線上回覆表單 參考範例 main.php

<-html>
<-head>
<-meta http-equiv="Content-Type" content="text/html; charset=big5">
<-title>線上回覆表單 參考範例<-/title>
<-/head>

<-body>
<-table borderColor="#000000" height="44" cellSpacing="0" borderColorDark="#ffffff" cellPadding="0" width="572" align="center" borderColorLight="#000000" border="1">
<-tr bgColor="#ccffff">
<-td width="529" height="21" align="middle" bgcolor="#66CCFF">
<-div align="center"><-font color="#FFFFFF" face="新細明體"><-strong>請填寫 線上回覆表單，將
儘速與您連絡，24h未聯絡請重填再傳送謝謝!<-/strong><-/font><-/div><-/td>
<-/tr>
<-/table>

<-form action="mail.php" method="post" name="report" target="_self" id="report">
<-table borderColor="#000000" height="584" cellSpacing="0" borderColorDark="#ffffff" cellPadding="0" width="572" align="center" borderColorLight="#000000" border="1">
<-tr bgcolor="#66CC66">
<-td height="30" align="right"><-strong><-font color="#000000">中文姓名：<-/font><-/strong><-/td>
<-td height="30">   <-input name="a1" id="a1" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabindex="1" size="14" maxlength="20">
<-font color="#FF0000">  * <-em>(必填項目)<-/em><-/font><-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">英文姓名：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-input name="b1" id="b1" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="2" size="14" maxLength="20">
<-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
性別：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-input tabIndex="3" type="radio" value="男" name="c1">
男  <-input tabIndex="4" type="radio" value="女" name="c1">
女<-font color="#FF0000">  *<-/font><-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
生日：<-/font><-/strong><-/td>
<-td width="414" height="30">  中華民國
<-select name="d1" size="1" id="d1" tabIndex="5">
<-option value selected>請選擇<-/option>
<-option value="76">76<-/option>
<-option value="75">75<-/option>
<-option value="74">74<-/option>
<-option value="73">73<-/option>
<-option value="72">72<-/option>
<-option value="71">71<-/option>
<-option value="70">70<-/option>
<-option value="69">69<-/option>
<-option value="68">68<-/option>
<-option value="67">67<-/option>
<-option value="66">66<-/option>
<-option value="65">65<-/option>
<-option value="64">64<-/option>
<-option value="63">63<-/option>
<-option value="62">62<-/option>
<-option value="61">61<-/option>
<-option value="60">60<-/option>
<-option value="59">59<-/option>
<-option value="58">58<-/option>
<-option value="57">57<-/option>
<-option value="56">56<-/option>
<-option value="55">55<-/option>
<-option value="54">54<-/option>
<-option value="53">53<-/option>
<-option value="52">52<-/option>
<-option value="51">51<-/option>
<-option value="50">50<-/option>
<-option value="49">49<-/option>
<-option value="48">48<-/option>
<-option value="47">47<-/option>
<-option value="46">46<-/option>
<-option value="45">45<-/option>
<-option value="44">44<-/option>
<-option value="43">43<-/option>
<-option value="42">42<-/option>
<-option value="41">41<-/option>
<-option value="40">40<-/option>
<-option value="39">39<-/option>
<-option value="38">38<-/option>
<-option value="37">37<-/option>
<-option value="36">36<-/option>
<-option value="35">35<-/option>
<-option value="34">34<-/option>
<-option value="33">33<-/option>
<-option value="32">32<-/option>
<-option value="其他">其他<-/option>
<-/select>
年
<-select name="d2" size="1" id="d2" tabIndex="6" width="2">
<-option value selected><-/option>
<-option value="1">1<-/option>
<-option value="2">2<-/option>
<-option value="3">3<-/option>
<-option value="4">4<-/option>
<-option value="5">5<-/option>
<-option value="6">6<-/option>
<-option value="7">7<-/option>
<-option value="8">8<-/option>
<-option value="9">9<-/option>
<-option value="10">10<-/option>
<-option value="11">11<-/option>
<-option value="12">12<-/option>
<-/select>
月
<-select name="d3" size="1" id="d3" tabIndex="7" width="2">
<-option value selected><-/option>
<-option value="1">1<-/option>
<-option value="2">2<-/option>
<-option value="3">3<-/option>
<-option value="4">4<-/option>
<-option value="5">5<-/option>
<-option value="6">6<-/option>
<-option value="7">7<-/option>
<-option value="8">8<-/option>
<-option value="9">9<-/option>
<-option value="10">10<-/option>
<-option value="11">11<-/option>
<-option value="12">12<-/option>
<-option value="13">13<-/option>
<-option value="14">14<-/option>
<-option value="15">15<-/option>
<-option value="16">16<-/option>
<-option value="17">17<-/option>
<-option value="18">18<-/option>
<-option value="19">19<-/option>
<-option value="20">20<-/option>
<-option value="21">21<-/option>
<-option value="22">22<-/option>
<-option value="23">23<-/option>
<-option value="24">24<-/option>
<-option value="25">25<-/option>
<-option value="26">26<-/option>
<-option value="27">27<-/option>
<-option value="28">28<-/option>
<-option value="29">29<-/option>
<-option value="30">30<-/option>
<-option value="31">31<-/option>
<-/select>
日 <-font color="#FF0000">*<-/font><-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
星座：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-select name="e1" size="1" id="e1" tabIndex="8">
<-option value selected>請選擇<-/option>
<-option value="牡羊座">牡羊座<-/option>
<-option value="金牛座">金牛座<-/option>
<-option value="雙子座">雙子座<-/option>
<-option value="巨蟹座">巨蟹座<-/option>
<-option value="獅子座">獅子座<-/option>
<-option value="處女座">處女座<-/option>
<-option value="天枰座">天枰座<-/option>
<-option value="天蠍座">天蠍座<-/option>
<-option value="射手座">射手座<-/option>
<-option value="摩羯座">摩羯座<-/option>
<-option value="水瓶座">水瓶座<-/option>
<-option value="雙魚座">雙魚座<-/option>
<-/select> <-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
擁有資源：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-input name="f1" type="checkbox" id="f1" tabIndex="9" value="寬頻">
寬頻  <-input name="f2" type="checkbox" id="f2" tabIndex="10" value="電腦">
電腦  <-input name="f3" type="checkbox" id="f3" tabIndex="11" value="人脈">
人脈  <-input name="f4" type="checkbox" id="f4" tabIndex="12" value="車輛">
車輛 <-font color="#FF0000">*<-/font> (可重覆選填)<-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
婚姻狀況：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-select name="g1" size="1" id="g1" tabIndex="13">
<-option value selected>請選擇<-/option>
<-option>未婚<-/option>
<-option>已婚<-/option>
<-/select> <-font color="#FF0000">  *<-/font>   有無子女:
<-select name="g2" size="1" id="g2" tabIndex="14">
<-option value selected>請選擇<-/option>
<-option>沒有<-/option>
<-option>有<-/option>
<-/select> <-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
目前職業：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-select name="h1" size="1" id="h1" tabIndex="15">
<-option value selected>請選擇<-/option>
<-option>內勤上班族<-/option>
<-option>業務行銷<-/option>
<-option>SOHO族<-/option>
<-option>自己當老板<-/option>
<-option>職業軍人<-/option>
<-option>義務役軍人<-/option>
<-option>家庭主婦<-/option>
<-option>待業中<-/option>
<-option>學生<-/option>
<-option>其他<-/option>
<-/select>
職稱:
<-input name="h2" id="h2" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="16" size="14" maxLength="40">
副業:
<-input name="h3" id="h3" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="17" size="14" maxLength="20">
<-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
行動電話：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-input name="i1" id="i1" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="18" size="14" maxLength="15">
<-font color="#FF0000">  *<-/font> <-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"> <-font color="#000000">白天電話：<-/font><-/td>
<-td width="414" height="30">   <-input name="j1" id="j1" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="19" size="14" maxLength="15">
    <-lselect> 晚上電話:
<-input name="j2" id="j2" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="20" size="14" maxLength="15">
<-/lselect><-font size="3"><-lselect><-/lselect><-/font><-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
兼職動機：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-select name="k1" size="1" id="k1" tabIndex="21">
<-option value selected>請選擇<-/option>
<-option value="找備胎">找備胎<-/option>
<-option value="錢不夠用">錢不夠用<-/option>
<-option value="增加第二份收入">增加第二份收入<-/option>
<-option value="創業當老板">創業當老板<-/option>
<-option value="就是想賺錢">就是想賺錢<-/option>
<-option value="發揮舞台魅力">發揮舞台魅力<-/option>
<-option value="認識朋友">認識朋友<-/option>
<-option value="其他">其他<-/option>
<-/select>     目前了解狀態:
<-select name="k2" size="1" id="k2">
<-option value selected>請選擇<-/option>
<-option value="不太了解">不太了解<-/option>
<-option value="有些認同">有些認同<-/option>
<-option value="請快來電">請快來電<-/option>
<-option value="我要加入">我要加入<-/option>
<-/select> <-font color="#FF0000">  *<-/font><-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
面談時間：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-select name="l1" size="1" id="l1" tabIndex="22">
<-option value selected>請選擇<-/option>
<-option>都可以<-/option>
<-option>星期一<-/option>
<-option>星期二<-/option>
<-option>星期三<-/option>
<-option>星期四<-/option>
<-option>星期五<-/option>
<-option>星期六<-/option>
<-option>星期日<-/option>
<-/select>     面談時段:
<-select name="l2" size="1" id="l2" tabIndex="23">
<-option value selected>請選擇<-/option>
<-option>都可以<-/option>
<-option>上午<-/option>
<-option>中午<-/option>
<-option>下午<-/option>
<-option>傍晚<-/option>
<-option>晚上<-/option>
<-/select> <-font color="#FF0000">  *<-/font> <-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
面談重點：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-select name="m1" size="1" id="m1" tabIndex="24">
<-option value selected>請選擇<-/option>
<-option>我已看懂了解這個事業，我要加入貴團隊，請與我聯絡!<-/option>
<-option>我要實際了解(網際)加(實體)的專業職技請為我展示!<-/option>
<-option>我要實地參觀及研究運作內容請與我接洽!<-/option>
<-option>想與貴網團隊百業結盟或其他合作提案，請與我聯絡。<-/option>
<-option>其他請在詢問或留言:留言<-/option>
<-/select> <-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
電子郵件：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-input name="n1" id="n1" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="25" size="40" maxLength="255">
<-font color="#FF0000">  *<-/font> <-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
郵遞區號：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-input name="o1" id="o1" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="26" size="10" maxLength="10">
<-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
郵遞地址：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-select name="p1" size="1" id="p1" tabIndex="27">
<-option value selected>選擇縣市<-/option>
<-option>基隆市<-/option>
<-option>台北市<-/option>
<-option>台北縣<-/option>
<-option>宜蘭縣<-/option>
<-option>桃園縣<-/option>
<-option>新竹市<-/option>
<-option>新竹縣<-/option>
<-option>苗栗縣<-/option>
<-option>台中市<-/option>
<-option>台中縣<-/option>
<-option>彰化縣<-/option>
<-option>南投縣<-/option>
<-option>嘉義市<-/option>
<-option>嘉義縣<-/option>
<-option>雲林縣<-/option>
<-option>台南市<-/option>
<-option>台南縣<-/option>
<-option>高雄市<-/option>
<-option>高雄縣<-/option>
<-option>澎湖縣<-/option>
<-option>屏東縣<-/option>
<-option>台東縣<-/option>
<-option>花蓮縣<-/option>
<-option>金門縣<-/option>
<-option>連江縣<-/option>
<-option>其他地區<-/option>
<-/select>
<-input name="p2" id="p2" style="BORDER-RIGHT: #0000ff 1px dotted; BORDER-TOP: #0000ff 1px dotted; BORDER-LEFT: #0000ff 1px dotted; BORDER-BOTTOM: #0000ff 1px dotted" tabIndex="28" size="42" maxLength="150">
<-font color="#FF0000">  *<-/font><-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="30" align="right"><-strong><-font color="#000000">
何種方式從事：<-/font><-/strong><-/td>
<-td width="414" height="30">   <-input name="q1" type="checkbox" id="q1" tabIndex="29" value="傳統">
傳統  <-input name="q2" type="checkbox" id="q2" tabIndex="30" value="網路">
網路   <-input name="q3" type="checkbox" id="q3" tabIndex="31" value="傳統加網路">
傳統加網路<-/td>
<-/tr>
<-tr bgcolor="#66CC66">
<-td width="152" height="71"> <-div align="right"><-font color="#000000"><-strong>
詢問或留言：<-/strong><-/font><-/div><-/td>
<-td width="414" height="71"> <-p align="center">
<-textarea name="r1" cols="55" rows="5" wrap="VIRTUAL" id="r1"><-/textarea>
<-/td>
<-/tr>
<-tr bgcolor="#CCCCFF">
<-td height="1" colSpan="2" align="middle"> <-div align="center"> <-font size="2" color="#800080"><-span lang="zh-tw">             
<-/span>  <-/font><-/div>
<-div align="center"> <-font color="#800080">
<-input type="submit" value="確認送出">
<-font size="2">   　　　　 　　          
<-/font>  
<-input type="reset" value="重新輸入">
<-/font><-/div>
<-/td>
<-/tr>
<-/table>
<-/form>
<-/body>
<-/html>