document.write('<form action="/app/newsletter/subscribe/confirm" method="post"><p>Enter your name and email address to subscribe to our newsletter</p><style>#newsletter_table td {	padding: 2px 0;}</style><table cellspacing="0" cellpadding="0" border="0" id="newsletter_table"><tr><td>First name:</td><td width="10">&nbsp;</td><td><input type="text" name="first_name" size="16" maxlength="255" style="width: 150px;" /></td></tr><tr><td>Last name:</td><td width="10">&nbsp;</td><td><input type="text" name="last_name" size="16" maxlength="255" style="width: 150px;" /></td></tr><tr><td>Email address:</td><td width="10">&nbsp;</td><td><input type="text" name="subscriber_email" size="16" maxlength="255" style="width: 150px;" /></td></td></tr><tr><td></td><td></td><td><input type="submit" value="Subscribe" /></td></tr></table></form>');