document.write("<form method=\"post\" action=\"https://ymlp.com/subscribe.php?id=gwwmmjwgmgh\">\n <input style=\"background-image: url(&amp;amp;amp; background-repeat: no-repeat; background-attachment: scroll; background-size: 16px 18px; background-position: 98% 50%;\" type=\"text\" name=\"YMP0\" />\n<p class=\"bold\">first name <i>(optional)</i>:</p>\n<input type=\"text\" name=\"YMP2\" />\n<p class=\"bold\">surname <i>(optional)</i>:</p>\n<input type=\"text\" name=\"YMP3\" /><br /> <input class=\"btn\" value=\"subscribe\" type=\"submit\" /> <input class=\"btn\" value=\"unsubscribe\" type=\"submit\" /> </form>");