   document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\" target=\"_new\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"942048009\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"wholesaleprices\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.mypet.net.au/ThankyouWholesale.htm\" id=\"redirect_0494b8c3612d4af2f83947a7d427a7b8\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"http://www.mypet.net.au/AlreadySubscribed.htm\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"MPWholesale\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"from,custom Business Name,custom Contact Name,custom Street,custom CityTown,custom City,custom Postcode,custom Country,custom Phone,custom ABN,custom Type of Business\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><P align=center><FONT face=Arial><STRONG>RETAILERS<BR>Wholesale Price List Application</STRONG> <BR></FONT><BR><FONT color=#ff00ff><FONT face=Arial><STRONG><U>IMPORTANT</U><BR></STRONG>After you submit this form you will receive an email&nbsp;<BR>asking you to confirm&nbsp;that you authorised this request.<BR>&nbsp;<BR></FONT></FONT><FONT color=#ff00ff><FONT face=Arial><STRONG><EM>Your request is NOT forwarded to us until&nbsp;<BR><U>AFTER</U> you&nbsp;click this link&nbsp;</EM>&nbsp;</STRONG></FONT></FONT><FONT color=#ff0000><FONT face=Arial color=#ff00ff><STRONG> <BR><BR></STRONG></FONT><DIV align=center><FONT face=Arial color=#ff00ff size=2>If you have difficulties please use the <BR></FONT><A title=\"Contact Us\" href=\"mailto:dogs@mypet.net.au?subject=Wholesale%20enquiry\"><FONT face=Arial size=2>CONTACT US</FONT></A><FONT face=Arial size=2> </FONT><FONT face=Arial><FONT color=#ff00ff><FONT size=2>link on our website.</FONT> </FONT></FONT></DIV><P align=center></FONT><EM><FONT size=2><FONT face=Arial>* Required fields</FONT><BR></FONT></EM></P></center></td></tr><tr><td>*E-mail Address:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>*Business Name:</td><td><input type=\"text\" name=\"custom Business Name\" value=\"\" size=\"20\"></td></tr><tr><td>*Contact Name:</td><td><input type=\"text\" name=\"custom Contact Name\" value=\"\" size=\"20\"></td></tr><tr><td>*Address:</td><td><input type=\"text\" name=\"custom Street\" value=\"\" size=\"20\"></td></tr><tr><td>*City/Town:</td><td><input type=\"text\" name=\"custom CityTown\" value=\"\" size=\"20\"></td></tr><tr><td>*State:</td><td><input type=\"text\" name=\"custom City\" value=\"\" size=\"20\"></td></tr><tr><td>*Postcode:</td><td><input type=\"text\" name=\"custom Postcode\" value=\"\" size=\"20\"></td></tr><tr><td>*Country:</td><td><input type=\"text\" name=\"custom Country\" value=\"\" size=\"20\"></td></tr><tr><td>*Business Phone (Landline):</td><td><input type=\"text\" name=\"custom Phone\" value=\"\" size=\"20\"></td></tr><tr><td>*ABN Number:</td><td><input type=\"text\" name=\"custom ABN\" value=\"\" size=\"20\"></td></tr><tr><td>Website URL:</td><td><input type=\"text\" name=\"custom Website URL\" value=\"\" size=\"20\"></td></tr><tr><td valign=\"top\">*Description of business:</td><td><textarea name=\"custom Type of Business\" rows=\"2\" cols=\"20\"></textarea></td></tr><tr><td colspan=\"2\" align=\"left\">Tick box for price lists required:</td></tr><tr><td colspan=\"2\"><input type=\"checkbox\" name=\"custom Pricelist Dog HATS\"> Dog Hats</td></tr><tr><td colspan=\"2\"><input type=\"checkbox\" name=\"custom Dog Jumpers\"> Dog Jumpers</td></tr><tr><td colspan=\"2\"><input type=\"checkbox\" name=\"custom Pricelist Dog COATS\"> Dog Coats</td></tr><tr><td valign=\"top\">Custom Product Order (Details):</td><td><textarea name=\"custom Custom Order\" rows=\"2\" cols=\"20\"></textarea></td></tr><tr><td valign=\"top\">Comments:</td><td><textarea name=\"custom Comments\" rows=\"2\" cols=\"20\"></textarea></td></tr>    <tr><td colspan=2><center><P align=center><FONT face=Arial size=2>You will&nbsp;receive an email asking you&nbsp;to CONFIRM your request for information. Your request is NOT forwarded to us until AFTER you click on the link provided. <BR>This is to stop spam.<BR></FONT></P></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Click here to request Wholesale Price List\"></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=nCxMDCwcDAyc";


