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document.write('<table border=0 width=150 bgcolor=#FFFFFF cellspacing=0 cellpadding=2>');
document.write('<tr><td colspan=2><font face="Verdana" size=-1 color="#000000"><b>How Many Pets Do You Have In Your Home?</b></td></tr>');
document.write('<tr><td width=5><input type=radio name=answer value=1></td><td><font face="Verdana" size=-1 color="#000000">1</td></tr>');
document.write('<tr><td width=5><input type=radio name=answer value=2></td><td><font face="Verdana" size=-1 color="#000000">2</td></tr>');
document.write('<tr><td width=5><input type=radio name=answer value=3></td><td><font face="Verdana" size=-1 color="#000000">3-5</td></tr>');
document.write('<tr><td width=5><input type=radio name=answer value=4></td><td><font face="Verdana" size=-1 color="#000000">5 or more</td></tr>');
document.write('<tr><td width=5><input type=radio name=answer value=5></td><td><font face="Verdana" size=-1 color="#000000">more than I can count</td></tr>');
document.write('<tr><td width=5><input type=radio name=answer value=6></td><td><font face="Verdana" size=-1 color="#000000">not enough</td></tr>');
document.write('<tr><td colspan=2>');
document.write('<input type=hidden name=username value="petlover1902">');
document.write('<input type=hidden name=poll value="1171314082">');
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document.write('<input type=hidden name=bars value="Assorted">');
document.write('<center><input type=submit value=Vote>');
document.write('</center>');
document.write('</td></tr>');
document.write('<tr><td bgcolor=#FFFFFF colspan=2 align=right><font face="Verdana" size=-2 color="#000000"><a href=http://www.pollhost.com/><font color=#000099>Free polls from Pollhost.com</font></a></td></tr>');
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