document.write("<tr>");
document.write("<script type=\"text/javascript\" src=\"../scripts/image_verification.js\"></script>");
document.write("<td width=\"40%\" class=\"fieldName\">Please enter verification image symbols<span class=\"required\">*<br /><br />If you can't read verication symbols click <a href=\"#\" onClick=\"this.blur(); new_image_verification(); return false;\">here</a>.</span></td>");
document.write("<td width=\"60%\" class=\"fieldValue\"><img src=\"./../image_verification/image_verification.php\" id=\"image_verification\" style=\"background-color:white; border: solid 1px #000000;\" width=\"279\" height=\"90\" hspace=\"0\" vspace=\"2\" /><br />");
document.write("<input type=\"text\" name=\"img_verification\" maxlength=\"10\" style=\"font-size:11px; width:145px;\" value=\"\" /></td>");
document.write("</tr>");
document.write("<tr><td height=\"1px\" colspan=\"2\" bgcolor=\"#FFFFFF\"></td></tr>");