var frag = "<div class='lookup'>\
 <input id='dom' type='text' size='25' />&nbsp;<select id='ext'>\
  <option selected='selected'>.com</option><option>.net</option><option>.org</option><option>.pt</option>\
  <option>.com.pt</option><option>.org.pt</option><option>.info</option><option>.biz</option><option>.tv</option><option>.cc</option>\
  <option>.bz</option><option>.ws</option><option>.co.uk</option><option>.eu</option>\
 </select>\
 <a id='submit_link' href='http://www.dominios.pt/register.aspx?ci=14065' onClick='return doLookup_36f1(this)'>Verificar</a>\
</div>";
document.write(frag);
function doLookup_36f1(sender) {
 var dom=document.getElementById('dom');
 var ext=document.getElementById('ext');
 if (dom) {
  var href='http://www.dominios.pt/register.aspx?ci=14065';
  if (ext)
   href+='&ext='+ext.options[ext.selectedIndex].text;
  href+='&dom='+dom.value; 
  document.location.href=href;
 }  
 else
  return true;   
 return false;
}