var output = ''
+ ' <style type="text/css"> .inp { background-color: #FFFFFF; font-size: 9px;'
+ ' width: 24px;} .inp4 { background-color: #FFFFFF; font-size: 9px; width: 2'
+ '9px;} .btn { width: 30px; font-family: arial; border: #000000 solid 1px; }'
+ ' </style> <table cellpadding=2 cellspacing=0 style="background-color: #FFF'
+ 'FFF; border: #336699 solid 1px; width: 125px; height: 125px; font-family: '
+ 'arial, helvetica"> <form method=post action="http://broadband.cheap56k.com'
+ '/prequal.php"> <input type=hidden name=code value="optonline"> <input type'
+ '=hidden name=ms value=1> <input type=hidden name=servicetype value="2"> <t'
+ 'r><td height=22 align=center style="background-color: #336699; color: #FFF'
+ 'FFF;"><b><font size=2>Find Internet Access</font></b></td></tr> <tr><td al'
+ 'ign=center><font face=arial size=1>Enter phone number:</font></td></tr> <t'
+ 'r><td align=center><font size=1><input class=inp type=text name=areacode m'
+ 'axlength=3 size=3>-<input class=inp type=text name=nxx maxlength=3 size=3>'
+ '-<input class=inp4 type=text name=lf maxlength=4 size=4> <input type=submi'
+ 't class=btn name=go value="Go!"></font></td></tr> </table> ';

document.write(output);