<!-- BOF: ./personal-templates/show.body -->
<!-- BOF: ./personal-templates/simple/generic/show -->
<!-- BOF: ./personal-templates/rtl.html -->
<!-- Locale=pt_BR -->
<!-- EOF: ./personal-templates/rtl.html -->


<!-- BOF: ./personal-templates/simple/generic/functions -->
<!-- BOF: ./personal-templates/simple/generic/navbar --><!-- EOF: ./personal-templates/simple/generic/navbar -->


<!-- EOF: ./personal-templates/simple/generic/functions -->


<!-- EOF: ./personal-templates/simple/generic/show -->

<!-- BOF: ./personal-templates/simple/generic/images -->

<!-- EOF: ./personal-templates/simple/generic/images -->


<!-- BOF: ./personal-templates/simple/personal/other/l36.settings.init -->


<!-- EOF: ./personal-templates/simple/personal/other/l36.settings.init -->


    <!-- BOF: ./personal-templates/simple/businessnew/form/style_l36.images -->

<!-- EOF: ./personal-templates/simple/businessnew/form/style_l36.images -->

    <!-- BOF: ./personal-templates/simple/businessnew/form/style_l36.wait -->


<!-- EOF: ./personal-templates/simple/businessnew/form/style_l36.wait -->

  
  <!-- BOF: ./personal-templates/simple/businessnew/layout/l36.wait -->


<!-- EOF: ./personal-templates/simple/businessnew/layout/l36.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="ADMINSEG SEGUROS">
<META NAME="Keywords"    CONTENT="SEGUROS">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


<!-- EOF: ./personal-templates/simple/themes.show -->


<!--<BASE HREF="http://d435021.u47.igempresas.ig.com.br/form1.html">-->
<TITLE>Solicite um Orcamento</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
 TEXT="#000000"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#000000"
 VLINK="#000000"
 ALINK="#000000"
>

  
      <!-- BOF: ./personal-templates/simple/businessnew/layout/l36.layout --> 

<TABLE WIDTH=100% HEIGHT=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top" BGCOLOR="#FFFFFF"> 
        <TR>
<!-- Begin Name -->
        
                <TD WIDTH=100% HEIGHT=48 BGCOLOR="#FFFFFF">                   
                       <TABLE WIDTH=100% HEIGHT=48 BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">  
                              <TR>
                                      <TD WIDTH=100% HEIGHT=48  VALIGN="top" BACKGROUND="widgets/gen_711.1.gif">
                                              <IMG SRC="widgets/gen_709.1.gif" WIDTH=711 HEIGHT=48 ALT=""></TD>
                                      <TD WIDTH=64 HEIGHT=48  VALIGN="top">
                                              <IMG SRC="widgets/gen_712.1.gif" WIDTH=64 HEIGHT=48 ALT=""></TD>
                              </TR>
                        </TABLE>                                
                </TD>
<!-- End Name -->
        </TR>
        <TR>
<!-- Begin Slogan -->
                <TD WIDTH=100% HEIGHT=21 BGCOLOR="#FFFFFF" VALIGN="top">
                        <TABLE WIDTH=100% HEIGHT=21 BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">  
                              <TR>
                                      <TD WIDTH=100% HEIGHT=21  VALIGN="top">
                                              <IMG SRC="widgets/gen_713.1.gif" WIDTH=711 ALT=""></TD>
                                      <TD WIDTH=64 HEIGHT=21  VALIGN="top">
                                              <IMG SRC="widgets/gen_715.1.gif" WIDTH=64 HEIGHT=21 ALT=""></TD>
                              </TR>
                        </TABLE>                                
                </TD>
<!-- End Slogan -->
        </TR>
        <TR>
                <TD>
                        <TABLE WIDTH=100% HEIGHT=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top" BGCOLOR="#FFFFFF"> 
                                <TR>
                                        <TD WIDTH=279 HEIGHT=100% BGCOLOR="#FFFFFF" VALIGN="top">
                                                <TABLE WIDTH=279 HEIGHT=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">  
                                                        <TR>
<!-- Begin Ris -->
                                                                <TD WIDTH=279 HEIGHT=284 VALIGN="top" BGCOLOR="#FFFFFF">  
                                                                        <IMG SRC="widgets/gen_716.1.gif" WIDTH=279 HEIGHT=284 ALT=""></TD>                   
                                                        </TR>
                                                        <TR>
                                                                <TD WIDTH=279 HEIGHT=159 VALIGN="top">
                                                                        <IMG SRC="widgets/gen_718.1.gif" WIDTH=279 HEIGHT=159 ALT=""></TD>                   
<!-- End Ris -->
                                                        </TR> 
                               
                                                        <TR>
<!-- Begin Menu -->
                                                                <TD WIDTH=279 VALIGN="top" BGCOLOR="#3B434C">  
                                                                        
                                                                        <a href="index.html" onMouseOver="document.images['img73'].src='widgets/gen_731.1.gif'" onMouseOut="document.images['img73'].src='widgets/gen_730.1.gif'"><img src="widgets/gen_730.1.gif" alt="Bem-vindo" name="img73" border="0"></a><br>
                                                                        <a href="about.html" onMouseOver="document.images['img239'].src='widgets/gen_793.1.gif'" onMouseOut="document.images['img239'].src='widgets/gen_792.1.gif'"><img src="widgets/gen_792.1.gif" alt="Quem Somos" name="img239" border="0"></a><br>
                                                                        <a href="photo_player_flash.html" onMouseOver="document.images['img60'].src='widgets/gen_735.1.gif'" onMouseOut="document.images['img60'].src='widgets/gen_734.1.gif'"><img src="widgets/gen_734.1.gif" alt="Seguradoras" name="img60" border="0"></a><br>
                                                                        <a href="catalog.html" onMouseOver="document.images['img42'].src='widgets/gen_737.1.gif'" onMouseOut="document.images['img42'].src='widgets/gen_736.1.gif'"><img src="widgets/gen_736.1.gif" alt="Seguros" name="img42" border="0"></a><br>
                                                                        <a href="form1.html" onMouseOver="document.images['img81'].src='widgets/gen_739.1.gif'" onMouseOut="document.images['img81'].src='widgets/gen_738.1.gif'"><img src="widgets/gen_738.1.gif" alt="Solicite um Orcamento" name="img81" border="0"></a><br>
                                                                        <a href="form.html" onMouseOver="document.images['img21'].src='widgets/gen_766.1.gif'" onMouseOut="document.images['img21'].src='widgets/gen_765.1.gif'"><img src="widgets/gen_765.1.gif" alt="Agende Sua Renovação " name="img21" border="0"></a><br>
                                                                        <a href="catalog1.html" onMouseOver="document.images['img246'].src='widgets/gen_813.1.gif'" onMouseOut="document.images['img246'].src='widgets/gen_812.1.gif'"><img src="widgets/gen_812.1.gif" alt="Calculo Automovel Online" name="img246" border="0"></a><br>
                                                                        <a href="faq.html" onMouseOver="document.images['img107'].src='widgets/gen_774.1.gif'" onMouseOut="document.images['img107'].src='widgets/gen_773.1.gif'"><img src="widgets/gen_773.1.gif" alt="Dicionário de Seguros " name="img107" border="0"></a><br>
                                                                        <a href="links.html" onMouseOver="document.images['img9'].src='widgets/gen_743.1.gif'" onMouseOut="document.images['img9'].src='widgets/gen_742.1.gif'"><img src="widgets/gen_742.1.gif" alt="Sites Uteis" name="img9" border="0"></a><br>
                                                                        <a href="contact.html" onMouseOver="document.images['img12'].src='widgets/gen_745.1.gif'" onMouseOut="document.images['img12'].src='widgets/gen_744.1.gif'"><img src="widgets/gen_744.1.gif" alt="Fale Conosco" name="img12" border="0"></a><br>
                                                                        
                                                                        <a href="mailto:adminseg@adminseg.com.br" onMouseOver="document.images['img_email'].src='widgets/gen_747.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_746.1.gif'"><img src="widgets/gen_746.1.gif" alt="Envie-me um e-mail" name="img_email" border="0"></a><br></TD>
<!-- End Menu -->
                                                        </TR>
                                                        <TR>
                                                                <TD WIDTH=279 HEIGHT=100% VALIGN="top" BACKGROUND="widgets/gen_725.1.gif">      
                                                                        <IMG SRC="widgets/gen_725.1.gif" WIDTH=279 ALT=""></TD>                   
<!-- End Ris -->
                                                        </TR>
                                                        
                                                </TABLE>
                                        </TD>
<!-- Begin Center -->
                                        <TD WIDTH=100% HEIGHT=100% BGCOLOR="#FFFFFF" VALIGN="top">
                                                <TABLE WIDTH=100% HEIGHT=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">  
                                                        <TR>
                                                                <TD WIDTH=14 HEIGHT=100% BGCOLOR="#FFFFFF" BACKGROUND="widgets/gen_720.1.gif">
                                                                        <IMG SRC="widgets/gen_720.1.gif" WIDTH=14 HEIGHT=223 ALT=""></TD>                   
                                                                <TD WIDTH=100% HEIGHT=100% BGCOLOR="#FFFFFF" background="" VALIGN="top">
                                                                        
                                                                        <!-- BOF: ./personal-templates/simple/businessnew/form/style_l36.html -->
<TABLE DIR="LTR" WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
    <TR>
        <TD>
            <TABLE WIDTH=100% BORDER=0 VALIGN="top" CELLPADDING=0 CELLSPACING=0 >
                <TR>
                    <TD WIDTH=114  HEIGHT=63 VALIGN="top">
                        <IMG SRC="widgets/gen_753.1.gif" WIDTH=114  HEIGHT=63></TD>
                    <TD WIDTH=100%  HEIGHT=63 VALIGN="top" ALIGN="right" BACKGROUND="widgets/gen_705.1.gif">
                        <img src="widgets/spacer.gif" height="1" width="1"></TD>
                    <TD HEIGHT=63 VALIGN="top" ALIGN="right">
                        <IMG SRC="widgets/gen_763.1.gif" WIDTH=242 HEIGHT=63></TD>
                </TR>
            </TABLE>
        </TD>
    </TR>
<TR>
    <TD WIDTH=100% VALIGN="top">
    <TABLE WIDTH=90% BORDER=0 CELLPADDING=5 CELLSPACING=0 VALIGN="top">
    <TR>
<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/studio/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

for(i = 0; i < frm.field_87.length; i++)
if (frm.field_87[i].checked) break;
if (frm.field_87.length==i) return error(frm.field_87[0]);

if (frm.field_88.value=="") return error(frm.field_88);
if (frm.field_y_90.value=="") return error(frm.field_y_90);

if (frm.field_91.value=="") return error(frm.field_91);

if (frm.field_92.value=="") return error(frm.field_92);

if (frm.field_98.value=="") return error(frm.field_98);

var url = document.URL;
if (url.indexOf(BUILDER) == -1 && url.charAt(url.length)!='/') {
 url = url.substring(0, url.lastIndexOf('/')+1);
}
frm.domain.value=url;
return true;

}
function error(field){ alert('Você não preencheu todos os campos necessários!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://200.226.246.18:8080/studio/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Solicite um Orcamento">
<input type="hidden" name="esubj" value="Solicitacao de Calculo pelo Site">
<input type="hidden" name="name" value="=GCh0WGybU1bal4b">
<input type="hidden" name="submit_url" value="onsubmit2.html">
<input type="hidden" name="error_url" value="onerror2.html">

<input type="hidden" name="order" value="85 86 87 88 89 d90 91 92 93 94 95 96 97 98 ">

        <TD>
        <TABLE border="0" cellpadding="5" cellspacing="5" width="95%">
        <TR><TD colspan=2>&nbsp;</td></TR>
        <input type="hidden" name="name_85" value="Nome do Solicitante:">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Nome do Solicitante:

</font>


</td>
            <TD><input type="text" name="field_85" size=35>
            
            </TD>
        </TR>
        <input type="hidden" name="name_86" value="Telefones">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Telefones

</font>


</td>
            <TD><input type="text" name="field_86" size=35>
            
            </TD>
        </TR>
        <input type="hidden" name="name_87" value="Seguro Novo">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Seguro Novo

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="radio" name="field_87" value="Yes">


<font face='Arial' size='2' color='#000000'>

Yes

</font>


 <input type="radio" name="field_87" value="No">


<font face='Arial' size='2' color='#000000'>

No

</font>


            </TD>
        </TR>
        <input type="hidden" name="name_88" value="Veiculo ">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Veiculo 

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_88" size=35>
            
            </TD>
        </TR>
        <input type="hidden" name="name_89" value="Nome do Proprietario ">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Nome do Proprietario 

</font>


</td>
            <TD><input type="text" name="field_89" size=35>
            
            </TD>
        </TR>
        <input type="hidden" name="name_90" value="Data de Nascimento Condutor">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Data de Nascimento Condutor

</font>


<font color="red" size="-1">*</font></td>
            <TD><select name="field_m_90" size="1">
            <option>Jan<option>Fev<option>Mar
            <option>Abr<option>Mai<option>Jun
            <option>Jul<option>Ago<option>Set
            <option>Out<option>Nov<option>Dez
            </select>
            <select name="field_d_90" size="1">
            <option>1<option>2<option>3<option>4<option>5<option>6<option>7<option>8<option>9<option>10<option>11<option>12<option>13<option>14<option>15<option>16<option>17<option>18<option>19<option>20<option>21<option>22<option>23<option>24<option>25<option>26<option>27<option>28<option>29<option>30<option>31
            </select>
            <input type="text" name="field_y_90" size="4" maxsize="4">
            
            </TD>
        </TR>
        <input type="hidden" name="name_91" value="Tempo de Habilitacao">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Tempo de Habilitacao

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_91" size=35>
            
            </TD>
        </TR>
        <input type="hidden" name="name_92" value="Estado Civil ">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Estado Civil 

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_92" size=35>
            
            </TD>
        </TR>
        <input type="hidden" name="name_93" value="Possui Garagem em Casa">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Possui Garagem em Casa

</font>


</td>
            <TD><input type="radio" name="field_93" value="Yes">


<font face='Arial' size='2' color='#000000'>

Yes

</font>


 <input type="radio" name="field_93" value="No">


<font face='Arial' size='2' color='#000000'>

No

</font>


            </TD>
        </TR>
        <input type="hidden" name="name_94" value="Possui Garagem no Trabalho">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Possui Garagem no Trabalho

</font>


</td>
            <TD><input type="radio" name="field_94" value="Yes">


<font face='Arial' size='2' color='#000000'>

Yes

</font>


 <input type="radio" name="field_94" value="No">


<font face='Arial' size='2' color='#000000'>

No

</font>


            </TD>
        </TR>
        <input type="hidden" name="name_95" value="Estuda">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Estuda

</font>


</td>
            <TD><input type="radio" name="field_95" value="Yes">


<font face='Arial' size='2' color='#000000'>

Yes

</font>


 <input type="radio" name="field_95" value="No">


<font face='Arial' size='2' color='#000000'>

No

</font>


            </TD>
        </TR>
        <input type="hidden" name="name_96" value="Tem Garagem onde estuda ">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Tem Garagem onde estuda 

</font>


</td>
            <TD><input type="radio" name="field_96" value="Yes">


<font face='Arial' size='2' color='#000000'>

Yes

</font>


 <input type="radio" name="field_96" value="No">


<font face='Arial' size='2' color='#000000'>

No

</font>


            </TD>
        </TR>
        <input type="hidden" name="name_97" value="CEP">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

CEP

</font>


</td>
            <TD><input type="text" name="field_97" size=35>
            
            </TD>
        </TR>
        <input type="hidden" name="name_98" value="Email">
        <TR><TD>


<font face='Arial' size='2' color='#000000'>

Email

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_98" size=35><input type="hidden" name="rcpt" value="field_98">
            
            </TD>
        </TR>
        
        <TR><TD colspan=2 align=center><input onClick="return validate(form)" type="submit" value="Enviar">
            <input type="reset"  value="Zerar"></TD>
        </TR>
        </TABLE>
        </TD>
</form>
    </TR>
    </TABLE>
    </TD>
</TR>
</TABLE>
<!-- EOF: ./personal-templates/simple/businessnew/form/style_l36.html -->

                                                                        
                                                                        <br>

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Bem-vindo</A>|</nobr>

<nobr>|<a href="about.html">Quem Somos</A>|</nobr>

<nobr>|<a href="photo_player_flash.html">Seguradoras</A>|</nobr>

<nobr>|<a href="catalog.html">Seguros</A>|</nobr>

<nobr>|Solicite um Orcamento|</nobr>

<nobr>|<a href="form.html">Agende Sua Renovação </A>|</nobr>

<nobr>|<a href="catalog1.html">Calculo Automovel Online</A>|</nobr>

<nobr>|<a href="faq.html">Dicionário de Seguros </A>|</nobr>

<nobr>|<a href="links.html">Sites Uteis</A>|</nobr>

<nobr>|<a href="contact.html">Fale Conosco</A>|</nobr>
</center>
</font>

<br>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<a href="http://www.psoft.net" target="_blank"><img src="widgets/ss_button.gif" border="0"></a>

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>

                                                                        </TD>                   
                                                                <TD WIDTH=30 HEIGHT=100% BGCOLOR="#FFFFFF" BACKGROUND="widgets/gen_721.1.gif">
                                                                        <IMG SRC="widgets/gen_721.1.gif" WIDTH=30 HEIGHT=223 ALT=""></TD>                   
                                                        </TR>
                                                        <TR>
                                                                <TD COLSPAN="3" WIDTH=100% HEIGHT=79 BGCOLOR="#3B434C" VALIGN="top">
                                                                        <TABLE WIDTH=100% HEIGHT=79 BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
                                                                                <TR>
                                                                                        <TD WIDTH=53 HEIGHT=79 BGCOLOR="#3B434C">
                                                                                                <IMG SRC="widgets/gen_727.1.gif" WIDTH=53 HEIGHT=79 ALT=""></TD>                   
                                                                                        <TD WIDTH=100% HEIGHT=79 BGCOLOR="#3B434C" BACKGROUND="widgets/gen_728.1.gif">
                                                                                                <IMG SRC="widgets/gen_728.1.gif" WIDTH=15 HEIGHT=79 ALT=""></TD>                   
                                                                                        <TD WIDTH=50 HEIGHT=79 BGCOLOR="#3B434C">
                                                                                                <IMG SRC="widgets/gen_729.1.gif" WIDTH=50 HEIGHT=79 ALT=""></TD>                   
                                                                                </TR>
                                                                        </TABLE>                                          
                                                                </TD>                                                                                        
                                                        </TR>
                                                </TABLE>
                                        </TD>
<!-- End Center -->
                                        <TD WIDTH=34 HEIGHT=100% BGCOLOR="#FFFFFF" VALIGN="top">
                                                <TABLE WIDTH=34 HEIGHT=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">  
                                                        <TR>
                                                                <TD WIDTH=34 HEIGHT=283 VALIGN="top">  
                                                                        <IMG SRC="widgets/gen_722.1.gif" WIDTH=34 HEIGHT=283 ALT=""></TD> 
                                                        </TR>
                                                        <TR>
                                                                <TD WIDTH=34 HEIGHT=158 VALIGN="top" BGCOLOR="#3B434C">    
                                                                        <IMG SRC="widgets/gen_723.1.gif" WIDTH=34 HEIGHT=158 ALT=""></TD> 
                                                        </TR>                                                                                
                                                        <TR>
                                                                <TD WIDTH=34 HEIGHT=100% VALIGN="top" BACKGROUND="widgets/gen_724.1.gif">      
                                                                        <IMG SRC="widgets/gen_724.1.gif" WIDTH=34 ALT=""></TD> 
                                                        </TR>
                                                </TABLE>
                                        </TD>
                               </TR>
                        </TABLE>
                </TD>
        </TR>
</TABLE>                
<!-- EOF: ./personal-templates/simple/businessnew/layout/l36.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>


<!-- EOF: ./personal-templates/show.body -->