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<?xml version='1.0' encoding='UTF-8'?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" lang="ja" xml:lang="ja">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
<meta http-equiv="Content-Script-Type" content="text/javascript" />
<meta http-equiv="Content-Style-Type" content="text/css" />
<link rel="stylesheet" href="/user_data/css/common.css" type="text/css" media="all" />
<link rel="alternate" type="application/rss+xml" title="RSS" href="http://www.hs-benzaiten.com/rss/index.php" />
<script type="text/javascript" src="/user_data/packages/default/js/css.js"></script>
<script type="text/javascript" src="/user_data/packages/default/js/navi.js"></script>
<script type="text/javascript" src="/user_data/packages/default/js/win_op.js"></script>
<script type="text/javascript" src="/user_data/packages/default/js/site.js"></script>
<title>Healing Stone 弁財天/お問い合わせ(入力ページ)</title>
<meta name="author" content="" />
<meta name="description" content="ヒーリングストーン、パワーストーン、天然石、、水晶を取り扱う弁財天のショッピングサイト" />
<meta name="keywords" content="ヒーリングストーン,パワーストーン,天然石,癒し,弁財天" />

<script type="text/javascript">//<![CDATA[
    
//]]>
</script>
</head>

<!-- ▼BODY部 スタート -->
<body onload="preLoadImg('/user_data/packages/default/'); ">


<noscript>
  <p>JavaScript を有効にしてご利用下さい.</p>
</noscript>

<a name="top" id="top"></a>

<!--▼HEADER-->
<div id="header">
  <h1>
    <a href="http://www.hs-benzaiten.com/">
      <em>Healing Stone 弁財天/お問い合わせ(入力ページ)</em>
    </a>
  </h1>
  <div id="information">
    <ul>
      <li>
        <a href="/mypage/login.php"
           onmouseover="chgImg('/user_data/packages/default/img/header/mypage_on.gif','mypage');"
           onmouseout="chgImg('/user_data/packages/default/img/header/mypage.gif','mypage');">
          <img src="/user_data/packages/default/img/header/mypage.gif" width="95" height="20" alt="MYページ" name="mypage" id="mypage" />
        </a>
      </li>
      <li>
        <a href="/entry/kiyaku.php"
           onmouseover="chgImg('/user_data/packages/default/img/header/member_on.gif','member');"
           onmouseout="chgImg('/user_data/packages/default/img/header/member.gif','member');">
          <img src="/user_data/packages/default/img/header/member.gif" width="95" height="20" alt="会員登録" name="member" id="member" />
        </a>
      </li>
      <li>
        <a href="/cart/index.php"
           onmouseover="chgImg('/user_data/packages/default/img/header/cartin_on.gif','cartin');"
           onmouseout="chgImg('/user_data/packages/default/img/header/cartin.gif','cartin');">
          <img src="/user_data/packages/default/img/header/cartin.gif" width="95" height="20" alt="カゴの中を見る" name="cartin" id="cartin" />
        </a>
      </li>
    </ul>
  </div>
</div>
<!--▲HEADER-->
<div id="container">

      <div id="leftcolumn">
                  <!-- ▼かごの中 ここから-->
                      
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<!--現在のカゴの中ここから-->
  <h2>
    <img src="/user_data/packages/default/img/side/title_cartin.jpg" width="166" height="35" alt="現在のカゴの中" />
  </h2>
  <div id="cartarea">
    <p class="item">商品数：0点</p>
    <p>合計：<span class="price">0円</span><br />
    <!-- カゴの中に商品がある場合にのみ表示 -->
        </p>
    <p class="btn">
      <a href="/cart/index.php" onmouseover="chgImg('/user_data/packages/default/img/side/button_cartin_on.gif','button_cartin');" onmouseout="chgImg('/user_data/packages/default/img/side/button_cartin.gif','button_cartin');">
        <img src="/user_data/packages/default/img/side/button_cartin.gif" width="87" height="22" alt="カゴの中を見る" border="0" name="button_cartin" id="button_cartin" />
      </a>
     </p>
  </div>
<!--現在のカゴの中ここまで-->
                  <!-- ▲かごの中 ここまで-->
              <!-- ▼カテゴリ ここから-->
                      
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<!--商品カテゴリーここから-->
<h2>
  <img src="/user_data/packages/default//img/side/title_cat.jpg" width="166" height="35" alt="商品カテゴリー" />
</h2>
<div id="categoryarea">
  <ul id="categorytree">
                                <li class="level1"><a href="/products/list.php?category_id=6">Bracelet(35)</a>
                                                                                                                              </li>
          <li class="level1"><a href="/products/list.php?category_id=7">Necklace(6)</a>
                                                      </li>
          <li class="level1"><a href="/products/list.php?category_id=8">Strap(2)</a>
                                                      </li>
          <li class="level1"><a href="/products/list.php?category_id=9">Raw ore(22)</a>
                                                      </li>
          <li class="level1"><a href="/products/list.php?category_id=11">Coaster(1)</a>
                                  </li>
              </ul>
</div>
<!--商品カテゴリーここまで-->
                  <!-- ▲カテゴリ ここまで-->
              <!-- ▼利用ガイド ここから-->
                      <!--▼リンクここから-->
<div id="guidearea">
  <ul>
        <li><a href="/abouts/index.php" onmouseover="chgImg('/user_data/packages/default/img/side/about_on.jpg','about');" onmouseout="chgImg('/user_data/packages/default/img/side/about.jpg','about');"><img src="/user_data/packages/default/img/side/about.jpg" width="166" height="30" alt="当サイトについて" style="border: none" name="about" id="about" /></a></li>
    
        <li><a href="/contact/index.php"><img src="/user_data/packages/default/img/side/contact_on.jpg" width="166" height="30" alt="お問い合わせ" style="border: none" name="contact" id="contact" /></a></li>
    
        <li><a href="/order/index.php" onmouseover="chgImg('/user_data/packages/default/img/side/low_on.jpg','low');" onmouseout="chgImg('/user_data/packages/default/img/side/low.jpg','low');"><img src="/user_data/packages/default/img/side/low.jpg" width="166" height="30" alt="特定商取引に関する法律" style="border: none" name="low" id="low" /></a></li>
    
        <li><a href="/user_data/maintenance.php" onmouseover="chgImg('/user_data/packages/default/img/side/maintenance_on.jpg','maintenance');" onmouseout="chgImg('/user_data/packages/default/img/side/maintenance.jpg','maintenance');"><img src="/user_data/packages/default/img/side/maintenance.jpg" width="166" height="30" alt="メンテナンス" style="border: none" name="maintenance" id="maintenance" /></a></li>
    
        <li><a href="/user_data/privacy.php" onmouseover="chgImg('/user_data/packages/default/img/side/privacy_on.jpg','privacy');" onmouseout="chgImg('/user_data/packages/default/img/side/privacy.jpg','privacy');"><img src="/user_data/packages/default/img/side/privacy.jpg" width="166" height="30" alt="プライバシーポリシー" style="border: none" name="privacy" id="privacy" /></a></li>
      </ul>
</div>
<!--▲リンクここまで-->
                  <!-- ▲利用ガイド ここまで-->
            </div>
    
      <div id="two_maincolumn">
                  
        <!--▼CONTENTS-->
<div id="undercolumn">
  
  <div id="undercolumn_contact">
    <h2 class="title"><img src="/user_data/packages/default/img/contact/title.jpg" width="580" height="40" alt="お問い合わせ" /></h2>
    
    <p>お問い合わせはメールにて承っています。<br />
    内容によっては回答をさしあげるのにお時間をいただくこともございます。また、土日、祝祭日、年末年始、夏季期間は翌営業日以降の対応となりますのでご了承ください。</p>
    
    <p class="mini"><em>※ご注文に関するお問い合わせには、必ず「ご注文番号」と「お名前」をご記入の上、メールくださいますようお願いいたします。</em></p>
    
    <form name="form1" method="post" action="/contact/index.php">
    <input type="hidden" name="mode" value="confirm" />
    
    <table summary="お問い合わせ">
      <tr>
        <th>お名前<span class="attention">※</span></th>
        <td>
          <span class="attention"></span>
          姓&nbsp;<input type="text"
                         class="box120"
                         name="name01"
                         value=""
                         maxlength="50"
                         style="" />　
          名&nbsp;<input type="text" class="box120" name="name02"
                         value=""
                         maxlength="50"
                         style="" />
        </td>
      </tr>
      <tr>
        <th>お名前（フリガナ）<span class="attention">※</span></th>
        <td>
          <span class="attention"></span>
          セイ&nbsp;<input type="text"
                           class="box120"
                           name="kana01"
                           value=""
                           maxlength="50"
                           style="" />　
          メイ&nbsp;<input type="text"
                           class="box120"
                           name="kana02"
                           value=""
                           maxlength="50"
                           style="" />
        </td>
      </tr>
      <tr>
        <th>郵便番号</th>
        <td>
          <span class="attention"></span>
          <p>
            〒&nbsp;
            <input type="text"
                   name="zip01"
                   class="box60"
                   value=""
                   maxlength="3"
                   style="" />&nbsp;-&nbsp;
            <input type="text"
                   name="zip02"
                   class="box60"
                   value=""
                   maxlength="4"
                   style="" />　
            <a href="http://search.post.japanpost.jp/zipcode/" target="_blank"><span class="fs10">郵便番号検索</span></a>
          </p>
          <p class="zipimg">
            <a href="javascript:fnCallAddress('/input_zip.php', 'zip01', 'zip02', 'pref', 'addr01');">
              <img src="/user_data/packages/default/img/common/address.gif" width="86" height="20" alt="住所自動入力" />
            </a>
            <span class="mini">&nbsp;郵便番号を入力後、クリックしてください。</span>
          </p>
        </td>
      </tr>
      <tr>
        <th>住所</th>
        <td>
          <span class="attention"></span>
          
          <select name="pref" style="">
          <option value="">都道府県を選択</option>
          <option label="北海道" value="1">北海道</option>
<option label="青森県" value="2">青森県</option>
<option label="岩手県" value="3">岩手県</option>
<option label="宮城県" value="4">宮城県</option>
<option label="秋田県" value="5">秋田県</option>
<option label="山形県" value="6">山形県</option>
<option label="福島県" value="7">福島県</option>
<option label="茨城県" value="8">茨城県</option>
<option label="栃木県" value="9">栃木県</option>
<option label="群馬県" value="10">群馬県</option>
<option label="埼玉県" value="11">埼玉県</option>
<option label="千葉県" value="12">千葉県</option>
<option label="東京都" value="13">東京都</option>
<option label="神奈川県" value="14">神奈川県</option>
<option label="新潟県" value="15">新潟県</option>
<option label="富山県" value="16">富山県</option>
<option label="石川県" value="17">石川県</option>
<option label="福井県" value="18">福井県</option>
<option label="山梨県" value="19">山梨県</option>
<option label="長野県" value="20">長野県</option>
<option label="岐阜県" value="21">岐阜県</option>
<option label="静岡県" value="22">静岡県</option>
<option label="愛知県" value="23">愛知県</option>
<option label="三重県" value="24">三重県</option>
<option label="滋賀県" value="25">滋賀県</option>
<option label="京都府" value="26">京都府</option>
<option label="大阪府" value="27">大阪府</option>
<option label="兵庫県" value="28">兵庫県</option>
<option label="奈良県" value="29">奈良県</option>
<option label="和歌山県" value="30">和歌山県</option>
<option label="鳥取県" value="31">鳥取県</option>
<option label="島根県" value="32">島根県</option>
<option label="岡山県" value="33">岡山県</option>
<option label="広島県" value="34">広島県</option>
<option label="山口県" value="35">山口県</option>
<option label="徳島県" value="36">徳島県</option>
<option label="香川県" value="37">香川県</option>
<option label="愛媛県" value="38">愛媛県</option>
<option label="高知県" value="39">高知県</option>
<option label="福岡県" value="40">福岡県</option>
<option label="佐賀県" value="41">佐賀県</option>
<option label="長崎県" value="42">長崎県</option>
<option label="熊本県" value="43">熊本県</option>
<option label="大分県" value="44">大分県</option>
<option label="宮崎県" value="45">宮崎県</option>
<option label="鹿児島県" value="46">鹿児島県</option>
<option label="沖縄県" value="47">沖縄県</option>

          </select>
          
          <p class="mini">
            <input type="text"
                   class="box380"
                   name="addr01"
                   value=""
                   style="" /><br />
            市区町村名（例：千代田区神田神保町）
          </p>
          
          <p class="mini">
            <input type="text"
                   class="box380"
                   name="addr02"
                   value=""
                   style="" /><br />
            番地・ビル名（例：1-3-5）
          </p>
          
          <p class="mini"><em>住所は2つに分けてご記入いただけます。マンション名は必ず記入してください。</em></p>
        </td>
      </tr>
      <tr>
        <th>電話番号</th>
        <td>
          <span class="attention"></span>
          <input type="text" 
                 class="box60"
                 name="tel01"
                 value=""
                 maxlength="6"
                 style="" />&nbsp;-&nbsp;
          <input type="text" 
                 class="box60"
                 name="tel02"
                 value=""
                 maxlength="6"
                 style="" />&nbsp;-&nbsp;
          <input type="text" 
                 class="box60"
                 name="tel03"
                 value=""
                 maxlength="6"
                 style="" />
        </td>
      </tr>
      <tr>
        <th>メールアドレス<span class="attention">※</span></th>
        <td>
          <span class="attention"></span>
          <input type="text"
                 class="box380"
                 name="email"
                 value=""
                 maxlength="200"
                 style="" /><br />
                              <input type="text"
                 class="box380"
                 name="email02"
                 value=""
                 maxlength="200"
                 style="" /><br />
          <p class="mini"><em>確認のため2度入力してください。</em></p>
        </td>
      </tr>        
      <tr>
        <th>お問い合わせ内容<span class="attention">※</span><br />
        <span class="mini">（全角1000字以下）</span></th>
        <td>
          <span class="attention"></span>
          <textarea name="contents"
                    class="area380"
                    cols="60"
                    rows="20"
                    style=""></textarea>
        </td>
      </tr>
    </table>
    
    <div class="tblareabtn">
      <input type="image"
             onmouseover="chgImgImageSubmit('/user_data/packages/default/img/common/b_confirm_on.gif', this)"
             onmouseout="chgImgImageSubmit('/user_data/packages/default/img/common/b_confirm.gif', this)"
             src="/user_data/packages/default/img/common/b_confirm.gif"
             style="width:150px; height=30px;"
             alt="確認ページへ"
             name="confirm" />
    </div>
    </form>
  </div>
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