document.write("\n
\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
*First Name:
*Last Name:
*E-mail address:
Birthday:
Text #:
*Number of Guests:
*Time of Reservation:
*Date of Reservation:
Select your borough / region:
  *required fields
\n
");