document.write('<form action="/cgi-bin/hav/poll.pl" method="post" id="sitepoll">');
document.write('<input type="hidden" name="act" value="vote">');
document.write('<h5 style="padding:0 5px;font-size:10px;text-align:center;color:#093E74;margin:0 0 0 0;">Are you looking forward to visiting Haverhill\'s new Cinema Complex?</h5>');

document.write('<p><input type="radio" name="vote" value="0"> Yes</p>');

document.write('<p><input type="radio" name="vote" value="1"> No</p>');

document.write('<p><input type="radio" name="vote" value="2"> Not Bothered</p>');

document.write('<p><button type="submit">Vote</button></p>');
document.write('<p class="gotoresults"><a href="/cgi-bin/hav/poll.pl?act=results">View Results</a></p>');
document.write('</form>');