document.write('<div style="border: 1px solid #ccc; background: #fff; width: 300px; min-height: 250px">');
document.write('<div style="padding: 10px; font-family: arial; font-size: 15px; color: #000; background: #eee">Please use the website contact form to give details like search terms, location, etc. Thank you!</div>');
document.write('<div style="padding: 10px; font-family: arial; font-size: 14px; color: #000">');
document.write('<form action="http://www.websitegoodies.com/vote.php" method="post">');
document.write('<input type="hidden" name="id" value="115483">');
        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="928242" /> &nbsp; Search engine results</label></div>');
        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="928243" /> &nbsp; Facebook (seeing a post from a friend counts)</label></div>');
        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="928244" /> &nbsp; Word of mouth other than social media</label></div>');
        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="928245" /> &nbsp; YouTube</label></div>');
        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="928246" /> &nbsp; Flyer</label></div>');
        document.write('<div style="vertical-align: middle; padding: 3px 0"><label style="font-weight: normal"><input type="radio" name="vote" value="928247" /> &nbsp; Something else</label></div>');
document.write('<div align="center" style="margin-top: 10px">');
document.write('<input type="submit" value="Submit My Vote"><br /><br />');
document.write('<a href="http://www.websitegoodies.com/pollresults.php?id=115483" target="_blank">View Results</a>');
document.write('</div>');
document.write('</form>');
document.write('</div>');
document.write('</div>');