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<br /> <br /> <font face="Arial, Verdana" size="2">Type verification image code (all letters in CAPS):</font><br /> <img src="securimage_show.php"><br /> <input type="text" align="top" name="imagetext" /> <br /> <br /> <input type="submit" name="submit" value="Send Form" /></form> <br><br> <td width="5" height="264" bgcolor="#5B7281" valign="top"></td></tr></table> </div> <div align="center"> <center> <table border="0" width="765" cellspacing="0" cellpadding="0" height="1"> <tr><td width="64" bgcolor="#5A6D7B" height="1"></td><td width="650" bgcolor="#5A6D7B" height="1"> </td></tr> </table> </center> </div> </body>