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 { background-color: #FFFFFF; }\n#flexiform { color: #000000; }\n#flexiform, #flexiform input, #flexiform select, #flexiform textarea\n  {\n  font-family: Arial;\n  font-size: ;\n  }\n\n\n</style>\n<div id=\"flexiform\">\n\n  <p><p>Don\'t worry if you can\'t answer all of the questions below, but the more you can tell us the better we can meet your needs.</p></p>\n\n  <form method=\"post\" action=\"http://forms.flexikit.net/public/javascript_collect/7745165\">\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[61]\" 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[62]\" rows=\"4\" cols=\"30\" /></textarea>\n        \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Telephone no.\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[63]\" 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[64]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Does part of your roof face:\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[66][]\" >\n            \n            <option value=\"South\">South</option>\n            \n            <option value=\"East\">East</option>\n            \n            <option value=\"West\">West</option>\n            \n            <option value=\"SSE\">SSE</option>\n            \n            <option value=\"SSW\">SSW</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Approximately what area of roof is \'southerly\' facing?\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[67]\" size=\"20\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Is the roof overshadowed by trees or other buildings?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[68][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        If Yes, please provide %\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[69]\" size=\"20\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Is there easy access to the roof available for installation of the collector(s)?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[70][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        What is the existing covering of your roof?\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[71]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Do you have you own installer?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[72][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        How many people are there in the household?\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[73]\" size=\"20\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        How many bathrooms?\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[74]\" size=\"20\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        How is your hot water currently heated?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[75][]\" >\n            \n            <option value=\"Gas\">Gas</option>\n            \n            <option value=\"Electric\">Electric</option>\n            \n            <option value=\"Oil\">Oil</option>\n            \n            \n            <option value=\"\" selected>Other, please specify...</option>\n            \n          </select>\n          \n          <div style=\"margin-left: 1em;\">Other <input type=\"text\" name=\"results[75][]\" value=\"\" /></div>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        If you have a boiler what is the make and age?\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[76]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Is your boiler a COMBI?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[77][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        If Yes, which make and model?\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[78]\" size=\"20\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Please specify any existing faults with your heating or hot water system.\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n        \n        \n          <textarea name=\"results[79]\" rows=\"3\" cols=\"20\" /></textarea>\n        \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Do you have a cold water storage tank in the roof?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[80][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        If yes, what is this made of?\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[81]\" size=\"30\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Does this supply water to the hot water cylinder?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[82][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        What material are your water pipes made from:\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[83][]\" >\n            \n            <option value=\"Copper\">Copper</option>\n            \n            <option value=\"Galvanised\">Galvanised</option>\n            \n            <option value=\"Plastic PVC\">Plastic PVC</option>\n            \n            \n            <option value=\"\" selected>Other, please specify...</option>\n            \n          </select>\n          \n          <div style=\"margin-left: 1em;\">Other <input type=\"text\" name=\"results[83][]\" value=\"\" /></div>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Are all your hot and cold water pipes insulated?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[84][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        What is the size of the existing cylinder including insulation and the age?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\">Please state height and width in mm, and the age in years.</div>\n      </dt>\n      <dd>\n        \n        \n        \n          <textarea name=\"results[85]\" rows=\"2\" cols=\"20\" /></textarea>\n        \n        \n        \n      </dd>\n    \n      \n      <dt>\n        What are the measurements of your airing cupboard?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\">Please state width and height in mm.</div>\n      </dt>\n      <dd>\n        \n        \n        \n          <textarea name=\"results[86]\" rows=\"3\" cols=\"30\" /></textarea>\n        \n        \n        \n      </dd>\n    \n      \n      <dt>\n        If you heat water by immersion heater, please state how many\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\">@ 3kW</div>\n      </dt>\n      <dd>\n        \n        \n        \n          <input type=\"text\" name=\"results[87]\" size=\"20\" value=\"\" class=\"flexiform-text\" />\n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        And what is the position in your cylinder?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[88][]\" >\n            \n            <option value=\"Top\">Top</option>\n            \n            <option value=\"Side\">Side</option>\n            \n            <option value=\"Bottom\">Bottom</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Is there a drain-cock connected to the cylinder?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[89][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            <option value=\"Don\'t know\">Don\'t know</option>\n            \n            \n          </select>\n          \n          \n        \n        \n      </dd>\n    \n      \n      <dt>\n        Do you have a thermostat connector wired to a boiler programmer?\n        <div style=\"color: #777; font-weight: normal; font-size: 98%;\"></div>\n      </dt>\n      <dd>\n        \n          \n          \n          \n          \n          <select name=\"results[90][]\" >\n            \n            <option value=\"Yes\">Yes</option>\n            \n            <option value=\"No\">No</option>\n            \n            <option value=\"Don\'t know\">Don\'t know</option>\n            \n            \n          </select>\n          \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          <input type=\"text\" name=\"results[183]\" 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>');