Código :
<html>
<head>
<title>Alicorp</title>
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<link href="img/logo_ali.ico" rel="shortcut icon" type="image/x-icon" />
</head>
<body>
<table cellspacing="0" cellpadding="0" width="611"
border="0">
<tbody>
<tr valign="top" align="left">
<td width="36"> </td>
<td class="texto"><p class="ContenidoInterior3">Asegúrese de ingresar todos
sus datos en las celdas.</p>
<table cellspacing="0" cellpadding="0" width="95%"
border="0">
<tbody>
<tr>
<td class="texsub" align="left" width="165"
height="24"><span class="ContenidoInterior5">Tema de la comunicación</span></td>
<td align="left" height="24"><select id="_tema" size="1"
name="_tema">
<option value="Información de Productos">Información de Productos</option>
<option value="Información de Distribudores Exclusivos" selected="selected">Información de Distribudores Exclusivos</option>
<option value="Negocios Internacionales">Negocios Internacionales</option>
<option
value="Consultas">Consultas</option>
<option value="Reclamos">Reclamos</option>
<option
value="Sugerencias">Sugerencias</option>
</select></td>
</tr>
<tr>
<td class="texsub" align="left" width="165"
height="24"><span class="ContenidoInterior5">Nombres y Apellidos </span></td>
<td align="left" height="24"><input class="campo"
id="_nombre" style="WIDTH: 225px"
name="_nombre" /></td>
</tr>
<tr>
<td class="texsub" align="left" height="24"><span class="ContenidoInterior5">DNI o Pasaporte</span></td>
<td align="left" height="24"><input class="campo"
id="_dni" style="WIDTH: 225px"
name="_dni" /></td>
</tr>
<tr>
<td class="texsub" align="left" width="165"
height="24"><span class="ContenidoInterior5">Teléfono</span></td>
<td align="left" height="24"><input class="campo"
id="_telefono" style="WIDTH: 225px"
name="_telefono" /></td>
</tr>
<tr>
<td class="texsub" align="left" width="165"
height="24"><span class="ContenidoInterior5">Razon Social </span></td>
<td align="left" height="24"><input class="campo"
id="_empresa" style="WIDTH: 225px"
name="_empresa" /></td>
</tr>
<tr>
<td class="texsub" align="left" height="24"><span class="ContenidoInterior5">RUC </span></td>
<td align="left" height="24"><input class="campo"
id="_ruc" style="WIDTH: 225px"
name="_ruc" /></td>
</tr>
<tr>
<td class="texsub" align="left" width="165"
height="24"><span class="ContenidoInterior5">E-mail</span></td>
<td align="left" height="24"><input class="campo"
id="_email" style="WIDTH: 225px"
name="_email" /></td>
</tr>
<tr>
<td class="texsub" align="left" height="24"><span class="ContenidoInterior5">País</span></td>
<td class="texsub" align="left" height="24"><select
class="campo" id="select" style="WIDTH: 112px"
name="select">
<option value="es">España</option>
<option value="af">Afganistán</option>
<option
value="al">Albania</option>
<option
value="de">Alemania</option>
<option
value="sa">Arabia Saudí</option>
<option
value="ad">Andorra</option>
<option
value="ao">Angola</option>
<option
value="ai">Anguila</option>
<option
value="aq">Antártida</option>
<option
value="ag">Antigua y Barbuda</option>
<option
value="dz">Argelia</option>
<option
value="ar">Argentina</option>
<option
value="am">Armenia</option>
<option
value="au">Australia</option>
<option
value="at">Austria</option>
<option
value="bs">Bahamas</option>
<option
value="be">Bélgica</option>
<option
value="bo">Bolivia</option>
<option
value="br">Brasil</option>
<option
value="bg">Bulgaria</option>
<option
value="ca">Canadá</option>
<option value="cz">Checa,
República</option>
<option
value="cl">Chile</option>
<option
value="cn">China</option>
<option
value="co">Colombia</option>
<option
value="kp">Corea del Norte</option>
<option
value="kr">Corea del Sur</option>
<option
value="cr">Costa Rica</option>
<option
value="hr">Croaciav</option>
<option
value="cu">Cuba</option>
<option
value="dk">Dinamarca</option>
<option
value="do">Dominicana, República</option>
<option
value="ec">Ecuador</option>
<option
value="eg">Egipto</option>
<option value="sv">El
Salvador</option>
<option value="ae">Emiratos
Árabes Unidos</option>
<option value="us">Estados
Unidos de América</option>
<option
value="ph">Filipinas</option>
<option
value="fi">Finlandia</option>
<option
value="fr">Francia</option>
<option
value="gi">Gibraltar</option>
<option
value="gr">Grecia</option>
<option
value="gt">Guatemala</option>
<option
value="gq">Guinea Equatorial</option>
<option
value="ht">Haití</option>
<option
value="hn">Honduras</option>
<option value="hk">Hong
Kong</option>
<option value="hu">Hungría</option>
<option value="in">India</option>
<option
value="id">Indonesia</option>
<option
value="iq">Irak</option>
<option
value="ir">Irán</option>
<option
value="ie">Irlanda</option>
<option
value="il">Israel</option>
<option
value="it">Italia</option>
<option
value="jp">Japón</option>
<option
value="jo">Jordania</option>
<option
value="lb">Líbano</option>
<option
value="lu">Luxemburgo</option>
<option
value="my">Malasia</option>
<option
value="mx">México</option>
<option
value="ma">Marruecos</option>
<option
value="nz">Nueva Zelanda</option>
<option
value="no">Noruega</option>
<option
value="nl">Países Bajos</option>
<option
value="pk">Pakistán</option>
<option
value="pa">Panamá</option>
<option
value="py">Paraguay</option>
<option value="pe"
selected="selected">Perú</option>
<option
value="pl">Polonia</option>
<option
value="pt">Portugal</option>
<option
value="pr">Puerto Rico</option>
<option
value="uk">Reino Unido</option>
<option
value="ro">Rumanía</option>
<option
value="ru">Rusia</option>
<option value="as">Samoa
Americana</option>
<option
value="sg">Singapur</option>
<option
value="za">Sudáfrica</option>
<option
value="se">Suecia</option>
<option
value="ch">Suiza</option>
<option
value="tw">Taiwán</option>
<option
value="th">Tailandia</option>
<option
value="tr">Turquía</option>
<option
value="uy">Uruguay</option>
<option value="um">U.S.
Minor Outlying Islands</option>
<option
value="ua">Ucrania</option>
<option
value="ve">Venezuela</option>
<option
value="yu">Yugoslavia (ex)</option>
<option
value="aw">Aruba</option>
<option
value="az">Azerbaiján</option>
<option
value="bh">Bahrain</option>
<option
value="bd">Bangladesh</option>
<option
value="bb">Barbados</option>
<option
value="by">Bielorrusia</option>
<option
value="bz">Belice</option>
<option
value="bj">Benín</option>
<option
value="bm">Bermuda</option>
<option
value="bt">Bhután</option>
<option
value="bw">Botswana</option>
<option
value="vg">Islas Vírgenes (RU)</option>
<option
value="bn">Brunei</option>
<option
value="bf">Burkina Faso</option>
<option
value="bi">Burundi</option>
<option
value="kh">Camboya</option>
<option
value="cm">Camerún</option>
<option value="cv">Cabo
Verde</option>
<option value="ky">Islas
Caimán</option>
<option value="cf">República
Centroafricana</option>
<option
value="td">Chad</option>
<option
value="km">Comoros</option>
<option value="ck">Islas
Cook</option>
<option value="cg">Congo</option>
<option value="ci">Costa de marfil</option>
<option value="cy">Chipre</option>
<option
value="dj">Djibuti</option>
<option
value="dm">Dominica</option>
<option
value="tp">Timor oriental</option>
<option
value="er">Eritrea</option>
<option
value="sk">Eslovaquia</option>
<option
value="si">Eslovenia</option>
<option
value="ee">Estonia</option>
<option
value="et">Etiopía</option>
<option
value="fj">Fiji</option>
<option value="gf">Guayana
francesa</option>
<option value="pf">Polinesia
francesa</option>
<option
value="ga">Gabón</option>
<option
value="gm">Gambia</option>
<option
value="ge">Georgia</option>
<option
value="gh">Ghana</option>
<option
value="gd">Grenada</option>
<option
value="gp">Guadalupe</option>
<option
value="gu">Guam</option>
<option
value="gn">Guinea</option>
<option
value="gw">Guinea-Bissau</option>
<option
value="gy">Guyana</option>
<option
value="is">Islandia</option>
<option
value="jm">Jamaica</option>
<option
value="ke">Kenia</option>
<option
value="ki">Kiribati</option>
<option
value="kg">Kirguistán</option>
<option
value="kw">Kuwait</option>
<option
value="la">Laos</option>
<option
value="lv">Letonia</option>
<option
value="ls">Lesotho</option>
<option
value="lr">Liberia</option>
<option
value="ly">Libia</option>
<option
value="li">Liechtenstein</option>
<option
value="lt">Lituania</option>
<option
value="mo">Macao</option>
<option
value="mk">Macedonia</option>
<option
value="mg">Madagascar</option>
<option
value="mw">Malawi</option>
<option
value="mv">Maldivas</option>
<option
value="ml">Mali</option>
<option
value="mt">Malta</option>
<option
value="mh">Marshall (Islas)</option>
<option
value="mq">Martinica</option>
<option
value="mr">Mauritania</option>
<option
value="kz">Kazajstán</option>
<option
value="mu">Mauricio</option>
<option
value="fm">Micronesia</option>
<option
value="md">Moldova</option>
<option
value="mc">Mónaco</option>
<option
value="mn">Mongolia</option>
<option
value="ms">Montserrat</option>
<option
value="mz">Mozambique</option>
<option
value="mm">Myanmar</option>
<option
value="na">Namibia</option>
<option
value="nr">Naurú</option>
<option
value="np">Nepal</option>
<option
value="an">Antillas holandesas</option>
<option
value="ni">Nicaragua</option>
<option
value="ne">Níger</option>
<option
value="ng">Nigeria</option>
<option
value="om">Omán</option>
<option value="mp">Marianas
del norte</option>
<option
value="pw">Palau</option>
<option
value="pg">Papúa-Nueva Guinea</option>
<option
value="pn">Pitcairn</option>
<option
value="qa">Qatar</option>
<option
value="re">Reunión</option>
<option
value="rw">Ruanda</option>
<option value="kn">Saint
Kitts & Nevis</option>
<option
value="ws">Samoa</option>
<option value="sm">San
Marino</option>
<option value="lc">Santa
Lucía</option>
<option value="vc">San Vicente y
Granadinas</option>
<option value="st">Santo Tomé
y Príncipe</option>
<option
value="sn">Senegal</option>
<option
value="sc">Seychelles</option>
<option
value="sl">Sierra Leona</option>
<option
value="sy">Siria</option>
<option
value="so">Somalia</option>
<option value="lk">Sri
Lanka</option>
<option value="sh">St.
Helena</option>
<option value="pm">San Pedro y
Miquelón (FR.)</option>
<option
value="sd">Sudán</option>
<option
value="sr">Suriname</option>
<option
value="sz">Swazilandia</option>
<option
value="tz">Tanzania</option>
<option
value="tj">Tayikistán</option>
<option
value="tg">Togo</option>
<option
value="tk">Tokelau</option>
<option
value="to">Tonga</option>
<option
value="tt">Trinidad y Tobago</option>
<option
value="tn">Tunisia</option>
<option
value="tc">Turcas y Caicos</option>
<option
value="tm">Turkmenistán</option>
<option
value="tv">Tuvalu</option>
<option
value="ug">Uganda</option>
<option
value="uz">Uzbekistán</option>
<option
value="vu">Vanuatu</option>
<option
value="va">Vaticano (Ciudad del)</option>
<option
value="vn">Vietnam</option>
<option
value="vi">Vírginenes Is.</option>
<option
value="eh">Sahara Occidental</option>
<option
value="ye">Yemen</option>
<option
value="zr">Zaire</option>
<option
value="zm">Zambia</option>
<option
value="zw">Zimbabwe</option>
<option
value="bv">Bouvet Is.</option>
<option
value="fo">Feroe</option>
<option
value="gl">Groenlandia</option>
<option
value="ba">Bosnia Herzegovina</option>
<option
value="sp">Solomon (Islas)</option>
<option
value="yt">Mayotte (FR.)</option>
<option
value="nc">Nueva Caledonia</option>
<option
value="nu">Niue</option>
<option value="nf">Norfolk
Is.</option>
<option value="io">Territorio
Británico en el Indico</option>
<option
value="cx">Christmas (Isla)</option>
<option
value="cc">Cocos (Islas)</option>
<option
value="fk">Malvinas (Falkland) (Islas)</option>
<option value="tf">Territorios franceses del
sur</option>
<option value="hm">Heard y McDonald
(Islas)</option>
<option value="gs">S. Georgia y
S. Sandwich (Islas)</option>
<option
value="sj">Svalbard y Jan Mayen (Islas)</option>
<option value="wf">Wallis y Futuna
(Islas)</option>
</select></td>
</tr>
<tr>
<td class="texsub" align="left" height="24"><span class="ContenidoInterior5">Código postal</span></td>
<td class="texsub" align="left" height="24"><input
class="campo" id="codpos2" style="WIDTH: 30px"
name="codpos2" /></td>
</tr>
<tr>
<td class="texsub" align="left" width="165"
height="24"><span class="ContenidoInterior5">Dirección</span></td>
<td align="left" height="24"><input class="campo"
id="_direccion" style="WIDTH: 225px"
name="_direccion" /></td>
</tr>
<tr>
<td class="texsub" align="left" width="165"
height="24"><span class="ContenidoInterior5">Distrito</span></td>
<td align="left" height="24"><input class="campo"
id="_distrito" style="WIDTH: 225px"
name="_distrito" /></td>
</tr>
<tr>
<td class="texsub" align="left" width="165"
height="24"><span class="ContenidoInterior5">Provincia</span></td>
<td align="left" height="24"><input class="campo"
id="_provincia" style="WIDTH: 225px"
name="_provincia" /></td>
</tr>
</tbody>
</table>
<table cellspacing="0" cellpadding="2" width="395"
border="0">
<tbody>
<tr>
<td valign="top" align="left"> </td>
</tr>
<tr>
<td class="InteriorHistoria1" valign="top"
align="left">Agradeceremos nos dé mayores detalles
sobre el motivo de su comunicación</td>
</tr>
<tr>
<td class="texto" valign="top" align="left"><textarea id="_comentarios" style="WIDTH: 390px" name="_comentarios" rows="7" cols="55"></textarea></td>
</tr>
<tr>
<td valign="top" align="left"> </td>
</tr>
</tbody>
</table>
<table cellspacing="0" cellpadding="0" width="95%"
border="0">
<tbody>
<tr>
<td class="ContenidoInterior5" align="left" width="165"
height="24">Relación </td>
<td align="left" height="24"><select name="_relacion_con_nosotros"
size="1" class="ContenidoInterior5"
id="_relacion_con_nosotros"
onchange="javascript:changelayer(this.value);">
<option
value="Cliente">Cliente</option>
<option
value="Consumidor" selected="selected">Consumidor</option>
<option value="Exportador">Exportador</option>
<option
value="Inversionista">Inversionista</option>
<option
value="Proveedor">Proveedor</option>
</select>
<script language="JavaScript" type="text/javascript">
if (location.search.substring(1) == 'Postulante')
{
form.relacion_con_nosotros.options[5] = new Option('Postulante','',false,false)
form.relacion_con_nosotros.selectedIndex = 5
}
</script>
</td>
</tr>
</tbody>
</table>
<table cellspacing="0" cellpadding="2" width="395"
border="0">
<tbody>
<tr>
<td valign="top" align="left"> </td>
</tr>
<tr>
<td valign="top" align="left" height="25"></td>
</tr>
<tr>
<td valign="top" align="left" height="25"><div id="Layer1"
style="VISIBILITY: hidden; POSITION: absolute">
<p class="texsub">Solo en caso marque
proveedor:</p>
<select id="_envio_facturas" size="1"
name="_envio_facturas">
<option value="0"
selected="selected"></option>
<option value="1">Complejo
Industrial
Callao (Av.Argentina
4793 - Callao)</option>
<option value="2">Planta
Nicovita -
Trujillo (Panamericana
Norte Km.558)</option>
<option value="3">Planta
Piura
(La Legua s/n - Catacaos)</option>
<option
value="4">Planta Sidsur -
Arequipa (Av.Parra
400)</option>
</select>
</div></td>
</tr>
<tr>
<td valign="top" align="left"> </td>
</tr>
<tr>
<td valign="top" align="right"><a
href="javascript:EnviarFormulario();"
target="_self"><br />
</a></td>
</tr>
</tbody>
</table></td>
</tr>
</tbody>
</table>
<td> </td>
</tr>
</table>
</body>
</html>
