document.write('<img src="/forms/captcha.php?str=mXuhm2g=&type=1../../forms/print_captcha.php?type=1" align="absmiddle" alt="Captcha" />&nbsp;&nbsp;');
document.write('<label><input name="captchacode" type="text" class="captcha_field_style_forms" placeholder="Enter code" /><span style="display:none;">Captcha</span></label>');
document.write('<input name="captchacodesalt" type="hidden" value="mXuhm2g=" />');