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<title>立即訂購 貨到再付款</title>
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<form method="post" name="form1" onSubmit="MM_validateForm('姓名','','R','電話','','R','行動','','R','訂購套數','','R','E-MAIL','','R','寄送地址','','R');return document.MM_returnValue" action="http://web.commq.com/ncommq/silva/post_form.asp">
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<table id="Table_01" height="1212" cellSpacing="0" cellPadding="0" width="600" align="center" border="0">
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<div align="center">
<table id="table2" borderColor="#36ba1c" cellSpacing="1" cellPadding="2" width="100%" border="1">
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<td colSpan="4">
<div class="style3" align="center" style5>
<strong>立即訂購 貨到再付款<span class="style4">(完全免加郵資)</span></strong></div>
</td>
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<td width="16%">
<div align="left">
<span class="style5" style1 style2><font size="3">*
姓名：</font></span></div>
</td>
<td width="26%">
<input name="姓名" type="text" id="姓名" size="16"></td>
<td width="17%">
<div align="left">
<span class="style5"><span class="style7">
<font size="3">*</font></span><font size="3"> 電話：</font></span></div>
</td>
<td width="37%">
<input name="電話" type="text" id="電話" size="16"></td>
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<td>
<div align="left">
<span class="style3" style1 style2>* 行動：</span></div>
</td>
<td><input name="行動" type="text" id="行動" size="16"></td>
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<div align="left">
<span class="style3"><font face="新細明體">
<span class="style7">*</span> 訂購套數</font>：</span></div>
</td>
<td><input name="訂購套數" type="text" id="訂購套數" size="16"></td>
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<td>
<div align="left">
<span class="style3" style1 style2>* 收據：</span></div>
</td>
<td colSpan="3"><span class="style3">
<input type="radio" value="請開收據" name="收據"> 請開收據
<input type="radio" CHECKED value="不必開收據" name="收據">
不必開收據</span></td>
</tr>
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<td>
<div align="left">
<span class="style3" style1 style2>* E-MAIL：</span></div>
</td>
<td colSpan="3">
<input name="E-MAIL" type="text" id="E-MAIL" size="60"></td>
</tr>
<tr>
<td height="39">
<div align="left">
<span class="cs style3 style1 style2">
<font face="新細明體">* 寄送地址</font>：</span></div>
</td>
<td colSpan="3" height="39">
<input name="寄送地址" type="text" id="寄送地址" size="60"></td>
</tr>
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<td height="52">
<div align="left">
<span class="style3" style1 style2>* 訂購商品：</span></div>
</td>
<td colSpan="3" height="52"><span class="style1">
<span style="vertical-align: top">品名 </span>
<select id="訂購商品品名" size="4" name="訂購商品品名">
<option value="幼幼套餐(四套)=$1000元">幼幼套餐(四套)=$1000元</option>
<option value="幼幼套餐+嘟嘟系列=$1600元(贈DVD)">
幼幼套餐+嘟嘟系列=$1600元(贈DVD)</option>
<option value="幼幼套餐+鴨鴨蛇哥來了+嘟嘟系列=$1900元(贈DVD+歌本)" selected>
幼幼套餐+嘟嘟系列+鴨鴨蛇哥來了=$1900元(贈DVD+歌本)</option>
<option value="嘟嘟CD1+嘟嘟CD2=$600元 ">嘟嘟CD1+嘟嘟CD2=$600元
</option>
</select> 數量 <font color="#800000" size="2">
<select id="申請項目" size="1" name="數量">
<option value="0">0</option>
<option value="1" selected>1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="10以上">10以上</option>
</select> </font><br>
</span></td>
</tr>
<tr>
<td colSpan="4">
<div align="center">
<span class="style3"><font color="#ff0000">
取消訂閱，請寫入e-mail</font>：
<input id="取消訂閱" size="27" name="取消訂閱"> </span>
</div>
</td>
</tr>
<tr>
<td colSpan="4">
<div align="center">
<input id="送出" type="submit" value="送出" name="送出">
<input id="重設" type="reset" value="重設" name="重設">
</div>
</td>
</tr>
</table>
</div>
</td>
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</table>
</form>
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