document.write("<tr><td class='order_form' colspan='2'><input type=hidden name=req value='op24=Please state Address Type'><div class='lt'>Address Type<br /><input type='radio' name='op24' value='Location_Home' />Home <input type='radio'  name='op24' value='Location_Business' />Business<input type='radio'  name='op24' value='Location_Hospital' />Hospital<input type='radio' name='op24' value='Location_Funeral_Home' />Funeral Home</div></td></tr>")