document.write("<div id='th_status_form'>");
	document.write("<form method='get' action='http://www.templatehelp.com/preset/order_status.php' name='order_status_form' target='_blank'>");
	document.write("<input type='hidden' name='pr_code' value='ePKBQ4hFiG59Y69k9r08S6V20Lb1rR'>");
	document.write("<h2 class='th_status_heading'>Check your order status</h2>");
	document.write("<div class='th_status_descr'>Please enter your transaction id to check the status of your order.</div>");
	document.write("<table border='0'>");
	document.write("<tr>");
	document.write("<td class='th_status_field_descr'>Transaction ID:</td>");
	document.write("<td>");
	document.write("<div><input name='order_id' class='th_status_field'/></div>");
	document.write("</td>");
	document.write("<td class='th_status_button'>");
	document.write("<a href='#' onclick='javascript:document.order_status_form.submit();return false;'>Submit</a>");
	document.write("</td>");
	document.write("</tr>");
	document.write("</table>");
	document.write("</form>");
	document.write("</div>");