document.write( "<img src=\"http://www.site-position.com/captcha/captcha_cache/captcha_c2f980bac79567dd864162b18552b365.png\" alt=\"[image] Please enter code as shown in graphic.\"><br>" );
document.write( "<input type=\"hidden\" name=\"captchaImg\" value=\"c2f980bac79567dd864162b18552b365\"><br>" );
document.write( "<label>Confirmation Code: <input type=\"text\" name=\"captchaAttempt\"></label>" );