var randomnumber=generateId(7);
var formid=generateId(4);
var referrer=document.referrer;
document.write("<style type=\"text/css\">#af-form-1904694356 .af-body .af-textWrap{width:98%;display:block;float:none;}#af-form-1904694356 .af-body a{color:#880303;text-decoration:underline;font-style:normal;font-weight:normal;}#af-form-1904694356 .af-body input.text, #af-form-1904694356 .af-body textarea{background-color:#FFFFFF;border-color:#919191;border-width:1px;border-style:solid;color:#000000;text-decoration:none;font-style:normal;font-weight:normal;font-size:12px;font-family:Verdana, sans-serif;}#af-form-1904694356 .af-body input.text:focus, #af-form-1904694356 .af-body textarea:focus{background-color:#FFFAD6;border-color:#030303;border-width:1px;border-style:solid;}#af-form-1904694356 .af-body label.previewLabel{display:block;float:none;text-align:left;width:auto;color:#000000;text-decoration:none;font-style:normal;font-weight:normal;font-size:12px;font-family:Verdana, sans-serif;}#af-form-1904694356 .af-body{background-repeat:no-repeat;background-position:top center;background-image:none;color:#000000;font-size:11px;font-family:Verdana, sans-serif;}#af-form-1904694356 .af-header{padding-bottom:22px;padding-right:10px;padding-left:75px;background-color:transparent;background-repeat:no-repeat;background-position:bottom center;background-image:url(\"http://www.lifetimehealthweightloss.com/images/cover.png\");border-width:1px;border-bottom-style:none;border-left-style:none;border-right-style:none;border-top-style:none;color:#880303;font-size:16px;font-family:Verdana, sans-serif;}#af-form-1904694356 .af-quirksMode .bodyText{padding-top:2px;padding-bottom:2px;}#af-form-1904694356 .af-quirksMode{padding-right:8px;padding-left:8px;}#af-form-1904694356 .af-standards .af-element{padding-right:8px;padding-left:8px;}#af-form-1904694356 .bodyText p{margin:1em 0;}#af-form-1904694356 .buttonContainer input.submit{background-color:#c208c2;background-image:url(\"http://www.weightlossforliving.com/wp-content/uploads/2009/12/Free-Kit.jpg\");color:#FFFFFF;text-decoration:none;font-style:normal;font-weight:normal;font-size:12px;font-family:Verdana, sans-serif;}#af-form-1904694356 .buttonContainer input.submit{width:auto;}#af-form-1904694356 .buttonContainer{text-align:center;}#af-form-1904694356 body,#af-form-1904694356 dl,#af-form-1904694356 dt,#af-form-1904694356 dd,#af-form-1904694356 h1,#af-form-1904694356 h2,#af-form-1904694356 h3,#af-form-1904694356 h4,#af-form-1904694356 h5,#af-form-1904694356 h6,#af-form-1904694356 pre,#af-form-1904694356 code,#af-form-1904694356 fieldset,#af-form-1904694356 legend,#af-form-1904694356 blockquote,#af-form-1904694356 th,#af-form-1904694356 td{float:none;color:inherit;position:static;margin:0;padding:0;}#af-form-1904694356 button,#af-form-1904694356 input,#af-form-1904694356 submit,#af-form-1904694356 textarea,#af-form-1904694356 select,#af-form-1904694356 label,#af-form-1904694356 optgroup,#af-form-1904694356 option{float:none;position:static;margin:0;}#af-form-1904694356 div{margin:0;}#af-form-1904694356 fieldset{border:0;}#af-form-1904694356 form,#af-form-1904694356 textarea,.af-form-wrapper,.af-form-close-button,#af-form-1904694356 img{float:none;color:inherit;position:static;background-color:none;border:none;margin:0;padding:0;}#af-form-1904694356 input,#af-form-1904694356 button,#af-form-1904694356 textarea,#af-form-1904694356 select{font-size:100%;}#af-form-1904694356 p{color:inherit;}#af-form-1904694356 select,#af-form-1904694356 label,#af-form-1904694356 optgroup,#af-form-1904694356 option{padding:0;}#af-form-1904694356 table{border-collapse:collapse;border-spacing:0;}#af-form-1904694356 ul,#af-form-1904694356 ol{list-style-image:none;list-style-position:outside;list-style-type:disc;padding-left:40px;}#af-form-1904694356,#af-form-1904694356 .quirksMode{width:176px;}#af-form-1904694356.af-quirksMode{overflow-x:hidden;}#af-form-1904694356{background-color:#FFFFFF;border-color:#9E0F9E;border-width:1px;border-style:solid;}#af-form-1904694356{overflow:auto;}.af-body .af-textWrap{text-align:left;}.af-body input.image{border:none!important;}.af-body input.submit,.af-body input.image,.af-form .af-element input.button{float:none!important;}.af-body input.text{width:100%;float:none;padding:2px!important;}.af-body.af-standards input.submit{padding:4px 12px;}.af-clear{clear:both;}.af-element label{text-align:left;display:block;float:left;}.af-element{padding:5px 0;}.af-form-wrapper{text-indent:0;}.af-form{text-align:left;margin:auto;}.af-header{margin-bottom:0;margin-top:0;padding:10px;}.af-quirksMode .af-element{padding-left:0!important;padding-right:0!important;}.lbl-right .af-element label{text-align:right;}body {}</style><form method=\"post\" class=\"af-form-wrapper\" action=\"hwnd-general-post.php\"  name=\"frmRequest"+formid+"\" onsubmit=\"return checkformright(this);\" ><div style=\"display: none;\"><input type=\"hidden\" name=\"hidreffer\" value=\""+referrer+"\" /><input type=\"hidden\" name=\"redirect\" value=\"http://www.lifetimehealthweightloss.com/healthy-living-weight-loss-kit\" id=\"redirect_6e09b6e7746090e6e6f86049ceaf69ad\" /><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"http://www.lifetimehealthweightloss.com/Healthy_Living/weightlosskit.pdf\" /></div><div id=\"af-form-1904694356\" class=\"af-form\"><div id=\"af-header-1904694356\" class=\"af-header\"><div class=\"bodyText\"><p>&nbsp;</p><p>&nbsp;</p><p>&nbsp;</p></div></div><div id=\"af-body-1904694356\" class=\"af-body af-standards\"><div class=\"af-element\"><div class=\"bodyText\"><p style=\"text-align: center;\"><strong><span style=\"font-size: 12px;\">FREE</span> </strong><span style=\"font-size: 13px;\"><strong>Healthy Living Weight Loss Kit</strong></span></p></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-3650505\">*Name: </label><div class=\"af-textWrap\"><input id=\"awf_field-3650505\" type=\"text\" name=\"name\" class=\"text\" value=\"\"  /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-3650506\">*Email:</label><div class=\"af-textWrap\"><input class=\"text\" id=\"awf_field-3650506\" type=\"text\" name=\"email\" value=''  /></div><div class=\"af-clear\"></div></div><div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-3650507\">*Phone Number:</label><div class=\"af-textWrap\"><input type=\"text\" id=\"awf_field-3650507\" class=\"text\" name=\"Phone\" value='555-555-5555'  onfocus=\" if (this.value == '555-555-5555') { this.value = ''; }\" onblur=\"if (this.value == '') { this.value='555-555-5555';} \" /></div><div class=\"af-clear\"></div></div>                                                                                                                        <!--start captcha-->  <input type=\"hidden\"  name=\"hiddencaptcha\" value=\""+randomnumber+"\"> <input type=\"hidden\"  name=\"hiddencaptchaid\" value=\""+formid+"\"> <div class=\"af-element\"><label class=\"previewLabel\" for=\"awf_field-5544992\">Enter the characters below:*</label><div class=\"af-textWrap\"><input id=\"awf_field-5544992\" type=\"text\" name=\"txtcaptcha\" class=\"text\" value=\"\"  /></div><div class=\"af-clear\"></div></div>           <div class=\"af-element\"><img style=\"float:left; margin-left:30px;\" src=\"/captcha.php?str="+randomnumber+"&strcaptcha="+formid+"\" /><div class=\"af-clear\"></div></div>  <!--end captcha-->                                                                       <div class=\"af-element buttonContainer\"><input name=\"submit\" id=\"af-submit-image-1904694356\" type=\"image\" class=\"image\" style=\"background: none;\"  border=\"0\" src=\"http://www.weightlossforliving.com/wp-content/uploads/2009/12/Free-Kit.jpg\"/><div class=\"af-clear\"></div></div><div class=\"af-element\"><div class=\"bodyText\"><p>*required</p></div><div class=\"af-clear\"></div></div></div></div></form><script type=\"text/javascript\">    <!--    (function() {        var IE = /*@cc_on!@*/false;        if (!IE) { return; }        if (document.compatMode && document.compatMode == 'BackCompat') {            if (document.getElementById(\"af-form-1904694356\")) {                document.getElementById(\"af-form-1904694356\").className = 'af-form af-quirksMode';            }            if (document.getElementById(\"af-body-1904694356\")) {                document.getElementById(\"af-body-1904694356\").className = \"af-body inline af-quirksMode\";            }            if (document.getElementById(\"af-header-1904694356\")) {                document.getElementById(\"af-header-1904694356\").className = \"af-header af-quirksMode\";            }            if (document.getElementById(\"af-footer-1904694356\")) {                document.getElementById(\"af-footer-1904694356\").className = \"af-footer af-quirksMode\";            }        }    })();    --></script>");


function checkformright(frmrequest){
	
	if(trim(frmrequest.name.value)==""){
		alert("Please enter name");	
		frmrequest.name.focus();
		return false;
	}
	
	if(trim(frmrequest.email.value)==""){
		alert("Please enter email");	
		frmrequest.email.focus();
		return false;
	}
	
	if(trim(frmrequest.Phone.value)=="" || trim(frmrequest.Phone.value)=="555-555-5555"){
		alert("Please enter phone");	
		frmrequest.Phone.focus();
		return false;
	}
	
	var bval=true;
	
	bval=emailCheck(trim(frmrequest.email.value));
	if(bval){
		bval=PhoneCheck(trim(frmrequest.Phone.value));
	}
	
	if(bval && frmrequest.txtcaptcha.value!=frmrequest.hiddencaptcha.value) {
	 	alert("Please type characters properly");
		bval=false;
	 }
	
	return bval;
	
}

function emailCheck(emailStr) {
	var emailPat=/^(.+)@(.+)$/
	var matchArray;	
	
	if(emailStr.length > 1)	{  	  	
		matchArray = emailStr.match(emailPat);
		if (matchArray == null){
			alert("Please Enter Correct Email Address"); 
			return false;
		}else{
			return true;
		}  		
	}				
}

function PhoneCheck(strPhone){  	  		  	  		
	strPhone=strPhone.replace(/[^0-9]/g, ''); 
	//if(strPhone.length
	if(strPhone.length!=10){
		alert("Invalid Phone Number");
		return false;
	}
	return true;	  	  	
}

function trim(stringToTrim) {
	return stringToTrim.replace(/^\s+|\s+$/g,"");
}

<!--Code for captcha-->
function generateId(varlength){	
	var id="";
	var rnd;
	var type;
	for(i=0; i<varlength; i++){
		rnd=getRandomInt(0,1)? Chr(getRandomInt(48, 57)) : Chr(getRandomInt(97, 122))
		id=id + String(rnd);										
	}	
	return id;
}

function Asc(String){
	return String.charCodeAt(0);
}

function Chr(AsciiNum){
	return String.fromCharCode(AsciiNum);
}

function getRandomInt (min, max) { 
    return Math.floor(Math.random() * (max - min + 1)) + min; 
} 
<!--Code for captcha-->