document.write('<form method="POST" action="http://www.mes-lettres-d-information.com/sub2.php">');
document.write('<input type="hidden" name="mc" value="2" />');
document.write('<input type="hidden" name="lc" value="1" />');
document.write('<input type="hidden" name="v" value="b86ea2628c0ce7eabe4081f559abbcbc" />');
document.write('Pr&eacute;nom : <input type="text" name="n" value="" /><br />');
document.write('Email : <input type="text" name="e" value="" /><br />');
document.write('<input type="submit" value="M\'abonner" />');
document.write('</form>');