<!- 設置の際には必ずxxxをご自身のＩＤに変更して下さい ->
<FORM method="POST" name="join_form" action="https://www.dtiserv3.com/cgi-bin/free_join.fcgi" target="_blank">
<div align="center">
<INPUT type="hidden" name="goods_id" value="1006903">
<INPUT type="hidden" name="lang" value="ja">
<INPUT type="hidden" name="action" value="join_confirm">
<INPUT type="hidden" name="aff_id" value="xxx">
</div>
<table width="600" height="381" border="0
" cellpadding="0" cellspacing="0">
<tr>
<td height="80" colspan="2"><img src="http://affiliate.dtiserv.com/sam/form/exshot/images/top.jpg" width="600" height="80" border="0"></td>
</tr>
<tr>
<td width="300" height="118" background="http://affiliate.dtiserv.com/sam/form/exshot/images/user.jpg">
<div align="center">
<p>
<input name="username" type="text" value="" size="20" maxlength="14">
</p>
<p> <SPAN STYLE="font-size:12px;"><strong><font color="#FF0000">半角英数</font>で4文字以上、14文字以内でお願いします</strong></span></p>
</div></td>
<td width="300" height="118" background="http://affiliate.dtiserv.com/sam/form/exshot/images/pass.jpg">
<div align="center">
<input name="password" type="text" value="" size="20" maxlength="14">
<p><SPAN STYLE="font-size:12px;"><strong><font color="#FF0000">半角英数</font>を混ぜて8文字以上、14文字以内</strong></span></p>
</div></td>
</tr>
<tr>
<td width="300" height="118" background="http://affiliate.dtiserv.com/sam/form/exshot/images/mail1.jpg">
<div align="center">
<p>
<input name="email" type="text" value="" size="30" maxlength="50">
</p>
<p><SPAN STYLE="font-size:12px;"><strong>Eメールアドレスを入力して下さい<font color="#FF0000">（無料アドレス禁止）</font></strong></span></p>
</div></td>
<td width="300" height="118" background="http://affiliate.dtiserv.com/sam/form/exshot/images/mail2.jpg">
<div align="center">
<p>
<input name="email2" type="text" value="" size="30" maxlength="50">
</p>
<p><SPAN STYLE="font-size:12px;"><strong>再確認のため、もう１度メールアドレスを入力</strong></span></p>
</div>
</td>
</tr>
<tr>
<td height="60" colspan="2" background="http://affiliate.dtiserv.com/sam/form/exshot/images/bottom.jpg"> <div align="center">
<p><input type=submit name=submit value="申し込む">
</p></div></td>
</tr>
</table></FORM>