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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" />
<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/お客様の声書き込み（入力ページ）</title>
</head>

<body onload="preLoadImg('/user_data/packages/default/');  ">
<noscript>
  <p><em>JavaScriptを有効にしてご利用下さい.</em></p>
</noscript>

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

<!--▼CONTENTS-->
<div id="windowcolumn">
  <div id="windowarea">
    <h2><img src="/user_data/packages/default/img/products/review_title.jpg" width="500" height="40" alt="お客様の声書き込み" /></h2>
    <p class="windowtext">以下の商品について、お客様のご意見、ご感想をどしどしお寄せください。<br />
      「<span class="attention">※</span>」印は入力必須項目です。<br />
       ご入力後、一番下の「確認ページへ」ボタンをクリックしてください。</p>
        <form name="form1" method="post" action="/products/review.php">
        <input type="hidden" name="mode" value="confirm" />
        <input type="hidden" name="product_id" value="" />
        <input type="hidden" name="transactionid" value="75a696bbeb4e7f37b4712c0666253ea9ad700ca2" />
        <table summary="お客様の声書き込み">
          <tr>
            <th>商品名</th>
            <td></td>
          </tr>
          <tr>
            <th>投稿者名<span class="attention">※</span></th>
            <td><span class="attention"></span><input type="text" name="reviewer_name" value="" maxlength="50" style="" size="40" class="box350" /></td>
          </tr>
          <tr>
            <th>ホームページアドレス</th>
            <td><span class="attention"></span><input type="text" name="reviewer_url" value="" maxlength="200" style="" size="40" class="box350" /></td>
          </tr>
          <tr>
            <th>性別</th>
            <td>
              <input type="radio" name="sex" id="man" value="1"  /><label for="man">男性</label>&nbsp;
              <input type="radio" name="sex" id="woman" value="2"  /><label for="woman">女性</label>
            </td>
          </tr>
          <tr>
            <th>おすすめレベル<span class="attention">※</span></th>
            <td>
              <span class="attention"></span>
              <select name="recommend_level" style="">
                <option value="" selected="selected">選択してください</option>
                  <option label="★★★★★" value="5">★★★★★</option>
<option label="★★★★" value="4">★★★★</option>
<option label="★★★" value="3">★★★</option>
<option label="★★" value="2">★★</option>
<option label="★" value="1">★</option>

              </select>
            </td>
          </tr>
          <tr>
            <th>タイトル<span class="attention">※</span></th>
            <td>
              <span class="attention"></span>
              <input type="text" name="title" value="" maxlength="50" style="" size="40" class="box350" />
            </td>
          </tr>
          <tr>
            <th>コメント<span class="attention">※</span></th>
            <td>
              <span class="attention"></span>
              <textarea name="comment" cols="50" rows="10" style="" class="area350"></textarea>
            </td>
          </tr>
        </table>
        <div class="btn">
          <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" class="box150" alt="確認ページへ" name="conf" id="conf" />
        </div>
      </form>
    </div>

</div>
</body>
</html>
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