var htm = '<style type="text/css"> @import url("http://www.unritalinsolution.com/styles/promote.css"); </style>';
htm += '<div id="promotebox1" style="width: 565px; "><a href="http://www.unritalinsolution.com/adhdnaturaltreatment"><div class="promote" id="pf"></div></a>';
htm += '<div class="optin">';
htm += '<form method="post" action="http://www.aweber.com/scripts/addlead.pl">';
htm += '<input type="hidden" name="meta_web_form_id" value="501615">';
htm += '<input type="hidden" name="meta_split_id" value="">';
htm += '<input type="hidden" name="unit" value="unritalin">';
htm += '<input type="hidden" name="redirect" value="http://www.unritalinsolution.com/activateunritalin" id="redirect_390e94fa57813b75d9038871146f6cb5">';
htm += '<input type="hidden" name="meta_redirect_onlist" value="">';
htm += '<input type="hidden" name="meta_adtracking" value="">';
htm += '<input type="hidden" name="meta_message" value="1">';
htm += '<input type="hidden" name="meta_required" value="from">';
htm += '<input type="hidden" name="meta_forward_vars" value="0">';
htm += '<div class="optinfield"><label>Name</label><input type="text" name="name" class="inputbox"  /></div>';
htm += '<div class="optinfield"><label>Email Address</label><input type="text" name="from" class="inputbox"  /></div>';
htm += '<div class="optinfield"><label>&nbsp;</label><input type="submit" class="btn" value="Subscribe to our Newsletter"  /></div>';
htm += '</form></div></div>';

document.write(htm);