document.write("    <!-- Web Form Generator 2.0 -->    <center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\">    <input type=\"hidden\" name=\"meta_web_form_id\" value=\"224277\">    <input type=\"hidden\" name=\"meta_split_id\" value=\"\">    <input type=\"hidden\" name=\"unit\" value=\"drnitchsurvey\">    <input type=\"hidden\" name=\"redirect\" value=\"http://www.drnitch.com/public/104.cfm\" id=\"redirect_552723697152fcd31d0beb2584e6f2a3\">    <input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"http://www.drnitch.com/public/19.cfm\">    <input type=\"hidden\" name=\"meta_adtracking\" value=\"order form\">    <input type=\"hidden\" name=\"meta_message\" value=\"1\">    <input type=\"hidden\" name=\"meta_required\" value=\"custom First Name,custom Surname,from\">    <input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\">    <table>    <tr><td colspan=2><center><DIV align=center><FONT face=Verdana color=#ffffff size=1><FONT size=4><STRONG><FONT color=#13305c>Get&nbsp;Dr Nitch's&nbsp;Tips, Ideas </FONT></STRONG></FONT></FONT></DIV><DIV align=center><FONT face=Verdana color=#ffffff size=1><FONT size=4><STRONG><FONT color=#13305c>&amp; Competitions&nbsp;Newsletter<BR>delivered to you for FREE!</FONT></STRONG><FONT color=#000000>&nbsp;</FONT></FONT></FONT></DIV></center></td></tr><tr><td>First Name:</td><td><input type=\"text\" name=\"custom First Name\" value=\"\" size=\"20\"></td></tr><tr><td>Surname:</td><td><input type=\"text\" name=\"custom Surname\" 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=\"Send me FREE Niche Tips & Ideas!\"></td></tr>    </table>    </form>        </center>");

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