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<div style="color: rgb(123, 123, 123); font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: normal; background-color: rgb(255, 255, 255); text-align: center;"><img alt="" com="" id="6652" src="http://www.flexamail.com/GetImage.ashx?Id=6652"></div>
<div style="color: rgb(123, 123, 123); font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: normal; background-color: rgb(255, 255, 255); text-align: center;"><span style="font-size: 18px;"><span style="color: rgb(255, 102, 0); font-weight: bold;">請注意喔!<span style="color: rgb(255, 0, 0);"> 非亞洲國家地區</span>請用<span style="color: rgb(255, 0, 0);">英文名字</span>註冊，並填寫正確資料。<br></span><span style="color: rgb(255, 102, 0); font-weight: bold;">以免未來產生獎金時無法領取。</span></span></div>
<br style="color: rgb(123, 123, 123); font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: normal; text-align: -webkit-center; background-color: rgb(255, 255, 255);"><center style="color: rgb(123, 123, 123); font-family: Arial, Helvetica, sans-serif; font-size: 14px; line-height: normal; background-color: rgb(255, 255, 255);"><b><font size="5">填寫您的個人資料</font></b>
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<div class="textwidget"><form action="http://www.vbuildernow.com/199638206" name="form" method="post" style="padding: 0px;">
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<table bordercolordark="#69C4E9" bordercolorlight="#69C4E9" class="formfont" style="border-collapse: collapse;" bordercolor="#69C4E9" cellpadding="5" cellspacing="0" width="415">

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<td class="formfont" align="center" bgcolor="#69C4E9" width="170"><b><font color="#FFFFFF">姓氏</font></b></td>
<td class="item" width="245"><input maxlength="50" value="" name="surveyFirstName" size="25" id="acpro_inp0" style="margin: 0px; padding-top: 0px; padding-bottom: 0px;" align="left" type="text"></td>
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<td class="formfont" align="center" bgcolor="#69C4E9" width="170"><b><font color="#FFFFFF">名字</font></b></td>
<td class="item" width="245"><input maxlength="50" value="" name="surveyLastName" size="25" id="acpro_inp1" style="margin: 0px; padding-top: 0px; padding-bottom: 0px;" align="left" type="text"></td>
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<td class="formfont" align="center" bgcolor="#69C4E9" width="170"><b><font color="#FFFFFF">行動電話</font></b></td>
<td class="item" width="245"><input maxlength="30" value="" name="surveyPhone" size="25" id="acpro_inp2" style="margin: 0px; padding-top: 0px; padding-bottom: 0px;" align="left" type="text"></td>
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<td class="formfont" align="center" bgcolor="#69C4E9" width="170"><b><font color="#FFFFFF">常用E-mail</font></b></td>
<td class="item" width="245"><input maxlength="50" value="" name="surveyEmail" size="25" id="acpro_inp3" style="margin: 0px; padding-top: 0px; padding-bottom: 0px;" align="left" type="text"></td>
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<td class="formfont" align="center" bgcolor="#69C4E9" width="170"><b><font color="#FFFFFF">再次輸入E-mail</font></b></td>
<td class="item" width="245"><input maxlength="50" value="" name="surveyConfirmEmail" size="25" id="acpro_inp4" style="margin: 0px; padding-top: 0px; padding-bottom: 0px;" align="left" type="text"></td>
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<td class="formfont" align="center" bgcolor="#69C4E9" width="170"><b><font color="#FFFFFF">國家地區</font></b></td>
<td class="item" width="245"><select class="formfont" name="surveyCountry"><option value="">請選擇一個地區</option><option value="1">美國</option><option value="12">澳洲</option><option value="13">奧地利</option><option value="36">加拿大</option><option value="78">德國</option><option value="94">香港 / 中國</option><option value="98">印尼</option><option value="99">愛爾蘭</option><option value="103">日本</option><option value="123">馬來西亞</option><option value="147">紐西蘭</option><option value="163">菲律賓</option><option value="183">新加坡</option><option value="184">斯洛伐尼亞</option><option value="197">臺灣</option><option value="213">英國</option></select></td>
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<td class="formfont" align="center" bgcolor="#69C4E9" width="170"><b><font color="#FFFFFF">我每個月想賺取</font></b></td>
<td class="item" width="245"><select class="formfont" name="surveyIncomeGoal"><option value="">請選擇</option><option value="0">每個月少於 $1,000美元</option><option value="1">每個月 $1,000美元</option><option value="2">每個月 $3,000美元</option><option value="3">每個月 $5,000美元</option><option value="4">每個月
$10,000美元以上  </option></select></td>
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<p style="margin: 0px; padding: 0.5em 0px; font-size: 16px !important; line-height: 1.5; color: rgb(236, 102, 162) !important;"><span style="color: rgb(153, 102, 255);"><br></span></p>
<p style="margin: 0px; padding: 0.5em 0px; font-size: 16px !important; line-height: 1.5; color: rgb(236, 102, 162) !important;"><font size="4"><font color="#9966FF" size="4"><input value="★免費註冊開始體驗 (未滿20歲請勿註冊)★" name="surveysubmit" style="margin: 0px; padding: 0px; color: rgb(12, 90, 248); font-size: 14pt;" type="submit"> <br></font></font></p>
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