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=\"883392523\">    <input type=\"hidden\" name=\"meta_split_id\" value=\"\">    <input type=\"hidden\" name=\"unit\" value=\"logcopy\">    <input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou.htm?m=default\" id=\"redirect_b679f37082cc67717fd3e9566053ce57\">    <input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\">    <input type=\"hidden\" name=\"meta_adtracking\" value=\"7 CRITICAL TIPS\">    <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><div align=\"center\">&nbsp;<strong>Please complete the&nbsp;form</strong></div><div align=\"center\"><strong>below </strong><strong>to receive your</strong></div><div align=\"center\"><strong><font face=\"Arial\" color=\"#ff0000\" size=\"7\">-FREE-</font></strong></div><div align=\"center\"><font size=\"5\"><strong><span style=\"background-color: #ffff00\">7 </span></strong><strong><span style=\"background-color: #ffff00\">CRITICAL TIPS</span></strong></font></div><div align=\"center\"><strong><font face=\"Arial\">to reduce the odds that</font></strong></div><div align=\"center\"><strong><font face=\"Arial\">you could be the victim</font></strong></div><div align=\"center\"><strong><font face=\"Arial\">of a violent crime.</font></strong></div></center></td></tr><tr><td>First 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>City:</td><td><input type=\"text\" name=\"custom a\" value=\"\" size=\"20\"></td></tr><tr><td>Gender:</td><td><input type=\"text\" name=\"custom Gender\" value=\"\" size=\"20\"></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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