document.write( "<img src=\"http://www.site-position.com/captcha/captcha_cache/captcha_2fbac1f85383e4381bf4f43eddbe3b69.png\" alt=\"[image] Please enter code as shown in graphic.\"><br>" );
document.write( "<input type=\"hidden\" name=\"captchaImg\" value=\"2fbac1f85383e4381bf4f43eddbe3b69\"><br>" );
document.write( "<label>Confirmation Code: <input type=\"text\" name=\"captchaAttempt\"></label>" );