document.write("<form METHOD=\'post\' NAME=\'frmSurvey\' action=http://www.webtools4free.com/webSiteSurvey/takeVotes.asp><table cellpadding=2 cellspacing=0 border=0 width=350 bgcolor=WHITE style='color:BLACK;border: solid black 1px' align=center><tr><td><table cellpadding=0 cellspacing=0 border=0 width=350><tr style='font-family:verdana;font-size:13px;color:BLACK'><td><b>Usulan Partai atau Independen</b></td></tr><tr style='font-family:verdana;font-size:13px;color:BLACK'><td>Setujukah Independen?</td></tr></table></td></tr><tr>	<td>		<table cellpadding=0 cellspacing=0 border=0 width=350>		<tr style='font-family:verdana;font-size:13px;color:BLACK'>			<td>				1.&nbsp;<b>Setujukah anda bila Bupati atau Wakilnya berasal dari Independen? </b>			</td>		</tr>		</table><table cellpadding=0 cellspacing=0 border=0 width=350><tr style='font-family:verdana;font-size:12px;color:BLACK' valign=top>	<td width=20>		<input type=radio name=457854 value=922290>	</td>	<td>Setuju	</td></tr><tr style='font-family:verdana;font-size:12px;color:BLACK' valign=top>	<td width=20>		<input type=radio name=457854 value=922291>	</td>	<td>Ragu-ragu	</td></tr><tr style='font-family:verdana;font-size:12px;color:BLACK' valign=top>	<td width=20>		<input type=radio name=457854 value=922292>	</td>	<td>Tidak Setuju	</td></tr></table><hr></td></tr><tr>	<td>		<table cellpadding=0 cellspacing=0 border=0 width=350>		<tr style='font-family:verdana;font-size:13px;color:BLACK'>			<td>				2.&nbsp;<b>Bila Setuju, sebaiknya dari mana?</b>			</td>		</tr>		</table><table cellpadding=0 cellspacing=0 border=0 width=350><tr style='font-family:verdana;font-size:12px;color:BLACK' valign=top>	<td width=20>		<input type=radio name=457855 value=922293>	</td>	<td>Indramayu Barat/Selatan	</td></tr><tr style='font-family:verdana;font-size:12px;color:BLACK' valign=top>	<td width=20>		<input type=radio name=457855 value=922294>	</td>	<td>Indramayu Tengah/Selatan	</td></tr><tr style='font-family:verdana;font-size:12px;color:BLACK' valign=top>	<td width=20>		<input type=radio name=457855 value=922295>	</td>	<td>Indramayu Timur/Selatan	</td></tr></table><hr></td></tr><tr>	<td>		<input type=submit value=VOTE>		<a href=http://www.webtools4free.com/webSiteSurvey/showSurveyResults.asp?surveyID=590210 target=_blank style='font-family:verdana;font-size:12px;color:BLACK'>SHOW RESULTS</a>	</td></tr></table></form>")