document.writeln("<style type=\"text\/css\">");
document.writeln("<!--");
document.writeln(".STYLE1 {");
document.writeln("	color: #FF0000;");
document.writeln("	font-weight: bold;");
document.writeln("	font-size: 12px;");
document.writeln("}");
document.writeln(".STYLE2 {color: #000000}");
document.writeln("-->");
document.writeln("<\/style>");
document.writeln("<table width=\"320\" height=\"250\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\" background=\"images\/loginbg.gif\" style=\" font-size:14px; color:#FFFFFF\">");
document.writeln("  <form id=\"form1\" name=\"form1\" method=\"get\" action=\"http:\/\/www.han120.com\/tmporder\/xunmazhen.asp\" >");
document.writeln("  <TR>");
document.writeln("    <td colspan=\"3\" align=\"center\" valign=\"bottom\"><span class=\"STYLE1\">");
document.writeln("      <label>");
document.writeln("      <input type=\"hidden\"  name=\"action\" value=\"tuofa\" \/>");
document.writeln("      <\/label>");
document.writeln("    <\/span><\/td>");
document.writeln("  <\/tr>");
document.writeln("  <tr>");
document.writeln("    <td width=\"55\" align=\"right\"><span class=\"STYLE2\">姓名<\/span><\/td>");
document.writeln("    <td width=\"227\" align=\"left\"><label>");
document.writeln("      <input type=\"text\" name=\"name\" \/>");
document.writeln("    <\/label><\/td>");
document.writeln("    <td width=\"68\">&nbsp;<\/td>");
document.writeln("  <\/tr>");
document.writeln("  <tr>");
document.writeln("    <td align=\"right\"><span class=\"STYLE2\">数量<\/span><\/td>");
document.writeln("    <td align=\"left\"><select name=\"place\" size=\"1\">");
document.writeln("      <option value=\"1疗程荨麻疹\">1疗程(8盒)464元:送2盒<\/option>");
document.writeln("      <option value=\"2疗程荨麻疹\">2疗程(16盒)928元:送1疗程<\/option>");

document.writeln("    <\/select>");
document.writeln("      <br \/><\/td>");
document.writeln("    <td><label><\/label><\/td>");
document.writeln("  <\/tr>");
document.writeln("  <tr>");
document.writeln("    <td align=\"right\" valign=\"top\"><span class=\"STYLE2\">详细<br \/>");
document.writeln("      信息<\/span><\/td>");
document.writeln("    <td align=\"center\" valign=\"top\"><textarea name=\"Content\" cols=\"30\" rows=\"4\" >");
document.writeln("地址：");
document.writeln("固定电话：");
document.writeln("移动电话：<\/textarea>");
document.writeln("      <br>");
document.writeln("      <input type=\"submit\" name=\"Submit\" value=\"确定订购了\" \/><\/td><br \/>");
document.writeln("    <td>&nbsp;<\/td>");
document.writeln("  <\/tr>");
document.writeln("  <\/form>");
document.writeln("<\/table>");
document.writeln("")