<form method="post" action="http://oi.vresp.com?fid=eee3dcfdce" target="vr_optin_popup" onsubmit="window.open( 'http://www.verticalresponse.com', 'vr_optin_popup', 'scrollbars=yes,width=600,height=450' ); return true;" >

  <div style="font-family: verdana; font-size: 11px; width: 160px; padding: 10px; border: 1px solid #000000; background: #dddddd;">
    <strong><span style="color: #333333;">Inscrivez-vous aujourd'hui !</span></strong>
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    <input name="email_address" size="15" style="margin-top: 5px; margin-bottom: 5px; border: 1px solid #999; padding: 3px;"/>
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    <input type="submit" value="Joignez mainten" style="margin-top: 5px; border: 1px solid #999; padding: 3px;"/><br/>
    <br/><span style="color: #333333"><a href="http://www.verticalresponse.com" title="Email Newsletter by VerticalResponse">Email Newsletter</a> by VerticalResponse</span>
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</form>