document.write('<div style="padding: 5px 5px 5px 5px;width: 175px;border: 1px solid #dddddd;">');document.write('<form method="get" action="http://LocoBee.com/Google-Listing-Preview.asp?sentby=widget" id="signupform" name="userSignup" target="_blank">');document.write('<input type="hidden" name="reseller" value="LocoBee Widget" />');document.write('<input type="hidden" name="referrer" value="105" />');document.write('<p style="background-color: #ffffEA;color: #660000;font-size: 12px;">Business Owner? See how your business listing could look on Google: ');document.write('<div id="usphone" class="row">');document.write('<div style="font-size: 12px;color: #660000;">');document.write('<label for="phone">Your Business Category:</label>');document.write('</div>');document.write('<div class="input">');document.write('<input name="ybc" id="ybc" class="required" tabindex="1" value="" />');document.write('</div>');document.write('</div>');document.write('<div class="row">');document.write('<div  style="font-size: 12px;color: #660000;">');document.write('<label for="company_name">Company Name:</label>');document.write('</div>');document.write('<div class="input">');document.write('<input name="company" id="company" class="required" type="text" tabindex="4" value=""/>');document.write('</div>');document.write('</div>');document.write('<div class="row">');document.write('<div  style="font-size: 12px;color: #660000;">');document.write('<label for="company_name">City & State:</label>');document.write('</div>');document.write('<div class="input">');document.write('<input name="town" id="town" class="required" type="text" tabindex="4" size="8" style="width: 100px;" />&nbsp; <input name="state" id="state" class="required" type="text" tabindex="4" size="4" style="width: 25px;"/>');document.write('</div>');document.write('</div><br/>');document.write('<input type="submit" class="submitbutton" value="My Google Listing"  tabindex="7"/><br />');document.write('</form></div></div>');