document.write('<div style="width: 300px;background-color: #5a534a;"><div style="padding:12px 10px;"><div style="font-family: Arial, Helvetica, sans-serif;font-size: 16px; color:#fff;font-weight: normal;line-height: 18px;margin:0px 5px 0px 15px; text-align:left;">Fill in your gross monthly income: </div><div style="margin: 10px 5px;"><form name="form1" method="get" action="http://www.bankrate.com/mail/calc/newhouse/calculator.asp?Ia=0&Io=0&D=0&T=0&R=0&Ei=0&Ex=0&Ec=0&Ea=0&Ed=0&tEo=0" style="margin:0px;padding:0px;"><div style="font-family: Arial, Helvetica, sans-serif;color:#fff;font-size: 12px;font-weight: bold;line-height: 15px;margin:12px 0px 2px 10px;text-align:left;">Wages:</div><span style="font-family: Arial, Helvetica, sans-serif;color:#fff;font-size: 12px;font-weight: bold;line-height: 15px;">$</span>&nbsp;<input type="text" name="Iw" size="9" maxlength="9" style="width:180px;" value="" id="Text1"><div style="font-family: Arial, Helvetica, sans-serif;font-size: 12px;color:#fff;font-weight: bold;line-height: 15px;margin:15px 0px 2px 10px;">Investments/Dividends: </div><span style="font-family: Arial, Helvetica, sans-serif;color:#fff;font-size: 12px;font-weight: bold;line-height: 15px;position:relative;top:-6px;">$</span>&nbsp;<input type="text" name="Ii" size="9" maxlength="9" style="width:180px;position:relative;top:-6px;" id="Text3">&nbsp;&nbsp;<input type="image" src="http://www.bankrate.com/images_mra/buttons/brown-go.jpg" name="Submitbut"></form></div></div></div>');
