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From: <todd1635@mochamail.com>
Subject: Fw: Disabled and can't work?            
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Date: Fri, 13 Jul 2001 00:41:26
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<div align="center"><font face="Arial, Helvetica, sans-serif" size="1" color="#000000">You 
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        <div align="center"><font color="#990000" size="3"><b><font color="#000000"> 
          <font size="4">SOCIAL SECURITY DISABILITY INSURANCE REPRESENTATION</font></font></b></font></div>
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                  <p align="center"><b><font color="#990000"><b><font size="5" color="#000000"><br>
                    Free Evaluation</font></b></font></b></p>
                  <p><b><font color="#990000" size="4"><br>
                    Are you, or is someone you know, unable to work because of 
                    a disabling condition?<br>
                    </font></b><b><font color="#990000"><font color="#000000">SSDI 
                    benefits are intended to provide the financial support you 
                    need.</font></font></b> </p>
                  <p><font color="#990000"><b><font size="4">Without expert help, 
                    applying for SSDI benefits can take years.</font><font color="#000000"><br>
                    Statistics show without assistance from a qualified professional, 
                    85% of claims are denied at the first level and 75% are denied 
                    at the appeal level.</font></b> </font></p>
                </DIV>
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                        <div class=homecontent><font color="#990000"><b><font color="#990000" size="4"><b>Our 
                          success rate is over 90%.We help you get the benefits 
                          you deserve and we don't get paid until you receive 
                          your SSDI benefits. </b></font></b></font></div>
                      </td>
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                      <td width="5%" valign="top"><img src="http://1077677838/redcheck.gif" width="20" height="20"></td>
                      <td width="95%"><font color="#990000"><b><font size="4">We 
                        help you complete all your application forms, appeal forms, 
                        questionnaires and we get your medical evidence in order. 
                        </font></b></font></td>
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                      <td width="95%"><font color="#990000" size="4"><b>If your 
                        claim must go before a judge, we will be there with you 
                        to help you through the hearing process. </b></font></td>
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                <blockquote>&nbsp; </blockquote>
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                <DIV class=homecontent> 
                  <p align="center"><font color="#990000"><b> <font size="4" color="#000000">Contact 
                    us, by filling out the form below, for a free <br>
                    evaluation to determine if you qualify for SSDI benefits.</font></b></font></p>
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        <div align="center"><div align="center">
          <table cellspacing=0 bordercolordark=#333300 cellpadding=3 width=625 
bordercolorlight=#ffffcc>
            <tbody> 
            <tr> 
              <td> 
                  <form 
      action="mailto:disable20@n2mail.com?cc=disable11@excite.com&subject=Disabled1" 
      method=post enctype=text/plain>
                    <table width="100%" border="0">
                      <tbody> 
                      <tr> 
                        <td width="45%"> 
                          <div align=right><font size="3" color="#000000" face="Arial, Helvetica, sans-serif"><b>Full 
                            Name:</b></font></div>
                        </td>
                        <td width="55%"> 
                          <input name=Full_Name>
                        </td>
                      </tr>
                      <tr> 
                        <td width="45%"> 
                          <div align=right><font size="3" color="#000000" face="Arial, Helvetica, sans-serif"><b>Email:</b></font></div>
                        </td>
                        <td width="55%"> 
                          <input name=Email_Address>
                        </td>
                      </tr>
                      <tr> 
                        <td width="45%"> 
                          <div align=right><font size="3" color="#000000" face="Arial, Helvetica, sans-serif"><b>Home 
                            Phone:</b></font></div>
                        </td>
                        <td width="55%"> 
                          <input name=HOME_PHONE>
                        </td>
                      </tr>
                      <tr>
                        <td width="45%">
                          <div align="right"><font face="Arial, Helvetica, sans-serif" color="#000000"><b>State:</b></font></div>
                        </td>
                        <td width="55%">
                          <input type="text" name="State">
                        </td>
                      </tr>
                      <tr> 
                        <td width="45%"> 
                          <div align=right><font size="3" color="#000000" face="Arial, Helvetica, sans-serif"><b>Date 
                            Last Worked:</b></font></div>
                        </td>
                        <td width="55%"> 
                          <input name=Date_Last_Worked>
                        </td>
                      </tr>
                      <tr> 
                        <td width="45%"> 
                          <div align=right><font size="3" color="#000000" face="Arial, Helvetica, sans-serif"><b>Your 
                            Disability:</b></font></div>
                        </td>
                        <td width="55%"> 
                          <input name=Disability>
                        </td>
                      </tr>
                      <tr> 
                        <td width="45%"> 
                          <div align="right"><font size="3" color="#000000" face="Arial, Helvetica, sans-serif"><b>Your 
                            Age: </b></font> </div>
                        </td>
                        <td width="55%"> 
                          <input name=Age size="5" maxlength="3">
                        </td>
                      </tr>
                      <tr> 
                        <td width="45%"> 
                          <div align="right"><font size="3" color="#000000" face="Arial, Helvetica, sans-serif"><b>Best 
                            Way to Contact:</b></font></div>
                        </td>
                        <td width="55%"> 
                          <select name="Best_Contact_Method">
                            <option value="Email" selected>Email</option>
                            <option value="Telephone">Telephone</option>
                          </select>
                        </td>
                      </tr>
                      <tr> 
                        <td width="45%" valign="top"> 
                          <div align="right"><font color="#000000"><b><font face="Arial, Helvetica, sans-serif">Comments:</font></b></font></div>
                        </td>
                        <td width="55%"> 
                          <textarea name="textfield" rows="5"></textarea>
                        </td>
                      </tr>
                      </tbody> 
                    </table>
                  <div 
      align=center><br>
                    <input type=submit value="Submit Information" name=submit>
                  </div>
                </form>
              </td>
            </tr>
            </tbody> 
          </table>
          <hr>
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        border=0>
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            <tr align=right> 
              <td width="100%">&nbsp;</td>
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