document.writeln('<center><div>');document.writeln('<div style="padding:0px; width:258px; margin:0px;background-color:#CEDFDD;"><form enctype=\'multipart/form-data\' ');document.writeln('action="http://www.freeleadswarehouse.com/phpform/forms/process.php" method="post" ');document.writeln('style="margin:0px;">');document.writeln('<div style="margin:10px; font: 10px arial; color: black; text-align:center;">');document.writeln('<div style="margin-bottom:5px;">Enter full name and email address:');document.writeln('</div>');document.writeln('Name: <input type="text" name="FullName" size="20" maxlength="100" /><br>');document.writeln('Email: <input type="text" name="EmailAddress" size="20" maxlength="100" /><br>');document.writeln('&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp<input type=submit value=\'Submit\'/>&nbsp;&nbsp;&nbsp;&nbsp;<input type=reset value=\'Reset\'>');document.writeln('</div>');document.writeln('</form>');document.writeln('</div>');document.writeln('</div></center>');