tag:blogger.com,1999:blog-67772615610813180122024-03-12T18:16:59.463-07:00The Hijabi DollRina Hamidhttp://www.blogger.com/profile/09324137582205593487noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-6777261561081318012.post-50173618465843992522012-10-06T04:18:00.001-07:002012-10-06T04:36:25.009-07:00Order FormSalam, kindly fill up the form for orders.
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<br />
<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="a3labr2y43183hnd" />
<input id="formid" name="formid" type="hidden" value="1130887" />
<input id="required_vars" name="required_vars" type="hidden" value="name,email,field-eee498b511b55ae,field-9a76224bef70e3f,field-1f52b6c7e910b3e,field-37f44dcc64164ef,field-cf485f1f469281d" />
</div>
<table border="0" cellpadding="5" cellspacing="5">
<tbody>
<tr>
<td valign="top"><strong>Name:</strong>
</td>
<td valign="top"><input id="name" name="name" size="40" type="text" value="" />
</td>
</tr>
<tr>
<td valign="top"><strong>Email Address:</strong>
</td>
<td valign="top"><input id="email" name="email" size="40" type="text" value="" />
</td>
</tr>
<tr>
<td valign="top"><strong>Contact Number:</strong>
</td>
<td valign="top"><input id="field-eee498b511b55ae" name="field-eee498b511b55ae" size="40" type="text" value="" />
</td>
</tr>
<tr>
<td valign="top"><strong>Delivery Address:</strong>
</td>
<td valign="top"><textarea cols="40" id="field-9a76224bef70e3f" name="field-9a76224bef70e3f" rows="6"></textarea>
</td>
</tr>
<tr>
<td valign="top"><strong>Product Code / Quantity:</strong>
</td>
<td valign="top"><textarea cols="40" id="field-1f52b6c7e910b3e" name="field-1f52b6c7e910b3e" rows="6"></textarea>
</td>
</tr>
<tr>
<td valign="top"><strong>Delivery Method:</strong>
</td>
<td valign="top"><input id="field-37f44dcc64164ef_0" name="field-37f44dcc64164ef" type="radio" value="Pos Laju (Semenanjung Only)" /> Pos Laju (Semenanjung Only)<br />
<input id="field-37f44dcc64164ef_1" name="field-37f44dcc64164ef" type="radio" value="Pos Laju (Sabah/Sarawak)" /> Pos Laju (Sabah/Sarawak)</td>
</tr>
<tr>
<td valign="top"><strong>Payment Method:</strong>
</td>
<td valign="top"><input id="field-cf485f1f469281d_0" name="field-cf485f1f469281d" type="radio" value="Maybank2U.com" /> Maybank2U.com<br />
<input id="field-cf485f1f469281d_1" name="field-cf485f1f469281d" type="radio" value="Maybank Cash Deposit" /> Maybank Cash Deposit<br />
<input id="field-cf485f1f469281d_2" name="field-cf485f1f469281d" type="radio" value="CiMB Clicks" /> CiMB Clicks<br />
<input id="field-cf485f1f469281d_3" name="field-cf485f1f469281d" type="radio" value="CiMB Cash Deposit" /> CiMB Cash Deposit<br />
<input id="field-cf485f1f469281d_4" name="field-cf485f1f469281d" type="radio" value="Interbank Transfer (Other Banks)" /> Interbank Transfer (Other Banks)</td>
</tr>
<tr>
<td align="center" colspan="2"><input type="submit" value=" Submit Form " />
</td>
</tr>
</tbody></table>
</form>
<br />
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Rina Hamidhttp://www.blogger.com/profile/09324137582205593487noreply@blogger.com0