document.write('',
'<table width="456" border="0" cellpadding="0">',
'  <tr>',
'    <td>',
'	<p class="text">',
'<form method="POST" action="http://www.antidepressants.ws/cgi-bin/autoresponder/ar.cgi">',
'                <div align="left">',
'                  <input type="hidden" name="mode" value="register">',
'                  <input type="hidden" name="ar" value=antide01>',
'                  <hr size="1" noshade>',
'                  <table width="210" border="0" align="left" cellpadding="2" cellSpacing="0" bgcolor="#F9F9F9" class="textsmaller">',
'                    <tr> ',
'                      <td width="206" height="99" colspan="2" align="right" valign="top" class="textsmaller"> ',
'                        <div align="center"><b><font size="2" face="Verdana, Arial, Helvetica, sans-serif" color="#FF3300"><u>Are ',
'                          You Paying Too Much For Your Medications?</u></font></b></span><font size="4"><span class="text"><font size="2"><strong><br>',
'                          Download FREE ebook:<br>',
'                  &quot;Six Powerful Ways To Instantly Reduce Your Drug Costs ',
'                  Up To 75%</strong></font></span></font><strong><font size="2"><span class="textsmaller">&quot;</span></font></strong><font size="3"><strong> ',
'                  </strong></font> </div></td>',
'                    </tr>',
'                  </table>',
'                  <table width="176" border="0" align="center" cellpadding="2" cellSpacing="0" bgcolor="#F9F9F9" class="textsmaller">',
'                    <tr> ',
'                      <td align="right"><div align="right"><font face="Tahoma">Name:</font></div></td>',
'                      <td><font face="Tahoma" size="2"> ',
'                        <input type="text" name="user" size="10">',
'                        </font></td>',
'                    </tr>',
'                    <tr> ',
'                      <td align="right"><div align="right"><font face="Tahoma">Email:</font></div></td>',
'                      <td><font face="Tahoma" size="2"> ',
'                        <input type="text" name="email" size="10">',
'                        </font></td>',
'                    </tr>',
'                    <tr valign="top"> ',
'                      <td height="38" colspan="2" align="right"> <div align="center"> <font size="1" face="Verdana, Arial, Helvetica, sans-serif">We ',
'                          value your privacy!<br>',
'                          </font><br>',
'                          <input name="B1" type="submit" class="textsmaller" value="Send Me Free Ebook!">',
'                          </font> ',
'                        </div></td>',
'                    </tr>',
'                  </table>',
'                 <hr size="1" noshade> ',
'                </div>',
'              </form>',
'	</td>',
'  </tr>',
'</table>',
'');