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<td class="title" height="25">天时科技售后服务登录单</td>
</tr>
<tr valign="top">
<td>
<p> </p>
<table width="80%" border="0" cellspacing="0" cellpadding="0" align="center">
<tr>
<td height="16">-----------------------------------(打*项为必填项)-------------------------------------</td>
</tr>
<tr>
<td height="224">
<form method="post" action="newtitle.asp" name="tianshi">
<p>【公司名称】
<input type="text" name="company">
* <br>
【联 系 人】
<input type="text" name="name">
* <br>
【联系电话】
<input type="text" name="phone">
* <br>
【通信地址】
<input type="text" name="address" size="50" maxlength="50">
*<br>
【E - Mail】
<input type="text" name="email">
<br>
【产品名称】
<input type="text" name="product">
* <br>
【原厂序号】
<input type="text" name="index">
* <br>
【购买日期】
<select name="year">
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
</select>
年
<select name="month">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
月
<select name="day">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
日* <br>
【保修期内】
<input type="radio" name="bxqf" value="ture">
是
<input type="radio" name="bxqf" value="false" checked>
否<br>
【已维修次数】
<select name="wxcs">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
</select>
*<br>
【故障描述】 *<br>
<textarea name="gzms" cols="56" rows="4"></textarea>
<br>
【配件明细】<br>
<input type="text" name="pj" size="60">
</p>
<p align="center">
<input type="submit" name="Submit" value="提交" class="botton">
<input type="reset" name="Submit2" value="重置" class="botton">
<br>
<br>
</p>
</form>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td height="16"> </td>
</tr>
</table>
</td>
</tr>
</table>
<table width="740" align="center" border="0" cellpadding="0" cellspacing="0">
<tr>
<td height="1" colspan="3" bgcolor="#000099"> </td>
</tr>
<tr>
<td width="66%" height="41"> <span class="link2">天时金洋电子技术有限公司</span><font color="Red">
</font>地址：北三环西路48号科技会展中心2# 1B 邮编：100086<br>
TEL：010-62583366 62628338 62564083/84 Fax：010-62588980<br>
</td>
<td width="4%" height="41" valign="middle"><img src="../../images/a18.gif" width="26" height="25"></td>
<td width="30%" height="41" valign="middle" class="link1"><a href="mailto:webmaster@tianshi.com.cn" class="link2">经理部</a> <a href="mailto:webmaster@tianshi.com.cn" class="link3">webmaster@tianshi.com.cn</a><br>
<a href="mailto:webmaster@tianshi.com.cn" class="link2">销售部</a> <a href="mailto:sales@tianshi.com.cn" class="link3">sales@tianshi.com.cn</a></td>
</tr>
<tr bgcolor="#000099">
<td align="center" height="1" colspan="3"></td>
</tr>
<tr>
<td height="11" colspan="3">
<p align="center"><i><font face="Georgia, Times New Roman, Times, serif" size="1">©Copyright March
27, 2000</font></i></p>
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