<!- 設置の際には必ずxxxをご自身のＩＤに変更して下さい ->
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<body leftmargin="0" topmargin="0">
<table border="0" cellpadding="0" cellspacing="0"
background="http://affiliate.dtiserv.com/sam/form/exshot/images/bgpic.jpg">
<tr>
<td height="168" colspan=2></td>
<td width="17"></td>
<td width="470"></td>
<td width="50"></td>
</tr>
<tr>
<td height="16" colspan=3></td>
<td rowspan="2" valign="top"><FORM method="POST"
name="join_form" action="https://www.dtiserv3.com/cgi-bin/free_join.fcgi"
target="_blank">
<div align="right">
<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">
<SPAN STYLE="font-size:16px;color:white;"><br><strong>「
初回限定$25で20ポイント獲得！」</strong><br></span>
</strong><SPAN STYLE="font-size:12px;color:white;">以下の項目をご記入下さい。<br></span>
</font><a href="javascript:;" onClick="MM_openBrWindow('http://affiliate.dtiserv.com/sam/form/exshot/index2a.html','','width=407,height=280')"><SPAN
STYLE="font-size:11px;color:red;"><strong>>>詳しい入力説明はこちら</strong></span></a><br>
<SPAN STYLE="font-size:12px;color:white;">ユーザー名
<input name="username" type="text" value="" size="20"
maxlength="14">
<br>パスワード
<input name="password" type="text" value="" size="20"
maxlength="14">
<br>eメール
<input name="email" type="text" value="" size="30"
maxlength="50">
<br>eメール確認
<input name="email2" type="text" value="" size="30"
maxlength="50"><br>
<input type="image" src="http://affiliate.dtiserv.com/sam/form/exshot/images/send.gif"
name="submit" width="201" height="35" border="0">
</span>
</div>
</FORM>
</td>
</tr>
<tr>
<td height="275" cospan=4></td>
</tr>
</table>
</body>
</html>