ÿþ<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" > <head> <title>Idealterapia - Cadastro</title> </head> <body bgcolor="#FFFFFF"> <div align="center"> <center> <table border="0" width="76%"> <tr> <td width="100%"> <p align="center" style="margin-top: 0"> <font face="Arial" size="4" color="#3399FF"><b>Fale Conosco</b></font><font color="#3399FF"></font> <form name="Form1" method="post" action="http://www.idealterapia.com.br/ftools/process.php"> <input type="hidden" name="form_tools_form_id" value="1" /> <font color="#3399FF"> <input type=HIDDEN name="redirect" value="http://www.idealterapia.com.br/Obrigado.htm"> </font> <div align="center"> <center> <table border="0" width="400"> <tr> <td width="180"> <p align="left" style="margin-top: 0; margin-bottom: 0"><b> <font face="Arial" color="#3399FF" size="2">Nome&nbsp; </font></b></td> <td width="196"> <b><font color="#3399FF" face="Arial" size="3"><input type="text" name="nome" size="47"></font></b></td> </tr> </table> </center> </div> <div align="center"> <center> <table border="0" width="400"> <tr> <td width="180"> <p align="left" style="margin-top: 0; margin-bottom: 0"><b> <font face="Arial" color="#3399FF" size="2">E-Mail&nbsp; </font></b></td> <td width="196"> <b><font color="#3399FF" face="Arial" size="3"><input type="text" name="email" size="47"></font></b></td> </tr> </table> </center> </div> <div align="center"> <center> <table border="0" width="402"> <tr> <td width="204"> <p align="left"><b><font face="Arial" size="2" color="#3399FF">Cidade</font><font color="#3399FF" face="Arial" size="3"><input type="text" name="Cidade" size="43"></font></b></p></td> <td width="41"> <p align="left"><b><font color="#3399FF" face="Arial" size="2">Estado<br> </font><font color="#3399FF" face="Arial" size="2"> <input type="text" name="Estado" size="6" maxlength="2"></font></b></p></td> </tr> </table> </center> </div> <div align="center"> <center> <table border="0" width="400"> <tr> <td width="430" > <p align="center" style="margin-top: 0; margin-bottom: 0"><b> <font face="Arial" color="#3399FF" size="2">Digite aqui sua dúvida, sugestão ou comentário ?</font></b></p> <p style="margin-top: 0"><font color="#3399FF"><textarea rows="6" name="S1" cols="46"></textarea></font></td> </tr> </table> </center> </div> <div align="center"> <center> <table border="0" width="400"> <tr> <td align="center" width="214"> <p align="center" style="margin-bottom: 0"><b> <font color="#3399FF" face="Arial" size="3"><input type="submit" value=" Enviar " name="B1"></font></b></td> <td align="center" width="206"> <p align="center" style="margin-bottom: 0"><b> <font color="#3399FF" face="Arial" size="3"><input type="reset" value=" Limpar " name="B2"></font></b></td> </tr> </table> </center> </div> </form> </td> </tr> </table> </center> </div> </body> </html>