<form name="contactfrm" method="post">
<table align=center style="font:9pt tahoma;"><tr><td>ادرس سایت : </td><td><input type=text id=field_1 name="field[0]" size="40" style="font:9pt tahoma;-moz-border-radius:5px;" dir="ltr" maxlength=40></td></tr>
<tr><td>ایمیل : </td><td><input type=text id=field_2 name="field[1]" size="40" style="font:9pt tahoma;-moz-border-radius:5px;" dir="ltr" maxlength=40></td></tr>
<tr><td>شماره موبایل : </td><td><input type=text id=field_3 name="field[2]" size="40" style="font:9pt tahoma;-moz-border-radius:5px;" dir="ltr" maxlength=40></td></tr>
<tr><td>نام کامل : </td><td><input type=text id=field_4 name="field[3]" size="40" style="font:9pt tahoma;-moz-border-radius:5px;" dir="ltr" maxlength=40></td></tr>
<tr><td>موضوع پیام : </td><td><input type=text id=field_5 name="field[4]" size="40" style="font:9pt tahoma;-moz-border-radius:5px;" dir="ltr" maxlength=40></td></tr>
<tr><td>پیام شما : </td><td><script type=text/javascript>
document.write("<textarea name='fi"+"e"+"ld[5]' id=message style='' cols='43' rows='10'></textarea>");
</script></td></tr>
<tr><td>شکلک ها : </td><td dir="ltr" align="right"><script>function SM(strCode) {document.getElementById ("message").value +=strCode;}</script><table>
<tr>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (0).gif" alt=":)" width="18" height="18" style="cursor:hand;" onClick=SM(":)")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (1).gif" alt=":(" width="18" height="18" style="cursor:hand;" onClick=SM(":(")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (2).gif" alt=";)" width="18" height="18" style="cursor:hand;" onClick=SM(";)")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (3).gif" alt=":D" width="18" height="18" style="cursor:hand;" onClick=SM(":D")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (29).gif" alt=";))" width="18" height="18" style="cursor:hand;" onClick=SM(";))")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (5).gif" alt=":X" width="18" height="18" style="cursor:hand;" onClick=SM(":X")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (24).gif" alt=":?" width="18" height="18" style="cursor:hand;" onClick=SM(":?")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (7).gif" alt=":P" width="18" height="18" style="cursor:hand;" onClick=SM(":P")><br /><br /></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (8).gif" alt=":*" width="18" height="18" style="cursor:hand;" onClick=SM(":*")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (9).gif" alt="=((" width="18" height="18" style="cursor:hand;" onClick=SM("=((")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (10).gif" alt=":O" width="18" height="18" style="cursor:hand;" onClick=SM(":O")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (27).gif" alt="@};-" width="18" height="18" style="cursor:hand;" onClick=SM("@};-")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (12).gif" alt=":B" width="18" height="18" style="cursor:hand;" onClick=SM(":B")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (16).gif" alt="/:)" width="18" height="18" style="cursor:hand;" onClick=SM("/:)")></td>
<td>
<img src="http://intrestroom.r98.ir/images/smilies/smile (13).gif" alt=":S" width="18" height="18" style="cursor:hand;" onClick=SM(":S")></td>
</tr>
</table></td></tr>
<tr>
<td valign="top">کد امنیتی : *</td>
<td><img src="/include/captcha/cap7.php?name_sess=contact_sess" id="im_secB" /><a href="#" onclick="document.getElementById('im_secB').src='/include/captcha/cap7.php?name_sess=contact_sess&Reload_id=' + Math.random(); return false"><img align="absbottom" border="0" src="/images/refresh.gif" /></a></td>
</tr><tr><td></td>
<td><input style="font:9pt tahoma;-moz-border-radius:5px;" id="capt_c" type="text" name="capt_c" size="10"/></td>
</tr>
<tr><td colspan=2 style='text-align:center'><input onclick="return RB_Contact(this.form)" name=submitreg style="font:9pt tahoma;-moz-border-radius:5px;" type=submit value="ارسال پیام"> <input style="font:9pt tahoma;-moz-border-radius:5px;" type=reset value="پاک کردن"></td></tr>
</table></form>
حمایت شده:
