document.write('	<br>');
document.write('	<br>');
document.write('		');
document.write('		<form name="F" action="newsletter-subscribe.php?" method="POST" onSubmit="return validateForm(this);">');
document.write('			<input type="hidden" name="return" value="newsletter-subscribe.php?">');
document.write('			<table width="450" cellspacing="1" cellpadding="5" align="center" class="table">');
document.write('				<tr>');
document.write('					<td class="th" colspan="2">Subscribe for our mailing list</td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<td class="td">First Name : </td>');
document.write('					<td class="td"><input type="text" size="30" maxlength="100" name="fname" value="" class="effect" alt="blank"></td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<td class="td">Last Name : </td>');
document.write('					<td class="td"><input type="text" size="30" maxlength="100" name="lname" value="" class="effect" alt="blank"></td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<td class="td">Email Address :</td>');
document.write('					<td class="td"><input type="text" size="30" maxlength="255" name="email" value="" class="effect" alt="blank"></td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<td class="td" valign="top" colspan="2">');
document.write('						Newsletter Categories<br><br>');
document.write('						<center>');
document.write('							<select name="categories[]" size="5" class="effect" multiple style="width : 275px;">');
document.write('								<option value="1002">New Products` Notification</option>');
document.write('								<option value="1001">Upgrades - Ad Network Script</option>');
document.write('								<option value="1004">Upgrades - Auction Script</option>');
document.write('								<option value="1003">Upgrades - Kaon Shopping Cart</option>');
document.write('								<option value="1000">Upgrades - Price Comparison Script</option>');
document.write('							</select><br>');
document.write('							<font size=1>Press and hold Ctrl to select multiple categories.</font>');
document.write('						</center>');
document.write('					</td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<td class="td" valign="top" colspan="2">');
document.write('						<input type="radio" name="isSubscribed" value="Y" checked>Subscribe &nbsp;&nbsp;&nbsp;<input type="radio" name="isSubscribed" value="N">Unsubscribe');
document.write('					</td>');
document.write('				</tr>');
document.write('				<tr>');
document.write('					<td class="td" colspan="2" align="center"><input type="image" name="btnAdd" src="http://www.kaonsoftwares.com/shopping-cart/images/btn-subscribe.gif" class="baseeffect"></td>');
document.write('				</tr>');
document.write('			</table>');
document.write('		</form>');