code
<style type="text/css">
.CommandButton {
font-size: 14px;
font-weight: bold;
color: #000;
}
.normal10pt {
font-size: 11px;
}
</style><span style="font-size: 13px; text-align: center;">
<table width="280">
<tbody>
<tr>
<td style="text-align: center;"><img alt="" src="http://golkoconsulting.com/portals/0/Images/OMG/Cover_SeptOct_125.png" style="border-width: 0px; border-style: solid;" /> </td>
<td>
<h1 style="text-align: center;">
<p><span style="font-size: 20px;">Get<span style="font-size: 20px;"> </span>Your Free<br />
</span><span style="font-size: 20px;">Online Marketing Guide!<br />
</span><strong><span><span style="font-size: 14px;">EVERY MONTH!</span></span></strong></p>
</h1>
</td>
</tr>
<tr>
<td colspan="2">Each monthly issue is jam-packed with useful information on how to grow your business using inexpensive online methods. Get it for free now!
</td>
</tr>
</tbody>
</table>
<form method="post" action="http://rapidresponsebot.net/subc.php" enctype="multipart/form-data">
<table width="280">
<INPUT TYPE="HIDDEN" name="aid" value="122">
<INPUT TYPE="HIDDEN" name="required" value="lemail,lfname">
<INPUT TYPE="HIDDEN" name="filledfrm" value="mysite.htm">
<tr>
<td><font size="2" face="Arial, Helvetica, sans-serif">First Name:<br></font></td>
<td><font size="2" face="Arial, Helvetica, sans-serif">
<input type="text" name="lfname" size="15">
</font></td>
</tr>
<tr>
<td><font size="2" face="Arial, Helvetica, sans-serif">Primary E-Mail:<br></font></td>
<td><font size="2" face="Arial, Helvetica, sans-serif">
<input name="lemail" type="text" size="15">
</font></td>
</tr>
<tr>
<td colspan="2" align="center"><input name="submit" type="submit" value="Subscribe" class="CommandButton">
</td>
</tr>
<tr>
<td colspan="2" class="normal10pt">
Your email address is safe with us. You can unsubscribe at any time. Get quality information that will help you get more customers.
</td>
</tr>
</table>
</td>
</tr>
</table>
</form>
/code