加盟申请表

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<!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"><head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" /><title>加盟申请表</title><style tyle="text/css">.one{font-size:24px;}.second{font-size:12px;color:#03F}.three{font-size:16px;}.four{font-size:14px;}.fifth{color:#F00}</style></head><body><table width="100%" border="1">  <tr>    <td width="219"><img src="1/apply_1.gif"></td>     </tr>  <tr>    <td rowspan="2"><img src="1/apply_2.gif"></td>    <td  ><p class="one">加盟申请表</p></td>    </tr>  <tr>         <td width="18"><p class="second">注:打*为必填项</p></td>     </tr>  <tr>  <td><p class="three"><strong>代理申请基本信息</strong></p> </td>  <td></td>  </tr>  <tr>  <td><p class="four">申请人姓名<span class="fifth">*</span></p></td>  <td><input name="xm"type="text"></td>  </tr>  <tr>  <td>  <p class="four">籍贯<span class="fifth">*</span></p>  </td>  <td><select name="s">  <option value="0">请选择</option>  </select>省   <select name="q">  <option value="0">请选择</option>  </select>区  </td>  </tr>  <tr>  <td>   <p class="four">性别<span class="fifth">*</span></p>  </td>  <td>  <input name="gen"type="radio"class="input"value="n">男   <input name="gen"type="radio"class="input"value="s">女  </td>  </tr>  <tr>  <td> <p class="four">身份证号<span class="fifth">*</span></p></td>  <td><input name="xm"type="text"></td>  </tr>  <tr>    <td> <p class="four">联系地址<span class="fifth">*</span></p></td>  <td><input name="xm"type="text"></td>   </tr>   <tr>     <td> <p class="four">电话<span class="fifth">*</span></p></td>  <td><input name="xm"type="text"></td>   </tr>   <tr>    <td> <p class="four">电子邮箱<span class="fifth">*</span></p></td>  <td><input name="xm"type="text"></td>      </tr>   <tr>    <td> <p class="four">加盟地区<span class="fifth">*</span></p></td>  <td><input name="xm"type="text"></td>  </tr>  <tr>  <td rowspan="2"><p class="four">你是从哪里了解我们的?</p></td>  <td><input name="name1"type="checkbox"value=" ">Baidu   <input name="name2"type="checkbox"value=" ">Google   <input name="name3"type="checkbox"value="ds">电视广告   <input name="name4"type="checkbox"value="bk">报刊杂志   <input name="name5"type="checkbox"value="lp">路牌广告   <input name="name6"type="checkbox"value="py">朋友介绍       </td>  </tr>  <tr>  <td><input name="name7"type="checkbox"value="pp">点击查看"Android"项目网上加盟免费声明<a href="#" targer="_blank">点击查看</a></td>  </tr></table></body></html>
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