Template:Sandbox4
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|- | width = 50% style="background:gray; color:white;" | {{{1}}} | width = 50% |{{{3}}}
1 - Title 2 - Choice # 3 - Default choice 4 to 13: Choices 1 to 10
|- | width = 50% style="background:gray; color:white;" | {{{1}}} | width = 50% |{{{3}}}
1 - Title 2 - Choice # 3 - Default choice 4 to 13: Choices 1 to 10