0000000000000000
*TopGloob Design*
<div id="mainContentDiv" style="font-family: Calibri; height: 683px; margin: auto auto 69px; padding: 3px 0px 0px; width: 1124px;">
<div id="mainContentHolder" style="height: 530px; margin: 0px; padding: 0px; width: 1124px;">
<div id="BenefitsDiv" style="background-color: #082948; color: white; float: left; font-size: 16px; height: 496px; margin: 0px; padding: 34px 0px 0px 30px; width: 350px;">
<div id="BenefitsHeader" style="color: red; font-size: 24px; font-weight: bold; margin: 0px 0px 28px; padding: 0px;">
0000000000000000</div>
</div>
<div id="formDiv" style="background-image: url(http://lp.usafis.org/newG_LP/Content/themes/base/images/Usafis/UsafisGLP3/bg_form_350x612.png); background-repeat: no-repeat; float: left; height: 576px; margin: -20px 0px 0px; padding: 29px 0px 0px; width: 350px;">
<div id="formDivHeader" style="color: white; font-size: 24px; font-weight: bold; margin: 0px 0px 30px; padding: 0px; text-align: center; width: 350px;">
*TopGloob Design*</div>
<form action="https://payments.usafis.org/Handlers/RegisterHandler.ashx" data-bind="submit: setHiddens" id="form1" method="post" novalidate="novalidate">
<div id="form" style="margin: auto; padding: 0px; width: 256px;">
<div id="formHeader" style="color: red; font-size: 18px; font-weight: bold; margin: 0px 0px 4px 8px; padding: 0px; width: 256px;">
2222222222222</div>
<div id="btn_hover_preload" style="background-attachment: initial; background-clip: initial; background-image: url(http://lp.usafis.org/newG_LP/Content/themes/base/images/Usafis/UsafisGLP3/o_btn_172x42.png); background-origin: initial; background-position: -9999px -9999px; background-repeat: no-repeat; background-size: initial; margin: 0px; padding: 0px;">
</div>
</div>
</form>
</div>
<div id="SmallSeperator" style="background-color: #082948; float: left; height: 530px; margin: 0px 20px 0px 0px; padding: 0px; width: 24px;">
</div>
</div>
</div>
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