<!-- 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 -->


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

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

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<!-- BOF: ./personal-templates/simple/personal/other/l59.settings.init -->


<!-- EOF: ./personal-templates/simple/personal/other/l59.settings.init -->


    <!-- BOF: ./personal-templates/simple/businessnew/amazon/style_l59.images -->

<!-- EOF: ./personal-templates/simple/businessnew/amazon/style_l59.images -->

    <!-- BOF: ./personal-templates/simple/businessnew/amazon/style_l59.wait -->

 
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  <!-- BOF: ./personal-templates/simple/business/layout/l59.wait -->


<!-- EOF: ./personal-templates/simple/business/layout/l59.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="quintino domingos corretora de seguros, quintino, domingos, quintino domingos">
<META NAME="Keywords"    CONTENT="quintino domingos corretora de seguros, corretora de seguros, quintino domingos. ">


<!-- 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://d2269331.u85.igempresas.ig.com.br/form1.html">-->
<TITLE>Orçamento de Seguro Residencial</TITLE></head>
<BODY  BGCOLOR="#F5FBFD"
 TEXT="#333333"

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

 onLoad=""
 
 LINK="#42718C"
 VLINK="#000000"
 ALINK="#000000"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l59.layout -->

 
<!-- html -->
<TABLE WIDTH="100%" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 align="center" valign="top" background="widgets/gen_23337.1.gif" bgcolor="#6391AB">
    <TR>
       <TD align="center" valign="top" background="">
            <TABLE WIDTH="90%" BORDER=0 CELLPADDING=0 CELLSPACING=10 align="center" valign="top">
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                <td width="100%" colspan="2">
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                         <td width="687" height="76"><img src="widgets/gen_23368.1.gif" border=0 width=687 height=76 alt=""></td>
                         <td background="widgets/gen_23381.1.gif">&nbsp;</td>
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              <tr>
                <td width="206" height="100%" valign="top">
                <TABLE WIDTH="206" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                    <tr><td valign="top">
                      <TABLE WIDTH="206" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                         <tr>
                           <td colspan="3"><img src="widgets/gen_23388.1.gif" border=0 width=206 height=31 alt=""></td>
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                         <tr>
                           <td width="13" background="widgets/gen_23279.1.gif"><img src="images/spacer.png" width="13" height="1"></td>
                           <td bgcolor="#C3E3F2" valign="top">
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                                            <a href="profile.html" onMouseOver="document.images['img68'].src='widgets/gen_23371.1.gif'" onMouseOut="document.images['img68'].src='widgets/gen_23383.1.gif'"><img src="widgets/gen_23383.1.gif" alt="Perfil da Empresa" name="img68" border="0"></a><br>
                                            <a href="form.html" onMouseOver="document.images['img51'].src='widgets/gen_23351.1.gif'" onMouseOut="document.images['img51'].src='widgets/gen_23350.1.gif'"><img src="widgets/gen_23350.1.gif" alt="Orçamento de Seguro Automóvel" name="img51" border="0"></a><br>
                                            <a href="form1.html" onMouseOver="document.images['img76'].src='widgets/gen_23353.1.gif'" onMouseOut="document.images['img76'].src='widgets/gen_23352.1.gif'"><img src="widgets/gen_23352.1.gif" alt="Orçamento de Seguro Residencial" name="img76" border="0"></a><br>
                                            <a href="form2.html" onMouseOver="document.images['img87'].src='widgets/gen_23355.1.gif'" onMouseOut="document.images['img87'].src='widgets/gen_23373.1.gif'"><img src="widgets/gen_23373.1.gif" alt="Orçamento de Seguro Empresarial" name="img87" border="0"></a><br>
                                            <a href="links.html" onMouseOver="document.images['img12'].src='widgets/gen_23357.1.gif'" onMouseOut="document.images['img12'].src='widgets/gen_23356.1.gif'"><img src="widgets/gen_23356.1.gif" alt="Seguradoras" name="img12" border="0"></a><br>
                                            <a href="contact.html" onMouseOver="document.images['img42'].src='widgets/gen_23359.1.gif'" onMouseOut="document.images['img42'].src='widgets/gen_23358.1.gif'"><img src="widgets/gen_23358.1.gif" alt="Contacte-nos" name="img42" border="0"></a><br>
                                            
                                            <a href="mailto:quintino@quintinodomingos.com.br" onMouseOver="document.images['img_email'].src='widgets/gen_23361.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_23360.1.gif'"><img src="widgets/gen_23360.1.gif" alt="Envie-me um e-mail" name="img_email" border="0"></a><br>
                                            </td>
                           <td width="13" background="widgets/gen_23343.1.gif"><img src="images/spacer.png" width="13" height="1"></td>
                         </tr>
                         <tr>
                           <td colspan="3"><img src="widgets/gen_23342.1.gif" border=0 width=206 height=17 alt=""></td>
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                      </table>
                      </td></tr>
                      <tr><td><img src="widgets/spacer.gif" height=5 width=20 alt=""></td></tr>
                      <tr>
                      <td WIDTH="206" height="100%">
                      <TABLE WIDTH="206" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                          <tr>
                             <td width="206" height="12"><img src="widgets/gen_23344.1.gif" border=0 width=206 height=12 alt=""></td>
                          </tr>
                          <tr>
                             <td height="100%" background="widgets/gen_23346.1.gif" height="100%">&nbsp;</td>
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                          <tr>
                             <td width="206" height="12" valign="bottom"><img src="widgets/gen_23345.1.gif" border=0 width=206 height=12 alt=""></td>
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                <td height="100%" width="100%" valign="top">
                <TABLE DIR="LTR" WIDTH="100%" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                          <TR>
                              <td colspan="3" width="100%">
                              <TABLE WIDTH="100%" height="30" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
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                                  <td width="478" height="30"><img src="widgets/gen_23300.1.gif" border=0 width=478 height=30 alt=""></td>
                                  <td width="100%" background="widgets/gen_23394.1.gif"><img src="widgets/spacer.gif" height=30 width=1 alt=""></td>
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                          <tr><td colspan="3" height="10"><img src="widgets/spacer.gif" height=10 width=11 alt=""></td></tr>
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                             <td width="11" height="10"><img src="widgets/gen_23338.1.gif" border=0 width=11 height=10 alt=""></td>
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                          <tr>
                             <td height="100%" width="11" background="widgets/gen_23335.1.gif"><img src="widgets/spacer.gif" height=1 width=11 alt=""></td>
                             <TD width="100%" height="100%" bgcolor="#ECF7FC" valign="top">
                             <!-- BOF: ./personal-templates/simple/businessnew/form/style_l59.html -->
<TABLE WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
<TR>
    <TD WIDTH=100% COLSPAN="2" VALIGN="top">
       <TABLE WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
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<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/studio/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

if (frm.field_80.value=="") return error(frm.field_80);

if (frm.field_81.value=="") return error(frm.field_81);

if (frm.field_82.value=="") return error(frm.field_82);

if (frm.field_85.value=="") return error(frm.field_85);

if (frm.field_83.value=="") return error(frm.field_83);

if (frm.field_84.value=="") return error(frm.field_84);

if (frm.field_97.value=="") return error(frm.field_97);

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="Orçamento de Seguro Residencial">
<input type="hidden" name="esubj" value="Solicite aqui o seu orçamento">
<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="80 81 82 85 83 84 97 ">

        <TD VALIGN="top">
        
<TABLE WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
                                 <TR>
                                    <TD WIDTH=6 HEIGHT=7>
                                        <img src="widgets/gen_23311.1.gif" border=0 width=6 height=7 alt=""></TD>
                                    <TD background="widgets/gen_23310.1.gif">
                                        <img src="widgets/spacer.gif" height=1 width=7 alt=""></TD>
                                    <TD ALIGN="right" WIDTH=5 HEIGHT=7>
                                        <img src="widgets/gen_23365.1.gif" border=0 width=5 height=7 alt=""></TD>
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                                 <TR>
                                    <TD background="widgets/gen_23314.1.gif">
                                        <img src="widgets/spacer.gif" height=5 width=6 alt=""></TD>
                                    <TD WIDTH=100% VALIGN="top" BGCOLOR="#C3E3F2" VALIGN="top" style='border-bottom: 1px dotted #6391AB'>

         <span style="color:#42718C;font-size:12px;font-weight:bold;font-family:Verdana,Arial,Helvetica">Orçamento de Seguro Residencial</span>
         </TD>
         <TD background="widgets/gen_23313.1.gif"><img src="widgets/spacer.gif" height=5 width=5 alt=""></TD>
         </TR>
         <TR>
                <TD background="widgets/gen_23315.1.gif"><img src="widgets/spacer.gif" height=1 width=6 alt=""></TD>
                <TD WIDTH=100% VALIGN="top" BGCOLOR="#F5FBFD" VALIGN="top">

        <TABLE border="0" cellpadding="5" cellspacing="5" width="100%">
        <input type="hidden" name="name_80" value="Nome completo:">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

Nome completo:

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_80" size=35 style="background: #ECF7FC;border:1px solid #6391AB">
            
            </TD>
        </TR>
        <input type="hidden" name="name_81" value="Cidade:">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

Cidade:

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_81" size=35 style="background: #ECF7FC;border:1px solid #6391AB">
            
            </TD>
        </TR>
        <input type="hidden" name="name_82" value="A residência é de alvenaria ou madeira?">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

A residência é de alvenaria ou madeira?

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_82" size=35 style="background: #ECF7FC;border:1px solid #6391AB">
            
            </TD>
        </TR>
        <input type="hidden" name="name_85" value="A residência é de uso habitual ou veraneio?">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

A residência é de uso habitual ou veraneio?

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_85" size=35 style="background: #ECF7FC;border:1px solid #6391AB">
            
            </TD>
        </TR>
        <input type="hidden" name="name_83" value="Valor da residência com os móveis (aproximado) R$ ">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

Valor da residência com os móveis (aproximado) R$ 

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_83" size=35 style="background: #ECF7FC;border:1px solid #6391AB">
            
            </TD>
        </TR>
        <input type="hidden" name="name_84" value="Seu E-mail:">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

Seu E-mail:

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_84" size=35 style="background: #ECF7FC;border:1px solid #6391AB"><input type="hidden" name="rcpt" value="field_84">
            
            </TD>
        </TR>
        <input type="hidden" name="name_97" value="Seu telefone com DDD:">
        <TR><TD>


<font face='Arial' size='2' color='#333333'>

Seu telefone com DDD:

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_97" size=35 style="background: #ECF7FC;border:1px solid #6391AB">
            
            </TD>
        </TR>
        
        <TR><TD colspan=2 align=center><input onClick="return validate(form)" type="submit" value="Enviar" style="background: #C3E3F2;border:1px solid #6391AB">
            <input type="reset"  value="Zerar" style="background: #C3E3F2;border:1px solid #6391AB"></TD>
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                                    <TD background="widgets/gen_23316.1.gif">
                                        <img src="widgets/spacer.gif" height=1 width=5 alt=""></TD>
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                                    <TD WIDTH=6 HEIGHT=8>
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                                    <TD WIDTH=5 HEIGHT=8>
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                                    <TD COLSPAN=3>
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                                 </TR>
                                        
                         </TABLE>
</form>
    </TR>
    </TABLE>
    </TD>
</TR>
</TABLE>
<!-- EOF: ./personal-templates/simple/businessnew/form/style_l59.html -->

                                </td>
                             <td height="100%" width="11" background="widgets/gen_23336.1.gif" align="right"><img src="widgets/spacer.gif" height=1 width=11 alt=""></td>
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                          <tr>
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                </td></tr>
              <tr>
                 <td width="100%" colspan="2">
                      <TABLE DIR="LTR" WIDTH="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                          <tr>
                             <td width="11" height="10"><img src="widgets/gen_23326.1.gif" border=0 width=11 height=10 alt=""></td>
                             <td background="widgets/gen_23328.1.gif" width="100%"></td>
                             <td width="16" height="10"><img src="widgets/gen_23327.1.gif" border=0 width=16 height=10 alt=""></td>
                          </tr>
                          <tr>
                             <td background="widgets/gen_23375.1.gif"><img src="widgets/spacer.gif" height=1 width=1 alt=""></td>
                             <TD bgcolor="#A3C5D9">
<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>


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

<nobr>|<a href="profile.html">Perfil da Empresa</A>|</nobr>

<nobr>|<a href="form.html">Orçamento de Seguro Automóvel</A>|</nobr>

<nobr>|Orçamento de Seguro Residencial|</nobr>

<nobr>|<a href="form2.html">Orçamento de Seguro Empresarial</A>|</nobr>

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

<nobr>|<a href="contact.html">Contacte-nos</A>|</nobr>
</center>
</font>

</td>
                             <td background="widgets/gen_23331.1.gif"><img src="widgets/spacer.gif" height=1 width=1 alt=""></td>
                          </tr>
                          <tr>
                             <td><img src="widgets/gen_23258.1.gif" border=0 width=11 height=15 alt=""></td>
                             <td background="widgets/gen_23329.1.gif" width="100%"></td>
                             <td><img src="widgets/gen_23325.1.gif" border=0 width=16 height=15 alt=""></td>
                          </tr>
                      </table>
                 </td>
              </tr>
            </TABLE>
       </TD>
    </TR>
</TABLE>
<!-- End html -->
<!-- EOF: ./personal-templates/simple/business/layout/l59.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 -->