tag:blogger.com,1999:blog-9430869773944189992011-07-08T11:11:25.833-07:00ORDER FORMzehttp://www.blogger.com/profile/10397943732334422382noreply@blogger.comBlogger11100tag:blogger.com,1999:blog-943086977394418999.post-79147593072717212812008-06-16T23:34:00.001-07:002010-01-26T22:16:02.250-08:00SCROLL DOWN PLEASE<!-- Begin Response-O-Matic Form --><br /><!-- DO NOT EDIT YOUR FORM HERE, PLEASE LOG IN AND EDIT AT RESPONSE-O-MATIC.COM --><br /><form enctype="multipart/form-data" method="post" action="http://www.response-o-matic.com/mail.php" accept-charset="UTF-8"><br /> <div><br /> <input type="hidden" name="acctid" id="acctid" value="vkg8jsf8yetc1nm5" /><br /> <input type="hidden" name="formid" id="formid" value="527761" /><br /> <input type="hidden" name="required_vars" id="required_vars" value="field-0f7c48c7983562b,name,field-54f9520e6f65402,email,field-84af41851671e7c,field-6fbafc4c4dd8266,field-85f29f82bd92f71" /><br /> </div><br /> <table cellspacing="5" cellpadding="5" border="0"><br /> <tr><br /> <td valign="top"><br /> <strong>ORDER DATE</strong><br /> </td><br /> <td valign="top"><br /> <input type="text" name="field-0f7c48c7983562b" id="field-0f7c48c7983562b" size="40" value="" /><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>FULL NAME:</strong><br /> </td><br /> <td valign="top"><br /> <input type="text" name="name" id="name" size="40" value="" /><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>CONTACT NUMBER:</strong><br /> </td><br /> <td valign="top"><br /> <input type="text" name="field-54f9520e6f65402" id="field-54f9520e6f65402" size="40" value="" /><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>EMAIL ADDRESS:</strong><br /> </td><br /> <td valign="top"><br /> <input type="text" name="email" id="email" size="40" value="" /><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>DELIVERY ADDRESS:</strong><br /> </td><br /> <td valign="top"><br /> <textarea name="field-84af41851671e7c" id="field-84af41851671e7c" rows="6" cols="40"></textarea><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>YOUR ORDER(PRODUCT CODE/COLOR/PRICE/QUANTITY): </strong><br /> </td><br /> <td valign="top"><br /> <textarea name="field-6fbafc4c4dd8266" id="field-6fbafc4c4dd8266" rows="6" cols="40"></textarea><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>POSTAGE FEE-CLOTHING:<br /> *EXTRA FEE WILL BE CHARGED ON 3RD ITEM -<br /> 1-2 CHARGE RM2(EACH)<br /> 3-5 CHARGE RM1(EACH)</strong><br /> </td><br /> <td valign="top"><br /> <input type="radio" name="field-084f4867b39f0d3" id="field-084f4867b39f0d3_0" value="WEST M'SIA(1-2ITEMS): RM6" /> WEST M'SIA(1-2ITEMS): RM6<br/><br /> <input type="radio" name="field-084f4867b39f0d3" id="field-084f4867b39f0d3_1" value="EAST M'SIA(1-2ITEMS): RM9" /> EAST M'SIA(1-2ITEMS): RM9<br/><br /> <input type="radio" name="field-084f4867b39f0d3" id="field-084f4867b39f0d3_2" value="FREE SHIPPING(W/M): PURCHASE RM160 AND ABOVE" /> FREE SHIPPING(W/M): PURCHASE RM160 AND ABOVE<br/><br /> <input type="radio" name="field-084f4867b39f0d3" id="field-084f4867b39f0d3_3" value="FREE SHIPPING(E/M): PURCHASE RM180 AND ABOVE" /> FREE SHIPPING(E/M): PURCHASE RM180 AND ABOVE<br/><br /> <input type="radio" name="field-084f4867b39f0d3" id="field-084f4867b39f0d3_4" value="DISCOUNT ITEM" /> DISCOUNT ITEM<br/><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>POSTAGE FEE-HANDBAG: *EXTRA FEE WILL BE CHARGED ON 2ND ITEM</strong><br /> </td><br /> <td valign="top"><br /> <input type="radio" name="field-2133b82e6c0908e" id="field-2133b82e6c0908e_0" value="WEST M'SIA: RM10" /> WEST M'SIA: RM10<br/><br /> <input type="radio" name="field-2133b82e6c0908e" id="field-2133b82e6c0908e_1" value="EAST M'SIA: RM12" /> EAST M'SIA: RM12<br/><br /> <input type="radio" name="field-2133b82e6c0908e" id="field-2133b82e6c0908e_2" value="DISCOUNT ITEM" /> DISCOUNT ITEM<br/><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>DATE OF BIRTH:</strong><br /> </td><br /> <td valign="top"><br /> <input type="text" name="field-85f29f82bd92f71" id="field-85f29f82bd92f71" size="40" value="" /><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td valign="top"><br /> <strong>REMARK:</strong><br /> </td><br /> <td valign="top"><br /> <textarea name="field-24edc2a50bf5210" id="field-24edc2a50bf5210" rows="6" cols="40"></textarea><br /> <br /> </td><br /> </tr><br /> <tr><br /> <td colspan="2" align="center"><br /> <input type="submit" value=" Submit Form " /><br /> </td><br /> </tr><br /> </table><br /></form><br /><br><center><font face="Arial, Helvetica" size="1"><b><br /><a href="http://www.response-o-matic.com">Click here</a> to put a form like this on your site.<br /></b></font></center><br /><!-- End Response-O-Matic Form --><div class="blogger-post-footer"><img width='1' height='1' src='https://blogger.googleusercontent.com/tracker/943086977394418999-7914759307271721281?l=orderprettyclues.blogspot.com' alt='' /></div>zehttp://www.blogger.com/profile/10397943732334422382noreply@blogger.com0