write("        <td>");
document.write("        <select name='ddfullbath' value='1'>");
document.write("        <option value='1fullbath'>1");
document.write("        <option value='2fullbath'>2");
document.write("        <option value='3fullbath'>3");
document.write("        <option value='4fullbath'>4");
document.write("        <option value='more4fullbath'>&gt;4");
document.write("        </select>");
document.write("        </td><td>&nbsp;</td>");
//
document.write("        <td colspan='2'># of Half Bathrooms");
document.write("        <input type='text' name='txthalfbaths' VALUE size='10'></td>");
//
//
document.write("     <tr>");
document.write("      <td># of Fireplaces</td>");
document.write("       <td><td>");
document.write("       <select name='ddfireplace' value='0'>");
document.write("       <option value='nofireplace'>0");
document.write("       <option value='1fireplace'>1");
document.write("       <option value='2fireplace'>2");
document.write("       <option value='3fireplace'>3");
document.write("       <option value='more3fireplace'>&gt;3");
document.write("       </td>");
//       <!-- Requested dwelling coverage field -->
document.write("       <td><td>Dwelling Market value</td>");
document.write("       <td><input type='text' name='txtmarketvalue' VALUE size='10'></td>");
document.write("      </tr>");
//
document.write("    <tr>");
//
document.write("       <td>Liability</td>");
document.write("       <td><td>");
document.write("	   <select name='ddliability' value='$100K'>");
document.write("		<option value='100k'>$100K");
document.write("		<option value='300k'>$300K");
document.write("		<option value='500k'>$500K");
document.write("		<option value='onemillion'>$1Million");
document.write("	   </select>");
document.write("       </td>");
//
document.write("	<td>&nbsp;</td>");
//
document.write("	<td>Occupancy</td>");
document.write("	<td>");
document.write("	<select name='ddoccupancy' value='Owner occupied'>");
document.write("		<option value='occupancyowner'>Owner Occupied");
document.write("		<option value='occupancynonowner'>Non-Owner Occupied");
document.write("		<option value='occupancyrenter'>Renter");
document.write("		<option value='occupancyseason'>Seasonal");
document.write("		<option value='occupancyseasonliab'>Seasonal w/ liability");
document.write("		<option value='occupancysecondary'>Secondary");
document.write("		<option value='occupancyvacancy'>Vacant");
document.write("	</select>");
document.write("	</td>");
//
document.write("	</tr>");
//
document.write("	<tr>");
//
document.write("	<td colspan='2'>Construction Type</td>");
document.write("	<td>");
document.write("	<select name='ddconsttype' value='Alum/vinyl Over Frame'>");
document.write("		<option value='consttypealum'>Alum/vinyl Over Frame");
document.write("		<option value='consttypeasbestos'>Asbestos Siding");
document.write("		<option value='consttypecomproll'>Comp Roll Siding");
document.write("		<option value='consttypeadobe'>Adobe");
document.write("		<option value='consttypewood'>Wood Siding Over Frame");
document.write("		<option value='consttypeframe0-33'>Frame w/ 0%-33% Masonry Vaneer");
document.write("		<option value='consttypeframe34-66'>Frame w/ 34%-66% Masonry Vaneer");
document.write("		<option value='consttypeframe67-100'>Frame w/ 67%-100% Masonry Vaneer");
document.write("		<option value='consttypelogfinish'>Log Home w/ Finished Interior");
document.write("		<option value='consttypelog'>Log Home");
document.write("		<option value='consttypesolid'>Solid Masonry");
document.write("	</select>");
document.write("	</td>");
//
document.write("	<td>&nbsp;</td>");
//
document.write("	<td>Fire or Burglar Alarm?</td>");
document.write("	<td>");
document.write("	<select name='ddalarms' value='None'>");
document.write("		<option value='noalarm'>None");
document.write("		<option value='alarmfire'>Fire Only");
document.write("		<option value='alarmburglar'>Burglar Only");
document.write("		<option value='alarmfireburglar'>Both Fire AND Burglar");
document.write("	</select>");
document.write("	</td>");
//
document.write("     </tr>");
//
document.write("     <tr>");
// 	<!-- Please list any additional coverage -->
document.write("        <td colspan='2'>Please list any additional coverage</td>");
document.write("        <td colspan='6'><textarea name='txtaddcoverage' cols='60' rows='5'></textarea></td>");
document.write("     </tr>");