var split_id = 1262839559;
   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=\"181221\"><input type=\"hidden\" name=\"meta_split_id\" value=\"1262839559\"><input type=\"hidden\" name=\"unit\" value=\"tulsacoupons\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_c01ad48eed565b31a8c8d28beaa5de21\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"Tulsa\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"name,from,custom Zip Code,custom How Did You Hear About Us,custom Birth Month\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div align=\"center\"><font face=\"Georgia\" color=\"#003399\" size=\"5\"><strong>TulsaAreaCoupons.com</strong></font></div><div align=\"center\"><font face=\"Georgia\" color=\"#000000\">Now's Your Chance to Sign-up For FREE!</font></div><div align=\"center\">&nbsp;</div></center></td></tr><tr><td>Enter First Name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Enter Primary Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Enter Zip Code:</td><td><input type=\"text\" name=\"custom Zip Code\" value=\"\" size=\"20\"></td></tr><tr><td>How Did You Hear About Us:</td><td><select name=\"custom How Did You Hear About Us\"><option value=\"Friend\">Friend</option><option value=\"Internet\">Internet</option><option value=\"Mailer\">Mailer</option><option value=\"Xango\">Xango</option></select></td></tr><tr><td>Birth Month:</td><td><select name=\"custom Birth Month\"><option value=\"January\">January</option><option value=\"February\">February</option><option value=\"March\">March</option><option value=\"April\">April</option><option value=\"May\">May</option><option value=\"June\">June</option><option value=\"July\">July</option><option value=\"August\">August</option><option value=\"September\">September</option><option value=\"October\">October</option><option value=\"November\">November</option><option value=\"December\">December</option></select></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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      unique_track = new Image();
      unique_track.src = "http://forms.aweber.com/form/displays.htm?id=jByMTEyM&split_id=" + split_id;