tag:blogger.com,1999:blog-28189736213805083082024-03-13T11:51:17.349-07:00Web-Formarieswardrobehttp://www.blogger.com/profile/15768484372396507315noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2818973621380508308.post-15478361473532124142009-05-13T09:00:00.000-07:002009-05-13T09:01:16.092-07:00<form action="http://pub15.bravenet.com/emailfwd/senddata.php" method="post" enctype="multipart/form-data" charset="utf-8"><br /><input type="hidden" value="1283823993" name="usernum"><br /><input type="hidden" value="2" name="cpv"><br /><!-- DO NOT CHANGE OR REMOVE THE 3 TAGS ABOVE THIS COMMENT--><br /><br /><table cellspacing="0" cellpadding="0" align="center" border="0"><br /><tbody><tr><br /><td><h3 style="BORDER-BOTTOM: black 1px solid">Order Form</h3></td><br /></tr><br /><tr><br /><td><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="Name">Name</label><input id="Name" style="WIDTH: 200px" name="Name"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="PhoneNumber">Phone Number:</label><input id="PhoneNumber" style="WIDTH: 200px" name="PhoneNumber"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="AddressLineOne">Address Line 1:</label><input id="AddressLineOne" style="WIDTH: 200px" name="AddressLineOne"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="AddressLineTwo">Address Line 2:</label><input id="AddressLineTwo" style="WIDTH: 200px" name="AddressLineTwo"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="City">City:</label><input id="City" style="WIDTH: 200px" name="City"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="StateProvince">State/Province:</label><input id="StateProvince " style="WIDTH: 200px" name="StateProvince "> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="Country">Country:</label><input id="Country" style="WIDTH: 200px" name="Country"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="ZipPostalCode">Zip/Postal Code:</label><input id="ZipPostalCode" style="WIDTH: 200px" name="ZipPostalCode"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="FirstItemNumber">1. Item Number:</label><input id="FirstItemNumber" style="WIDTH: 200px" name="FirstItemNumber"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="FirstQuantity">1. Quantity:</label><input id="FirstQuantity" style="WIDTH: 200px" name="FirstQuantity"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="SecondItemNumber">2. Item Number:</label><input id="SecondItemNumber" style="WIDTH: 200px" name="SecondItemNumber"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="SecondQuantity">2. Quantity:</label><input id="SecondQuantity" style="WIDTH: 200px" name="SecondQuantity"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="ThirdItemNumber">3. Item Number:</label><input id="ThirdItemNumber" style="WIDTH: 200px" name="ThirdItemNumber"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="ThirdItemQuantity">3. Quantity:</label><input id="ThirdItemQuantity" style="WIDTH: 200px" name="ThirdItemQuantity"> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px">Delivery Instructions:</label><span style="DISPLAY: block; WIDTH: 400px" name="SpecialDeliveryInstructions"><input id="SpecialDeliveryInstructions1checkboxOption" style="BORDER-RIGHT: 0px; BORDER-TOP: 0px; VERTICAL-ALIGN: middle; BORDER-LEFT: 0px; BORDER-BOTTOM: 0px; BACKGROUND-COLOR: transparent" type="checkbox" value="RM8" name="SpecialDeliveryInstructions1"><label for="SpecialDeliveryInstructions1checkboxOption">Poslaju (West Malaysia)</label><input id="SpecialDeliveryInstructions2checkboxOption" style="BORDER-RIGHT: 0px; BORDER-TOP: 0px; VERTICAL-ALIGN: middle; BORDER-LEFT: 0px; BORDER-BOTTOM: 0px; BACKGROUND-COLOR: transparent" type="checkbox" value="RM7" name="SpecialDeliveryInstructions2"><label for="SpecialDeliveryInstructions2checkboxOption">Poslaju (East Malaysia)</label><input id="SpecialDeliveryInstructions3checkboxOption" style="BORDER-RIGHT: 0px; BORDER-TOP: 0px; VERTICAL-ALIGN: middle; BORDER-LEFT: 0px; BORDER-BOTTOM: 0px; BACKGROUND-COLOR: transparent" type="checkbox" value="RM5" name="SpecialDeliveryInstructions3"><label for="SpecialDeliveryInstructions3checkboxOption">Registered Mail (West Malaysia)</label><input id="SpecialDeliveryInstructions4checkboxOption" style="BORDER-RIGHT: 0px; BORDER-TOP: 0px; VERTICAL-ALIGN: middle; BORDER-LEFT: 0px; BORDER-BOTTOM: 0px; BACKGROUND-COLOR: transparent" type="checkbox" value="RM4" name="SpecialDeliveryInstructions4"><label for="SpecialDeliveryInstructions4checkboxOption">Registered Mail (East Malaysia)</label></span> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><label style="FLOAT: left; WIDTH: 140px" for="OtherComments">Other Comments:</label> <textarea id="OtherComments" style="WIDTH: 374px; HEIGHT: 176px" name="OtherComments" rows="1" cols="37" maxlength=""></textarea> <div style="CLEAR: left; HEIGHT: 20px"></div><br /><br /><div style="CLEAR: left; HEIGHT: 10px"></div><br /><br /><br /></td><br /><tr><br /><td align="right"><br /><!-- YOU CAN MODIFY THE TEXT WITHIN VALUE="" TO MODIFY YOUR BUTTON TEXT--><br /><input type="submit" value=" Submit "> <input type="reset" value=" Reset "><br /></td><br /></tr><br /></tbody></table><br /></form>arieswardrobehttp://www.blogger.com/profile/15768484372396507315noreply@blogger.com0