<form name="form" METHOD="POST" action="http://www.keyifkahvesi.info/cgi-bin/mail.cgi"> 
   
  <INPUT TYPE=HIDDEN NAME="kopya" VALUE="keyifkahvesi@gmail.com"> 
  <INPUT TYPE=HIDDEN NAME="konu" VALUE="paket siparişi"> 
  <TABLE CELLSPACING=0 CELLPADDING=3 ALIGN=CENTER BORDER=1> 
  <TR><TD COLSPAN="2" ALIGN=CENTER>Asagidaki Formu Doldurup Gonderin:<br></TD></TR> 
  <TR><TD>Adiniz</TD> 
  <TD><INPUT TYPE="text" NAME="Adiniz"> 
  </TD></TR> 
  <TR><TD>Soyadýnýz</TD> 
  <TD><INPUT TYPE="text" NAME="Soyadýnýz"> 
  </TD></TR> 
  <TR><TD>Mail Adresiniz</TD> 
  <TD><INPUT TYPE="text" NAME="Mail Adresiniz"> 
  </TD></TR> 
  <TR><TD>Adres</TD> 
  <TD><INPUT TYPE="text" NAME="Adres"> 
  </TD></TR> 
  <TR><TD>Telefon</TD> 
  <TD><INPUT TYPE="text" NAME="Telefon"> 
  </TD></TR> 
  <TR><TD>paket</TD><TD><SELECT NAME="HOSTÝNG"> 
  <option value=PAKET 1>PAKET 1</option> 
  <option value=PAKET 2>PAKET 2</option> 
  <option value=PAKET 3>PAKET 3</option> 
  <option value=PAKET 4>PAKET 4</option> 
  <option value=PAKET 5>PAKET 5</option> 
  </SELECT></TD></TR> 
  <TR> 
  <TD VALIGN=TOP>BÝZÝ SEÇME NEDENÝNÝZ</TD> 
  <TD><TABLE> 
  <TR><TD>Ucuz Olma</TD> 
  <TD><INPUT TYPE="checkbox" NAME="BÝZÝ SEÇME NEDENÝNÝZ" VALUE="Ucuz Olma"></TD></TR> 
  <TR><TD>Güvenilir Olma</TD> 
  <TD><INPUT TYPE="checkbox" NAME="BÝZÝ SEÇME NEDENÝNÝZ" VALUE="Güvenilir Olma"></TD></TR> 
  <TR><TD>Deneyim</TD> 
  <TD><INPUT TYPE="checkbox" NAME="BÝZÝ SEÇME NEDENÝNÝZ" VALUE="Deneyim"></TD></TR> 
  </TABLE></TD></TR> 
  <TR> 
  <TD VALIGN=TOP>ÖDEME ÞEKLÝ </TD> 
  <TD><TABLE> 
  <TR><TD>Aylýk Ödeme</TD> 
  <TD><INPUT TYPE="radio" checked NAME="ÖDEME ÞEKLÝ " VALUE="Aylýk Ödeme"> 
  </TD></TR> 
  <TR><TD>6 Aylýk Ödeme</TD> 
  <TD><INPUT TYPE="radio"  NAME="ÖDEME ÞEKLÝ " VALUE="6 Aylýk Ödeme"> 
  </TD></TR> 
  <TR><TD>Yýllýk Ödeme</TD> 
  <TD><INPUT TYPE="radio"  NAME="ÖDEME ÞEKLÝ " VALUE="Yýllýk Ödeme"> 
  </TD></TR> 
  </TABLE></TD></TR> 
  <TR><TD COLSPAN="2">Diðer Ýstekleriniz:<BR></TD></TR> 
  <TR><TD COLSPAN="2" ALIGN=CENTER><textarea name="mesaj" rows=5 cols=20></textarea></TD></TR> 
  <TR><TD COLSPAN="2" ALIGN=CENTER><br><INPUT TYPE="SUBMIT" VALUE="GONDER"> 
  </TD></TR> 
  </TABLE></FORM>