HTML code for "Link Exchange Request" form

<h2>Link Exchange Request</h2>
<script type="text/javascript">
function ValidateForm(frm) {
if (frm.First_Name.value == "") {alert('First name is required.');frm.First_Name.focus();return false;}
if (frm.Last_Name.value == "") {alert('Last name is required.');frm.Last_Name.focus();return false;}
if (frm.Email_Address.value == "") {alert('Email address is required.');frm.Email_Address.focus();return false;}
if (frm.Email_Address.value.indexOf("@") < 1 || frm.Email_Address.value.indexOf(".") < 1) {alert('Please enter a valid email address.');frm.Email_Address.focus();return false;}
if (frm.Reciprocal_URL.value == "") {alert('Reciprocal URL is required.');frm.Reciprocal_URL.focus();return false;}
if (frm.Your_website_URL.value == "") {alert('Your website URL is required.');frm.Your_website_URL.focus();return false;}
if (frm.Title_for_your_entry.value == "") {alert('Title for your entry is required.');frm.Title_for_your_entry.focus();return false;}
if (frm.skip_CaptchaCode.value == "") {alert('Enter security code.');frm.skip_CaptchaCode.focus();return false;}
return true; }
function ReloadCaptchaImage(captchaImageId) {
var obj = document.getElementById(captchaImageId);
var src = '' + obj.src;
obj.src = '';
var date = new Date();
var pos = src.indexOf('&rad=');
if (pos >= 0) { src = src.substr(0, pos); }
obj.src = src + '&rad=' + date.getTime();
return false; }
</script>
<hr />
<form action="https://www.SnapHost.com/captcha/send.aspx" id="ContactUsCaptchaWebForm" method="post" onsubmit="return ValidateForm(this);" target="_top">
<input id="skip_WhereToSend" name="skip_WhereToSend" type="hidden" value="your@email.com" />
<input id="skip_SnapHostID" name="skip_SnapHostID" type="hidden" value="PHQU2XHKLW3G" />
<input id="skip_WhereToReturn" name="skip_WhereToReturn" type="hidden" value="http://www.YourWebsiteAddress.com/ThankYouPage.htm" />
<input id="skip_Subject" name="skip_Subject" type="hidden" value="Link Exchange Request" />
<input id="skip_ShowUsersIp" name="skip_ShowUsersIp" type="hidden" value="1" />
<input id="skip_SendCopyToUser" name="skip_SendCopyToUser" type="hidden" value="1" />
<table border="0" cellpadding="5" cellspacing="0">
<tr>
<td style="width:50%;">
<b>First name *</b><br />
<input name="First_Name" type="text" maxlength="50" style="width:260px;" />
</td>
<td style="width:50%;">
<b>Last name *</b><br />
<input name="Last_Name" type="text" maxlength="50" style="width:260px;" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Email *</b><br />
<input name="Email_Address" type="text" maxlength="100" style="width:535px;" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Reciprocal URL *</b> - where you have placed the link to our website<br />
<input name="Reciprocal_URL" type="text" maxlength="500" style="width:535px;" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Your website URL *</b><br />
<input name="Your_website_URL" type="text" maxlength="500" style="width:535px;" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Title for your entry *</b><br />
<input name="Title_for_your_entry" type="text" maxlength="1000" style="width:535px;" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Your entry description</b><br />
<textarea name="Your_entry_description" rows="5" cols="40" style="width:535px;"></textarea>
</td>
</tr>
<tr>
<td colspan="2">
<b>Comments</b><br />
<textarea name="Comments" rows="4" cols="40" style="width:535px;"></textarea>
</td>
</tr>
</table>
<br />
<div style="text-align:center;">
<table border="0" cellpadding="0" cellspacing="0" style="text-align:center; width:300px; margin:auto;">
<tr><td colspan="2" style="padding-bottom:18px;">
<!-- Please check our ProCaptcha service which is ad-free:
https://www.SnapHost.com/captcha/ProCaptchaOverview.aspx -->
<a href="http://www.snaphost.com/captcha/ReadyForms/SignUpForm.aspx" alt="free online registration form" title="free online registration form">
free online registration form</a></td></tr>
<tr>
<td><i>Enter security code</i></td>
<td>SECURITY CODE</td>
</tr>
<tr>
<td>
<input name="skip_CaptchaCode" type="text" maxlength="6"
style="width:130px; height:28px; font-size:24px; text-align:center;" />
</td>
<td>
<a href="https://www.snaphost.com/captcha/ReadyForms/LinkExchangeRequestForm.aspx"><img id="CaptchaImage" alt="Link Exchange Request Form" title="Link Exchange Request Form"
style="margin-left:20px; border:1px solid #999999;"
src="https://www.SnapHost.com/captcha/CaptchaImage.aspx?id=PHQU2XHKLW3G&ImgType=2" /></a>
<br /><a href="#" onclick="return ReloadCaptchaImage('CaptchaImage');"><span style="font-size:12px;">reload image</span></a>
</td>
</tr>
</table>
<br /><br />
<input name="skip_Submit" type="submit" value="Submit" />
</div>
</form>