document.write('<style>\n#flexiform dt { margin: 0px; padding: 0px; float: none; width: auto; text-align: left; font-weight: bold; }\n#flexiform dd { margin: 0px 0px 0px 0px; padding: 0px; float: none; width: auto; }\n\n\n#flexiform dd { padding: 2px; margin-left: 250px; }\n#flexiform dl { overflow: hidden; }\n#flexiform dt\n{\n  font-weight: normal;\n  float: left;\n  clear:  both;\n  width: 28%;\n  clear: left;\n  padding-top:  0.5em;\n  text-align: left;\n}\n\n#form dd { margin-bottom: 0.5em; }\n#flexiform-submit { margin-left: 250px; value:Submit; }\n\n\n</style>\n<div id=\"flexiform\">\n\n  <p></p>\n\n  <form method=\"post\" action=\"http://forms.flexikit.net/public/javascript_collect/5810055\">\n\n    <dl>\n    \n      \n      <dt>\n        Name*\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <input type=\"text\" name=\"results[275]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Address 1*\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <input type=\"text\" name=\"results[276]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Address 2\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <input type=\"text\" name=\"results[277]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        City/Town*\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <input type=\"text\" name=\"results[278]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Postcode*\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <input type=\"text\" name=\"results[279]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Telephone\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <input type=\"text\" name=\"results[280]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Email*\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <input type=\"text\" name=\"results[281]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Products I am interested in*\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <textarea name=\"results[282]\" rows=\"5\" cols=\"30\" /></textarea>\n        \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Where did you hear about us?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n           \n          \n          \n          <input name=\"results[283][]\" type=\"checkbox\" value=\"Friend\" class=\"flexiform-check\" /> Friend<br />\n          \n          <input name=\"results[283][]\" type=\"checkbox\" value=\"Magazine article\" class=\"flexiform-check\" /> Magazine article<br />\n          \n          <input name=\"results[283][]\" type=\"checkbox\" value=\"Direct mail\" class=\"flexiform-check\" /> Direct mail<br />\n          \n          <input name=\"results[283][]\" type=\"checkbox\" value=\"Advertisement\" class=\"flexiform-check\" /> Advertisement<br />\n          \n          <input name=\"results[283][]\" type=\"checkbox\" value=\"Search engine\" class=\"flexiform-check\" /> Search engine<br />\n          \n          \n          Other <input type=\"text\" name=\"results[283][]\" size=\"25\" value=\"\" />\n          \n          \n        \n      </dd>\n    \n    </dl>\n\n    <p><input type=\"submit\" value=\"Submit Form\" id=\"flexiform-submit\" /></p>\n  </form>\n\n  <p>* required information</p>\n\n</div>');