<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=big5">
<meta name="GENERATOR" content="Microsoft FrontPage 4.0">
<meta name="ProgId" content="FrontPage.Editor.Document">
<title>新網頁1</title>
<base target="_blank">
</head>
<body>
<div align="center">
<center>
<table border="0" width="66%">
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<td width="100%" align="center"><a href="http://news98.org/pc/273/3">如您看不到圖片請點選這</a></td>
</tr>
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<td width="100%" align="center"><a href="http://news98.org/pc/273/3/"><img border="0" src="http://news98.org/pc/273/3/3.gif" width="798" height="638"></a></td>
</tr>
<tr>
<td width="100%" align="center">
<div align="left">
<table border="0" width="59%">
<tr>
<td width="100%">
<div align="left">
<table width="35%" border="0">
<tbody>
<tr>
<td width="100%">
<form action="http://kdm.idv.tw/f2m.php?F=1029924159" method="post">
<input type="hidden" value="呆帳" name="SOB">
<div align="center">
<table height="1" borderColorDark="#6699ff" width="595" borderColorLight="#99ccff" border="0">
<tbody>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="1"><font size="2">聯絡姓名</font></td>
<td width="391" bgColor="#eae8e3" height="1"><font size="2"><input size="31" name="聯絡姓名"></font></td>
</tr>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="1"><font size="2">性別</font></td>
<td width="391" 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>
<option value="老師">老師</option>
<option value="主任">主任</option>
<option value="組長">組長</option>
</select></font></td>
</tr>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="1"><font size="2">聯絡電話</font></td>
<td width="391" 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>
</center>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="30">
<p align="right"><font size="2">聯絡地址</font></p>
</td>
<center>
<td width="391" bgColor="#eae8e3" height="30"><font size="2"><input size="31" name="聯絡地址"></font></td>
</tr>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="11"><font size="2">請問您是否有正本</font></td>
<td width="391" bgColor="#eae8e3" height="11"><select name="是否有正本" target="_blank" size="1">
<option value="有">有
<option value="無">無</option>
</select></td>
</tr>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="1"><font size="2">請問您有下列哪種憑據1</font></td>
<td width="391" bgColor="#eae8e3" height="1"><select name="請問您有下列哪種憑據-1" target="_blank" size="1">
<option value="支票" selected>支票
<option value="本票">本票
<option value="借據">借據
<option value="互助會款單">互助會款單</option>
<option value="請款單">請款單</option>
<option value="法院判決書">法院判決書</option>
<option value="法院憑證">法院憑證</option>
<option value="協議書">協議書</option>
<option value="合約書">合約書</option>
<option value="賠償費">賠償費</option>
<option value="其他">其他</option>
</select></td>
</tr>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="1"><font size="2">請問您有下列哪種憑據2</font></td>
<td width="391" bgColor="#eae8e3" height="1"><select name="請問您有下列哪種憑據-2" target="_blank" size="1">
<option value="支票" selected>支票
<option value="本票">本票
<option value="借據">借據
<option value="互助會款單">互助會款單</option>
<option value="請款單">請款單</option>
<option value="法院判決書">法院判決書</option>
<option value="法院憑證">法院憑證</option>
<option value="協議書">協議書</option>
<option value="合約書">合約書</option>
<option value="賠償費">賠償費</option>
<option value="其他">其他</option>
</select></td>
</tr>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="1"><font size="2">請問您要討下列哪種款項</font></td>
<td width="391" bgColor="#eae8e3" height="1"><select name="請問您要討下列哪種款項" target="_blank" size="1">
<option value="私人借款" selected>私人借款
<option value="會款">會款
<option value="貨款">貨款
<option value="賠償費">賠償費</option>
<option value="其他">其他</option>
</select></td>
</tr>
<tr>
<td align="right" width="257" bgColor="#eae8e3" height="1"><font size="2">聯絡</font><font size="2" face="Verdana">Mail</font></td>
<td width="391" bgColor="#eae8e3" height="1"><font size="2"><input size="31" name="聯絡Mail"></font></td>
</tr>
<tr>
<td align="middle" width="566" 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>
</tr>
<tr>
<td align="middle" width="566" colSpan="2" height="12">
<p align="center"><font size="2">收到訊息會儘快為您服務!!</font></p>
</td>
</tr>
</tbody>
</table>
</div>
</form>
</center>
</td>
</tr>
</tbody>
</table>
</div>
</td>
</tr>
</table>
</div>
</td>
</tr>
</table>
</div>
<p align="center"> </p>
</body>
</html>