document.writeln('<iframe src=\"about:blank\" name=\"hidform1\" style=\"width:0px;height:0px;display:none\"></iframe>')
document.writeln('<script src=\"/ks_inc/common.js\"></script>')
document.writeln('<script src=\"/ks_inc/form_ck.js\"></script>')
document.writeln('<form name=\"myform1\" action=\"/plus/form/form.asp\" onSubmit=\"return(form_c(1));\"  target=\"hidform1\" method=\"post\"> ')
document.writeln('<table width=\"100%\" border=\"0\" cellspacing=\"2\" cellpadding=\"1\">')
document.writeln('<input type=\"hidden\" value=\"Save\" name=\"action\"/>')
document.writeln('<input type=\"hidden\" value=\"1\" name=\"id\"/>')
document.writeln('<input type=\"hidden\" value=\"0\" name=\"m\"/>')
document.writeln('<input type=\"hidden\" value=\"0\" name=\"d\"/>')
document.writeln('<input type=\"hidden\" value=\"{$ToUserName}\" id=\"tousername\" name=\"tousername\"/>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\"> 您的姓名：</td>')
document.writeln('  <td><input type=\"text\" maxlength=\"255\" class=\"upfile\" style=\"width:200px\" id=\"KS_name\" name=\"KS_name\" value=\"\"><span ')
document.writeln('class=\"formstrck1\" id=\" 您的姓名|%|KS_name|%|1\" style=\"display:none\"></span><font color=\"red\"> * </font>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">您的电话：</td>')
document.writeln('  <td><input type=\"text\" maxlength=\"255\" class=\"upfile\" style=\"width:200px\" id=\"KS_tel\" name=\"KS_tel\" value=\"\"><span ')
document.writeln('class=\"formstrck1\" id=\"您的电话|%|KS_tel|%|4\" style=\"display:none\"></span><font color=\"red\"> * </font>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\"> 邮箱：</td>')
document.writeln('  <td><input type=\"text\" maxlength=\"255\" class=\"upfile\" style=\"width:200px\" id=\"KS_email\" name=\"KS_email\" value=\"\"><span ')
document.writeln('class=\"formstrck1\" id=\" 邮箱|%|KS_email|%|8\" style=\"display:none\"></span><font color=\"red\"> * </font>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">其他备注：</td>')
document.writeln('  <td><textarea style=\"width:200px;height:100px\" rows=\"5\" id=\"KS_content\" name=\"KS_content\"></textarea>  </td>')
document.writeln('</tr>')
document.writeln(' <tr class=\"tdbg\">')
document.writeln('  <td align=\"right\" class=\"lefttdbg\">产品类别：</td>')
document.writeln('  <td><input type=\"checkbox\" id=\"KS_prolei\" name=\"KS_prolei\" value=\"定制多肽\" checked>定制多肽<input type=\"checkbox\" ')
document.writeln('id=\"KS_prolei\" name=\"KS_prolei\" value=\"药物多肽\">药物多肽<input type=\"checkbox\" id=\"KS_prolei\" name=\"KS_prolei\" value=\"化妆品')
document.writeln('多肽\">化妆品多肽<input type=\"checkbox\" id=\"KS_prolei\" name=\"KS_prolei\" value=\"其他多肽\">其他多肽  </td>')
document.writeln('</tr>')
document.writeln('<tr class=\"tdbg\"><td class=\"lefttdbg\" align=\"right\">验证码：</td><td><input name=\"Verifycode\" id=\"Verifycode\" type=\"text\" ')
document.writeln('name=\"textbox\" size=5><span style=\"color:#999\">请输入下图中的字符</span><br/><IMG style=\"cursor:pointer\" ')
document.writeln('src=\"/plus/verifycode.asp\" onClick=\"this.src=\'/plus/verifycode.asp?n=\'+ Math.random();\" align=\"absmiddle\"></td></tr>')
document.writeln('<tr><td colspan=\"2\" class=\"subtdbg\" align=\"center\"><input type=\"submit\" value=\"确认提交\" name=\"submit1\"></td></tr>')
document.writeln('</table>')
document.writeln('</form>')
document.writeln('')