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<form name="form" method="post" action="http://www.vemmabuilder.com/opportunity/628515105/mail">
<p>Selamat Sejahtera </p>
<p>Jika anda ingin mengubah masa depan dan ingin ada perniagan sendiri</p>
<p>Sila daftar sebagai ahli e-dagang , Anda akan diberi tunjuk ajar bagai mana mahu memulakan perniaga internet yang SAH dan di daftarkan di Malaysia . </p>
<p> </p>
<table border="1" width="52%" id="table1" style="border: 3px dashed #FF0000">
<tr>
<td><p align="center" class="style123">Iskan kan borang ni untuk mendaftar sebagai ahli e-dagang </p>
<table class="formfont" style="width: 426px; height: 228px;" bordercolordark="#ffffff" bordercolorlight="#ffffff" align="center" bordercolor="#ffffff" cellpadding="0" cellspacing="0">
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<td width="144" class="style12">Nama awal:</td>
<td class="item" width="181"><input maxlength="50" size="25" name="surveyFirstName" align="left" /></td>
</tr>
<tr>
<td class="style12">Nama akhir:</td>
<td class="item"><input maxlength="50" size="25" name="surveyLastName" align="left" /></td>
</tr>
<tr>
<td class="style12">Telefon:</td>
<td class="item"><input maxlength="30" size="25" name="surveyPhone" align="left" /></td>
</tr>
<tr>
<td class="style12">E-Mail:</td>
<td class="item"><input maxlength="50" size="25" name="surveyEmail" align="left" /></td>
</tr>
<tr>
<td class="style12">E-Mail sekali lagi:</td>
<td class="item"><input maxlength="50" size="25" name="surveyConfirmEmail" align="left" /></td>
</tr>
<tr>
<td class="style12">Negara:</td>
<td class="item"><select class="formfont" name="surveyCountry">
<option value="" selected="selected">Pilih negara anda</option>
<option value="1">United States</option>
<option value="12">Australia</option>
<option value="13">Austria</option>
<option value="36">Canada</option>
<option value="78">Germany</option>
<option value="98">Indonesia</option>
<option value="99">Ireland</option>
<option value="103">Japan</option>
<option value="123">Malaysia</option>
<option value="132">Mexico</option>
<option value="147">New Zealand</option>
<option value="163">Philippines</option>
<option value="183">Singapore</option>
<option value="184">Slovenia</option>
<option value="197">Taiwan</option>
<option value="213">United Kingdom</option>
</select></td>
</tr>
<tr>
<td class="style11">Saya berminat untuk menjana pendapatan:</td>
<td class="item"><select class="formfont" name="surveyIncomeGoal">
<option value="" selected="selected">Pilih salah satu</option>
<option value="0">Kurang daripada $1,000 setiap bulan</option>
<option value="1">$1,000 setiap bulan</option>
<option value="2">$3,000 setiap bulan</option>
<option value="3">$5,000 setiap bulan</option>
<option value="4">$10,000 setiap bulan ataupun lebih</option>
</select></td>
</tr>
</tbody>
</table>
<p align="center" class="style9"><font color="#9966ff">
<input value="Mulakan Impian Anda" name="surveysubmit" onclick="exit=false" type="submit" />
</font></p>
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_uacct = "UA-1175864-1";
urchinTracker();
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