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=\"1743029824\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"mariaportas\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.amazinglifetoday.com/thankyou.htm\" id=\"redirect_87ceb5bb6f9b2ba654eca003460b812a\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><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><div><h2 align=\"center\">Learn How To Manifest The Life You Deserve<br>and Achieve Financial Independence:<br><u>Free</u> 5-Day E-course and Teleseminar</h2><br><center>Just fill in your name and contact info to get access to the insider secrets that the <u>richest</u> 1% of business owners <em>won't</em> tell <u>you</u>.</center></div></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 Number:</td><td><input type=\"text\" name=\"custom Phone Number\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center><img alt=\"\" title=\"\" src=\"http://amazinglifetoday.webs.com/iStock_000003650442XSmall.jpg\" height=\"278\" width=\"431\"><br></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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