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://pub35.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=2996064010&formid=3918&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:2996064010:35:3918\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Contact Leading Hearts</div></div> <div class=\"bn-form-desc\"><p>Please fill out the fields below.</p></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Name </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"your first and last name\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><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\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Interested in Advertising in Leading Hearts? <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-147486538844647[]\" value=\"Send me some info.\" required=\"required\"> <span class=\"bn-inner-label\">Send me some info.</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-147486538844647[]\" value=\"Not at this time.\" required=\"required\"> <span class=\"bn-inner-label\">Not at this time.</span></label></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Comments </span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"enter your comments here\" validator=\"\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"LindaReply@gmail.com,ReachOut2Linda@gmail.com,barefacedjourney@gmail.com,melaniereply@gmail.com\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"Thank you for your form submission\"> <input type=\"hidden\" name=\"subject\" value=\"Leading Hearts Email\"><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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