tag:blogger.com,1999:blog-70500153906747356182024-02-20T17:16:06.648-08:00Pembelian OnlineFaidzal aka Apaihttp://www.blogger.com/profile/10921198136053203349noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-7050015390674735618.post-67577853700810552432011-01-19T08:10:00.000-08:002011-04-05T05:30:15.662-07:00Agro Fast Forward Enterprise<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/KjiDcBb9ZXb" name="emf-form"><table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="#8FC63D"><tr> <td style="" colspan="2"><br />
<font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">BORANG TEMPAHAN PEMBELIAN</b><br />
<br />
<label style="font-size:15px;">Selamat Datang ke Menu Tempahan Agro Fast Forward Enterprise.<br />
</label><br />
</font><br />
</td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Nama</b></font> <span style="color:red;"><small>*</small></span><br />
</td> <td style=""><br />
<input id="element_0" name="element_0" value="" size="30" class="validate[required]" type="text" /><br />
<div style="padding-bottom:8px;color:#000000;"></div></td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Telephone</b></font> <span style="color:red;"><small>*</small></span><br />
</td> <td style=""><br />
<input id="element_1" name="element_1" class="validate[required,custom[onlyNumber]]" value="" size="15" type="text" /><br />
<div style="padding-bottom:8px;color:#000000;"></div></td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Email</b></font> <span style="color:red;"><small>*</small></span><br />
</td> <td style=""><br />
<input id="element_2" name="element_2" class="validate[required,custom[email]]" value="" size="30" type="text" /><br />
<div style="padding-bottom:8px;color:#000000;"></div></td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Alamat<br />
<br />
Penghantaran</b></font> <span style="color:red;"><small>*</small></span><br />
</td> <td style=""><br />
<table cellpadding='0' cellspacing='0' border='0' width='100%'><tr> <td colspan='2' style='padding-left:0;'><br />
<input value='' type='text' style='width:99%;' id='element_3_1' name='element_3[]' class='validate[required]' /><br />
<br />
<font face="Verdana" size="2" color="#000000">Alamat Baris 1</font><br />
</td> </tr>
<tr> <td colspan='2' style='padding-left:0;'><br />
<input value='' type='text' style='width:99%;' id='element_3_2' name='element_3[]' class='validate[optional]' /><br />
<br />
<font face="Verdana" size="2" color="#000000">Alamat Baris 2</font><br />
</td> </tr>
<tr> <td style='width:50%;padding-left:0;'><br />
<input value='' type='text' style='width:99%;' id='element_3_3' name='element_3[]' class='validate[required]' /><br />
<br />
<font face="Verdana" size="2" color="#000000">Bandar</font><br />
</td> <td style='width:50%;padding-left:5px;'><br />
<input value='' type='text' style='width:99%;' id='element_3_4' name='element_3[]' class='validate[required]' /><br />
<br />
<font face="Verdana" size="2" color="#000000">Negeri</font><br />
</td> </tr>
<tr> <td style='width:50%;padding-left:0;'><br />
<input value='' type='text' style='width:99%;' id='element_3_5' name='element_3[]' class='validate[required]' /><br />
<br />
<font face="Verdana" size="2" color="#000000">Poskod</font><br />
</td> <td style='width:50%;padding-left:5px;'><br />
<select style='width:100%;' id='element_3_6' name='element_3[]' class='validate[required]'><br />
<optgroup label="North America"><br />
<option value="Antigua and Barbuda"><br />
Antigua and Barbuda<br />
</option><br />
<option value="Aruba,Bahamas"><br />
Aruba,Bahamas<br />
</option><br />
<option value="Barbados"><br />
Barbados<br />
</option><br />
<option value="Belize"><br />
Belize<br />
</option><br />
<option value="Canada"><br />
Canada<br />
</option><br />
<option value="Cook Islands"><br />
Cook Islands<br />
</option><br />
<option value="Costa Rica"><br />
Costa Rica<br />
</option><br />
<option value="Cuba"><br />
Cuba<br />
</option><br />
<option value="Dominica"><br />
Dominica<br />
</option><br />
<option value="Dominican Republic"><br />
Dominican Republic<br />
</option><br />
<option value="El Salvador"><br />
El Salvador<br />
</option><br />
<option value="Grenada"><br />
Grenada<br />
</option><br />
<option value="Guatemala"><br />
Guatemala<br />
</option><br />
<option value="Haiti"><br />
Haiti<br />
</option><br />
<option value="Honduras"><br />
Honduras<br />
</option><br />
<option value="Jamaica"><br />
Jamaica<br />
</option><br />
<option value="Mexico"><br />
Mexico<br />
</option><br />
<option value="Netherlands Antilles"><br />
Netherlands Antilles<br />
</option><br />
<option value="Nicaragua"><br />
Nicaragua<br />
</option><br />
<option value="Panama "><br />
Panama<br />
</option><br />
<option value="Puerto Rico "><br />
Puerto Rico<br />
</option><br />
<option value="Saint Kitts and Nevis"><br />
Saint Kitts and Nevis<br />
</option><br />
<option value="Saint Lucia"><br />
Saint Lucia<br />
</option><br />
<option value="Saint Vincent and the Grenadines"><br />
Saint Vincent and the Grenadines<br />
</option><br />
<option value="Trinidad and Tobago"><br />
Trinidad and Tobago<br />
</option><br />
<option value="United States"><br />
United States<br />
</option><br />
</optgroup><br />
<optgroup label="South America"><br />
<option value="Argentina"><br />
Argentina<br />
</option><br />
<option value="Bolivia"><br />
Bolivia<br />
</option><br />
<option value="Brazil"><br />
Brazil<br />
</option><br />
<option value="Chile"><br />
Chile<br />
</option><br />
<option value="Colombia"><br />
Colombia<br />
</option><br />
<option value="Ecuador"><br />
Ecuador<br />
</option><br />
<option value="Guyana"><br />
Guyana<br />
</option><br />
<option value="Paraguay"><br />
Paraguay<br />
</option><br />
<option value="Peru"><br />
Peru<br />
</option><br />
<option value="Suriname"><br />
Suriname<br />
</option><br />
<option value="Uruguay"><br />
Uruguay<br />
</option><br />
<option value="Venezuela"><br />
Venezuela<br />
</option><br />
</optgroup><br />
<optgroup label="Europe"><br />
<option value="Albania"><br />
Albania<br />
</option><br />
<option value="Andorra"><br />
Andorra<br />
</option><br />
<option value="Armenia"><br />
Armenia<br />
</option><br />
<option value="Austria"><br />
Austria<br />
</option><br />
<option value="Azerbaijan"><br />
Azerbaijan<br />
</option><br />
<option value="Belarus"><br />
Belarus<br />
</option><br />
<option value="Belgium"><br />
Belgium<br />
</option><br />
<option value="Bosnia and Herzegovina"><br />
Bosnia and Herzegovina<br />
</option><br />
<option value="Bulgaria"><br />
Bulgaria<br />
</option><br />
<option value="Croatia"><br />
Croatia<br />
</option><br />
<option value="Cyprus"><br />
Cyprus<br />
</option><br />
<option value="Czech Republic"><br />
Czech Republic<br />
</option><br />
<option value="Denmark"><br />
Denmark<br />
</option><br />
<option value="Estonia"><br />
Estonia<br />
</option><br />
<option value="Faroe Islands"><br />
Faroe Islands<br />
</option><br />
<option value="Finland"><br />
Finland<br />
</option><br />
<option value="France"><br />
France<br />
</option><br />
<option value="Georgia"><br />
Georgia<br />
</option><br />
<option value="Germany"><br />
Germany<br />
</option><br />
<option value="Greece"><br />
Greece<br />
</option><br />
<option value="Hungary"><br />
Hungary<br />
</option><br />
<option value="Iceland"><br />
Iceland<br />
</option><br />
<option value="Ireland"><br />
Ireland<br />
</option><br />
<option value="Italy"><br />
Italy<br />
</option><br />
<option value="Latvia"><br />
Latvia<br />
</option><br />
<option value="Liechtenstein"><br />
Liechtenstein<br />
</option><br />
<option value="Lithuania"><br />
Lithuania<br />
</option><br />
<option value="Luxembourg"><br />
Luxembourg<br />
</option><br />
<option value="Macedonia"><br />
Macedonia<br />
</option><br />
<option value="Malta"><br />
Malta<br />
</option><br />
<option value="Moldova"><br />
Moldova<br />
</option><br />
<option value="Monaco"><br />
Monaco<br />
</option><br />
<option value="Montenegro"><br />
Montenegro<br />
</option><br />
<option value="Netherlands"><br />
Netherlands<br />
</option><br />
<option value="Norway"><br />
Norway<br />
</option><br />
<option value="Poland"><br />
Poland<br />
</option><br />
<option value="Portugal"><br />
Portugal<br />
</option><br />
<option value="Romania"><br />
Romania<br />
</option><br />
<option value="San Marino"><br />
San Marino<br />
</option><br />
<option value="Serbia"><br />
Serbia<br />
</option><br />
<option value="Slovakia"><br />
Slovakia<br />
</option><br />
<option value="Slovenia"><br />
Slovenia<br />
</option><br />
<option value="Spain"><br />
Spain<br />
</option><br />
<option value="Sweden"><br />
Sweden<br />
</option><br />
<option value="Switzerland"><br />
Switzerland<br />
</option><br />
<option value="Ukraine"><br />
Ukraine<br />
</option><br />
<option value="United Kingdom"><br />
United Kingdom<br />
</option><br />
<option value="Vatican City"><br />
Vatican City<br />
</option><br />
</optgroup><br />
<optgroup label="Asia"><br />
<option value="Afghanistan"><br />
Afghanistan<br />
</option><br />
<option value="Bahrain"><br />
Bahrain<br />
</option><br />
<option value="Bangladesh"><br />
Bangladesh<br />
</option><br />
<option value="Bhutan"><br />
Bhutan<br />
</option><br />
<option value="Brunei Darussalam"><br />
Brunei Darussalam<br />
</option><br />
<option value="Myanmar"><br />
Myanmar<br />
</option><br />
<option value="Cambodia"><br />
Cambodia<br />
</option><br />
<option value="China"><br />
China<br />
</option><br />
<option value="East Timor"><br />
East Timor<br />
</option><br />
<option value="Hong Kong"><br />
Hong Kong<br />
</option><br />
<option value="India"><br />
India<br />
</option><br />
<option value="Indonesia"><br />
Indonesia<br />
</option><br />
<option value="Iran"><br />
Iran<br />
</option><br />
<option value="Iraq"><br />
Iraq<br />
</option><br />
<option value="Israel"><br />
Israel<br />
</option><br />
<option value="Japan"><br />
Japan<br />
</option><br />
<option value="Jordan"><br />
Jordan<br />
</option><br />
<option value="Kazakhstan"><br />
Kazakhstan<br />
</option><br />
<option value="North Korea"><br />
North Korea<br />
</option><br />
<option value="South Korea"><br />
South Korea<br />
</option><br />
<option value="Kuwait"><br />
Kuwait<br />
</option><br />
<option value="Kyrgyzstan"><br />
Kyrgyzstan<br />
</option><br />
<option value="Laos"><br />
Laos<br />
</option><br />
<option value="Lebanon"><br />
Lebanon<br />
</option><br />
<option value="Malaysia" selected="selected"><br />
Malaysia<br />
</option><br />
<option value="Maldives"><br />
Maldives<br />
</option><br />
<option value="Mongolia"><br />
Mongolia<br />
</option><br />
<option value="Nepal"><br />
Nepal<br />
</option><br />
<option value="Oman"><br />
Oman<br />
</option><br />
<option value="Pakistan"><br />
Pakistan<br />
</option><br />
<option value="Palestine"><br />
Palestine<br />
</option><br />
<option value="Philippines"><br />
Philippines<br />
</option><br />
<option value="Qatar"><br />
Qatar<br />
</option><br />
<option value="Russia"><br />
Russia<br />
</option><br />
<option value="Saudi Arabia"><br />
Saudi Arabia<br />
</option><br />
<option value="Singapore"><br />
Singapore<br />
</option><br />
<option value="Sri Lanka"><br />
Sri Lanka<br />
</option><br />
<option value="Syria"><br />
Syria<br />
</option><br />
<option value="Taiwan"><br />
Taiwan<br />
</option><br />
<option value="Tajikistan"><br />
Tajikistan<br />
</option><br />
<option value="Thailand"><br />
Thailand<br />
</option><br />
<option value="Turkey"><br />
Turkey<br />
</option><br />
<option value="Turkmenistan"><br />
Turkmenistan<br />
</option><br />
<option value="United Arab Emirates"><br />
United Arab Emirates<br />
</option><br />
<option value="Uzbekistan"><br />
Uzbekistan<br />
</option><br />
<option value="Vietnam"><br />
Vietnam<br />
</option><br />
<option value="Yemen"><br />
Yemen<br />
</option><br />
</optgroup><br />
<optgroup label="Oceania"><br />
<option value="Australia"><br />
Australia<br />
</option><br />
<option value="Fiji"><br />
Fiji<br />
</option><br />
<option value="Kiribati"><br />
Kiribati<br />
</option><br />
<option value="Marshall Islands"><br />
Marshall Islands<br />
</option><br />
<option value="Micronesia"><br />
Micronesia<br />
</option><br />
<option value="Nauru"><br />
Nauru<br />
</option><br />
<option value="New Zealand"><br />
New Zealand<br />
</option><br />
<option value="Palau"><br />
Palau<br />
</option><br />
<option value="Papua New Guinea"><br />
Papua New Guinea<br />
</option><br />
<option value="Samoa"><br />
Samoa<br />
</option><br />
<option value="Solomon Islands"><br />
Solomon Islands<br />
</option><br />
<option value="Tonga"><br />
Tonga<br />
</option><br />
<option value="Tuvalu"><br />
Tuvalu<br />
</option><br />
<option value="Vanuatu"><br />
Vanuatu<br />
</option><br />
</optgroup><br />
<optgroup label="Africa"><br />
<option value="Algeria"><br />
Algeria<br />
</option><br />
<option value="Angola"><br />
Angola<br />
</option><br />
<option value="Benin"><br />
Benin<br />
</option><br />
<option value="Botswana"><br />
Botswana<br />
</option><br />
<option value="Burkina Faso"><br />
Burkina Faso<br />
</option><br />
<option value="Burundi"><br />
Burundi<br />
</option><br />
<option value="Cameroon"><br />
Cameroon<br />
</option><br />
<option value="Cape Verde"><br />
Cape Verde<br />
</option><br />
<option value="Central African Republic"><br />
Central African Republic<br />
</option><br />
<option value="Chad"><br />
Chad<br />
</option><br />
<option value="Comoros"><br />
Comoros<br />
</option><br />
<option value="Democratic Republic of the Congo"><br />
Democratic Republic of the Congo<br />
</option><br />
<option value="Republic of the Congo"><br />
Republic of the Congo<br />
</option><br />
<option value="Djibouti"><br />
Djibouti<br />
</option><br />
<option value="Egypt"><br />
Egypt<br />
</option><br />
<option value="Equatorial Guinea"><br />
Equatorial Guinea<br />
</option><br />
<option value="Eritrea"><br />
Eritrea<br />
</option><br />
<option value="Ethiopia"><br />
Ethiopia<br />
</option><br />
<option value="Gabon"><br />
Gabon<br />
</option><br />
<option value="Gambia"><br />
Gambia<br />
</option><br />
<option value="Ghana"><br />
Ghana<br />
</option><br />
<option value="Gibraltar"><br />
Gibraltar<br />
</option><br />
<option value="Guinea"><br />
Guinea<br />
</option><br />
<option value="Guinea-Bissau"><br />
Guinea-Bissau<br />
</option><br />
<option value="Cote d'Ivoire"><br />
Cote d'Ivoire<br />
</option><br />
<option value="Kenya"><br />
Kenya<br />
</option><br />
<option value="Lesotho"><br />
Lesotho<br />
</option><br />
<option value="Liberia"><br />
Liberia<br />
</option><br />
<option value="Libya"><br />
Libya<br />
</option><br />
<option value="Madagascar"><br />
Madagascar<br />
</option><br />
<option value="Malawi"><br />
Malawi<br />
</option><br />
<option value="Mali"><br />
Mali<br />
</option><br />
<option value="Mauritania"><br />
Mauritania<br />
</option><br />
<option value="Mauritius"><br />
Mauritius<br />
</option><br />
<option value="Morocco"><br />
Morocco<br />
</option><br />
<option value="Mozambique"><br />
Mozambique<br />
</option><br />
<option value="Namibia"><br />
Namibia<br />
</option><br />
<option value="Niger"><br />
Niger<br />
</option><br />
<option value="Nigeria"><br />
Nigeria<br />
</option><br />
<option value="Rwanda"><br />
Rwanda<br />
</option><br />
<option value="Sao Tome and Principe"><br />
Sao Tome and Principe<br />
</option><br />
<option value="Senegal"><br />
Senegal<br />
</option><br />
<option value="Seychelles"><br />
Seychelles<br />
</option><br />
<option value="Sierra Leone"><br />
Sierra Leone<br />
</option><br />
<option value="Somalia"><br />
Somalia<br />
</option><br />
<option value="South Africa"><br />
South Africa<br />
</option><br />
<option value="Sudan"><br />
Sudan<br />
</option><br />
<option value="Swaziland"><br />
Swaziland<br />
</option><br />
<option value="United Republic of Tanzania"><br />
United Republic of Tanzania<br />
</option><br />
<option value="Togo"><br />
Togo<br />
</option><br />
<option value="Tunisia"><br />
Tunisia<br />
</option><br />
<option value="Uganda"><br />
Uganda<br />
</option><br />
<option value="Zambia"><br />
Zambia<br />
</option><br />
<option value="Zimbabwe"><br />
Zimbabwe<br />
</option><br />
</optgroup><br />
</select><br />
<br />
<font face="Verdana" size="2" color="#000000">Negara</font><br />
</td> </tr>
</table><div style="padding-bottom:8px;color:#000000;"></div></td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Produk Tempahan</b></font> <span style="color:red;"><small>*</small></span><br />
</td> <td style=""><br />
<select id="element_4" name="element_4" class="validate[required]"><br />
<option value="" selected="selected"><br />
Pilih Produk (Harga termasuk pos)<br />
</option><br />
<option value="DVD Fertigasi - RM100 Sem/Sbh/Swk"><br />
DVD Fertigasi - RM100 Sem/Sbh/Swk<br />
</option><br />
<option value="Set 10-DIY - RM180 Sem"><br />
Set 10-DIY - RM180 Sem<br />
</option><br />
<option value="Set 10 DIY - RM200 Sbh/Swk"><br />
Set 10 DIY - RM200 Sbh/Swk<br />
</option><br />
<option value="Set 20-DIY - RM220 Sem"><br />
Set 20-DIY - RM220 Sem<br />
</option><br />
<option value="Set 20-DIY - RM250 Sbh/Swk"><br />
Set 20-DIY - RM250 Sbh/Swk<br />
</option><br />
<option value="Lain-Sila nyatakan di bawah"><br />
Lain-Sila nyatakan di bawah<br />
</option><br />
</select><br />
<div style="padding-bottom:8px;color:#000000;"></div></td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Bank Pilihan Anda</b></font> <span style="color:red;"><small>*</small></span><br />
</td> <td style=""><br />
<div style="width:100%;padding-bottom:5px;"><input id="element_5_0" name="element_5[]" value="Maybank 566010-103586 Mohd Faidzal Abu" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color=
"#000000"> Maybank 566010-103586 Mohd Faidzal Abu </font><br />
</div><div style="width:100%;padding-bottom:5px;"><input id="element_5_1" name="element_5[]" value="CIMB 1601-0001-0250-58 Mohd Faidzal Abu" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color=
"#000000"> CIMB 1601-0001-0250-58 Mohd Faidzal Abu </font><br />
</div><div style="width:100%;padding-bottom:5px;"><input id="element_5_2" name="element_5[]" value="Paypal ID soho699@yahoo.com.my" class="validate[required]" type="checkbox" /><font face="Verdana" size="2" color="#000000"> Paypal ID<br />
soho699@yahoo.com.my </font><br />
</div><div style="clear:both;"></div><div style="padding-bottom:8px;color:#000000;"></div></td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Arahan Bayaran<br />
<br />
(Online)</b></font><br />
</td> <td style=""><br />
<textarea id="element_6" name="element_6" cols="45" rows="8" class="validate[optional,length[0,400]]"><br />
Sila lakukan pembayaran ke bank pilihan anda dengan segera. Penghantaran akan dilakukan dalam tempoh 1-2 hari setelah pengesahan bayaran diterima. Sila masukkan emel agrofastforward@yahoo.com.my di ruangan -Recipient Email- semasa membuat bayaran.<br />
</textarea><br />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Sila baca arahan bayaran ini sebelum membuat bayaran</font></small><br />
</div></td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Arahan Bayaran<br />
<br />
(ATM/Kaunter)</b></font><br />
</td> <td style=""><br />
<textarea id="element_7" name="element_7" cols="45" rows="7" class="validate[optional,length[0,400]]"><br />
Sekiranya anda memilih untuk membayar melalui mesin ATM atau kaunter, sila SMS maklumat bayaran seperti Nama Anda, Produk, Jumlah, Tarikh dan Waktu Bayaran ke 017-2388381 sejurus bayaran dibuat.<br />
</textarea><br />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Sila baca arahan bayaran ini sebelum membuat bayaran</font></small><br />
</div></td> </tr>
<tr valign="top"> <td style="" align="left"><br />
<font face="Verdana" size="2" color="#000000"><b>Maklumat Tambahan</b></font><br />
</td> <td style=""><br />
<textarea id="element_8" name="element_8" cols="40" rows="10" class="validate[optional]"><br />
</textarea><br />
<div style="padding-bottom:8px;color:#000000;"></div></td> </tr>
<tr> <td colspan="2"><br />
<table cellpadding="5" cellspacing="0" bgcolor="#EBEBEB" width="100%"><tr bgcolor="#197B30"> <td colspan="2"><br />
<font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font><br />
</td> </tr>
<tr> <td style="padding:2px; width:100px;"><br />
<img id="captcha_image" src="http://www.emailmeform.com/builder/captcha/index/8c0004b9787ef696044e4efa71e267ed" alt="captcha" name="captcha_image" /><br />
</td> <td valign="top"><br />
<div><font color="#000000">Please enter the text from the image</font>:<br />
<br />
<input type="text" id="captcha_code" name="captcha_code" maxlength="10" size="10" class="validate[required,funcCall[valid_captcha]]" /> [<a id="captcha_code_refresh" href=
"javascript:void(0);" onclick="document.getElementById('captcha_image').src = 'http://www.emailmeform.com/builder/captcha/index/'+Math.random();get_valid_captcha();return false;"
name="captcha_code_refresh">Refresh Image</a>] [<a id="captcha_code_about" href="javascript:void(0);" onclick=
"window.open('http://www.emailmeform.com/captcha-instruction.html','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;" name=
"captcha_code_about">What's This?</a>]<br />
</div></td> </tr>
</table></td> </tr>
<tr> <td colspan="2" align="center"><br />
<input name="element_counts" value="9" type="hidden" /> <input name="embed" value="forms" type="hidden" /><input value="HANTAR" type="submit" /><br />
</td> </tr>
</table></form><div><font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src=
"http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF</font> <a style="text-decoration:none;" href="http://www.emailmeform.com"
target="_blank"><font face="Verdana" size="2" color="#000000">Online Form Builder</font></a><br />
</div><a style="line-height:20px;font-size:70%;text-decoration:none;" href="http://www.emailmeform.com/report-abuse.html?http://www.emailmeform.com/builder/form/KjiDcBb9ZXb" target=
"_blank"><font face="Verdana" size="2" color="#000000">Report Abuse</font></a>Faidzal aka Apaihttp://www.blogger.com/profile/10921198136053203349noreply@blogger.com0