Start The Process

<!–
Do not modify the NAME value of any of the INPUT fields
the FORM action, or any of the hidden fields (eg. input type=hidden).
These are all required for this form to function correctly.
–>
<style type=”text/css”>

.myForm td, input, select, textarea, checkbox {
font-family: tahoma;
font-size: 12px;
}

.required {
color: red;
}

</style>
<form method=”post” action=”http://synmk.com/inter/form.php?form=4″ id=”frmSS4″ onsubmit=”return CheckForm4(this);”>
<table border=”0″ cellpadding=”2″ class=”myForm”>
<tr>
<td><span class=”required”>*</span>&nbsp;
Your Email Address:</td>
<td><input type=”text” name=”email” value=”” /></td>
</tr><tr>
<td>&nbsp;&nbsp;&nbsp;&nbsp;First Name:</td>
<td><input type=”text” name=”CustomFields[2]” id=”CustomFields_2_4″ value=”” size=’50’></td>
</tr><tr>
<td>&nbsp;&nbsp;&nbsp;&nbsp;Last Name:</td>
<td><input type=”text” name=”CustomFields[3]” id=”CustomFields_3_4″ value=”” size=’50’></td>
</tr><input type=”hidden” name=”format” value=”h” /><tr>
<td><span class=”required”>*</span>&nbsp;
Enter the security code shown:</td>
<td><script type=”text/javascript”>
// <![CDATA[
if (!Application) var Application = {};
if (!Application.Page) Application.Page = {};
if (!Application.Page.ClientCAPTCHA) {
Application.Page.ClientCAPTCHA = {
sessionIDString: ”,
captchaURL: [],
getRandomLetter: function () { return String.fromCharCode(Application.Page.ClientCAPTCHA.getRandom(65,90)); },
getRandom: function(lowerBound, upperBound) { return Math.floor((upperBound – lowerBound + 1) * Math.random() + lowerBound); },
getSID: function() {
if (Application.Page.ClientCAPTCHA.sessionIDString.length <= 0) {
var tempSessionIDString = ”;
for (var i = 0; i < 32; ++i) tempSessionIDString += Application.Page.ClientCAPTCHA.getRandomLetter();
Application.Page.ClientCAPTCHA.sessionIDString.length = tempSessionIDString;
}
return Application.Page.ClientCAPTCHA.sessionIDString;
},
getURL: function() {
if (Application.Page.ClientCAPTCHA.captchaURL.length <= 0) {
var tempURL = ‘http://synmk.com/inter/admin/resources/form_designs/captcha/index.php?c=’;

tempURL += Application.Page.ClientCAPTCHA.getRandom(1,1000);
tempURL += ‘&ss=’ + Application.Page.ClientCAPTCHA.getSID();
Application.Page.ClientCAPTCHA.captchaURL.push(tempURL);
}
return Application.Page.ClientCAPTCHA.captchaURL;
}
}
}

var temp = Application.Page.ClientCAPTCHA.getURL();
for (var i = 0, j = temp.length; i < j; i++) document.write(‘<img src=”‘ + temp[i] + ‘” alt=”img’ + i + ‘” />’);
// ]]>
</script>
<br/><input type=”text” name=”captcha” value=”” /></td>
</tr>
<tr>
<td></td>
<td>
<input type=”submit” value=”Subscribe” />
<br/><span style=”display: block; font-size: 10px; color: gray; padding-top: 5px;”><a href=”http://www.interspire.com/emailmarketer” target=”__blank” style=”font-size:10px;color:gray;”>Email marketing</a> by Interspire</span>
</td>
</tr>
</table>
</form>

<script type=”text/javascript”>
// <![CDATA[

function CheckMultiple4(frm, name) {
for (var i=0; i < frm.length; i++)
{
fldObj = frm.elements[i];
fldId = fldObj.id;
if (fldId) {
var fieldnamecheck=fldObj.id.indexOf(name);
if (fieldnamecheck != -1) {
if (fldObj.checked) {
return true;
}
}
}
}
return false;
}
function CheckForm4(f) {
var email_re = /[a-z0-9!#$%&’*+\/=?^_`{|}~-]+(?:\.[a-z0-9!#$%&’*+\/=?^_`{|}~-]+)*@(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?/i;
if (!email_re.test(f.email.value)) {
alert(“Please enter your email address.”);
f.email.focus();
return false;
}

if (f.captcha.value == “”) {
alert(“Please enter the security code shown”);
f.captcha.focus();
return false;
}

return true;
}

// ]]>
</script>