document.writeln('<form action="http://www.earth911.org/usa/master.asp" method="post" target="_blank">');
document.writeln('<table cellpadding="0" cellspacing="0" width="275"><tr>');
document.writeln('	<td align="center">');
document.writeln('		<table><tr>');
document.writeln('			<td colspan="2" align="center"><div style="font-family:arial, sans-serif; font-size:10pt; font-weight:bold;">To locate your nearest recycling or Household Hazardous Waste Collection Center, please enter your ZIP Code:</div><br></td>');
document.writeln('		</tr><tr>');
document.writeln('			<td align="right"><input type="Text" name="newpostal" size="7" maxlength="7"></td>');
document.writeln('			<td><input type="Submit" value="Enter"></td>');
document.writeln('		</tr><tr>');
document.writeln('			<td align="center" colspan="2"><img src="http://www.earth911.org/locator/images/phoneurl877.jpg" border="0"></td>');
document.writeln('		</tr><tr>');
document.writeln('			<td align="center" colspan="2"><div style="font-family:arial, sans-serif; font-size:10pt; font-weight:bold;">Making Every Day Earth Day!</div><br></td>');
document.writeln('		</table></td>');
document.writeln('</tr></table>');
document.writeln('</form>');