document.write("<form>Website address<br><input type=text name=i1 size=15><br>Birth month (e.g. May)<br><input type=text name=i2 size=15><br>Last 4-digits of your SSN<br><input type='text' name='i3' size='4' maxlength='4'><br>PassPal password<br><input type=password name=i4 size=15><br>Required password length<br><input type=text name=i5 value=8 size=2><br><input type=button value=Convert class='bt' onclick='h.value=c4(i1.value+i2.value+i3.value+i4.value).substring(0,i5.value)'><br>Website password<br><input type='text' name='h' size='20' readonly></form>");