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\nform{line-height:2em;}\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/7562070\">\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[524]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Address\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <textarea name=\"results[525]\" rows=\"5\" cols=\"30\" /></textarea>\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[526]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Telephone Number\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[527]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Mobile Number\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[528]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Email Address\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[529]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Do you have a specific pub in mind?\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[530]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Features you would like:\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n           \n          \n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"In a town  	 \" class=\"flexiform-check\" /> In a town  	 <br />\n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"In the country\" class=\"flexiform-check\" /> In the country<br />\n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"By the coast 	\" class=\"flexiform-check\" /> By the coast 	<br />\n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"Bar meals 	\" class=\"flexiform-check\" /> Bar meals 	<br />\n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"Restaurant/Dining room\" class=\"flexiform-check\" /> Restaurant/Dining room<br />\n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"Parking 	\" class=\"flexiform-check\" /> Parking 	<br />\n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"Garden/Courtyard 	\" class=\"flexiform-check\" /> Garden/Courtyard 	<br />\n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"Children welcome\" class=\"flexiform-check\" /> Children welcome<br />\n          \n          <input name=\"results[531][]\" type=\"checkbox\" value=\"Accommodation \" class=\"flexiform-check\" /> Accommodation <br />\n          \n          \n          \n        \n      </dd>\n    \n      \n      <dt>\n        Date you would be available to take over\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[532]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\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></p>\n\n</div>');