document.write("<form name='form1' method='post' action='http://cf.tomo.ac:81/coldfusion/coldfusion/tips/well2.cfm' target='_blank'>");
document.write("  <img src='http://tomo.ac/goodstream/xdata/hand4.gif' width='50' height='36' align='absmiddle'><strong>このページの情報が役立った！という方は、評価をチェックして、送信ボタンを押してください。 ");
document.write("  </strong> ");
document.write("  <blockquote>");
document.write("    <table border='0' cellspacing='0' cellpadding='0'>");
document.write("      <tr> ");
document.write("        <td nowrap><div align='right'><strong>役立たなかった&nbsp;</strong></div></td>");
document.write("        <td> <div align='center'> ");
document.write("            <input type='radio' name='grade' value='1'>");
document.write("          </div></td>");
document.write("        <td> <div align='center'> ");
document.write("            <input type='radio' name='grade' value='2'>");
document.write("          </div></td>");
document.write("        <td> <div align='center'> ");
document.write("            <input type='radio' name='grade' value='3' checked>");
document.write("          </div></td>");
document.write("        <td> <div align='center'> ");
document.write("            <input type='radio' name='grade' value='4'>");
document.write("          </div></td>");
document.write("        <td> <div align='center'> ");
document.write("            <input type='radio' name='grade' value='5'>");
document.write("          </div></td>");
document.write("        <td nowrap><div align='left'><strong>&nbsp;役立った</strong></div></td>");
document.write("        <td>&nbsp;&nbsp;&nbsp;</td>");
document.write("        <td><input type='submit' name='submit' value='評価の送信'></td>");
document.write("        <td>&nbsp;&nbsp;&nbsp;</td>");
document.write("        <td nowrap> <strong>[<a href='http://cf.tomo.ac:81/coldfusion/coldfusion/tips/well0.cfm' target='_blank'>これってなんなの？</a>]</font></strong></td>");
document.write("      </tr>");
document.write("      <tr> ");
document.write("        <td>&nbsp;</td>");
document.write("        <td><div align='center'><strong>1</strong></div></td>");
document.write("        <td><div align='center'><strong>2</strong></div></td>");
document.write("        <td><div align='center'><strong>3</strong></div></td>");
document.write("        <td><div align='center'><strong>4</strong></div></td>");
document.write("        <td><div align='center'><strong>5</strong></div></td>");
document.write("        <td>&nbsp;</td>");
document.write("        <td>&nbsp;</td>");
document.write("        <td>&nbsp;</td>");
document.write("        <td>&nbsp;</td>");
document.write("        <td>&nbsp;</td>");
document.write("      </tr>");
document.write("    </table>");
document.write("  </blockquote>");
document.write("</form>");