<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta content="text/html; charset=utf-8" http-equiv="Content-Type">
<title>
ValidClick.net
</title>
<link href="images/999.css" rel="stylesheet" type="text/css">
<link href="favicon.ico" rel="icon" type="image/x-icon">
</head>
<body>
<div class="click_wrapper">
<form method="post">
<div class="logo">
<img src="images/validclick.jpg">
</div>
<div class="text_headline">
<strong>
In order to ensure quality customer service
</strong>
,
<br>
please confirm the following:
</div>
<input name="hash" type="hidden" value="6f553c2501a0aa42d88525462997dd6b">
<input name="url" type="hidden" value="./thankyou.php">
<div class="fields">
<ul>
<li>
<div class="col">
<span class="field_name">
What Site Referred You Here?
</span>
<input class="oneline" id="site" name="site" type="text">
</div>
</li>
<li class="lidark validation">
<div class="col">
<span class="field_name">
</span>
<div class="numbers">
<table align="center" border="0" cellpadding="0" cellspacing="0" width="80">
<tbody>
<tr>
<td width="80">
<img alt="" border="0/" src="http://members.admedia.com/font/f_3.gif">
<img alt="" border="0/" src="http://members.admedia.com/font/f_9.gif">
<img alt="" border="0/" src="http://members.admedia.com/font/f_1.gif">
<img alt="" border="0/" src="http://members.admedia.com/font/f_6.gif">
<img alt="" border="0/" src="http://members.admedia.com/font/f_5.gif">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</li>
<li>
<div class="col">
<span class="field_name">
What Numbers Appear Above?
</span>
<input class="oneline" id="vercode" name="vercode" type="text">
</div>
</li>
<li class="lidark">
<div class="col">
<span class="field_name">
Questions or Comments?
</span>
<textarea class="twoline" cols="45" id="comments" name="comments" rows="5"></textarea>
</div>
</li>
</ul>
<p>
<input class="button" id="button" name="submit" type="submit" value="Submit">
</p>
</div>
</form>
</div>
</body>
</html>