<html>

<head>

<title>Area de Contacto Cecposadas.com.ar ::.</title>

<link rel='stylesheet' href='styles/formulario.css'>

<script src='scripts/jquery-1.4.1.min.js'></script>

<script src='scripts/formulario.js'></script>

<style type="text/css">

<!--

.Estilo1 {font-size: 24px}

body {

	background-image: url(images/fondo.jpg);

}
.localidad {

	background-color: #006699;
	font-style:normal; font-size:14px; color:#FFFFFF;
	width:400px; margin-right:10px; margin-left:10px;
}



-->

</style>

 <script type="text/javascript">
function msk_cuit(){ 	
 	if(document.getElementById('cuit').value.length == 2 ||document.getElementById('cuit').value.length == 11 ){
 		document.getElementById('cuit').value += "-"; 	 		
 	} 	
 }

</script>

<meta http-equiv="Content-Type" content="text/html; charset=utf-8"></head>



<body leftmargin="0" topmargin="0" marginwidth="0" marginheight="0">

<table width="600" border="0" cellpadding="0" cellspacing="0" align="center">

  <tr>

    <td width="600">

		<div style="margin-top:10px">

			<img src="images/contacto.png" width="550">		</div>

		<form class='contacto' method='post' action='registro_empre.php' enctype='multipart/form-data'>
						
						<div>

						  <label>Raz&oacute;n Social:</label>
						  <input type='text' name='razon' class='razon' value='' required >
						</div>						

						<div>

						 <label>C.U.I.T:</label>
						  <input type='text' pattern="[0-9]{2}-[0-9]{8}-[0-9]{1}" placeholder='00-00000000-0' name='cuit'id='cuit' onkeyup="msk_cuit()" autocomplete="off"  maxlength="13" class='cuit' value= ''>

						</div>	
						
						<div>

						  <label>Email:</label>
						  <input type='text' name='email' class='email' value='' required >
						</div>						

						<div>

						  <label>Direcci&oacute;n:</label>
						  <input type='text' name='direccion' class='direccion' value='' required ></div>

						<div>

						  <label>Telefono:</label>
						  <input type='text' name='telefono' class='telefono' value='' required >
						</div>						

						<div>

						  <label>Cod. Postal:</label>
						  <input type='text' name='postal' class='postal' value='' required >
						</div>

						<div>
						  <label>Localidad:</label>					  

                          <SELECT NAME="localidad" SIZE=1 class="localidad" id="localidad" required >  

							<OPTION VALUE="0">Seleccione una Localidad</OPTION>
							<OPTION VALUE="1">ALBA POSSE</OPTION>
							<OPTION VALUE="2">ALMAFUERTE</OPTION>
							<OPTION VALUE="3">F.AMEGHINO</OPTION>
							<OPTION VALUE="4">APOSTOLES</OPTION>
							<OPTION VALUE="5">A. DEL VALLE</OPTION>
							<OPTION VALUE="6">ARROYO DEL MEDIO</OPTION>
							<OPTION VALUE="7">AZARA</OPTION>
							<OPTION VALUE="8">BERNARDO IRIGOYEN</OPTION>
							<OPTION VALUE="9">BONPLAND</OPTION>
							<OPTION VALUE="10">CAA YARI</OPTION>
							<OPTION VALUE="11">CAMPO GRANDE</OPTION>
							<OPTION VALUE="12">CAMPO RAMON</OPTION>
							<OPTION VALUE="13">CAMPO VIERA</OPTION>
							<OPTION VALUE="14">CANDELARIA</OPTION>
							<OPTION VALUE="15">CAPIOVI</OPTION>
							<OPTION VALUE="16">CARAGUATAY</OPTION>
							<OPTION VALUE="17">CERRO AZUL</OPTION>
							<OPTION VALUE="18">CERRO CORA</OPTION>
							<OPTION VALUE="19">COLONIA ALBERDI</OPTION>
							<OPTION VALUE="20">COL. AURORA</OPTION>
							<OPTION VALUE="21">COLONIA DELICIA</OPTION>
							<OPTION VALUE="22">COLONIA POLANA</OPTION>
							<OPTION VALUE="23">COLONIA VICTORIA</OPTION>
							<OPTION VALUE="24">COLONIA WANDA</OPTION>
							<OPTION VALUE="25">CONCEPCION DE LA SIERRA</OPTION>
							<OPTION VALUE="26">CORPUS</OPTION>
							<OPTION VALUE="27">DOS ARROYOS</OPTION>
							<OPTION VALUE="28">2 DE MAYO</OPTION>
							<OPTION VALUE="29">EL ALCAZAR</OPTION>
							<OPTION VALUE="30">ELDORADO</OPTION>
							<OPTION VALUE="31">EL SOBERVIO</OPTION>
							<OPTION VALUE="32">PUERTO ESPERANZA</OPTION>
							<OPTION VALUE="33">FACHINAL</OPTION>
							<OPTION VALUE="34">GARUHAPE</OPTION>
							<OPTION VALUE="35">GARUPA</OPTION>
							<OPTION VALUE="36">GRAL. ALVEAR</OPTION>
							<OPTION VALUE="37">SAN ANTONIO</OPTION>
							<OPTION VALUE="38">GOB.URQUIZA</OPTION>
							<OPTION VALUE="39">GOB. LOPEZ</OPTION>
							<OPTION VALUE="40">GOB. ROCA</OPTION>
							<OPTION VALUE="41">GUARANI</OPTION>
							<OPTION VALUE="42">H.IRIGOYEN</OPTION>
							<OPTION VALUE="43">IGUAZU</OPTION>
							<OPTION VALUE="44">ITACARUARE</OPTION>
							<OPTION VALUE="45">JARDIN AMERICA</OPTION>
							<OPTION VALUE="46">L.N.ALEM</OPTION>
							<OPTION VALUE="47">PUERTO LEONI</OPTION>
							<OPTION VALUE="48">LIBERTAD</OPTION>
							<OPTION VALUE="49">LORETO</OPTION>
							<OPTION VALUE="50">LOS HELECHOS</OPTION>
							<OPTION VALUE="51">MARTIRES</OPTION>
							<OPTION VALUE="52">MOJON GRANDE</OPTION>
							<OPTION VALUE="53">MONTECARLO</OPTION>
							<OPTION VALUE="54">9 DE JULIO </OPTION>
							<OPTION VALUE="55">OBERA</OPTION>
							<OPTION VALUE="56">O.V.ANDRADE</OPTION>
							<OPTION VALUE="57">PANAMBI</OPTION>
							<OPTION VALUE="58">PUERTO PIRAY</OPTION>
							<OPTION VALUE="59" selected>POSADAS</OPTION>
							<OPTION VALUE="60">PROFUNDIDAD</OPTION>
							<OPTION VALUE="61">PUERTO RICO</OPTION>
							<OPTION VALUE="62">RUIZ DE MONTOYA</OPTION>
							<OPTION VALUE="63">SANTIAGO DE LINIERS</OPTION>
							<OPTION VALUE="64">SAN IGNACIO</OPTION>
							<OPTION VALUE="65">SAN JAVIER</OPTION>
							<OPTION VALUE="66">SAN JOSE</OPTION>
							<OPTION VALUE="67">SAN MARTIN</OPTION>
							<OPTION VALUE="68">SAN PEDRO</OPTION>
							<OPTION VALUE="69">SANTA ANA</OPTION>
							<OPTION VALUE="70">SANTA MARIA</OPTION>
							<OPTION VALUE="71">SANTO PIPO</OPTION>
							<OPTION VALUE="72">TRES CAPONES</OPTION>
							<OPTION VALUE="73">25 DE MAYO</OPTION>
							<OPTION VALUE="74">SAN VICENTE</OPTION>
							<OPTION VALUE="75">COMANDANTE A.GUACURARI</OPTION>
						</SELECT>

						</div>	

							<div>
						  <label>Ingrese Codigo:</label>
							<div style="padding-bottom:5px"></div>
							<img src="captcha.php" border="0"/> &nbsp;
							<div style="padding-bottom:5px"></div>
							<input type="text" name="codigo" maxlength="5" onFocus="$('error_cod').style.display='none'" class="form_ancho2" /></div>				

						<div>

							<input type="image" src="images/registro.png" width="180" height="38"  value='Solicitar Alta' class='boton'/>							
							<a> 	    	 </a>   
							<a href="login.php" target="_self"><img src="images/regresar2.png" width="180"  height="38" border="0"></a>       		                   
						</div>

	  </form>

	</td>

  </tr>

</table>

</body>

</html>

