初期入力画面
<input name="qsID" type="hidden" value="" />
<input name="pURI" type="hidden" value="" />

<!-- showEdit=0 -->
<table class="formBlockSurveyTable">
<!-- bbbb -->
<tr>
	<td valign="top" class="question">会社名</td>
	<td valign="top"><input name="Question70" id="Question70" type="text" value="ああああ" size="50" style="ime-mode:active" />&nbsp;</td>
</tr>
<!-- bbbb -->
<tr>
	<td valign="top" class="question">氏名</td>
	<td valign="top"><input name="Question71" id="Question71" type="text" value="いいいい" size="50" style="ime-mode:active" />&nbsp;</td>
</tr>
<!-- bbbb -->
<tr>
	<td valign="top" class="question">ご意見&nbsp;<span class="required">*</span></td>
	<td valign="top"><textarea name="Question72" cols="50" rows="3" style="ime-mode:active" style="width:95%">ううううううう</textarea></td>
</tr>
<tr>
	<td colspan="2">画像中の文字と数字を、下のテキストボックスに入力して下さい。</td>
</tr>
<tr>
	<td>&nbsp;</td>
	<td><img src="" alt="Captcha Code" class="ccm-captcha-image" /><br/>
	<input type="text" name="ccmCaptchaCode" class="ccm-input-captcha" /></td>
</tr>
<tr>
	<td>&nbsp;</td>
	<td><input class="formBlockSubmitButton" name="Submit" type="submit" value="確認する" /></td>
</tr>
</table>