06 novembre 2005 alle 13:40:59

<!--#include file="includes/includes-inc.asp"-->
<!--#include file="includes/toppage-inc.asp"-->
<_html>
<_head>
<_title>modulo contatto con opzioni<_/title>
<_meta HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=iso-8859-1">
<style type="text/css">
A:link, A:visited { text-decoration: none }
A:hover { text-decoration: underline }
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<_Script language="Java_Script" type="text/Java_Script">
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<_/head>
<%
If sPseudo <> "" THEN
CreateTopTable "Contatto", "Richiesta Informazioni"%>
<_body BGCOLOR=#FFFFFF text="#333333">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center" height="500">
<tr>
<td width="63%" valign="top" class="normal">COMPILATE CORRETTAMENTE IL MODULO PER RICEVERE LE INFORMAZIONI RICHIESTE.


<br><br>
<table border="0" cellpadding="0" cellspacing="0" width="40%" align="center">
<tr>
<td width="100%">
<_form action="formcdosys.asp" method="post" name="form1" onSubmit="MM_validateForm('email','','RisEmail');return document.MM_returnValue">
<table width="361" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="170" class="small">Nome *</td>
<td width="191">
<input type="text" name="nome" size="20">
</td>
</tr>
<tr>
<td width="170" class="small">Cognome *</td>
<td width="191">
<input type="text" name="cognome" size="20">
</td>
</tr>
<tr>
<td width="170" class="small">Indirizzo *</td>
<td width="191">
<input type="text" name="indirizzo" size="20">
</td>
</tr>
<tr>
<td width="170" class="small">Cap *</td>
<td width="191">
<input type="text" name="cap" size="20">
</td>
</tr>
<tr>
<td width="170" class="small">Città *</td>
<td width="191">
<input type="text" name="città" size="20">
</td>
</tr>
<tr>
<td width="170" class="small">Provincia *</td>
<td width="191">
<input type="text" name="provincia" size="20">
</td>
</tr>
<tr>
<td width="170" class="small">Telefono *</td>
<td width="191">
<input type="text" name="tel" size="20">
</td>
</tr>
<tr>
<td width="170" class="small">E-mail
*</td>
<td width="191">
<input type="text" name="email" size="20">
</td>
</tr>

<tr>
<td width="170" class="small">Note</td>
<td width="191">
<textarea name="note" rows="5" cols="33" wrap="VIRTUAL"></textarea>
</td>
</tr>
<tr>
<td class="small">Desidero ricevere *</td>
<td class="small"><p>
<INPUT type="checkbox" value="1" name="Radio1"> CD Linux<br>
<INPUT type="checkbox" value="2" name="Radio2"> Info su tesseramento <br>
<INPUT type="checkbox" value="3" name="Radio3"> Info su XXXXX<br><br>
</p></td>
</tr>

<tr>
<td class="small">Giudizio *</td>
<td><select name="select">
<option value="opt1">Ottimo</option>
<option value="opt2">Buono</option>
<option value="opt3">Sufficiente</option>
<option value="opt4">Cosi cosi</option>
<option value="opt5">Scarso</option>
<option selected>Lista ...</option>
</select></td>
</tr>
</table>
<p align="center">
<input type="submit" name="Submit" value="Contatto" class="button">&nbsp;</p>
</_form>
<p class="small">* richiesto<br><br>
<p class="small">Assicuratevi di aver indicato esattamente l' indirizzo E-Mail, altrimenti non potrete ricevere quanto richiesto.</p>
</td>
</tr>
</table>
</td>
</tr>
</table>
<p>&nbsp;</p>
<_/body>
<%CreateBottomTable""%>
<_/html>
<%CreateTopTable "Informativa", "Legge 675/96"%>
<table width="100%" cellspacing="0" cellpadding="2">
<tr><td class="small">www.MIOSITO.com informa i visitatori che ai sensi della legge nr.
675 del 31 Dicembre 1996 tutte le informazioni personali fornite
all'interno di questo sito vengono conservate e non verranno cedute
a terzi senza l'autorizzazione del cliente stesso
(art. 12, lettere A e B, Legge N°675/96).
</td></tr></table>
<%CreateBottomTable""
Else
CreateTable "Role", "", GetTranslation("LANG_MUST_HAVE_ROLE"), ""
End If
%>
<!--#include file="includes/bottompage-inc.asp"-->