function sendJSRequest(callback,data,url){
	
	var select1_0value = "";
for(i=0; i<document.form376254.select1_0.length; i++){
	if(document.form376254.select1_0[i].checked){
		select1_0value = encodeURIComponent(document.form376254.select1_0[i].value);
	}
}
data = '&select1_0=+'+select1_0value+'+' + data;


	//ローディング表示
	document.getElementById("LoadingBox376254").style.visibility = "visible";	
	 
	 //
	var s = document.createElement("script");
    s.charset = "utf-8";
    s.src = url + "?_callback=" + callback + "&" + data;
    document.body.appendChild(s);
	
  }

  //コールバック関数 ( 受信時に実行 )
  function on_loaded1(res)
  {
	
	//レスポンスされた文字列を表示
    document.getElementById("output376254").innerHTML=res
	
  }

  document.write('<div id="output376254">')
document.write(decodeURIComponent('%3Cdiv%20id%3D%22fc2form%22%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22toparea%22%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22message%22%3E%E3%83%9D%E3%82%A4%E3%83%B3%E3%83%88%E3%81%AE%E7%8F%BE%E9%87%91%E4%BA%A4%E6%8F%9B%E3%82%92%E3%81%94%E5%B8%8C%E6%9C%9B%E3%81%AE%E6%96%B9%E3%81%AF%3Cbr%3E%E4%B8%8B%E8%A8%98%E3%83%95%E3%82%A9%E3%83%BC%E3%83%A0%E3%81%B8%E5%BF%85%E8%A6%81%E4%BA%8B%E9%A0%85%E3%82%92%E5%85%A5%E5%8A%9B%E3%81%97%E7%94%B3%E8%AB%8B%E3%81%97%E3%81%A6%E3%81%8F%E3%81%A0%E3%81%95%E3%81%84%E3%80%82%20%3Cbr%3E%E5%85%A5%E5%8A%9B%E5%BE%8C%5B%20%E7%A2%BA%20%E8%AA%8D%20%5D%20%E3%83%9C%E3%82%BF%E3%83%B3%E3%82%92%E6%8A%BC%E3%81%97%E3%81%A6%E3%81%8F%E3%81%A0%E3%81%95%E3%81%84%E3%80%82%3Cbr%3E%3Cbr%3E%E2%80%BB%E7%8F%BE%E9%87%91%E4%BA%A4%E6%8F%9B%E6%AF%94%E7%8E%87%E3%81%AF90%EF%BC%85%E3%81%AB%E3%81%AA%E3%82%8A%E3%81%BE%E3%81%99%E3%80%82%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cform%20name%3D%22form376254%22%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22title%22%3E%3Cli%3E%E5%90%8D%E3%80%80%E5%89%8D'))
document.write(decodeURIComponent('%3Cb%20id%3D%22coution2%22%3E%20%E2%80%BB%20%3C%2Fb%3E'))
document.write(decodeURIComponent('%3C%2Fli%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22comment%22%3E%3Cinput%20name%3D%22name%22%20type%3D%22text%22%20maxlength%3D%2250%22%20value%3D%22%22%3E'))
document.write(decodeURIComponent('%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22title%22%3E%3Cli%3E%E3%81%B5%E3%82%8A%E3%81%8C%E3%81%AA'))
document.write(decodeURIComponent('%3C%2Fli%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22comment%22%3E%3Cinput%20name%3D%22kana_name%22%20type%3D%22text%22%20maxlength%3D%2250%22%20value%3D%22%22%3E'))
document.write(decodeURIComponent('%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22title%22%3E%3Cli%3E%E3%83%A1%E3%83%BC%E3%83%AB%E3%82%A2%E3%83%89%E3%83%AC%E3%82%B9'))
document.write(decodeURIComponent('%3Cb%20id%3D%22coution2%22%3E%20%E2%80%BB%20%3C%2Fb%3E'))
document.write(decodeURIComponent('%3C%2Fli%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22comment%22%3E%3Cinput%20name%3D%22mail%22%20type%3D%22text%22%20maxlength%3D%22100%22%20value%3D%22%22%20style%3D%22ime-mode%3Adisabled%3B%22%3E'))
document.write(decodeURIComponent('%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22title%22%3E%3Cli%3E%E4%BC%9A%E5%93%A1%E7%95%AA%E5%8F%B7'))
document.write(decodeURIComponent('%3Cb%20id%3D%22coution2%22%3E%20%E2%80%BB%20%3C%2Fb%3E'))
document.write(decodeURIComponent('%3C%2Fli%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22comment%22%3E%3Cinput%20name%3D%22text2%22%20type%3D%22text%22%20class%3D%22form-textline%22%20size%3D%2230%22%20maxlength%3D%2220%22%20value%3D%22%22%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22title%22%3E%3Cli%3E%E3%83%9D%E3%82%A4%E3%83%B3%E3%83%88%E4%BA%A4%E6%8F%9B%E3%81%AE%E9%81%B8%E6%8A%9E'))
document.write(decodeURIComponent('%3Cb%20id%3D%22coution2%22%3E%20%E2%80%BB%20%3C%2Fb%3E'))
document.write(decodeURIComponent('%3C%2Fli%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22comment%22%3E'))
document.write(decodeURIComponent('%3Cdiv%3E%3Cinput%20type%3D%22radio%22%20name%3D%22select1_0%22%20value%3D%22%E3%83%9D%E3%82%A4%E3%83%B3%E3%83%88%E8%B2%A9%E5%A3%B2%22%20%3E%20%E3%83%9D%E3%82%A4%E3%83%B3%E3%83%88%E8%B2%A9%E5%A3%B2%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%3E%3Cinput%20type%3D%22radio%22%20name%3D%22select1_0%22%20value%3D%22%E3%83%9D%E3%82%A4%E3%83%B3%E3%83%88%E8%B2%A9%E5%A3%B2%E4%B8%AD%E6%AD%A2%22%20%3E%20%E3%83%9D%E3%82%A4%E3%83%B3%E3%83%88%E8%B2%A9%E5%A3%B2%E4%B8%AD%E6%AD%A2%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22title%22%3E%3Cli%3E%E6%89%8B%E6%8C%81%E3%81%A1%E3%83%9D%E3%82%A4%E3%83%B3%E3%83%88%E6%95%B0'))
document.write(decodeURIComponent('%3Cb%20id%3D%22coution2%22%3E%20%E2%80%BB%20%3C%2Fb%3E'))
document.write(decodeURIComponent('%3C%2Fli%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22comment%22%3E%3Cinput%20name%3D%22text4%22%20type%3D%22text%22%20class%3D%22form-textline%22%20size%3D%2230%22%20maxlength%3D%2220%22%20value%3D%22%22%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22title%22%3E%3Cli%3E%E3%83%9D%E3%82%A4%E3%83%B3%E3%83%88%E8%B2%A9%E5%A3%B2%E6%95%B0%E3%82%82%E3%81%97%E3%81%8F%E3%81%AF%E8%B2%A9%E5%A3%B2%E4%B8%AD%E6%AD%A2%E6%95%B0'))
document.write(decodeURIComponent('%3Cb%20id%3D%22coution2%22%3E%20%E2%80%BB%20%3C%2Fb%3E'))
document.write(decodeURIComponent('%3C%2Fli%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22comment%22%3E%3Cinput%20name%3D%22text3%22%20type%3D%22text%22%20class%3D%22form-textline%22%20size%3D%2230%22%20maxlength%3D%2220%22%20value%3D%22%22%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22title%22%3E%3Cli%3E%E9%80%A3%E7%B5%A1%E4%BA%8B%E9%A0%85'))
document.write(decodeURIComponent('%3C%2Fli%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22comment%22%3E%3Ctextarea%20name%3D%22text1%22%20cols%3D%2250%22%20rows%3D%2210%22%20class%3D%22form-textbox%22%3E%3C%2Ftextarea%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22submit%22%3E%3Cdiv%20id%3D%22LoadingBox376254%22%20style%3D%22clear%3Aleft%3Bpadding%3A3px%3Bvisibility%3Ahidden%3Bposition%3Arelative%3Btop%3A23%3Bbackground-color%3A%20%23FFFFFF%3Bborder%3A%201px%20solid%20%23999999%3Btext-align%3A%20center%3B%22%3E%3Cimg%20src%3D%22http%3A%2F%2Fform1.fc2.com%2Fparts%2Floading1.gif%22%3E%3Cimg%20src%3D%22http%3A%2F%2Fform1.fc2.com%2Fparts%2Floading2.gif%22%3E%3C%2Fdiv%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22submit%22%3E%3Cinput%20type%3D%22button%22value%3D%22%E7%A2%BA%E8%AA%8D%22onclick%3DsendJSRequest%28%22on_loaded1%22%2C%22%26name%3D%22%2BencodeURIComponent%28this.form.name.value%29%2B%22%26kana_name%3D%22%2BencodeURIComponent%28this.form.kana_name.value%29%2B%22%26mail%3D%22%2BencodeURIComponent%28this.form.mail.value%29%2B%22%26text2%3D%22%2BencodeURIComponent%28this.form.text2.value%29%2B%22%26text4%3D%22%2BencodeURIComponent%28this.form.text4.value%29%2B%22%26text3%3D%22%2BencodeURIComponent%28this.form.text3.value%29%2B%22%26text1%3D%22%2BencodeURIComponent%28this.form.text1.value%29%2B%22%26Submit1%3D%22%2B1%2B%22%26id%3D%22%2B376254%2C%22http%3A%2F%2Fform1.fc2.com%2Fparts%2F%22%29%20class%3D%22button%22%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3C%2Fform%3E'))
document.write(decodeURIComponent('%3Cdiv%20class%3D%22bottomarea%22%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cdiv%20style%3D%22font-size%3A12px%3Bmargin-top%3A3px%3B%22%3E%3Ca%20href%3D%22http%3A%2F%2Fform.fc2.com%2F%22%20target%3D%22_blank%22%3E%5B%20FC2%E3%83%A1%E3%83%BC%E3%83%AB%E3%83%95%E3%82%A9%E3%83%BC%E3%83%A0%20%5D%3C%2Fa%3E%3C%2Fdiv%3E'))
document.write(decodeURIComponent('%3Cstyle%20type%3D%22text%2Fcss%22%3E'))
document.write(decodeURIComponent('%3C%21--'))
document.write(decodeURIComponent('%23fc2form%20%23coution1%7Bcolor%3A%20%23FF0000%3B%7D'))
document.write(decodeURIComponent('%23fc2form%20%23coution2%7Bcolor%3A%20%23FF0000%3B%7D'))
document.write(decodeURIComponent('--%3E'))
document.write(decodeURIComponent('%3C%2Fstyle%3E'))
document.write('</div>')