document.write('<form method="post" name="miniform1" action="/results/students" onSubmit="f1_validate();">');
document.write('<table id="smallquote" border="0" cellpadding="0" cellspacing="0" width="100%" height="280">');
document.write('	<tbody>');
document.write('	          <tr> ');
document.write('	            <td  height="25">Student&#39;s Age</td>');
document.write('	            <td  colspan="3" height="25"> <input size="2" name="Age" onkeypress="return numbersonly(event);" maxlength="2"></td>');
document.write('	          </tr>');
document.write('	          <tr> ');
document.write('	            <td   height="25">Spouse&#39;s Age</td>');
document.write('	            <td  colspan="3" height="25" > <input size="2" name="spouseAge" onkeypress="return numbersonly(event);" maxlength="2">	');
document.write('	            </td>');
document.write('	          </tr>');
document.write('	          <tr> ');
document.write('	            <td   height="25">Max coverage </td>');
document.write('            <td colspan="3" height="25"> <select name="MaxPolicyLimit" size="1">');
document.write('						<option value="50000">$50,000</option>');
document.write('						<option value="100000">$100,000</option>');
document.write('						<option value="200000-250000" selected="selected">$200,000 to $250,000</option>');
document.write('						<option value="300000">$300,000</option>');
document.write('						<option value="500000">$500,000</option>');
document.write('						<option value="1000000">$1000,000</option>');		
document.write('	              </select></td>');
document.write('	          </tr>');
document.write('	          <tr> ');
document.write('             <td nowrap height="25">Coverage Period</td>');
document.write('             <td nowrap height="25"> <input name="monthsOfCoverage" style="width: 20px;" value="1" onkeypress="return numbersonly(event);" maxlength="2" type="text" /> months </td>');
document.write('			<td nowrap height="25"> ');
document.write('			 <input name="daysOfCoverage" style="width: 20px;" value="0" onkeypress="return numbersonly(event);" maxlength="2" type="text" /> days </td>');
document.write('         </tr>');
document.write('         <tr> ');
document.write('			 <td  height="25" >Citizenship</td>');
document.write('			<td nowrap height="25"> ');
document.write('			 <input checked="checked" name="CountryofCitizenship" value="2" onclick="document.miniform1.CountryforCoverage.value=1;;dispSchLocation(2);" type="radio" /> Non US</td>');
document.write('			<td nowrap height="25">');
document.write('			<input name="CountryofCitizenship" value="1" onclick="document.miniform1.CountryforCoverage.value=4;;dispSchLocation(1);" type="radio" /> US</td>');
document.write('         </tr>');
document.write('         <tr  id="qshst"> ');
document.write('			 <td  height="25" >School/Univ Location</td>');
document.write('			<td nowrap height="25"> ');
document.write('			 <input name="SchoolState" value="FL" type="radio" /> Florida</td>');
document.write('			<td nowrap height="25">');
document.write('			<input checked="checked" name="SchoolState" value="AL" type="radio" /> Others</td>');
document.write('         </tr>');
document.write('					<input type="hidden" name="NumberOfChildren" value="0">');
document.write('					<input type="hidden" name="Deductible" value="50-100">');
document.write('					<input type="hidden" name="MailingAddress" value="2">');
document.write('					<input type="hidden" name="CountryforCoverage" value="1">');
document.write('					<input type="hidden" name="Research" value="1">');
document.write('					<input type="hidden" name="Course" value="1">');
document.write('						<input type="hidden" name="affiliate" value="zstudent">');
document.write('						<input type="hidden" name="P"><input type="hidden" name="S"><input type="hidden" name="mths">');
document.write('						<input type="hidden" name="dys"><input type="hidden" name="x"><input type="hidden" name="us">');
document.write('	          <tr> ');
document.write('	               <td colspan=4 height="35"> <div align="center"> ');
document.write('	<input  onClick="f1_validate();" class="formbuttonminif1" onmouseover="this.className=&#39;formbuttonsubmitminif1&#39;" onmouseout="this.className=&#39;formbuttonminif1&#39;" value=" Get Quote! " name="quote"  type="button" />');
document.write('	              <input class="formbuttonminif1" onmouseover="this.className=&#39;formbuttonsubmitminif1&#39;" onmouseout="this.className=&#39;formbuttonminif1&#39;" value="More Options"  name="quote2" onClick="f1_gomain();" type="button"/></div>');
document.write('		 </td');
document.write('         </tr>');
document.write('	        </tbody>');
document.write('	      </table>');
document.write('			</form>');