document.write('<form name="partnerbox0_922158402" method="post" action="http://www.redirecty.fr/Inscription-Partner-17" target="_blank">\n');
document.write('<table bgcolor="#000000" border="0" cellspacing="1" cellpadding="0" align="center"><tr><td>\n');
document.write('<table bgcolor="#ffffff" border="0" align="center" cellpadding="2" cellspacing="0" width=350>\n');
document.write('<tr><td bgcolor="#8090a0" colspan="2" align="center"><font size="2" face="sans-serif" color="#ffffff"><b>\n');
document.write('Votre Nom de Domaine GRATUIT\n');
document.write('</b></font></td></tr>\n');
document.write('<tr><td colspan="2" align="center" bgcolor="#ffffff" style="padding-top:10px;padding-bottom:5px;font-weight:bold;font-family:sans-serif;">\n');
document.write('<span style="color:#9c979b;font-size:18px;">www.</span>\n');
document.write('<input type="text" name="subdomain" id="subdomain" style="padding:1px;font-size:15px;border:1px solid #9c979b;" size="15" maxlength="40" />\n');
document.write('<select name="extension" id="extension" style="padding:1px;font-size:13px;border:1px solid #9c979b;" >\n');
document.write('<option value="1" >wb.st</option>\n');
document.write('<option value="26" >fr.cx</option>\n');
document.write('<option value="31" >team.st</option>\n');
document.write('<option value="29" >03net.net</option>\n');
document.write('</select>\n');
document.write('<input type="image" align="top" style="background:#ffffff;" onclick="document.forms.partnerbox0_922158402.submit();" src="http://img.redirecty.com/valid_nom_domaine_frcx.png" alt="Nom de domaine gratuit" title="Nom de domaine gratuit" />\n');
document.write('</td></tr>\n');
document.write('<tr>\n');
document.write('<td align="center" style="padding-top:3px;"><font color="#000000" size="1" face="sans-serif">\n');
document.write('<a href="http://www.redirecty.fr">Nom de Domaine Gratuit - Redirecty</a>\n');
document.write('</font></td>\n');
document.write('<td bgcolor="#ffffff" align="center"><font size="1" face="sans-serif">\n');
document.write('</font></td>\n');
document.write('</tr>\n');
document.write('</table>\n');
document.write('</td></tr></table>\n');
document.write('</form>\n');