document.write('<form action="http://www.fortunecafe.net/uranai.cgi">');
document.write('<table border=0 bgcolor="#efeaff" width=300 cellpadding=5><tr bgcolor="#ffffff">');
document.write('<td align=center><img src="http://www.fortunecafe.net/img/fortune2.gif" width=150 height=25 alt="口説き方占い"></td>');
document.write('</tr><tr bgcolor="#ffffff">');
document.write('<td>');
document.write('あなたの生年月日<br>');
document.write('<select name="wareki">');
document.write('<option value="s" selected>昭和');
document.write('<option value="h">平成');
document.write('</select>');
document.write('<select name="by">');
document.write('<option value="01">1');
document.write('<option value="02">2');
document.write('<option value="03">3');
document.write('<option value="04">4');
document.write('<option value="05">5');
document.write('<option value="06">6');
document.write('<option value="07">7');
document.write('<option value="08">8');
document.write('<option value="09">9');
document.write('<option value="10">10');
document.write('<option value="11">11');
document.write('<option value="12">12');
document.write('<option value="13">13');
document.write('<option value="14">14');
document.write('<option value="15">15');
document.write('<option value="16">16');
document.write('<option value="17">17');
document.write('<option value="18">18');
document.write('<option value="19">19');
document.write('<option value="20">20');
document.write('<option value="21">21');
document.write('<option value="22">22');
document.write('<option value="23">23');
document.write('<option value="24">24');
document.write('<option value="25">25');
document.write('<option value="26">26');
document.write('<option value="27">27');
document.write('<option value="28">28');
document.write('<option value="29">29');
document.write('<option value="30">30');
document.write('<option value="31">31');
document.write('<option value="32">32');
document.write('<option value="33">33');
document.write('<option value="34">34');
document.write('<option value="35">35');
document.write('<option value="36">36');
document.write('<option value="37">37');
document.write('<option value="38">38');
document.write('<option value="39">39');
document.write('<option value="40">40');
document.write('<option value="41">41');
document.write('<option value="42">42');
document.write('<option value="43">43');
document.write('<option value="44">44');
document.write('<option value="45">45');
document.write('<option value="46">46');
document.write('<option value="47">47');
document.write('<option value="48">48');
document.write('<option value="49">49');
document.write('<option value="50">50');
document.write('<option value="51">51');
document.write('<option value="52">52');
document.write('<option value="53">53');
document.write('<option value="54">54');
document.write('<option value="55" selected>55');
document.write('<option value="56">56');
document.write('<option value="57">57');
document.write('<option value="58">58');
document.write('<option value="59">59');
document.write('<option value="60">60');
document.write('<option value="61">61');
document.write('<option value="62">62');
document.write('<option value="63">63');
document.write('</select>年');
document.write('<select name="bm">');
document.write('<option value="01">1');
document.write('<option value="02">2');
document.write('<option value="03">3');
document.write('<option value="04">4');
document.write('<option value="05">5');
document.write('<option value="06">6');
document.write('<option value="07">7');
document.write('<option value="08">8');
document.write('<option value="09">9');
document.write('<option value="10">10');
document.write('<option value="11">11');
document.write('<option value="12">12');
document.write('</select>月');
document.write('<select name="bd">');
document.write('<option value="01">1');
document.write('<option value="02">2');
document.write('<option value="03">3');
document.write('<option value="04">4');
document.write('<option value="05">5');
document.write('<option value="06">6');
document.write('<option value="07">7');
document.write('<option value="08">8');
document.write('<option value="09">9');
document.write('<option value="10">10');
document.write('<option value="11">11');
document.write('<option value="12">12');
document.write('<option value="13">13');
document.write('<option value="14">14');
document.write('<option value="15">15');
document.write('<option value="16">16');
document.write('<option value="17">17');
document.write('<option value="18">18');
document.write('<option value="19">19');
document.write('<option value="20">20');
document.write('<option value="21">21');
document.write('<option value="22">22');
document.write('<option value="23">23');
document.write('<option value="24">24');
document.write('<option value="25">25');
document.write('<option value="26">26');
document.write('<option value="27">27');
document.write('<option value="28">28');
document.write('<option value="29">29');
document.write('<option value="30">30');
document.write('<option value="31">31</select>日');
document.write('<select name="sex">');
document.write('<option value="m" selected>男性');
document.write('<option value="w">女性');
document.write('</select><br>');
document.write('相手の誕生日<br>');
document.write('<select name="co_wareki">');
document.write('<option selected value="s">昭和');
document.write('<option value="h">平成');
document.write('</select>');
document.write('<select name="co_by">');
document.write('<option value="01">1');
document.write('<option value="02">2');
document.write('<option value="03">3');
document.write('<option value="04">4');
document.write('<option value="05">5');
document.write('<option value="06">6');
document.write('<option value="07">7');
document.write('<option value="08">8');
document.write('<option value="09">9');
document.write('<option value="10">10');
document.write('<option value="11">11');
document.write('<option value="12">12');
document.write('<option value="13">13');
document.write('<option value="14">14');
document.write('<option value="15">15');
document.write('<option value="16">16');
document.write('<option value="17">17');
document.write('<option value="18">18');
document.write('<option value="19">19');
document.write('<option value="20">20');
document.write('<option value="21">21');
document.write('<option value="22">22');
document.write('<option value="23">23');
document.write('<option value="24">24');
document.write('<option value="25">25');
document.write('<option value="26">26');
document.write('<option value="27">27');
document.write('<option value="28">28');
document.write('<option value="29">29');
document.write('<option value="30">30');
document.write('<option value="31">31');
document.write('<option value="32">32');
document.write('<option value="33">33');
document.write('<option value="34">34');
document.write('<option value="35">35');
document.write('<option value="36">36');
document.write('<option value="37">37');
document.write('<option value="38">38');
document.write('<option value="39">39');
document.write('<option value="40">40');
document.write('<option value="41">41');
document.write('<option value="42">42');
document.write('<option value="43">43');
document.write('<option value="44">44');
document.write('<option value="45">45');
document.write('<option value="46">46');
document.write('<option value="47">47');
document.write('<option value="48">48');
document.write('<option value="49">49');
document.write('<option value="50">50');
document.write('<option value="51">51');
document.write('<option value="52">52');
document.write('<option value="53">53');
document.write('<option value="54">54');
document.write('<option value="55" selected>55');
document.write('<option value="56">56');
document.write('<option value="57">57');
document.write('<option value="58">58');
document.write('<option value="59">59');
document.write('<option value="60">60');
document.write('<option value="61">61');
document.write('<option value="62">62');
document.write('<option value="63">63');
document.write('</select>年');
document.write('<select name="co_bm">');
document.write('<option value="01">1');
document.write('<option value="02">2');
document.write('<option value="03">3');
document.write('<option value="04">4');
document.write('<option value="05">5');
document.write('<option value="06">6');
document.write('<option value="07">7');
document.write('<option value="08">8');
document.write('<option value="09">9');
document.write('<option value="10">10');
document.write('<option value="11">11');
document.write('<option value="12">12');
document.write('</select>月');
document.write('<select name="co_bd">');
document.write('<option value="01">1');
document.write('<option value="02">2');
document.write('<option value="03">3');
document.write('<option value="04">4');
document.write('<option value="05">5');
document.write('<option value="06">6');
document.write('<option value="07">7');
document.write('<option value="08">8');
document.write('<option value="09">9');
document.write('<option value="10">10');
document.write('<option value="11">11');
document.write('<option value="12">12');
document.write('<option value="13">13');
document.write('<option value="14">14');
document.write('<option value="15">15');
document.write('<option value="16">16');
document.write('<option value="17">17');
document.write('<option value="18">18');
document.write('<option value="19">19');
document.write('<option value="20">20');
document.write('<option value="21">21');
document.write('<option value="22">22');
document.write('<option value="23">23');
document.write('<option value="24">24');
document.write('<option value="25">25');
document.write('<option value="26">26');
document.write('<option value="27">27');
document.write('<option value="28">28');
document.write('<option value="29">29');
document.write('<option value="30">30');
document.write('<option value="31">31</select>日<br>');
document.write('<input name="kudoki" type=submit value="口説き方占い">');
document.write('</td>');
document.write('</tr></table>');
document.write('</form>');