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05 de Fevereiro de 2012
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<div align="left"> <p> <script type="text/javascript"> var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); </script> <script type="text/javascript"> var pageTracker = _gat._getTracker("UA-5826555-1"); pageTracker._trackPageview(); </script> </p> </div> <form onSubmit="return checa_formulario(this)" action="conclui_cadastro_2.php" method="post" enctype="multipart/form-data" name="cadastro"> <div align="center"> <p align="left"><em><strong><font color="#0000FF">Etapa 1 de 5</font></strong></em></p> <p align="left"><em><span class="style1"><span class="style2"><span class="style3"><span class="style4"><span class="style5"><span class="style2"><span class="style6"><span class="style10"><strong><font color="#0000FF">Conclusão de Cadastro</font></strong><font color="#0099FF"> - Escolha do Plano - Contrato - Criação de usuário para acesso - Forma de pagamento</font><font color="#0099FF"></font></span></span></span></span></span></span></span></span></em></p> <table width="700" align="left" bgcolor="#0066FF"> <input name="ip" type="Hidden" value="201.13.91.157"> <input name="data" type="Hidden" value="20/11/2006"> <tr bgcolor="#0000FF"> <td colspan="3"><font color="#FFFFFF" style="font-family: tahoma; font-size: 18;"><b><em>CONCLUSÃO DE CADASTRO</em></b></font></td> </tr> <tr> <td height=20 colspan="3"></td> </tr> <tr> <td colspan="3" align="center"><font color="#FFFFFF" style="font-family: tahoma; font-size: 11px;"><b>Confira e preencha todos os campos para continuar</b></font></td> </tr> <tr> <td height=4 colspan="3"></td> </tr> <tr> <td height=20><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td height=20><div align="left"><strong><font color="#FFFFFF" size="1" face="Arial, Helvetica, sans-serif">Selecione o tipo de empresa </font></strong></div></td> <td height=20><div align="left"><select name="tipo_empresa" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onChange="option()"> <option value="0" selected >Selecione</option> <option value="1" >Pizzaria</option> <option value="2" >Fornecedor</option> <option value="3" >Buffet de pizza</option> </select></div></td> </tr> <tr> <td width="59" align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td width="150" align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">Nome da empresa</font></strong></font></div></td> <td width="375" align="center"><div align="left"> <input name="nome_empresa" type="text" id="nome_empresa" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">CNPJ</font></strong></font></div></td> <td align="center"><div align="left"> <input name="cnpj" type="text" id="cnpj" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">Responsável</font></strong></font></div></td> <td align="center"><div align="left"> <input name="responsavel" type="text" id="responsavel" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">CPF</font></strong></font></div></td> <td align="center"><div align="left"> <input name="cpf" type="text" id="cpf" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">Bairro</font></strong></font></div></td> <td align="center"><div align="left"> <input name="bairro" type="text" id="bairro" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">Endereço</font></strong></font></div></td> <td align="center"><div align="left"> <input name="endereco" type="text" id="endereco" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">CEP</font></strong></font></div></td> <td align="center"><div align="left"> <input name="cep" type="text" id="cep" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">1º Telefone</font></strong></font></div></td> <td align="center"><div align="left"> <input name="fone_1" type="text" id="fone_1" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">2º Telefone</font></strong></font></div></td> <td align="center"><div align="left"> <input name="fone_2" type="text" id="fone_2" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td height="20" align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font color="#FFFFFF" size="1" face="Arial, Helvetica, sans-serif"><strong>Email Pessoal </strong></font></div></td> <td align="center"><div align="left"> <input name="email" type="text" id="email" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; color:#000; font-style:normal; " onFocus="clear_field(this)" onBlur="check_field(this)" value=""> </div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">Região</font></strong></font></div></td> <td align="center"><div align="left"><font size="1"> <select name="regiao" id="select4" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; "> <option value="1" >ZONA NORTE</option> <option value="2" >ZONA SUL</option> <option value="3" >ZONA LESTE</option> <option value="4" >ZONA OESTE</option> <option value="5" >ZONA CENTRAL</option> </select> </font></div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">Estado</font></strong></font></div></td> <td align="center"><div align="left"><font size="1"> <select name="estado" id="estado" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)" onChange="option()"> <option>Selecione um estado</option> <option value="15" >Alagoas</option> <option value="23" >Amapá</option> <option value="24" >Amazonas</option> <option value="13" >Bahia</option> <option value="19" >Ceará</option> <option value="27" >Distrito Federal</option> <option value="9" >Espirito Santo</option> <option value="8" >Goiás</option> <option value="21" >Maranhão</option> <option value="10" >Mato Grosso</option> <option value="4" >Mato Grosso de Sul</option> <option value="3" >Minas Gerais</option> <option value="22" >Pará</option> <option value="17" >Paraíba</option> <option value="5" >Paraná</option> <option value="16" >Pernambuco</option> <option value="20" >Piauí</option> <option value="2" >Rio de Janeiro</option> <option value="18" >Rio Grande do Norte</option> <option value="7" >Rio Grande do Sul</option> <option value="11" >Rondônia</option> <option value="25" >Roraima</option> <option value="6" >Santa Catarina</option> <option value="1" >São Paulo</option> <option value="14" >Sergipe</option> <option value="12" >Tocantins</option> </select> </font></div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font><font size="2"><em></em></font></div></td> <td align="center"><div align="left"><font size="1"><strong><font color="#FFFFFF" face="Arial, Helvetica, sans-serif">Cidade</font></strong></font></div></td> <td align="center"><div align="left"><font size="1"> <select name="cidade" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; " onFocus="clear_field(this)" onBlur="check_field(this)"> <option>Selecione uma cidade</option> </select> </font></div></td> </tr> <tr> <td align="center"><div align="right"><font size="1"> </font></div></td> <td align="center"><div align="left"><font color="#FFFFFF" size="1" face="Arial, Helvetica, sans-serif"><strong>A empresa possui Delivery</strong></font><font color="#FFFFFF" size="1" face="Arial, Helvetica, sans-serif"><strong> </strong></font></div></td> <td align="center"><div align="left"> <select name="delivery" style="background-color: white; width: 250px; height: 18px; font-family: tahoma; font-size: 11px; "> <option value="0" selected >Não</option> <option value="1" >Sim</option> </select> </font> </div></td> </tr> <tr> <td colspan="3" align="center"><input name="Submit" type="submit" id="Submit" style="border: 1px solid #ffffff; background-color: efefef; font-family: tahoma; font-size: 11px;" VALUE="Prosseguir"> </td> </tr> </table> </div> </form>
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