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=\"1551572199\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"ricopizza\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.withcoupon.com/thanks_coupons.cfm\" id=\"redirect_6c6ba922e43e59acc922bfce08056007\"><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=\"from,name\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><FONT color=#ff0000><STRONG><P align=center><FONT color=red><FONT face=Verdana><STRONG>Win A FREE PIZZA...</STRONG> </FONT></FONT><STRONG><BR></STRONG><FONT face=Verdana>Join our</FONT><STRONG><FONT face=Verdana> <BR></FONT><FONT face=Verdana><FONT color=blue>FREE PIZZA CLUB<BR><BR>Two winners each month will win a<BR>FREE 16\" Cheese Pizza<BR><BR></FONT></FONT></STRONG><STRONG><FONT color=blue><FONT size=1>(Please enter your first and last name. Photo ID will be required to claim your prize.)</FONT></FONT></STRONG></STRONG></FONT></P></center></td></tr><tr><td>E-mail Address:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>First & last name:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Location:</td><td><input type=\"text\" name=\"custom Location\" value=\"Rico's\" size=\"20\"></td></tr><tr><td colspan=\"2\" align=\"left\">How did you hear about us?:</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Source\" value=\"Creative Loafing\"> Creative Loafing</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Source\" value=\"Word of mouth\"> Word of mouth</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Source\" value=\"Radio\"> Radio</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Source\" value=\"Mail\"> Mail</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Source\" value=\"In-store promotion\"> In-store promotion</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Source\" value=\"Sarasota Sally\"> Sarasota Sally</td></tr><tr><td colspan=\"2\"><input type=\"radio\" name=\"custom Source\" value=\"Withcoupon.com\"> Withcoupon.com</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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