function booking_form(hotel_name,room_type,currency,rate)	{
var html_code=''

html_code+='<html>'

html_code+='<head>'
html_code+='<title>Budget Bali Reservation Form</title>'
html_code+='</head>'

html_code+='<body bgcolor="#F0DBB5">'
html_code+='<div align="center"><center>'

html_code+='    <form method="POST" name="reservation_form" action="/cgi-bin/budget">'
html_code+='      <div align="center"><center><table border="0" cellspacing="0" cellpadding="0" width="95%%"'
html_code+='      bgcolor="#F0DBB5">'
html_code+='        <tr>'
html_code+='          <td valign="top" align="center" colspan="3"><div align="center">'
html_code+='          <p><h3>Budget Bali Reservation Form</h3></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="25" valign="top" align="right"><font color="#800040">Hotel Name:</font></td>'
html_code+='          <td width="14" height="25" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="hotel_name" size="30" tabindex="1" value='+hotel_name+'></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="25" valign="top" align="right"><font color="#800040">Room Type:</font></td>'
html_code+='          <td width="14" height="25" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="room_type" size="30" tabindex="2" value='+room_type+'></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='           <td width="255" height="25" valign="top" align="right"><font color="#800040">Number of'
html_code+='           Rooms:</font></td>'
html_code+='           <td width="14" height="25" valign="top"></td>'
html_code+='           <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='           name="number_of_rooms" size="6" tabindex="2"></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="25" valign="top" align="right"><font color="#800040">Rate per Room Night:</font></td>'
html_code+='          <td width="14" height="25" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="currency" size="3" tabindex="3" value='+currency+'>&nbsp; <input type="text" name="rate" size="15"'
html_code+='          tabindex="4" value='+rate+'></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="25" valign="top" align="right"><font color="#800040">Name:</font></td>'
html_code+='          <td width="14" height="25" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="guest_name" size="20" tabindex="5"></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="25" valign="top" align="right"><font color="#800040">Citizenship:</font></td>'
html_code+='          <td width="14" height="25" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="citizen" size="20" tabindex="6"></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="26" valign="top" align="right"><font color="#800040">Arrival Date:</font></td>'
html_code+='          <td width="14" height="26" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="26" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="arrival_day" size="3" tabindex="7"><select name="arrival_month" size="1"'
html_code+='          tabindex="8">'
html_code+='            <option value="Jan">Jan</option>'
html_code+='            <option value="Feb">Feb</option>'
html_code+='            <option value="Mar">Mar</option>'
html_code+='            <option value="Apr">Apr</option>'
html_code+='            <option value="May">May</option>'
html_code+='            <option value="Jun">Jun</option>'
html_code+='            <option value="Jul">Jul</option>'
html_code+='            <option value="Aug">Aug</option>'
html_code+='            <option value="Sep">Sep</option>'
html_code+='            <option value="Oct">Oct</option>'
html_code+='            <option value="Nov">Nov</option>'
html_code+='            <option value="Dec">Dec</option>'
html_code+='          </select><select name="arrival_year" size="1" tabindex="9">'
html_code+='            <option selected value="2009">2009</option>'
html_code+='            <option value="2010">2010</option>'
html_code+='            <option value="2011">2011</option>'
html_code+='          </select> &nbsp;Flight #: <input type=text size=15 name=arrival_flight tabindex="10"></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="26" valign="top" align="right"><font color="#800040">Departure'
html_code+='          Date:</font></td>'
html_code+='          <td width="14" height="26" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="26" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="depart_day" size="3" tabindex="11"><select name="dapart_month" size="1"'
html_code+='          tabindex="12">'
html_code+='            <option value="Jan">Jan</option>'
html_code+='            <option value="Feb">Feb</option>'
html_code+='            <option value="Mar">Mar</option>'
html_code+='            <option value="Apr">Apr</option>'
html_code+='            <option value="May">May</option>'
html_code+='            <option value="Jun">Jun</option>'
html_code+='            <option value="Jul">Jul</option>'
html_code+='            <option value="Aug">Aug</option>'
html_code+='            <option value="Sep">Sep</option>'
html_code+='            <option value="Oct">Oct</option>'
html_code+='            <option value="Nov">Nov</option>'
html_code+='            <option value="Dec">Dec</option>'
html_code+='          </select><select name="depart_year" size="1" tabindex="13">'
html_code+='            <option selected value="2009">2009</option>'
html_code+='            <option value="2010">2010</option>'
html_code+='            <option value="2011">2011</option>'
html_code+='          </select> &nbsp;Flight #: <input type=text size=15 name=depart_flight tabindex="14"></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="25" valign="top" align="right"><font color="#800040">Email:</font></td>'
html_code+='          <td width="14" height="25" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="email" size="40" tabindex="15"></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" height="25" valign="top" align="right"><font color="#800040">Phone/Fax:</font></td>'
html_code+='          <td width="14" height="25" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="phone" size="20" tabindex="16"></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" valign="top" height="25" align="right"><font color="#800040">Mailing Address:</font></td>'
html_code+='          <td width="14" valign="top" height="25">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><input type="text" name="T1" size="50"></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" valign="top" height="25" align="right"><font color="#800040">Note:</font></td>'
html_code+='          <td width="14" valign="top" height="25">&nbsp; </td>'
html_code+='          <td width="414" height="25" valign="top"><font color="#800040"><input type="text"'
html_code+='          name="note" size="50" tabindex="18"></font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="646" valign="top" height="90" align="center" colspan="3"><div align="left"><p><font'
html_code+='          color="#400080"><br>'
html_code+='           In addition to the room night charges we will charge you US$ 5 for booking fee.<br>'
html_code+='          </font></td>'
html_code+='        </tr>'
html_code+='        <tr>'
html_code+='          <td width="255" align="right" height="65" valign="top"><div align="right"><p>&nbsp;</p>'
html_code+='          </div><div align="right"><p><input type="submit" value="Send Reservation Request" name="B1"></td>'
html_code+='          <td width="14" height="65" valign="top">&nbsp; </td>'
html_code+='          <td width="414" height="65" valign="top">&nbsp;<p><input type="reset" value="Reset" name="B2"></td>'
html_code+='        </tr>'
html_code+='      </table>'
html_code+='      </center></div>'
html_code+='    </form>'
html_code+='</center></div>'
html_code+='</body>'
html_code+='</html>'
document.close()
document.write(html_code)
document.close()
}
