   document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"1331546105\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"debtsettlefpi\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_9ed56d1db46f102641a7d1ec43eb8214\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"Net\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"name,from,custom State (Required),custom Best Contact Phone (Required),custom Best Time to Call\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><DIV align=center><FONT color=#ff3300 size=5>Debt&nbsp;Settlement &amp; Relief</FONT></DIV><DIV align=center>Get out of Debt for Good</DIV><DIV align=center><U>For Immediate Assistance Call Our <FONT color=#ff0000><STRONG>Hot Line</STRONG></FONT> <FONT style=\"BACKGROUND-COLOR: #ffff00\"><STRONG>800.826.1929</STRONG></FONT></U>&nbsp;</DIV></center></td></tr><tr><td>Full Name (required):</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Email (Required):</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Street Address:</td><td><input type=\"text\" name=\"custom Street Address\" value=\"\" size=\"20\"></td></tr><tr><td>City:</td><td><input type=\"text\" name=\"custom City\" value=\"\" size=\"20\"></td></tr><tr><td>State (Required):</td><td><select name=\"custom State (Required)\"><option value=\" \"> </option><option value=\"AK\">AK</option><option value=\"AL\">AL</option><option value=\"AR\">AR</option><option value=\"AZ\">AZ</option><option value=\"CA\">CA</option><option value=\"CO\">CO</option><option value=\"CT\">CT</option><option value=\"DC\">DC</option><option value=\"DE\">DE</option><option value=\"FL\">FL</option><option value=\"GA\">GA</option><option value=\"HI\">HI</option><option value=\"ID\">ID</option><option value=\"IL\">IL</option><option value=\"IN\">IN</option><option value=\"IA\">IA</option><option value=\"KS\">KS</option><option value=\"KY\">KY</option><option value=\"LA\">LA</option><option value=\"ME\">ME</option><option value=\"MD\">MD</option><option value=\"MA\">MA</option><option value=\"MI\">MI</option><option value=\"MN\">MN</option><option value=\"MS\">MS</option><option value=\"MO\">MO</option><option value=\"MT\">MT</option><option value=\"NE\">NE</option><option value=\"NV\">NV</option><option value=\"NH\">NH</option><option value=\"NJ\">NJ</option><option value=\"NM\">NM</option><option value=\"NY\">NY</option><option value=\"NC\">NC</option><option value=\"ND\">ND</option><option value=\"OH\">OH</option><option value=\"OK\">OK</option><option value=\"OR\">OR</option><option value=\"PA\">PA</option><option value=\"PR\">PR</option><option value=\"RI\">RI</option><option value=\"SC\">SC</option><option value=\"SD\">SD</option><option value=\"TN\">TN</option><option value=\"TX\">TX</option><option value=\"UT\">UT</option><option value=\"VT\">VT</option><option value=\"VA\">VA</option><option value=\"WA\">WA</option><option value=\"WV\">WV</option><option value=\"WI\">WI</option><option value=\"WY\">WY</option></select></td></tr><tr><td>Zip Code:</td><td><input type=\"text\" name=\"custom Zip Code\" value=\"\" size=\"20\"></td></tr><tr><td>Best Contact Phone (Required):</td><td><input type=\"text\" name=\"custom Best Contact Phone (Required)\" value=\"\" size=\"20\"></td></tr><tr><td>Home Phone:</td><td><input type=\"text\" name=\"custom Phone\" value=\"\" size=\"20\"></td></tr><tr><td>Cell Phone:</td><td><input type=\"text\" name=\"custom Cell Phone\" value=\"\" size=\"20\"></td></tr><tr><td>Work Phone:</td><td><input type=\"text\" name=\"custom Work Phone\" value=\"\" size=\"20\"></td></tr><tr><td colspan=\"2\" align=\"left\">Best Time to Call (Required):</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Best Time to Call\" value=\"Morning\"> Morning</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Best Time to Call\" value=\"Afternoon\"> Afternoon</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Best Time to Call\" value=\"Evening\"> Evening</td></tr><tr><td>Employment Status:</td><td><input type=\"text\" name=\"custom Employment Status\" value=\"\" size=\"20\"></td></tr><tr><td>Household Monthly Income:</td><td><input type=\"text\" name=\"custom Household Monthly Income\" value=\"\" size=\"20\"></td></tr><tr><td>Estimate Unsecured Total Debt:</td><td><input type=\"text\" name=\"custom Unsecured Debt\" value=\"\" size=\"20\"></td></tr><tr><td>Credit Card Balance(s):</td><td><input type=\"text\" name=\"custom Credit Card Balance\" value=\"\" size=\"20\"></td></tr><tr><td>CC Total Payments:</td><td><input type=\"text\" name=\"custom CC Total Payments\" value=\"\" size=\"20\"></td></tr><tr><td>Personal Loan Balance:</td><td><input type=\"text\" name=\"custom Personal Loans\" value=\"\" size=\"20\"></td></tr><tr><td>Student Loan Balance:</td><td><input type=\"text\" name=\"custom Student Loans\" value=\"\" size=\"20\"></td></tr><tr><td>In Bankruptcy:</td><td><input type=\"text\" name=\"custom In Bankruptcy\" value=\"\" size=\"20\"></td></tr><tr><td>Medical Bills:</td><td><input type=\"text\" name=\"custom Medical Bills\" value=\"\" size=\"20\"></td></tr><tr><td valign=\"top\">Explain Hardship and Goal:</td><td><textarea name=\"custom Explain Hardship and Goal\" rows=\"5\" cols=\"30\"></textarea></td></tr>    <tr><td colspan=2><center><DIV align=center><FONT size=1>Secure &amp; Confidential</FONT></DIV><DIV align=center><FONT size=1>Your email address will never be rented, traded or sold.</FONT></DIV><DIV align=center><FONT size=1>Sometimes we do work with third parties, but will</FONT></DIV><DIV align=center><FONT size=1>contact you for your permission to share personal</FONT></DIV><DIV align=center><FONT size=1>information.</FONT></DIV><DIV>&nbsp;</DIV></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr></table></form></center>");

      function setCookie(name, value, expires, path, domain, secure) {
     var curCookie = name + "=" + escape(value) +
      ((expires) ? "; expires=" + expires.toGMTString() : "") +
      ((path) ? "; path=" + path : "") +
      ((domain) ? "; domain=" + domain : "") +
      ((secure) ? "; secure" : "");
     document.cookie = curCookie;
   }

   function getCookie(name) {
      var dc = document.cookie;
      var prefix = name + "=";
      var begin = dc.indexOf("; " + prefix);
      if (begin == -1) {
    begin = dc.indexOf(prefix);
    if (begin != 0) return null;
      } else
    begin += 2;
      var end = document.cookie.indexOf(";", begin);
   if (end == -1)
      end = dc.length;
      return unescape(dc.substring(begin + prefix.length, end));
   }


      unique_track = new Image();
      unique_track.src = "http://forms.aweber.com/form/displays.htm?id=jMzMjKwsbIwMrA==";


