var split_id = 662942335;
   document.write("<center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"1352012549\"><input type=\"hidden\" name=\"meta_split_id\" value=\"662942335\"><input type=\"hidden\" name=\"unit\" value=\"veroaffare\"><input type=\"hidden\" name=\"redirect\" value=\"http://veroaffare.info/grazie.html\" id=\"redirect_9225840a900f39876a164805e45c2789\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"http://veroaffare.info/ilmiomangostano\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"VEROAFFARE\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"name,custom Cognome,from\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div>Inserisci i tuoi dati per ricevere le informazioni.&nbsp;</div></center></td></tr><tr><td>Nome:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Cognome:</td><td><input type=\"text\" name=\"custom Cognome\" value=\"\" size=\"20\"></td></tr><tr><td>Provincia:</td><td><input type=\"text\" name=\"custom Provincia\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" 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=\"VOGLIO LE INFORMAZIONI!\"></td></tr></table></form>      <img src=\"http://forms.aweber.com/form/ci/?tc=FFFFFF&bg=0077E7&d=bCzMzOxMPoLqpkamTj7MrCzM\" style=\"margin-top: 8px;\"></center>");

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