Psst.. new poll here.
[email protected] web/email now available. Want one? Go here.
Cannot use outlook/hotmail/live here to register as they blocking our mail servers. #microsoftdeez
Obey the Epel!
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Pasted as HTML by registered user webref ( 14 years ago )
<p align="center">Envíanos tu consulta y te responderemos a la brevedad.
<form name='envio' action='sendmail.php' method='POST' enctype="multipart/form-data>
<table align="center" cellspacing='0' class='table_form_1' id='table_form_1'>
<tr>
<td class='ftbl_row_1' ><LABEL for='nombre' ACCESSKEY='none' ><b style='color:red'>*</b>Nombre y Apellido
</td>
<td class='ftbl_row_1a' ><input type='text' name='nombre' id='nombre' size='32' value=''> </td>
</tr>
<tr>
<td class='ftbl_row_2' ><LABEL for='telefono' ACCESSKEY='none' ><b style='color:red'>*</b>Telefono
</td>
<td class='ftbl_row_2a' ><input type='text' name='telefono' id='telefono' size='18' value=''> </td>
</tr>
<tr>
<td class='ftbl_row_1' ><LABEL for='celular' ACCESSKEY='none' ><b style='color:red'>*</b>Celular
</td>
<td class='ftbl_row_1a' ><input type='text' name='celular' id='celular' size='18' value=''> </td>
</tr>
<tr>
<td class='ftbl_row_2' ><LABEL for='email'><b style='color:red'>*</b>E-Mail
</td>
<td class='ftbl_row_2a' ><input type='text' name='email' id='email' size='18' value=''> </td>
</tr>
<tr>
<td class='ftbl_row_2' ><LABEL for='localidad'><b style='color:red'>*</b>Localidad
</td>
<td class='ftbl_row_2a' ><input type='text' name='localidad' id='localidad' size='18' value=''> </td>
</tr>
<tr>
<td class='ftbl_row_2' ><LABEL for='provincia'><b style='color:red'>*</b>Provincia
</td>
<td class='ftbl_row_2a' ><input type='text' name='provincia' id='provincia' size='18' value=''> </td>
</tr>
<tr>
<td class='ftbl_row_2' ><LABEL for='notas'><b style='color:red'>*</b>Otras consultas
</td>
<td class='ftbl_row_2a' ><input type='text' name='notas' id='notas' size='30
' value=''> </td>
</tr>
<tr>
<td colspan='2' align='right'><input type='submit' name='submit' value='Enviar'> <input type='reset' name='reset' value='Reiniciar'><br /><a href='http://www.formgenics.com' style='font-family:arial;font-size:10px;color:#C0C0C0;text-decoration:none'></a> </td>
</tr>
</table>
</form> </p>
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