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=\"2059098575\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"fsfspanish\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_c36628cb1c92be41986c532b6d933c35\"><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=\"name,custom Telefono,from,custom Estimado de Deuda De Tarjetas,custom Tasa de Interes Mas Alto,custom Multas por Pasar Limite,custom Pagos Retrasados\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div align=\"center\"><strong><span style=\"\">Llena este formato para explorar tus opciones.</span></strong> </div></center></td></tr><tr><td>Nombre:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Telefono:</td><td><input type=\"text\" name=\"custom Telefono\" value=\"\" size=\"20\"></td></tr><tr><td>Email:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Estimado de Deuda De Tarjetas:</td><td><input type=\"text\" name=\"custom Estimado de Deuda De Tarjetas\" value=\"\" size=\"20\"></td></tr><tr><td>Tasa de Interes Mas Alto:</td><td><input type=\"text\" name=\"custom Tasa de Interes Mas Alto\" value=\"\" size=\"20\"></td></tr><tr><td>Dificultad para Hacer Pagos:</td><td><select name=\"custom Dificultad para Hacer Pagos\"><option value=\"Seleccione...\">Seleccione...</option><option value=\"Si\">Si</option><option value=\"No\">No</option></select></td></tr><tr><td>Multas por Pasar Limite:</td><td><select name=\"custom Multas por Pasar Limite\"><option value=\"Seleccione...\">Seleccione...</option><option value=\"Si\">Si</option><option value=\"No\">No</option></select></td></tr><tr><td>Pagos Retrasados:</td><td><select name=\"custom Pagos Retrasados\"><option value=\"Seleccione...\">Seleccione...</option><option value=\"Si\">Si</option><option value=\"No\">No</option></select></td></tr><tr><td valign=\"top\">Preguntas:</td><td><textarea name=\"custom Preguntas\" rows=\"5\" cols=\"30\"></textarea></td></tr>    <tr><td colspan=2><center></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Someter\"></td></tr></table></form></center>");

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