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=\"770884\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"the-hcg-diet\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.thinkhcgdiet.com/infopage\" id=\"redirect_052a2efd6c8b5f3db2eb9dad4db489de\"><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,from\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><div align=\"center\">Fill in the form below and have </div><div align=\"center\">\"The HCG Diet\" eBook emailed to you!</div><div align=\"center\">&nbsp;</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>Referred by:</td><td><input type=\"text\" name=\"custom Referred by\" value=\"Pounds and Inches\" size=\"20\"></td></tr>    <tr><td colspan=2><center><div><span class=\"text\"><font size=\"1\"><span style=\"font-size: 10px; line-height: 13px;\">By clicking submit you agree to our </span></font><a href=\"http://pounds-and-inches.com/termsandconditions1.html\" target=\"_blank\"><font size=\"1\"><span style=\"font-size: 10px; line-height: 13px;\">Terms &amp; <br soft=\"\"></span></font></a><a href=\"http://pounds-and-inches.com/termsandconditions1.html\" target=\"_blank\"><font size=\"1\"><span style=\"font-size: 10px; line-height: 13px;\">Conditions.</span></font></a><font size=\"1\"><span style=\"font-size: 10px; line-height: 13px;\"> &nbsp;You Won't be Spammed - <br soft=\"\">we hate it as much as you do!</span></font></span></div></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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