document.write("<style type='text/css'>");
document.write(".hpo_text_n_header_bg {");
document.write("	color: " + hpo_Header_Text + ";");
document.write("	background-color: " + hpo_Header_Background + ";");
document.write("}");
document.write("b.rtop b, b.rbottom b{");
document.write(" 	background-color: " + hpo_Button_Background + ";");			  
document.write("}");
document.write(".hpo_text_n_button_bg {");
document.write("	background-color: " + hpo_Button_Background + ";");
document.write("	color: " + hpo_Button_Text + ";"); 
document.write("}");
document.write(".hpo_poweredBy {");
document.write("    width: 135px;"); 
document.write("    border-top-color: #ccc;");
document.write("    text-align: center;"); 
document.write("    padding-top:6px;"); 
document.write("    padding-bottom:3px;");
document.write("    text-decoration:none;");
document.write("    font-size: 8px;"); 
document.write("    font-family: Arial;"); 
document.write("    color: #666;");
document.write("}");
document.write(".small_power ");
document.write(" {" );
document.write("	width: 135px; ");
document.write("   text-align: left; ");
document.write("  text-decoration:none; ");
document.write("	} ");
document.write(".simple ");
document.write(" {" );
document.write("  text-decoration:none;");
document.write("   font-size: 8px; ");
document.write("  color: #666;");
document.write("	} ");

document.write("a:visited { ");
document.write("   text-decoration: none; ");
document.write("	} ");
document.write("a:link { ");
document.write("   text-decoration: none; ");
document.write("	} ");
document.write("a:hover  { ");
document.write("   text-decoration: none; ");
document.write("	} ");
document.write("a:active   { ");
document.write("   text-decoration: none; ");
document.write("	} ");

document.write(".linkme a:link { ");
document.write("   text-align: left; ");
document.write("   text-decoration: none; ");
document.write("  font-size: 8px; ");
document.write("  color: black; ");
document.write("	} ");
document.write(".linkme a:visited { ");
document.write("   text-align: left; ");
document.write("   text-decoration: none; ");
document.write("  font-size: 8px; ");
document.write("  color: black; ");
document.write("	} ");
document.write(".linkme a:hover  { ");
document.write("   text-align: left; ");
document.write("   text-decoration: none; ");
document.write("  font-size: 8px; ");
document.write("  color: black; ");
document.write("	} ");
document.write(".linkme a:active   { ");
document.write("font-family: Arial, Helvetica, sans-serif; ");
document.write("   text-align: left; ");
document.write("   text-decoration: none; ");
document.write("  font-size: 8px; ");
document.write("  color: black; ");
document.write("	} ");

document.write("</style>");


    document.write("<div style='width: 135px;border: 1px solid #CCC; text-align:center;'><div class='hpo_text_n_header_bg' style='padding-bottom: 4px; "); 
    document.write("padding-top: 4px;  font-weight: 800; font-size: 17px; font-family: Arial; float: left; width: 135px; text-align: center; "); 
    document.write("margin-bottom: 6px; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: #ccc;'>Medicare Quotes</div>");

    document.write("<div style='color: #666; font-weight: normal; font-size: 12px; font-family: Arial; text-align:right; margin-right: 30px;'>");    
    document.write("<label>Zip: ");
    document.write("<input name='txtZip' type='text' id='txtZip' size='6' maxlength='5' style='text-align:center;'/>");
    document.write("</label></div>");
      
    document.write("<div style='color: #666; font-weight: normal; font-size: 12px; font-family: Arial; padding-top:1px;"); 
    document.write("padding-bottom:1px; text-align:right; margin-right:30px;'>");
    
    document.write("<label>Age: "); 
    document.write("<input name='txtAge' type='text' id='txtAge' size='6' maxlength='3' style='text-align:center;'/>");
    document.write("</label></div>");          
    
    document.write("<div style='color: #666; font-weight: normal; font-size: 12px; font-family: Arial; padding-bottom:2px;'>");
    document.write("  <div align='center'>");
    document.write("    <input type='radio' name='txtGender' value='M'  checked='checked'/>");
    document.write("    <span>Male </span>");
    document.write("    <input type='radio' name='txtGender' value='F' />");
    document.write("    <span>Female </span></div>");
    document.write("</div>");
    
    document.write("<label for='smoker'><span style='text-align: left'></span></label>");
    document.write("<div style='color: #666; font-weight: normal; font-size: 12px; font-family: Arial; text-align:right; margin-right: 33px;'>");
    document.write("	<label for='smoker2'>Tobacco ?");
    document.write("		<input type='checkbox' name='txtAppSmoker' id='txtAppSmoker' />");
    document.write("	</label>");
    document.write("</div>");

document.write(" <div class='hpo_text_n_button_bg' style='width: 90px; margin-left:auto; margin-right:auto; display: block;border: 1px solid #D6D6D6;padding-top:2px;"); 
document.write("font-family:Arial; font-weight:Bold; font-size: 15px; margin-top:6px; margin-bottom:9px; ");
document.write("         display:block; cursor:pointer;' id='hpo_button' onclick='getQuotes();'>");
document.write("<div align='center'>Get Quotes");
document.write("</div>");
document.write("    </div>");