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233 234 235 <section class="sub-cnt"> 236 237 <p class="mb30 tac"><span style="color:red;">â»</span>ã¯å ¥åå¿ é é ç®ã§ãã</p> 238 239 <form name="contact_form" action="confirm.php" method="post"> 240 <input type="hidden" name="ticket" value="aa25df58427434e3b64211700966c62542c677e0"> 241 <dl class="formList"> 242 243 <dt>ãç¨ä»¶</dt> 244 <dd> 245 <input type="radio" name="type01" value="ãåãåãã"> 246 <label>ãåãåãã</label>ã 247 <input type="radio" name="type01" value="ã¹ã¿ããå¿å"> 248 <label>ã¹ã¿ããå¿å</label>ã 249 <input type="radio" name="type01" value="ãã®ä»"> 250 <label>ãã®ä»</label>ã 251 </dd> 252 253 <dt>å¸æé¢æ¥æ¥ç¨</dt> 254 <dd> 255 <span class="">â»ã¹ã¿ããå¿åããã§ãã¯ãããã客æ§ã®ã¿ãå ¥åãã ããã</span><br> 256 <input type="text" name="reserveday" class="reserveday" size="30" value=""> 257 </dd> 258 259 <dt>å¸æé¢æ¥æé</dt> 260 <dd> 261 <span class="">â»ã¹ã¿ããå¿åããã§ãã¯ãããã客æ§ã®ã¿ãå ¥åãã ããã</span><br> 262 <input type="text" name="reservetime" class="reservetime" size="30" value=""> 263 </dd> 264 265 <dt>ãåå<span style="color:red;">â»</span></dt> 266 <dd> 267 <input type="text" name="name" size="30" value=""> 268 </dd> 269 270 <dt>ãååï¼ã«ãï¼</dt> 271 <dd> 272 <input type="text" name="kana1" size="30" value=""> 273 </dd> 274 275 <dt>ã¡ã¼ã«ã¢ãã¬ã¹<span style="color:red;">â»</span></dt> 276 <dd> 277 <p><input name="email1" type="text" class="mail" style="ime-mode: disabled;" value=""></p> 278 <p>確èªã®ãããããä¸åº¦ã¡ã¼ã«ã¢ãã¬ã¹ãå ¥åãã¦ãã ããã</p> 279 <p><input name="email2" type="text" class="mail" style="ime-mode: disabled;" value=""></p> 280 </dd> 281 282 <dt>ä½æ<span style="color:red;">â»</span></dt> 283 <dd> 284 <p> 285 <label for="postCode1">ã</label> 286 <input id="postCode1" name="postCode1" type="text" class="number" style="ime-mode: disabled;" value="" size="5" maxlength="3"> 287 - 288 <input id="postCode2" name="postCode2" type="text" class="number" style="ime-mode: disabled;" value="" size="6" maxlength="4" 289 onkeyup="AjaxZip3.zip2addr('postCode1','postCode2','state','city','address');"><br> 290 éµä¾¿çªå·ãå ¥ãã¦é ãã¨èªåçã«ä½æãå ¥ãã¾ãã 291 </p> 292 <p> 293 <label>é½éåºç</label> 294 <input type="text" id="state" name="state" size="15" value=""> 295 </p> 296 <p> 297 <label>å¸åºçºæ</label> 298 <input id="city" name="city" type="text" class="text" value=""> 299 </p> 300 <p> 301 <label>以éã®ä½æ</label> 302 <input id="address" name="address" type="text" class="text" value=""> 303 </p> 304 </dd> 305 306 <dt>é»è©±çªå·<span style="color:red;">â»</span></dt> 307 <dd> 308 <p><input name="iphonetel" type="text" class="text" style="ime-mode: disabled;" value=""></p> 309 </dd> 310 311 <dt>ãã®ä»ã®é£çµ¡å </dt> 312 <dd> 313 <p><input name="tel2" type="text" class="text" style="ime-mode: disabled;" value=""></p> 314 </dd> 315 316 <dt>ãã®ãµã¤ããä½ã§ç¥ãã¾ãããï¼</dt> 317 <dd> 318 <p> 319 <label> 320 <input type="checkbox" name="use[]" value="googleæ¤ç´¢"> 321 googleæ¤ç´¢ </label>ã 322 <label> 323 <input type="checkbox" name="use[]" value="Yahooæ¤ç´¢"> 324 Yahooæ¤ç´¢ </label>ã 325 <label> 326 <input type="checkbox" name="use[]" value="æ±äººåºå"> 327 æ±äººåºå </label>ã 328 <label> 329 <input type="checkbox" name="use[]" value="ãã®ä»"> 330 ãã®ä» </label>ã 331 </p> 332 </dd> 333 334 <dt>åè</dt> 335 <dd> 336 <textarea name="comment" cols="50" rows="10"></textarea> 337 </dd> 338 339 </dl> 340 <div class="formnav"> 341 <input type="submit" value="確èªç»é¢ã¸"> 342 </div> 343 </form> 344 </section> 345 </section> 346</div> 347 348 349</div><!-- .wrapper --> 350<footer class="footer"> 351 <div class="page-top"> 352 <p><a href="#"><i class="fa fa-angle-up" aria-hidden="true"></i></a></p> 353 </div> 354 355 <div class="footer-inner"> 356 357 <div class="detail"> 358 <p>æ ªå¼ä¼ç¤¾ãæç°è¾²å<br> 359 ä½æï¼ ã6130045 京é½åºä¹ ä¸é¡ä¹ 御山çºåå·é¡é¦¬å¶9çªå°1<br> 360 é»è©±çªå·ï¼075-631-5620<br> 361 FAX:075-631-5699<br> 362 Mailï¼[email protected]</p> 363 </div> 364 365 </div> 366 <div class="copy"> 367 <p>Copyright(c) murata farm.co.ltd.All right Reserved.</p> 368 </div> 369 370 </footer><!-- /footer -->
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