document.write('<div id=\"fleximailer\">\n  \n  <form method=\"post\" action=\"http://mailer.flexikit.net/public/subscribe/6\">\n    Email: \n    <input type=\"text\" name=\"subscriber[email]\" size=\"14\" id=\"flexiform-email\" />\n    \n    \n    <br />\n    <input type=\"checkbox\" name=\"channels[]\" value=\"10\" id=\"channel_10\" />\n    <label for=\"channel_10\">Charity</label>\n    \n    <br />\n    <input type=\"checkbox\" name=\"channels[]\" value=\"11\" id=\"channel_11\" />\n    <label for=\"channel_11\">Customer</label>\n    \n    <br />\n    <input type=\"checkbox\" name=\"channels[]\" value=\"13\" id=\"channel_13\" />\n    <label for=\"channel_13\">Artist</label>\n    \n    <br />\n    <input type=\"checkbox\" name=\"channels[]\" value=\"45\" id=\"channel_45\" />\n    <label for=\"channel_45\">Organisation</label>\n    \n    \n    <p><input type=\"submit\" value=\"Subscribe\" id=\"flexiform-submit\" /></p>\n    <input type=\"hidden\" name=\"url\" value=\"REMOTE_URL\" />\n  </form>\n  \n  <a href=\"#\" onclick=\"window.open(\'http://mailer.flexikit.net/public/options/6\',\'options\',\'width=200,height=300\'); return false;\">Change your subscription options</a>\n</div>'.replace(/REMOTE_URL/i,location.href));