訂&nbsp; 購&nbsp; 單</H1>       
<HR>       
<fORM METHOD="POST" action="_vti_bin/shtml.exe/new_page_55.htm" webbot-action="--WEBBOT-SELF--">       
<!--webbot bot="SaveResults" startspan U-File="_private/purchase-1.htm" S-Format="TEXT/TSV"
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B-Email-Label-Fields="TRUE" B-Email-ReplyTo-From-Field="TRUE"
S-Email-ReplyTo="wally" B-Email-Subject-From-Field="FALSE"
S-Email-Subject="訂購單" S-Builtin-Fields
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bot="SaveResults" endspan i-checksum="43374" --><P>
<font size="5"><b>
訂購人資料：</b></font></P>
<bLOCKQUOTE>
<TABLE>
<TR>
<TD ALIGN="right">
<em>姓名</em></TD>
<TD>
<INPUT TYPE=TEXT NAME="Personal_全名" SIZE=18>
</TD>
</TR>
<TR>
<TD ALIGN="right">
<EM>生日</EM></TD>
<TD>
<INPUT TYPE=TEXT NAME="Personal_DateOfBirth" SIZE=8>
</TD>
</TR>
<TR>
<TD ALIGN="right">
<EM>性別</EM></TD>
<TD>
<INPUT TYPE=RADIO NAME="Personal_性別" VALUE="男" CHECKED>
男 <INPUT TYPE=RADIO NAME="Personal_性別" VALUE="女">
女 </TD>
</TR>
<TR>
<TD ALIGN="right">
<EM>身分證號碼</EM></TD>
<TD>
<INPUT TYPE=TEXT NAME="Personal_IDNumber" SIZE=16 MAXLENGTH=16>
</TD>
</TR>
</TABLE>
</BLOCKQUOTE>
<P>
<font size="5"><b>
連絡方式:</b></font></P>
<bLOCKQUOTE>
<TABLE>
<TR>
<TD ALIGN="right">
<EM>聯絡地址</EM></TD>
<TD>
<INPUT TYPE=TEXT NAME="information_地址2" SIZE=42>
</TD>
</TR>
<TR>
<TD ALIGN="right">
<EM>郵遞區號</EM></TD>
<TD>
<INPUT TYPE=TEXT NAME="information_ZipCode" SIZE=12 MAXLENGTH=12>
</TD>
</TR>
<TR>
<TD ALIGN="right">
<EM>辦公室電話</EM></TD>
<TD>
<INPUT TYPE=TEXT NAME="information_WorkPhone" SIZE=25 MAXLENGTH=25>
</TD>
</TR>
<TR>
<TD ALIGN="right">
<EM>住家電話</EM></TD>
<TD>
<INPUT TYPE=TEXT NAME="information_HomePhone" SIZE=25 MAXLENGTH=25>
</TD>
</TR>
<TR>
<TD ALIGN="right">
<em>行動電話</em></TD>
<TD>
<INPUT TYPE=TEXT NAME="information_傳真機" SIZE=25 MAXLENGTH=25>
</TD>
</TR>
<TR>
<TD ALIGN="right">
<EM>電子郵件</EM></TD>
<TD>
<INPUT TYPE=TEXT NAME="information_電子郵件" SIZE=25>
</TD>
</TR>
</TABLE>
</BLOCKQUOTE>
<P></P>
<P><font size="5"><b>複製畫或古典鏡子的編號與訂購數量:</b></font></P>
<bLOCKQUOTE>
<TABLE>
<TR>
<TD>
<strong>&nbsp;&nbsp; 編號</strong></TD> 
<TD> 
<strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 數&nbsp;  
量&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
總金額</strong></TD>     
</TR>     
<TR><TD><INPUT TYPE=TEXT NAME="order_OrderQty0" SIZE=9 MAXLENGTH=6></TD><TD><INPUT TYPE=TEXT NAME="order_訂購內容0" SIZE=14><input type="text" name="T1" size="20"></TD></TR><TR><TD><INPUT TYPE=TEXT NAME="order_OrderQty1" SIZE=9 MAXLENGTH=6></TD><TD><INPUT TYPE=TEXT NAME="order_訂購內容1" SIZE=14><input type="text" name="T2" size="20"></TD></TR><TR><TD><INPUT TYPE=TEXT NAME="order_OrderQty2" SIZE=9 MAXLENGTH=6></TD><TD><INPUT TYPE=TEXT NAME="order_訂購內容2" SIZE=14><input type="text" name="T3" size="20"></TD></TR><TR><TD><INPUT TYPE=TEXT NAME="order_OrderQty3" SIZE=9 MAXLENGTH=6></TD><TD><INPUT TYPE=TEXT NAME="order_訂購內容3" SIZE=14><input type="text" name="T4" size="20"></TD></TR><TR><TD><INPUT TYPE=TEXT NAME="order_OrderQty4" SIZE=9 MAXLENGTH=6></TD><TD><INPUT TYPE=TEXT NAME="order_訂購內容4" SIZE=14><input type="text" name="T5" size="20"></TD></TR><TR><TD><INPUT TYPE=TEXT NAME="order_OrderQty5" SIZE=9 MAXLENGTH=6></TD><TD><INPUT TYPE=TEXT NAME="order_訂購內容5" SIZE=14><input type="text" name="T6" size="20"></TD></TR></TABLE>     
<P>     
</P>     
<TABLE>     
<TR>     
<TD ALIGN="right">     
<em>交貨地址</em></TD>     
<TD>     
<INPUT TYPE=TEXT NAME="order_縣/市" SIZE=46>     
</TD>     
</TR>     
<TR>     
<TD ALIGN="right">     
聯絡電話</TD>     
<TD>     
<INPUT TYPE=TEXT NAME="order_StreetAddress" SIZE=25>     
</TD>     
</TR>     
<TR>     
<TD ALIGN="right">     
<em>行動電話</em></TD>     
<TD>     
<INPUT TYPE=TEXT NAME="order_地址2" SIZE=25>     
</TD>     
</TR>     
<TR>     
<TD ALIGN="right">     
<EM>郵遞區號</EM></TD>     
<TD>     
<INPUT TYPE=TEXT NAME="order_ZipCode" SIZE=12 MAXLENGTH=12>     
</TD>     
</TR>     
</TABLE>     
</BLOCKQUOTE>     
<bLOCKQUOTE>
<P>
<font size="4"><b>
請選擇最佳送貨時間</b></font><select size="1" name="D1">
  <option>上午8:00至12:00</option>
  <option>下午12:00至6:00</option>
  <option>晚上6:00至9:00</option>
</select>
</P>
</BLOCKQUOTE>
<P>
<font size="5"><b>
備註：</b></font> </P>
<bLOCKQUOTE>
<P>
<TEXTAREA NAME="notice" ROWS=5 COLS=35></TEXTAREA>
<bR>
</P>
</BLOCKQUOTE>
<INPUT TYPE=SUBMIT VALUE="送出訂購單">
<INPUT TYPE=RESET VALUE="更改訂購單">        
</FORM>        
<HR>        
<H5>        
製作者資訊。<br>Copyright c 1999 [OrganizationName]. All rights reserved. <bR>        
修訂日期: <!--WEBBOT bot=TimeStamp        
    S-Type="EDITED"        
    S-Format="%B %d, %Y" startspan        
-->March 07, 2001<!--WEBBOT bot=TimeStamp endspan i-checksum="17347"        
--></H5>        
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</HTML>        
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