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<title>ONLINE KEŞİF TALEP FORMU</title>
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<p align="center">&nbsp;</p>
<p align="center">&nbsp;</p>
<p align="center">&nbsp;</p><CENTER>
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					<span style="font-weight: 700; font-size: 9pt">KONERJI 
					MÜH.LTD.ŞTİ - KEŞİF 
					TALEP FORMU</span></td>
					<td>
					<p style="text-align: right">
			<img border="0" src="img/all/exit.png" width="28" height="28"></td>
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			&nbsp;</td>
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					<p align="left">
			Merhabalar&nbsp;, Lütfen istenen bilgileri eksiksiz ve tam doldurun!<p align="left">
					Bugün <font color="#990000">
			21.05.2012 07:27:30</font></td>
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					<img border="0" src="img/all/logo.png"></td>
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			<p>&nbsp;</p>
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					<td width="56">&nbsp;</td>
					<td width="112">&nbsp;</td>
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					&nbsp;</td>
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					<img border="0" src="img/icon/line_dik.jpg" width="11" height="70"><p>
					<img border="0" src="img/icon/line_dik.jpg" width="11" height="70"></td>
					<td width="337" rowspan="8">
					<input type="radio" value="1"  name="kesif" checked> 
					Kablolu Isıtma için Keşif Talebi<p>
					<input type="radio" value="2"  name="kesif"> 
					Karbon Isıtma için Keşif Talebi</p>
					<input type="radio" value="3"  name="kesif"> 
					Yerden Isıtma için Keşif Talebi<p>
					<input type="radio" value="4"  name="kesif"> 
					Güneş Enerjisi için Keşif Talebi</p>
					<p>
					<input type="radio" value="5" name="kesif"> 
					Isı Pompası&nbsp; için Keşif Talebi</p>
					<p>&nbsp;</p>
					<p>Keşif şartlarını okudum ve 
					verdiğim bilgilerin doğruluğunu kabul ediyorum!</p>
					<hr width="70%" align="left">
					<p><input type="checkbox" name="C1" value="ON"> Keşif 
					şartlarını okundum ve kabul ediyorum. <b>Keşif Şartları.</b></p>
					<p>&nbsp;</p>
					<p>
					<img border="0" src="img/icon/icon_gonder.jpg" width="60" height="40"></td>
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					<td width="56">&nbsp;</td>
					<td width="112">TC no / Vergi No</td>
					<td width="316">
					<INPUT id=Kesif_talep1_adi5 
      name=Kesif_talep1:adi5 size=40></td>
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					<td width="56">&nbsp;</td>
					<td width="112">Adınız Soyadınız</td>
					<td width="316">
					<INPUT id=Kesif_talep1_adi 
      name=Kesif_talep1:adi size=40></td>
				</tr>
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					<td width="56">&nbsp;</td>
					<td width="112">Telefon Numaranız</td>
					<td width="316">
					<INPUT id=Kesif_talep1_adi2 
      name=Kesif_talep1:adi2 size=40></td>
				</tr>
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					<td width="56">&nbsp;</td>
					<td width="112">E-posta Adresiniz</td>
					<td width="316">
					<INPUT id=Kesif_talep1_adi3 
      name=Kesif_talep1:adi3 size=40></td>
				</tr>
				<tr>
					<td width="56">&nbsp;</td>
					<td width="112">Keşif Adresi</td>
					<td width="316">
					<TEXTAREA style="HEIGHT: 57; width:271" id=Kesif_talep1_Adres cols=30 rows=3 name=Kesif_talep1:Adres></TEXTAREA></td>
				</tr>
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					<td width="56">&nbsp;</td>
					<td width="112">Keşif Şehri</td>
					<td width="316">
							<select size="1" name="sehir" style="word-spacing: 0; font-family: Tahoma; font-size: 8pt; margin: 0; " tabindex="4">

<option value="1" >Adana</option>

<option value="2" >Adıyaman</option>

<option value="3" >Afyon</option>

<option value="4" >Ağrı</option>

<option value="5" >Amasya</option>

<option value="6" >Ankara</option>

<option value="7" >Antalya</option>

<option value="8" >Artvin</option>

<option value="9" >Aydın</option>

<option value="10" >Balıkesir</option>

<option value="11" >Bilecik</option>

<option value="12" >Bingöl</option>

<option value="13" >Bitlis</option>

<option value="14" >Bolu</option>

<option value="15" >Burdur</option>

<option value="16" >Bursa</option>

<option value="17" >Çanakkale</option>

<option value="18" >Çankırı</option>

<option value="19" >Çorum</option>

<option value="20" >Denizli</option>

<option value="21" >Diyarbakır</option>

<option value="22" >Edirne</option>

<option value="23" >Elazığ</option>

<option value="24" >Erzincan</option>

<option value="25" >Erzurum</option>

<option value="26" >Eskişehir</option>

<option value="27" >Gaziantep</option>

<option value="28" >Giresun</option>

<option value="29" >Gümüşhane</option>

<option value="30" >Hakkari</option>

<option value="31" >Hatay</option>

<option value="32" >Isparta</option>

<option value="33" >Mersin</option>

<option value="34" >İstanbul</option>

<option value="35" >İzmir</option>

<option value="36" >Kars</option>

<option value="37" >Kastamonu</option>

<option value="38" >Kayseri</option>

<option value="39" >Kırklareli</option>

<option value="40" >Kırşehir</option>

<option value="41" >Kocaeli</option>

<option value="42" >Konya</option>

<option value="43" >Kütahya</option>

<option value="44" >Malatya</option>

<option value="45" >Manisa</option>

<option value="46" >Kahramanmaraş</option>

<option value="47" >Mardin</option>

<option value="48" >Muğla</option>

<option value="49" >Muş</option>

<option value="50" >Nevşehir</option>

<option value="51" >Niğde</option>

<option value="52" >Ordu</option>

<option value="53" >Rize</option>

<option value="54" >Sakarya</option>

<option value="55" >Samsun</option>

<option value="56" >Siirt</option>

<option value="57" >Sinop</option>

<option value="58" >Sivas</option>

<option value="59" >Tekirdağ</option>

<option value="60" >Tokat</option>

<option value="61" >Trabzon</option>

<option value="62" >Tunceli</option>

<option value="63" >Şanlıurfa</option>

<option value="64" >Uşak</option>

<option value="65" >Van</option>

<option value="66" >Yozgat</option>

<option value="67" >Zonguldak</option>

<option value="68" >Aksaray</option>

<option value="69" >Bayburt</option>

<option value="70" >Karaman</option>

<option value="71" >Kırıkkale</option>

<option value="72" >Batman</option>

<option value="73" >Şırnak</option>

<option value="74" >Bartın</option>

<option value="75" >Ardahan</option>

<option value="76" >Iğdır</option>

<option value="77" >Yalova</option>

<option value="78" >Karabük</option>

<option value="79" >Kilis</option>

<option value="80" >Osmaniye</option>

<option value="81" >Düzce</option>

</select></td>
				</tr>
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					<td width="56">&nbsp;</td>
					<td width="112">Keşif Alanı m2</td>
					<td width="316">
					<INPUT id=Kesif_talep1_adi4 
      name=Kesif_talep1:adi4 size=8></td>
				</tr>
				</table>
			<p>
			</p><p style="text-align: right">&nbsp;<p style="text-align: right">&nbsp;</td>
		<td rowspan="4" background="img/tabloa_img/tabloa_07.png" width="21">
			&nbsp;</td>
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					<img border="0" src="img/all/my.png" width="33" height="38"></td>
					<td width="103" bgcolor="#FFFFFF">
					<img border="0" src="img/all/visa_master.png" width="93" height="30"></td>
					<td valign="bottom" width="706">
					<table border="0" width="100%" id="table1539" cellspacing="0" cellpadding="0">
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							<p style="text-align: right">Bağlantı
			38.107.179.239</td>
						</tr>
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							<td>&nbsp;</td>
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							<td>
					<p style="text-align: right"><font color="#990000">Sistem 
					IP, Mac Adres ve Gateway kontrolü yapmaktadır!</font></td>
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			</td>
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			<img src="img/tabloa_img/tabloa_10.png" width="32" height="21" alt=""></td>
		<td background="img/tabloa_img/tabloa_11.png" height="21">
			&nbsp;</td>
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			<img src="img/tabloa_img/tabloa_13.png" width="21" height="21" alt=""></td>
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