How to insert the "Call me back service"

<div class="eaKeep">
<SCRIPT src="../../../third-parties/yav/js_compact/yav.js">&nbsp;</SCRIPT>
<SCRIPT src="../../../third-parties/yav/js_compact/yav-config.js">&nbsp;</SCRIPT>
<SCRIPT>
    var rulesr=new Array();
    rulesr[0]='name|required';
    rulesr[1]='phone|required';

    function swapDisplay (id){
        if (getStyleObject(id).display=='block'){
            hideCompById(id);
        } else {
            showCompById(id);
        }
    }
    
    function nbFocus(nbItem){
        if (nbItem.value == nbItem.name) {
            nbItem.value='';
        }
    }
    function nbBlur(nbItem){
        if (nbItem.value == '' ) {
            nbItem.value=nbItem.name;
        }
    }    
    function nbSubmit(){
        if (document.callForm.name.value == document.callForm.name.name ) {
            document.callForm.name.value = '';
        }
        if (document.callForm.phone.value == document.callForm.phone.name ) {
            document.callForm.phone.value = '';
        }
    }        
    function nbReText() {
        if (document.callForm.name.value == '' ) {
            document.callForm.name.value = document.callForm.name.name;
        }
        if (document.callForm.phone.value == '' ) {
            document.callForm.phone.value = document.callForm.phone.name;
        }
    }        
    function nbCheck(){
        nbSubmit();
        var yavReturn=performCheck('callForm', rulesr, 'classic');
        if (!yavReturn){
            nbReText();
        }
        return yavReturn;
    }    

</SCRIPT>                              <style type="text/css">
                <!--
                .inputError { border:#FF8000 1px solid; background-color: #FFFFD7; }
                .recallTable { margin-top:10px; border:#999999 1px solid;}
                .recallTable th { background-color:#DDDDDD; font-weight:bold; text-align:left }
                .recallTable ol { padding-left:15px }
                -->
                </style>
<form name="callForm" action="../../../iw/core/main/sendForm.jsp" onsubmit="return nbCheck()" style="margin: 0pt;" class="fckForm">
    <table border="0" width="100%" class="contactTable">
        <tbody>
            <tr>
                <th colspan="7">Call me back service</th>
            </tr>
            <tr>
                <td width="30"><img height="16" width="24" alt="" src="../../../iwetc/res/img/callMeBack.jpg" /></td>
                <td><input value="name" name="name" onfocus="nbFocus(this)" style="width: 100%;" onblur="nbBlur(this)" /></td>
                <td width="5">&#160;</td>
                <td><input value="phone" name="phone" onFocus="nbFocus(this)" style="width: 100%;" onBlur="nbBlur(this)" /></td>
                <td width="5">&#160;</td>
                <td width="50">&#160;                   <input type="hidden" value="Call me back service" name="formTitle" /><input type="submit" value="  go  " name="go" /></td>
            </tr>
        </tbody>
    </table>
</form>
</div>