formCssOverride='<style type="text/css"> .adTagFormContainer {width:726px; height:88px; border:1px solid #003399; background:#ffffff; color:#666666; font-family: Arial, Helvetica, sans-serif; font-size: 11px; padding-bottom:0; position:relative; }'
+ '.adTagFormContainerInner, .adTagFormContainer form { height:88px; }'
+ '.adTagFormContainer select *, .adTagFormContainer select { font-size:11px; }'
+ '.adTagFormContainer select { width:100%; margin:0; margin-top:2px; }'
+ '.adTagFormContainer td { padding:0 8px; font-size:11px; }'
+ '.adTagFormContainer .optional, .adTagFormContainer .zipContainer, .adTagFormContainer .emailContainer { }'
+ '.adTagFormContainer .optional { margin-bottom:6px; margin-top:1px; font-weight:bold; }'
+ '.adTagFormContainer .smallText * { font-weight:bold; font-family:Verdana, Arial, Helvetica, sans-serif; font-size:9px; color:#666666; }'

+ '.adTagFormContainer .required, .adTagFormContainer .optional  { font-weight:bold; font-family:Verdana, Arial, Helvetica, sans-serif; font-size:9px; color:#666666; }'
+ '.adTagFormContainer .optional option { font-weight:normal; }'
+ '.adTagForm { top:0; }'
+ '.adTagFormContainer .error { color:#f00; display:block;  }'

+ '.adTagFormContainer .submitButton { width:81px; font:bold 12px Arial, Helvetica, sans-serif; }'
+ '.adTagFormContainer .submitButtonDisabled { width:81px; font:bold 12px Arial, Helvetica, sans-serif; background:#ffff09; }'
+ '.adTagFormContainer .submitContainer { padding:0;background:#FEC443;margin:0 auto 0 auto; width:91px; height:32px; }'
+ '.adTagFormContainer .submitContainer input { color:#343435; background:#F3F3F3; position:relative; top:5px; left:5px; }'

+ '.adTagFormContainer .zipFieldContent input { width:93px; }'



+ '.searchterm { text-transform:capitalize; }'
+ '.strapline { position:relative; top:2px; font-size:14px; line-height:14px; }'
+ '.headline { position:relative; top:-5px; }'

+ '.adTagFormContainerInner, .adTagForm { padding:0; margin:0; }'

+ '.adTagFormContainer .headlineContainer { width:273px; color:#ffffff; background:#003399 }'
+ '.adTagFormContainer .headlineContainer .headline { margin:0; font-size:24px; font-weight:bold; line-height:24px; text-align:center; padding:0; }'
+ '.adTagFormContainer .mpPoweredBy { position:absolute; bottom:6px; left:140px; text-align:right; color:#ffffff; font-family:Verdana, Arial, Helvetica, sans-serif; font-size:9px; }'
+ '.adTagFormContainer .mpArrows { font-size:36px; color:#FFCD5E; text-align:center; }'

+ '.adTagFormContainer .zipFieldContent input { width:93px; margin:0;}'
+ '.adTagFormContainer .zipFieldContent { width:110px; display:block; }'
+ '.adTagFormContainer .zipFieldContent, .submitContainer { float:left; margin:0; }'
+ '.adTagFormContainer .mpMid_mpRight select { width:200px; }'
+ '.adTagFormContainer .mpMid_mpRight div.optional { position:relative; top:-4px; }'

+ '</style>'
+ '<!--[if IE]>'
+ '<style type="text/css">'
+ '.adTagFormContainer .mpMid_mpRight div.optional { position:relative; top:0px; }'
+ '</style>'
+ '<![endif]-->'

document.write(formCssOverride);

formHtml =	'<form style="margin:0;padding:0;" name=\'default_0\' action="http://www.matchpoint.com:80/mpFormSubmit.htm" target="_new">'

+ '<div class="adTagFormContainerInner" id=defaultform_0>'

+ '<table id="defaulttable_0" class="adTagForm" border="0" cellpadding="0" cellspacing="0" width="100%" height="100%">'
+ '<tr>'
+ '<td class="headlineContainer"><div class="headline"><span class=searchterm>lasik eye surgery</span><br><span class=strapline>Find the best match. Get the best deal.</span></div></td>'



                    




+ '<td class="mpLeft">'
  + '<div id="0_CurrentVision_16Row_0" class="smallText optional">How do you currently correct your vision?<br/><select class=\'mpDropdown\'  id=\'0_CurrentVision_16_0\' name=\'0_CurrentVision_16\'><option value= >Select One</option><option value=\'70\'  > Reading Glasses<option value=\'71\'  > Glasses all the time<option value=\'72\'  > Contact Lenses<option value=\'73\'  > A prior corrective surgery<option value=\'74\'  > Nothing at this time</select></div>'
      + '<div id="1_DesiredTimeframe_15Row_0" class="smallText optional">Desired Timeframe<br/><select class=\'mpDropdown\'  id=\'1_DesiredTimeframe_15_0\' name=\'1_DesiredTimeframe_15\'><option value= >Select One</option><option value=\'65\'  > Immediately<option value=\'66\'  > In 30 days<option value=\'67\'  > In 60 days<option value=\'68\'  > In 90 days<option value=\'69\'  > Sometime this year</select></div>'
        + '</td>'



+ '<td id="2_zipcode_14Row_0" class="mpMid">'
+ '<span class=\'zipFieldContent required\'>ZIP Code<br/><input type=text name=\'2_zipcode_14\' value=\'\' id=\'2_zipcode_14_0\'  onKeyUp="validateZipAndButton(this,\'_0\')"  onFocus="clearMsg(this)"  onBlur="validate(\'http://www.matchpoint.com:80\',\'/fa?state=val\', this, document.forms[\'default_0\'], true, false,\'\',\'ZIP Code is not a valid zip code.\',\'_0\');" ></span>'
+ '</td>'
+ '<td class="mpRight">'
+ '<div class="submitContainer"><input type=button class=\'submitButton\' name=\'submitButton\' value="Search &gt;&gt;&gt;" onClick="javascript:checkRequiredFields(\'default_0\', \'\',\'2_zipcode_14\',\'_0\',\'ZIP Code\');"></div>'
+ '</td>'

+ '</tr>'
+ '</table>'
+ '<span class="mpPoweredBy">powered by <strong>Matchpoint</strong></span>'
+ '</div>'
+ '<input type=\'hidden\' name=suffix value=_0 ><input type=\'hidden\' name=\'tagid\' value=\'6C88CB790D03E81043A4B61F1CECE005\'> <input type=\'hidden\' name=\'searchTerm\' value=\'lasik eye surgery\'> <input type=\'hidden\' name=\'domain\' value=\'www.matchpoint.com\'> <input type=\'hidden\' name=\'lead_id\' value=\'10133099199623508\'> <input type=\'hidden\' name=\'imp_ts\' value=\'1224734982097\'> <input type=\'hidden\' name=\'rand_num\' value=\'0\'> <input type=\'hidden\' name=\'click_id\' value=\'\'> <input type=\'hidden\' name=\'pid\' value=\'\'> <input type=\'hidden\' name=\'t_p\' value=\'1900006209\'> <input type=\'hidden\' name=\'referrer\' value=\'\'> <input type=\'hidden\' name=\'jump\' value=\'\'> <input type=\'hidden\' name=\'mp_x\' value=\'\'> <input type=\'hidden\' name=\'payout_id\' value=\'0\'> <input type=\'hidden\' name=\'pub_placement_id\' value=\'0\'> <input type=\'hidden\' name=\'pub_section_id\' value=\'0\'> <input type=\'hidden\' name=\'opt_name\' value=\'MP.fieldChoice-1.0:leaveOneOut\'> <input type=\'hidden\' name=\'flowexp\' value=\'2021\'> <input type=\'hidden\' name=\'flow\' value=\'22\'> <input type=\'hidden\' name=\'mp_err_msg_type\' value=\'inline\' ><input type=\'hidden\' name=\'mp_color_err_msg\' value=\'ff0000\' ><input type=\'hidden\' name=\'mp_sub_target\' value=\'_new\' ><input type=\'hidden\' name=\'x1\' value=\'\'> <input type=\'hidden\' name=\'x2\' value=\'\'> <input type=\'hidden\' name=\'x3\' value=\'\'> <input type=\'hidden\' name=\'x4\' value=\'\'> '
+ '</form>';






createForm('leadFormDiv_0',formHtml, '_0');
;