PASAI - Suministros Industriales

Tienda online

Contacto



	<link href="estilos.css" rel="stylesheet" type="text/css" /> <title>PASAI - Suministros Industriales</title><table width="460" border="0" align="left" cellpadding="2" cellspacing="0"> <tr> <td colspan="2" align="left" valign="middle" class="txt_normal" style="padding-top:5px;">Si desea un presupuesto personalizado, rellene el siguiente formulario:</td> </tr> <tr> <td colspan="2" align="center" valign="middle" style="padding-top:5px;"><link href="estilos.css" rel="stylesheet" type="text/css" /> <table width="450" border="0" align="center" cellpadding="0" cellspacing="6" class="borde_punteado_total"> <tr> <td colspan="3" class="tit_rojo"><div align="center" class="tit_rojo"> </div></td> </tr> <form action="email_presupuestos.php" method="post" enctype="multipart/form-data" name="form1" id="form1"><input type="hidden" name="PHPSESSID" value="7c10a86d6320eaf9c9f08ab8c5af9121" /> <tr> <td colspan="2" valign="top" class="borde_punteado"><table width="100%" align="center" cellpadding="1" cellspacing="1" class="bg_transp borde_total"> <tr valign="baseline"> <td width="20" align="right" nowrap="nowrap"> </td> <td align="right" nowrap="nowrap" class="txt_normal"><div align="left" class="style1azul"> <div align="right">Nombre: () </div> </div></td> <td><div align="left"> <input class="enla_gris" type="text" name="pre_nombre" value="" size="32" id="nombre" /> </div></td> </tr> <tr valign="baseline"> <td width="20" align="right" nowrap="nowrap"> </td> <td align="right" nowrap="nowrap" class="txt_normal"><div align="left" class="style1azul"> <div align="right">1er apellido: () </div> </div></td> <td><div align="left"> <input name="pre_apellido" type="text" class="enla_gris" id="pre_apellido" value="" size="32" /> </div></td> </tr> <tr valign="baseline"> <td width="20" align="right" nowrap="nowrap"> </td> <td align="right" nowrap="nowrap" class="txt_normal"><div align="left" class="style1azul"> <div align="right">Dirección: () </div> </div></td> <td><div align="left"> <input type="text" class="enla_gris" name="pre_direccion" value="" id="direccion" size="32" /> </div></td> </tr> <tr valign="baseline"> <td width="20" align="right" nowrap="nowrap"> </td> <td align="right" nowrap="nowrap" class="txt_normal"><div align="left" class="style1azul"> <div align="right">Población: () </div> </div></td> <td><div align="left"> <input type="text" class="enla_gris" name="pre_poblacion" value="" id="poblacion" size="32" /> </div></td> </tr> <tr valign="baseline"> <td width="20" align="right" nowrap="nowrap"> </td> <td align="right" nowrap="nowrap" class="txt_normal"><div align="left" class="style1azul"> <div align="right">Provincia: () </div> </div></td> <td><div align="left"> <input type="text" class="enla_gris" name="pre_prov" value="" id="provincia" size="32" /> </div></td> </tr> <tr valign="baseline"> <td width="20" align="right"> </td> <td align="right" nowrap="nowrap" class="txt_normal"><div align="left" class="style1azul"> <div align="right">Teléfono:()</div> </div></td> <td><div align="left"> <input type="text" class="enla_gris" name="pre_tel_fijo" value="" id="telefono" size="32" /> </div></td> </tr> <tr valign="baseline"> <td width="20" align="right"> </td> <td align="right" nowrap="nowrap" class="txt_normal"><div align="left" class="style1azul"> <div align="right">Email: () </div> </div></td> <td><div align="left"> <input type="text" class="enla_gris" name="pre_email" value="" id="email" size="32" /> </div></td> </tr> <!-- <tr valign="baseline"> <td width="20" align="right"> </td> <td align="right" valign="top" nowrap class="txt_normal"><div align="left" class="style1azul"><strong>Producto: () </strong></div></td> <td><div align="left"> <select name="pre_articulo"> <option value="" selected> </option> <option value=""></option> </select> </div></td> </tr> --> <tr valign="baseline"> <td width="20" align="right"> </td> <td align="right" valign="top" nowrap="nowrap" class="txt_normal"><div align="left" class="style1azul"> <div align="right">Comentarios: ()</div> </div></td> <td><div align="left"> <textarea name="pre_com" cols="34" rows="3" class="enla_gris" id="pre_com"></textarea> </div></td> </tr> </table></td> </tr> <tr> <td width="40%" valign="top" class="txt_normal"><div align="left" class="enla_gris">() Campo obligatorio</div></td> <td width="60%" valign="top" class="txt_normal"><div align="center"><span class="listtitle"> <input name="submit" type="submit" class="botones" value='Enviar Solicitud' /> </span></div></td> </tr> </form> </table> </td> </tr> </table>