<table border="0" cellspacing="0" cellpadding="1" align="center" bgcolor="#666699">

  <tr align="center">

    <td>

     <style type="text/css">

      <!--

       .button {  font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 8pt}

       .textarea {  font-family: "MS Sans Serif"; font-size: 9pt; width: 195px}

       .input {  width: 195px}

      -->

    </style><font color="#FFFFFF" face="Verdana, Arial, Helvetica, sans-serif" size="2"><b>Send Your Comment</b></font></td>

  </tr>

  <tr>

    <td>

      <table border="0" cellspacing="0" cellpadding="5" align="center" bgcolor="#F3F3F3" width="200">

        <tr>

          <td width="149">

            <form method="post" action="$this->form_forward">

              <table border="0" cellspacing="0" cellpadding="2" bgcolor="" align="center">

                <tr>

                  <td class="td1" height="40"><b><font face="Verdana, Arial, Helvetica, sans-serif" size="1">$question</font></b></td>

                </tr>

                <tr>

                  <td class="td1"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">Name:</font><br>

                    <input type="text" name="name" maxlength="25" class="input" size="23">

                  </td>

                </tr>

                <tr>

                  <td class="td1"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">e-mail:</font><br>

                    <input type="text" name="email" size="23" maxlength="50" class="input">

                  </td>

                </tr>

                <tr>

                  <td class="td1"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">Comment(*):</font><br>

                    <font face="MS Sans Serif" size="1">

                    <textarea name="message" cols="19" wrap="VIRTUAL" rows="6" class="textarea"></textarea>

                    </font>

                  </td>

                </tr>

                <tr valign="top">

                  <td>

                    <input type="submit" value="Submit" class="button">

                    <input type="reset" value="Reset" class="button">

                    <input type="hidden" name="action" value="add">

                    <input type="hidden" name="id" value="$poll_id">

                  </td>

                </tr>

              </table>

            </form>

          </td>

        </tr>

      </table>

    </td>

  </tr>

</table>

