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://pub14.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=1161590665&formid=5629&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:1161590665:14:5629\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Peace Of Mind</div></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=\"\" validator=\"\" value=\"\" style=\"background-image: url(&quot;data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAABHklEQVQ4EaVTO26DQBD1ohQWaS2lg9JybZ+AK7hNwx2oIoVf4UPQ0Lj1FdKktevIpel8AKNUkDcWMxpgSaIEaTVv3sx7uztiTdu2s/98DywOw3Dued4Who/M2aIx5lZV1aEsy0+qiwHELyi+Ytl0PQ69SxAxkWIA4RMRTdNsKE59juMcuZd6xIAFeZ6fGCdJ8kY4y7KAuTRNGd7jyEBXsdOPE3a0QGPsniOnnYMO67LgSQN9T41F2QGrQRRFCwyzoIF2qyBuKKbcOgPXdVeY9rMWgNsjf9ccYesJhk3f5dYT1HX9gR0LLQR30TnjkUEcx2uIuS4RnI+aj6sJR0AM8AaumPaM/rRehyWhXqbFAA9kh3/8/NvHxAYGAsZ/il8IalkCLBfNVAAAAABJRU5ErkJggg==&quot;); background-repeat: no-repeat; background-attachment: scroll; background-size: 16px 18px; background-position: 98% 50%; cursor: auto;\" required=\"required\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Email <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"\" validator=\"email\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Phone </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-150817862634216\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Message <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"\" validator=\"\" required=\"required\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"info@peaceofmindservices.ca\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"\"> <input type=\"hidden\" name=\"subject\" value=\"Peace Of Mind Online Inquiry\"><div class=\"bn-form-submit\"><button type=\"submit\" class=\"formbtn\">Send</button></div> <style type=\"text/css\">.bnet-form ::-webkit-input-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form ::-moz-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form :-ms-input-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form :-moz-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bn-form-legend, .bn-form-legend div {');
document.write('      font-size:23px;');
document.write('      font-family:Arial, Helvetica, sans-serif;');
document.write('      color:#000000;');
document.write('}');
document.write('.bn-form-desc {');
document.write('	  font-size:15px;');
document.write('    font-family:Arial, Helvetica, sans-serif;');
document.write('    color:#222222;');
document.write('}');
document.write('#the-form, .bnet-form, .form-wrapper, .bn-form-preview, .bn-thankyou-msg {');
document.write('     background-color:#ffffff;');
document.write('}');
document.write('.bn-form-submit .formbtn {');
document.write('	 font-size:22px;');
document.write('      font-family:Arial, Helvetica, sans-serif;');
document.write('      color:#ffffff;');
document.write('      border-radius:7px;');
document.write('      background-color:#af97c8;');
document.write('}');
document.write('.bn-label {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('}');
document.write('.bn-thankyou-msg, .bn-form-preview {');
document.write('   font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('}');
document.write('.bn-response {');
document.write('  color:#000000;');
document.write('}');
document.write('.bn-input input[type=text], .bn-input textarea {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	border-radius:5px;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('}');
document.write('.bn-select {');
document.write('	border-style:solid;display:inline-block;width:100%;overflow:hidden;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('	border-radius:5px;');
document.write('}');
document.write('.bn-select select {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	background-color:#ffffff;');
document.write('	border:0;');
document.write('}');
document.write('.bn-input label.bn-radio, .bn-input label.bn-checkbox {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('}');
document.write('.bn-radio input, .bn-checkbox input {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	border-radius:5px;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('}</style></form>');
document.write('<p style="text-align:center;margin-top: 10px;font-size:12px;"><a href="http://www.bravenet.com" style="text-decoration:underline;">Email Forms by Bravenet</a> | <a href="http://www.bravenet.com/global/abuse.php" style="text-decoration:underline;" target="_blank">Report Abuse (spam, phishing, etc)</a></p>');