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://pub19.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=1571961379&formid=3895&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:1571961379:19:3895\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Please tell us the name of the film you are ordering:</div></div> <div class=\"bn-form-desc\"><p>Please fill out the fields below.</p></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Name <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"your name\" validator=\"\" required=\"required\" 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=\"you must enter a valid email address\" validator=\"email\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Film Title <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"enter your film title here\" validator=\"\" required=\"required\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"paypal@vicpine.co.uk\"> <input type=\"hidden\" name=\"thankyou\" value=\"https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&amp;hosted_button_id=E7TCX4NCEEV6C\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"\"> <input type=\"hidden\" name=\"subject\" value=\"PayPal Order Information\"><div class=\"bn-form-submit\"><button type=\"submit\" class=\"formbtn\">Submit Form</button></div> <style type=\"text/css\">.bnet-form ::-webkit-input-placeholder {');
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