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://pub48.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=4050009923&formid=3391&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:4050009923:48:3391\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Prayer Requests</div></div> </div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">First and Last Name: </span> <span class=\"bn-input\"><input type=\"text\" name=\"FirstLastName\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">E-Mail Address: </span> <span class=\"bn-input\"><input type=\"text\" name=\"replyemail\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Message: </span> <span class=\"bn-input\"><textarea name=\"Message\" placeholder=\"\" validator=\"\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"\"> <input type=\"hidden\" name=\"subject\" value=\"\"><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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document.write('  right: 5px;');
document.write('  top: 50%;');
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