<link rel="stylesheet" href="css/bulten.css" type="text/css" />
<link rel="stylesheet" href="css/reset.css" type="text/css" />
<script language="JavaScript">
function kontrol_kayit(yorumlar)


{



if (yorumlar.isim.value.length < 2){

alert("İsim alanını zorunludur")

return false

}



if (yorumlar.baslik.value.length < 1){

alert("Adet Belirtiniz")

return false

}

if (yorumlar.email.value.length < 1){

alert("Cep telefonu numaranızı giriniz")

return false

}

if (yorumlar.yorum.value.length < 10){

alert("Yazmış olduğunuz mesaj çok kısa")

return false

}



return true

}

</script>



<table align='center' width='100%' bgcolor='#d8c8ae'><tr><td ><div class="contact"><h1>Sipariş verilecek Ürün :<font color="#017b95">Laboratuvar Mikserleri</font></h1></div></td></tr></table>
<form name="yorumlar" method="post" onsubmit="return kontrol_kayit(this)" action="siparis-21-tr.html">
<INPUT TYPE="hidden" name="kontrol" value="1">
<input type="hidden" name="guvenlik" value="72184" />
<input type="hidden" name="urunadi" value="Laboratuvar Mikserleri - Ürün kodu : Laboratuvar Mikserleri" />

<table width="100%" border="0" cellspacing="1" cellpadding="2"  >


<tr>

    <td>&nbsp;</td>

 
  </tr>
  <tr>

    <td><font face="Arial, Helvetica, sans-serif" style="font-size:14px;"><b>Ä°sim Soyisim</b></font></td>

    <td><input name="isim" type="text" size="73" maxlength="75" class="contact-input"></td>

  </tr>

<tr>

    <td>&nbsp;</td>

 
  </tr>

  <tr>

    <td><font face="Arial, Helvetica, sans-serif" style="font-size:14px; "><b>Telefon numaranız</b></font></td>

    <td><input name="email" type="text" size="73" maxlength="100" class="contact-input"></td>

  </tr>

<tr>

    <td>&nbsp;</td>

   

  </tr>

<tr>

    <td><font face="Arial, Helvetica, sans-serif" style="font-size:14px; "><b>İstenilen ürün adeti</b></font></td>

    <td><input name="baslik" type="text" size="73" maxlength="100" class="contact-input"></td>

  </tr>

<tr>

    <td>&nbsp;</td>

   

  </tr>

  <tr>

    <td><font face="Arial, Helvetica, sans-serif" style="font-size:14px; ">Sipariş açıklamanız</font></td>

    <td><textarea name="yorum" cols="35" rows="5" class="contact-input" style="width:350;"></textarea></td>

  </tr>
<tr>

    <td>&nbsp;</td>

   

  </tr>

 <tr>

   <td><font face="Arial, Helvetica, sans-serif" style="font-size:14px; ">Kod</font></td>

   <td>
<table border="0" width="100%">
	<tr>
		<td width="200"><input type="text" name="guvenlikkontrol" id="guvenlikkontrol"  class="contact-input" style="width:280;" /></td>
		<td><div class="contact"><h1>72184</h1></td>
	</tr>
</table>


</td>

 </tr>

  <tr>

    <td>&nbsp;</td>

    <td><input type="submit" name="gonder" value="SipariÅŸi ver" class="contact-button">

	&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/arrow.gif">&nbsp;<font face="Arial, Helvetica, sans-serif" style="font-size:11px; ">Tüm alanlari doldurmaniz gerekmektedir</font>

	</td>

  </tr>


</table>
<table border="0" width="100%" height="114">
	<tr>
		<td valign="top"><img src="images_up/" border="0"></td>
	</tr>
</table>

</form>