<div style="font-family: verdana; font-size: 11px; width:
160px; padding: 10px; border: 1px solid #000000; background:
#dddddd">
<strong><span style="color:
#333333;">Title</span></strong><br/><br/>
<label style="color: #333333;">Email
Address:</label><br/>
<input
name="email_address" size="15" style="margin-top: 5px; border: 1px solid #999;
padding: 3px;"/><br/>
<input type="submit"
value="Join Now" style="margin-top: 5px; border: 1px solid #999; padding:
3px;"/><br/>
<br/><span style="color:
#333333;"><a href="
http://www.verticalresponse.com"
title="Email Marketing by VerticalResponse">Email Marketing</a> by
VerticalResponse</span>
</div>
</form>