Form for Information Requests - Elife International S.r.l.

<body bgcolor="#000550" text="#DECE84" link="#EFE4B3" vlink="#A3976F" topmargin="0" leftmargin="2"> <div align="center"><center> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="740"> <tr> <td width="100%" align="center" height="60"><font size="5"><b>Form for Information Requests</b></font></td> </tr> <div align="center"><center><table border="0" width="590" height="720" cellspacing="0" cellpadding="0"> <tr> <td width="100%" align="center" valign="bottom"><script Language="JavaScript" Type="text/javascript"></script><form method="POST" action="http://www.elifeinternational.com/cgi-bin/form/info_en.pl" onsubmit="return FrontPage_Form1_Validator(this)" name="FrontPage_Form1" language="JavaScript"> <tr> <td width="100%"><div align="center"><center><table border="0" width="510" cellspacing="0" cellpadding="0"> <tr> <td width="128" height="50" align="left"><font face="Arial"><strong>Mr./Mrs.</strong></font></td> <td width="382" height="50" align="center"><div align="left"><p><font face="Verdana" size="1">(*) Compulsory gaps</font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong>Name </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="1"><font color="#000080"> <input type="text" name="Nome" size="40" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></font></td> </tr> <tr> <td width="150" height="32" align="left"> <strong><font face="Arial">Surname</font></strong><font face="Arial"><strong> </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="23"><font color="#000080"> <input type="text" name="Cognome" size="40" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong> Company </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="23"><font color="#000080"> <input type="text" name="Societa" size="40" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong> Address </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="23"><font color="#000080"> <input type="text" name="Indirizzo" size="40" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong>Cap </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="23"><font color="#000080"> <input type="text" name="Cap" size="5" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt" maxlength="5"></font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong> City </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="23"><font color="#000080"> <input type="text" name="Citta" size="40" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong> State </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="23"><font color="#000080"> <input type="text" name="Provincia" size="30" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong> Phone </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="22"><font color="#000080"> <input type="text" name="Telefono" size="30" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong>Fax</strong></font></td> <td width="360" height="21"><font color="#000080"> <input type="text" name="Fax" size="16" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt;"></font></td> </tr> <tr> <td width="150" height="32" align="left"><font face="Arial"><strong>E-mail </strong></font><font face="Verdana" size="1">*</font></td> <td width="360" height="23"><font color="#000080"> <input type="text" name="email" size="30" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></font></td> </tr> <tr> <td width="510" height="32" align="center" colspan="2" valign="bottom"><font face="Arial"><strong>Please send infos on any of the following Business units:               </strong></font></td> </tr> <tr> <td width="150" height="45" align="right"></td> <td width="360" height="23"><br> <input TYPE="checkbox" NAME="check1" value="ON"> Electronic<br> <br> <input TYPE="checkbox" NAME="check2" value="ON"> Grafic & Web<br> <br> <input TYPE="checkbox" NAME="check3" value="ON"> Real Estate</td> </tr> <tr> <td width="510" height="40" align="center" colspan="2" valign="bottom"><font face="Arial"><strong>Message</strong></font></td> </tr> <tr> <td width="510" height="120" align="center" colspan="2"><font color="#000080"><textarea name="Note" COLS="60" ROWS="10" style="background-color: rgb(255,255,244); color: rgb(0,0,160); font-size: 8pt"></textarea></font></td> </tr> </table> </center></div><div align="center"><center><table border="0" width="510" cellspacing="0" cellpadding="0" height="60"> <tr> <td width="100%"><div align="center"><center><p><small><small> The Italian Law no. 675/96 – Regulates the use of personal data of any people and subjects:<br> The information contained in this form will never be disclosed to anyone for whatsoever reason. </table> </center></div><div align="center"><center><p><input type="submit" value="Send" style="background-color: rgb(222,206,132); color: rgb(0,0,128); font-family: Verdana; font-weight: bold"></td> </tr> </table> </center></div><div align="center"><center><table border="0" width="510" cellspacing="0" cellpadding="0"> </table> </center></div> </form> </td> </tr> </table> </center></div> <p align="center"> </p> <p align="center">Elife International S.r.l. - Electronics - Graphics & Web - Real Estate Isola d'Elba</p> <p align="center">Our Experience list:</p> <p align="center">Electronic Design, Real Estate, Elba Island, Graphic Design,<br> Microelectronics, Feasibility Study, Systems Automation, Analogic, Digital, <br> Tecnology, Instrumentation, Analogic Design, Digital Design Tecnical Consulting, electronic board, data acquisition, <br> industrial, SBC, input, output, I/O, resolution, signal, temperature, measure, reader, firmware, microcontroller, <br> electronic circuit, accessories, converter, interface, RS232, RS485, RS422, firmware design, hardware design,<br> software design, engineering, special applications, industrial controller, industrial automation, sistems for test, <br> supervisury, teleservice, industrial box</p> <p align="center"> <a target="_top" href="http://www.elifeinternational.com"> www.elifeinternational.com</a></p> <hr color="#0000FF" width="98%" size="1"> <p align="center"><font face="Verdana" size="2"> <b>Elife International S.r.l.</b> - Località Sghinghetta, 3 - 57037  Portoferraio LI - Italy<br> tel. +39.0565.944121  fax +39.0565.945726  <a href="mailto:info@elifeinternational.com"> info@elifeinternational.com</a></font></p> <p align="center"> <img border="0" src="images/barra.gif" hspace="10" width="740" height="20"></p> </body>