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 dt { font-family: Verdana, sans-serif;\n  color: #C2A48B;\nfloat: left;\nwidth: 170px;}\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/9748389\">\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[259]\" 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[499]\" 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[260]\" rows=\"5\" cols=\"35\" /></textarea>\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[261]\" 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>*Required information</p>\n\n</div>');