tag:blogger.com,1999:blog-66817205464184770832024-03-13T06:26:35.333-07:00:: byAnysSyuhada ::ANYS SYUHADAhttp://www.blogger.com/profile/10302486993386243945noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-6681720546418477083.post-44024803836609837522013-02-07T01:30:00.000-08:002013-02-11T19:40:36.490-08:00ORDER FORM<!-- Begin Response-O-Matic Form -->
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<form accept-charset="UTF-8" action="http://www.response-o-matic.com/mail.php" enctype="multipart/form-data" method="post">
<div>
<input id="acctid" name="acctid" type="hidden" value="a6235ni91j32klko" />
<input id="formid" name="formid" type="hidden" value="1163272" />
<input id="required_vars" name="required_vars" type="hidden" value="name,field-721275e55a7971e,field-d4d02aab63fa69a,email,field-a9f158ea4115990" />
</div>
<table border="0" cellpadding="5" cellspacing="5">
<tbody>
<tr>
<td valign="top"><b>NAME :</b>
</td>
<td valign="top"><input id="name" name="name" size="40" type="text" value="" />
</td>
</tr>
<tr>
<td valign="top"><b>FULL ADDRESS WITH POSCODE :</b>
</td>
<td valign="top"><textarea cols="40" id="field-721275e55a7971e" name="field-721275e55a7971e" rows="6"></textarea>
</td>
</tr>
<tr>
<td valign="top"><b>PHONE NUMBER :</b>
</td>
<td valign="top"><input id="field-d4d02aab63fa69a" name="field-d4d02aab63fa69a" size="40" type="text" value="" />
</td>
</tr>
<tr>
<td valign="top"><b>EMAIL ADDRESS (IMPORTANT! ):</b>
</td>
<td valign="top"><input id="email" name="email" size="40" type="text" value="" />
</td>
</tr>
<tr>
<td valign="top"><b>YOUR ORDER ITEMS : (PLEASE STATE IN THIS FORM 1.___ 2.____ 3.____ ( as much as you wish)</b>
</td>
<td valign="top"><textarea cols="40" id="field-a9f158ea4115990" name="field-a9f158ea4115990" rows="6"></textarea>
</td>
</tr>
<tr>
<td valign="top"><b>ALTERNATIVE ORDER :</b>
</td>
<td valign="top"><textarea cols="40" id="field-60495a741ae1cbd" name="field-60495a741ae1cbd" rows="6"></textarea>
</td>
</tr>
<tr>
<td align="center" colspan="2"><input type="submit" value=" Submit Form " />
</td>
</tr>
</tbody></table>
</form>
wELCOME dear customer, sebelum mengisi order form, SILA PASTIKAN :<br /><br />-Anda benar2 pasti tentang order, dilarang sama sekali membuat order palsu<br />-Customer yang tidak membuat bayaran selepas membuat tempahan akan di BLACKLISTED<br />-Sila pastikan segala butir-butir anda LENGKAP untuk memudahkan proses pengeposan barang<br /><br />
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<!-- End Response-O-Matic Form -->ANYS SYUHADAhttp://www.blogger.com/profile/10302486993386243945noreply@blogger.com3