var QueryString = '';
if(typeof UserID != "undefined")
{
    QueryString = '?p='+UserID;
}
SignUpForm = '<script language="javscript" type="text/javascript" src="http://www.debtconsolidationcare.com/common/js/signup-form-validation.js"></script><form action="http://www.debtconsolidationcare.com/signup/dbsignup.php'+QueryString+'" method="post" name="SignUpForm" id="SignUpForm" onSubmit="return validate_SignUpForm(this);"><div><input name="FldUserType" value="1" type="hidden"><table border="0" bgcolor="#006666" cellpadding="1" cellspacing="0"><tr><td><table border="0" bgcolor="#FFFFFF" cellpadding="4" cellspacing="0"><tr><td align="center" bgcolor="#006666" colspan="2"><span style="color: #FFFFFF;"><b>Sign up to get debt free with</b></span></td></tr><tr><td align="center" bgcolor="#f3f2e0" colspan="2"><span style="color: #FFFFFF;"><a href="http://www.debtconsolidationcare.com/" style="color: #0000FF; text-decoration: none"><b>Debt Consolidation Care</b></a></span></td></tr><tr><td align="right" valign="top"><span style="color: rgb(255, 0, 0);">*</span><span style="color: #000000; font-weight: bold;">Full Name:</span></td><td align="left" valign="top"><input maxlength="255" name="FirstName" type="text"></td></tr><tr><td align="right" valign="top"><span style="color: rgb(255, 0, 0);">*</span><span style="color: #000000; font-weight: bold;">Email address:</span></td><td align="left" valign="top"><input maxlength="255" name="EmailAddress" type="text"></td></tr><tr><td align="right" valign="top"><span style="color: rgb(255, 0, 0);">*</span><span style="color: #000000; font-weight: bold;">Zip Code:</span></td><td align="left" valign="top"><input size="10" maxlength="10" name="ZipCode" type="text"></td></tr><tr><td align="right" valign="top"><span style="color: rgb(255, 0,0);">*</span><span style="color: #000000; font-weight: bold;">Best Phone:</span></td><td align="left" valign="top"><input size="20" maxlength="20" name="HomePhone" type="text"></td></tr><tr><td align="right" valign="top"><span style="color: #000000; font-weight: bold;">Debt Amount:</span></td><td align="left" valign="top"><select name="DebtAmount"><option value="Not sure">Not sure</option><option value="$0 - $5000">$0 - $5000</option><option value="$5001 - $10000">$5001 - $10000</option><option value="$10001 - $15000">$10001 - $15000</option><option value="$15001 - $20000">$15001 - $20000</option><option value="More than $20000">More than $20000</option></select></td></tr><tr><td align="right" valign="top"><b></b></td><td align="left" valign="top"><input class="cms_button" name="ActionButton" value="Submit" type="submit"></td></tr><tr><td align="center" valign="top" colspan="2"><span style="font-size: 80%; color: rgb(255, 0, 0);">*</span><span style="font-size: 80%; color: #000000;"><i>denotes required field</i></span></td></tr></table></td></tr></table></div></form>';
document.write(SignUpForm);
