document.write('<form action="/app/newsletter/subscribe/confirm/default" method="post"><table cellpadding="2" cellspacing="2"><tr><td><h2>Subscribe</h2></td></tr><tr><td><input type="text" name="first_name" value="your name" class="input_txtWhite" onfocus="this.value=\'\'" /></td></tr><tr><td><input type="text" name="subscriber_email" value="your email address" class="input_txtWhite" onfocus="this.value=\'\'" /></td></tr><tr><td><input name="submit" type="image" value="go" src="/persistent/templateimages/signupBtn.jpg" /></td></tr></table></form>');