97
| <![CDATA[<input name='nome' type='text' id='nome' size='40' />]]>
|
105
| <![CDATA[<input name='fone' type='text' id='fone' size='40' />]]>
|
112
| <![CDATA[<input name='email' type='text' id='email' size='40' />]]>
|
120
| <![CDATA[<input name='sev_1' type='checkbox' id='sev_1' value='X' />]]>
|
125
| <![CDATA[<input name='sev_8' type='checkbox' id='sev_8' value='X' />]]>
|
130
| <![CDATA[<input name='sev_2' type='checkbox' id='sev_2' value='X' />]]>
|
135
| <![CDATA[<input name='sev_6' type='checkbox' id='sev_6' value='X' />]]>
|
140
| <![CDATA[<input name='sev_3' type='checkbox' id='sev_3' value='X' />]]>
|
146
| <![CDATA[<input name='sev_7' type='checkbox' id='sev_7' value='X' />]]>
|
170
| <![CDATA[<input name='doc_1' type='checkbox' id='doc_1' value='X' />]]>
|
172
| <![CDATA[<input name='doc_5' type='checkbox' id='doc_5' value='X' />]]>
|
181
| <![CDATA[<textarea name='pedido' cols='40' rows='4' id='pedido'></textarea>]]>
|