document.write('<div class="step_number">');
document.write('<img src="/img/lightbox-step-2.gif" width="34" height="34" />');
document.write('</div>');
document.write('<div class="step_text" style="color:#2b2b2b;">');
document.write('<div class="step_title">');
document.write('<b>Final Step:</b>');
document.write('</div>');
document.write('<div class="step_description">');
document.write('<b>Complete the last fields to request your free quotes</b>');
document.write('</div>');
document.write('</div>');

document.write('<div class="clear_both"></div>');

document.write('<div class="field_name">');
document.write('Full Name:');
document.write('</div>');
document.write('<div class="field_input">');
document.write('<input type="text" name="name" class="lit_input" style="width:200px;height:25px;">');
document.write('</div>');

document.write('<div class="field_name">');
document.write('Valid E-mail:');
document.write('</div>');
document.write('<div class="field_input">');
document.write('<input type="text" name="email" class="lit_input" style="width:200px;height:25px;">');
document.write('</div>');

document.write('<div class="field_name">');
document.write('Valid Phone:');
document.write('</div>');
document.write('<div class="field_input">');
document.write('(<input type="text" onkeyup="moveOnMax(this,\'xxx\')" maxlength="3" name="area_code" size="3" class="lit_input" style="text-align:center; width:34px;height:25px;">)');
document.write('<input type="text" onkeyup="moveOnMax(this,\'xxxx\')" maxlength="3" name="xxx" id="xxx" size="3" class="lit_input" style="text-align:center;width:34px;height:25px; ">-');
document.write('<input type="text" onkeyup="moveOnMax(this,\'ext\')" maxlength="4" name="xxxx" id="xxxx" size="4" class="lit_input"  style="text-align:center; width:44px;height:25px;">');
document.write('EXT <input type="text" name="ext" id="ext" size="2" class="lit_input" style="text-align:center; width:24px;height:25px;">');
document.write('</div>');

document.write('<div class="field_name">');
document.write('2nd Phone:');
document.write('</div>');
document.write('<div class="field_input">');
document.write('(<input type="text" onkeyup="moveOnMax(this,\'xxx_2\')" maxlength="3" name="area_code_2" size="3" class="lit_input" style="text-align:center; width:34px;height:25px;">)');
document.write('<input type="text" onkeyup="moveOnMax(this,\'xxxx_2\')" maxlength="3" name="xxx_2" id="xxx_2" size="3" class="lit_input"  style="text-align:center; width:34px;height:25px; ">-');
document.write('<input type="text" maxlength="4" name="xxxx_2" id="xxxx_2" size="4" class="lit_input" style="text-align:center; width:44px;height:25px;">');
document.write('</div>');

document.write('<div class="field_name">');
document.write('Move Date:');
document.write('</div>');
document.write('<div class="field_input">');
document.write('<input onfocus="show_calendar()" type="text" value="" name="month" maxlength="2" size="3" class="lit_input"  style="text-align:center; width:30px;height:25px;"> / ');
document.write('<input onfocus="show_calendar()" type="text" value="" name="day" maxlength="2" size="3" class="lit_input" style="text-align:center; width:30px;height:25px;"> / ');
document.write('<input onfocus="show_calendar()" type="text" value="" name="year" maxlength="4" size="4" class="lit_input" style="text-align:center;width:60px;height:25px; ">');
document.write('&nbsp;&nbsp;<img src="/img/calendar_icon.gif" onclick="show_calendar()" id="calendar_icon" style="cursor:pointer;">');
document.write('</div>');

document.write('<div class="field_name">');
document.write('Rooms:');
document.write('</div>');
document.write('<div class="field_input">');
document.write('<select class="lit_input" name="number_of_rooms">');
document.write('<option value="">Number of Rooms</option>');
document.write('<option value="Studio">Studio</option>');
document.write('<option value="One bedroom">One bedroom</option>');
document.write('<option value="Two bedrooms">Two bedrooms</option>');
document.write('<option value="Three bedrooms">Three bedrooms</option>');
document.write('<option value="Four bedrooms">Four bedrooms</option>');
document.write('<option value="Five bedrooms">Five bedrooms</option>');
document.write('<option value="Six bedrooms and more">Six bedrooms and more</option>');
document.write('</select>');
document.write('</div>');

document.write('<div class="clear_both">');
document.write('</div>');

document.write('<div class="lit_submit_button">');
document.write('<input type="submit" name="submit_quote" value="" class="lit_submit_request">');
document.write('</div>');