document.write('<form method="post" action="http://insyt.mobi/image/highway.php">Masukkan Teks <span class="grey">(Max 120)</span><br /><input type="text" name="name" maxlength="120" style="width:100%"/><br /><input type="hidden" name="site" value="" /><input type="submit" name="submit" value="Create" /></form>' )