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=\"485819\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"tgb_personal\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.texasgulfbank.com/thankyou.asp\" id=\"redirect_d57b9d88bf909dcff42ce9c4e30c833b\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"http://www.texasgulfbank.com\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"from\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center></center></td></tr><tr><td>Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Phone:</td><td><input type=\"text\" name=\"custom Phone\" value=\"\" size=\"20\"></td></tr><tr><td>Nearest Branch:</td><td><select name=\"custom Nearest Branch\"><option value=\"Angleton\">Angleton</option><option value=\"Brazosport\">Brazosport</option><option value=\"Clute\">Clute</option><option value=\"Freeport\">Freeport</option><option value=\"Houston\">Houston</option><option value=\"Lake Jackson\">Lake Jackson</option><option value=\"West Columbia\">West Columbia</option></select></td></tr><tr><td>Loan Service:</td><td><select name=\"custom Loan Service\"><option value=\"Consumer Loan\">Consumer Loan</option><option value=\"Comercial Loan\">Comercial Loan</option><option value=\"Gulf Advantage Checking\">Gulf Advantage Checking</option><option value=\"General Deposits\">General Deposits</option><option value=\"Business Deposits\">Business Deposits</option><option value=\"Otherr\">Otherr</option></select></td></tr><tr><td valign=\"top\">If Other Please Explain:</td><td><textarea name=\"custom If Other Please Explain\" rows=\"5\" cols=\"15\"></textarea></td></tr>    <tr><td colspan=2><center></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Submit\"></td></tr></table></form></center>");

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