document.write('<FORM NAME="newsletter" METHOD="POST" ACTION=https://www.myfirecompanies.com/newsentry.php><TABLE><TR><td class="nlHeading">Newsletter</td></tr><tr><TD><Input type="text" name="name" value="Name" class="nlInput" onclick=this.value=""></td></tr><tr><TD><Input type="text" name="email" value="Email" class="nlInput" onclick=this.value=""></td></tr><tr><td><input type="hidden" name="page" value="http://www.jfd39.com/subscription.php"><input type="hidden" name="company" value="10203"><input type="submit" name="subscribe" value="subscribe" class="nlButton"></td></tr></TABLE></FORM>')