Untitled Document</itle>
<style type="text/css">
/* FALE CONOSCO */
.formStyle {
font-family: Arial, Helvetica, sans-serif;
font-size: 12px;
color: #666;
text-decoration: none;
background-color: #FFF;
border: 1px solid #999;
}
.formLabel{
float: left;
width: 80px;
text-align: left;
padding-right: 5px;
}
.formLabel2{
margin:0;
position:inherit;
float: right;
text-align: left;
margin-right: 50px;
}
.formField {
width: 380px;
text-align:left;
}
</style>
</head>
<body>
<h1>Seja um revendedor da Prime Business Import</h1>
<div class="formLabel">Razão Social:</div> <div class="formField">
<input name="faleNome" type="text" id="faleNome2" class="formStyle" style="width: 300px;"/>
</div>
<div class="formLabel2">Mensagem:<br /><textarea name="comentario" class="formStyle" style="width: 300px; height:200px; overflow:auto;" cols="2" rows="5" id="faleComentario"></textarea></div>
<div id="fcNome" class="faleConoscoError"></div>
<div class="formLabel">E-mail: </div> <div class="formField"><input name="email" type="text" id="faleEmail" class="formStyle" style="width: 300px;"/></div>
<div id="fcEmail" class="faleConoscoError"></div>
<div class="formLabel">Cidade: </div> <div class="formField"><input name="cidade" type="text" id="faleCidade" class="formStyle" style="width: 300px;"/></div>
<div id="fcCidade" class="faleConoscoError"></div>
<div class="formLabel">Estado: </div> <div class="formField"><select name="estado" class="formStyle" style="width: 150px;" id="faleUF">
<option value="0" selected="selected" >Selecione ↓ </option>
<option value="AC" >Acre</option>
<option value="AL" >Alagoas</option>
<option value="AP" >Amapá</option>
<option value="AM" >Amazonas</option>
<option value="BA" >Bahia</option>
<option value="CE" >Ceará</option>
<option value="DF" >Distrito Federal</option>
<option value="ES" >Espírito Santo</option>
<option value="GO" >Goiás</option>
<option value="MA" >Maranhão</option>
<option value="MT" >Mato Grosso</option>
<option value="MS" >Mato Grosso do Sul</option>
<option value="MG" >Minas Gerais</option>
<option value="PA" >Pará</option>
<option value="PB" >Paraíba</option>
<option value="PR" >Paraná</option>
<option value="PE" >Pernambuco</option>
<option value="PI" >Piauí</option>
<option value="RJ" >Rio de Janeiro</option>
<option value="RN" >Rio Grande do Norte</option>
<option value="RS" >Rio Grande do Sul</option>
<option value="RO" >Rondônia</option>
<option value="RR" >Roraima</option>
<option value="SC" >Santa Catarina</option>
<option value="SP" >São Paulo</option>
<option value="SE" >Sergipe</option>
<option value="TO" >Tocantins</option>
</select></div>
<div id="fcUF" class="faleConoscoError"></div>
<div class="formLabel">Telefone:</div> <div class="formField"> <input onkeypress="return txtBoxFormat(this, '(99)9999-9999', event);" name="telefone" type="text" class="formStyle" style="width: 100px;" id="faleTelefone" maxlength="13" /></div>
<div class="formLabel">Responsável: </div>
<div class="formField"><input name="email" type="text" id="faleResponsavel" class="formStyle" style="width: 300px;"/></div>
<div class="formLabel">Cnpj: </div>
<div class="formField"><input name="email" type="text" id="faleCNPJ" class="formStyle" style="width: 300px;"/></div>
<div id="fcMsg" class="faleConoscoError"></div>
<div class="formLabel"> </div> <div class="formField"><input type="image" src="http://senior.expresso.com.br/wp-content/themes/senior/images/accBtnenviar.gif" value="Enviar" onclick="checkFaleConosco();" /> <img src="wp-content/themes/senior/images/loading.gif" border="0" alt="Carregando" id="loading" style="visibility: hidden;" /></div>
</body>
</html></div>
</div>
<div class="footer">Todos os direitos reservados a Prime Business Import.<a href="http://www.ketupropaganda.com.br/"><img src="images/ketu.png" width="22" height="26" alt="Ketu" /></a></div>
</div>
</body>
</html>