document.writeln("");
document.writeln("<form name=\"form1\" method=\"post\" action=\"http://www.mcssl.com/app/contactsave.asp\">");
document.writeln("<input name=\"merchantid\" type=\"hidden\" id=\"merchantid\" value=\"3109\">");
document.writeln("<input name=\"ARThankyouURL\" type=\"hidden\" id=\"ARThankyouURL\" value=\"http://fredgleeck.com/fred-gleeck-audio-video.php\">");
document.writeln("<input name=\"copyarresponse\" type=\"hidden\" id=\"copyarresponse\" value=\"0\">");
document.writeln("<input name=\"custom\" type=\"hidden\" id=\"custom\" value=\"0\">");
document.writeln("<input name=\"defaultar\" type=\"hidden\" id=\"defaultar\" value=\"190327\">");
document.writeln("<input name=\"allowmulti\" type=\"hidden\" id=\"allowmulti\" value=\"1\">");
document.writeln("<input name=\"visiblefields\" type=\"hidden\" id=\"visiblefields\" value=\"Name,Email1\">");
document.writeln("<input name=\"requiredfields\" type=\"hidden\" id=\"requiredfields\" value=\"Email1\">");
document.writeln("<div><table align=\"center\" id=\"newsletter\"><tr><td><table>");
document.writeln("    <tr>");
document.writeln("      <td>Name</td>");
document.writeln("      <td><input name=\"Name\" type=\"text\" size=\"40\"></td>");
document.writeln("    </tr>");
document.writeln("    <tr>");
document.writeln("      <td>Email</td>");
document.writeln("      <td><input name=\"Email1\" type=\"text\" size=\"40\"></td>");
document.writeln("    </tr>");
document.writeln("	<tr align=\"center\">");
document.writeln("		<td colspan=\"2\">");
document.writeln("			<input type=\"Submit\" name=\"cmdSubmit\" value=\"Join Newsletter\">");
document.writeln("		</td>");
document.writeln("	</tr>");
document.writeln("  </table></td></tr></table></div>");
document.writeln("</form>");