document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub18.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=1526002652&formid=3681&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:1526002652:18:3681\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Join Vintage Vixens by UK Banking</div></div> <div class=\"bn-form-desc\"><p>Please fill out the fields below.</p></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Name </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Email Address <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"you must enter a valid email address\" validator=\"email\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Join for how long? </span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-151778096274467\" value=\"Join one month\" checked=\"checked\"> Join one month</label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-151778096274467\" value=\"Join three months\"> Join three months</label></span></span></div></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Preferred username </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-151768683468720\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Preferred password </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-151768686147440\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper ui-sortable-handle\"><label class=\"bn-row\"><span class=\"bn-label\">Comments (Join VV by bank) </span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"\" validator=\"\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"\"> <input type=\"hidden\" name=\"subject\" value=\"\"><div class=\"bn-form-submit\"><button type=\"submit\" class=\"formbtn\">Submit Form</button></div> <style type=\"text/css\">.bnet-form ::-webkit-input-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form ::-moz-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form :-ms-input-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bnet-form :-moz-placeholder {');
document.write('  color:rgba(0,0,0,0.3)!important;');
document.write('}');
document.write('.bn-form-legend, .bn-form-legend div {');
document.write('      font-size:23px;');
document.write('      font-family:Arial, Helvetica, sans-serif;');
document.write('      color:#000000;');
document.write('}');
document.write('.bn-form-desc {');
document.write('	  font-size:15px;');
document.write('    font-family:Arial, Helvetica, sans-serif;');
document.write('    color:#222222;');
document.write('}');
document.write('#the-form, .bnet-form, .form-wrapper, .bn-form-preview, .bn-thankyou-msg {');
document.write('     background-color:#ffffff;');
document.write('}');
document.write('.bn-form-submit .formbtn {');
document.write('	 font-size:15px;');
document.write('      font-family:Arial, Helvetica, sans-serif;');
document.write('      color:#ffffff;');
document.write('      border-radius:7px;');
document.write('      background-color:#474747;');
document.write('}');
document.write('.bn-label {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('}');
document.write('.bn-thankyou-msg, .bn-form-preview {');
document.write('   font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('}');
document.write('.bn-response {');
document.write('  color:#000000;');
document.write('}');
document.write('.bn-input input[type=text], .bn-input textarea {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	border-radius:5px;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('}');
document.write('.bn-select {');
document.write('	border-style:solid;display:inline-block;width:100%;overflow:hidden;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('	border-radius:5px;');
document.write('}');
document.write('.bn-select select {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	background-color:#ffffff;');
document.write('	border:0;');
document.write('}');
document.write('.bn-input label.bn-radio, .bn-input label.bn-checkbox {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('}');
document.write('.bn-radio input, .bn-checkbox input {');
document.write('	font-size:15px;');
document.write('	font-family:Arial, Helvetica, sans-serif;');
document.write('	color:#000000;');
document.write('	border-radius:5px;');
document.write('	border-color:#c4c4c4;');
document.write('	border-width:1px;');
document.write('	background-color:#ffffff;');
document.write('}</style></form>');
document.write('<p style="text-align:center;margin-top: 10px;font-size:12px;"><a href="http://www.bravenet.com" style="text-decoration:underline;">Email Forms by Bravenet</a> | <a href="http://www.bravenet.com/global/abuse.php" style="text-decoration:underline;" target="_blank">Report Abuse (spam, phishing, etc)</a></p>');document.write('<scr' + 'ipt src="//assets.bnidx.com/pixel/proMarket"></scr' + 'ipt>');