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<p><img border="0" src="http://i106.photobucket.com/albums/m275/hi2001/EDM-01.jpg" width="769" height="556"><img border="0" src="http://i106.photobucket.com/albums/m275/hi2001/EDM-02.jpg" width="766" height="578"><img border="0" src="http://i106.photobucket.com/albums/m275/hi2001/EDM-03.png" width="768" height="527"><img border="0" src="http://i106.photobucket.com/albums/m275/hi2001/EDM-04.jpg" width="768" height="162"></p>
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<td width="100%">
<form action="http://kdm.idv.tw/f2m.php?F=1029924159" method="post">
<input type="hidden" value="暴力熊2" name="SOB">
<div align="center">
<table height="1" borderColorDark="#6699ff" width="496" borderColorLight="#99ccff" border="0">
<tbody>
<tr>
<td align="center" width="202" bgColor="#eae8e3" height="1"><font size="2">聯絡姓名</font></td>
<td width="347" bgColor="#eae8e3" height="1"><font size="2"><input size="31" name="聯絡姓名"></font></td>
</tr>
<tr>
<td align="center" width="202" bgColor="#eae8e3" height="1"><font size="2">性別</font></td>
<td width="347" bgColor="#eae8e3" height="1"><font size="2"><select id="稱呼" name="稱呼">
<option value=" " selected>請選擇</option>
<option value="先生">先生</option>
<option value="小姐">小姐</option>
</select></font></td>
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<tr>
<td align="center" width="202" bgColor="#eae8e3" height="11"><font size="2">出生年月日</font></td>
<td width="347" bgColor="#eae8e3" height="11"><font size="2"><input size="31" name="出生年月日"></font></td>
</tr>
<tr>
<td align="center" width="202" bgColor="#eae8e3" height="1"><font size="2">目前</font></td>
<td width="347" bgColor="#eae8e3" height="1"><font size="2"><input type="radio" value="在職" name="method">在職.
</font><font size="2"><input type="radio" value="在學" name="method">在</font><font size="2">學.
</font><font size="2"><input type="radio" value="待業" name="method">待業.
</font><font size="2"><input type="radio" value="其他" name="method">其他</font></td>
</tr>
<tr>
<td align="center" width="202" bgColor="#eae8e3" height="1"><font size="2">聯絡電話</font></td>
<td width="347" bgColor="#eae8e3" height="1"><font size="2">市內<input size="27" name="市內"><br>
行動<input size="27" name="行動"></font></td>
</tr>
<tr>
<td align="center" width="202" bgColor="#eae8e3" height="1"><font size="2">聯絡時間</font></td>
<td width="347" bgColor="#eae8e3" height="1"><select name="聯絡時間" target="_blank" size="1">
<option value="都可以" selected>都可以
<option value="上午">上午
<option value="下午">下午
<option value="晚上">晚上</option>
</select></td>
</tr>
<tr>
<td align="center" width="202" bgColor="#eae8e3" height="1"><font size="2">聯絡Mail</font></td>
<td width="347" bgColor="#eae8e3" height="1"><font size="2"><input size="31" name="聯絡Mail"></font></td>
</tr>
<tr>
<td align="center" width="202" bgColor="#eae8e3" height="30">
<p align="center"><font size="2">聯絡地址</font></p>
</td>
<td width="347" bgColor="#eae8e3" height="30"><font size="2"><input size="31" name="聯絡地址"></font></td>
</tr>
<tr>
<td align="middle" width="467" colSpan="2" height="12">
<p align="center"><font size="2"><input type="submit" value="送出留言" name="OK確定">
<input type="reset" value="清除資料" name="清除"></font></p>
</td>
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<tr>
<td align="middle" width="467" colSpan="2" height="12">
<p align="center"><font size="2">收到訊息會有專人儘快為您服務!!</font></p>
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