if(EFCID) {
	document.write('<form name="frm_newsletter" method="post" action="http://www.ewriteforms.com/apps/newsletter.php" onSubmit="return newsletter_formValidation(this)">');
	document.write('<table cellspacing="2" cellpadding="2" width="90%" border="0">');
	document.write('<tr>');
	document.write('<td><input type="text" name="mr_honeypot" style="display:none;"><input name="user_name" onclick="checkthis(this);" value="your name" size="12" maxlength="150"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td><input name="user_email" onClick="checkthis(this);" value="your email address" size="12" maxlength="150"></td>');
	document.write('</tr>');
	document.write('<tr>');
	document.write('<td><input type="hidden" value="'+EFCID+'" name="frm_client_number"><input type="hidden" value="2" name="frm_application_number"><input type="submit" value="Subscribe" name="submit"></td>');
	document.write('</tr>');
	document.write('</table>'); 
	document.write('</form>');
}