document.write('<script type="text/javascript" src="http://alerts.vestamobile.com/Alerts/include/script/client/VMS_validation.js"></script>');

document.write("<div id=\"vms_mobile_signup\">");
document.write("<form action=\"http://alerts.vestamobile.com/Alerts/ALERTSIGNUP_AUTOVALIDATE\" onsubmit=\"return validateOnSubmit(this)\" method=\"post\" name=\"user_login\" >");
document.write("<table border=\"0\" id=\"sc_table\" style=\"font:normal 11px/13px Verdana,Arial,sans-serif;\">");
document.write("<tr><td colspan=\"2\"><p>Get discounts &amp; promotions sent directly to your phone. Std text messaging rates apply. Reply &quot;STOPIMAGE&quot; to opt-out.</></td></tr>");
document.write("<tr><td width=\"50%\">Mobile Phone Number:</td><td width=\"50%\"><input name=\"phone\" id=\"phone\" type=\"text\" maxlength=\"10\"></td></tr>");
document.write("<tr><td width=\"50%\">Select Mobile Carrier:</td><td width=\"50%\"><select id=\"carrier\" name=\"carrier\" >");
document.write("<option value=\"0\">Select Carrier...</option><option value=\"87\">Alltel</option><option value=\"7\">AT&T</option>");
document.write("<option value=\"534\">Boost Mobile</option><option value=\"386\">Cellular South</option><option value=\"557\">Centennial Wireless</option>");
document.write("<option value=\"40\">Cricket</option><option value=\"554\">Farmers Wireless</option><option value=\"66\">Midwest Wireless</option>");
document.write("<option value=\"516\">Metro PCS</option><option value=\"555\">nTelos</option><option value=\"34\">Sprint</option>");
document.write("<option value=\"384\">SunCom Wireless</option><option value=\"79\">T-Mobile</option><option value=\"549\">Union Wireless</option>");
document.write("<option value=\"77\">Verizon Wireless</option><option value=\"525\">Virgin Mobile</option><option value=\"476\">VOCE</option></select></td></tr>");
document.write("<tr style=\"padding-top:15px;\"><td colspan=\"2\" style=\"padding-top:15px\" ><input name=\"accept\" id=\"accept\" type=\"checkbox\" value=\"1\" /><a href=\"\#\" onclick=\"window.open('http://alerts.vestamobile.com/Alerts/webForm_TOS.html','mywindow','width=400,height=300')\">I agree to the terms &amp; conditions</a></td></tr>");
document.write("<tr><td>&nbsp;</td><td><input name=\"submit\" type=\"submit\" value=\" Signup \" class=\"button\"></td>");
document.write("</tr></table>");
document.write("<input id=\"identifier\" name=\"identifier\" type=\"hidden\" value=\"43136253\">");
document.write("<input id=\"group\" name=\"group\" type=\"hidden\" value=\"993\">");
document.write("</form>");
document.write("</div>");