<code><div id="cc_req_result_tzlxtuby1"></div>
<form>
Song artist: <input type="text" id="cc_req_artist_tzlxtuby1" name="request[artist]" size="40" maxlength="127" /><br />
Song title: <input type="text" id="cc_req_title_tzlxtuby1" name="request[title]" size="40" maxlength="127" /><br />
Dedicated to: <input type="text" id="cc_req_dedi_tzlxtuby1" name="request[dedication]" size="40" maxlength="127" /><br />
Your name: <input type="text" id="cc_req_sender_tzlxtuby1" name="request[sender]" size="40" maxlength="127" /><br />
Your E-mail: <input type="text" id="cc_req_email_tzlxtuby1" name="request[email]" size="40" maxlength="127" /><br />
<input type="button" id="cc_req_button_tzlxtuby1" class="cc_request_form" value="Submit song request" /><br />
</form>
<script language="javascript" type="text/javascript" src="http://cent5.serverhostingcenter.com:2199/system/request.js"></script>