<form name="form1" method="post" action="/cgi-bin/formmail.pl" enctype="multipart/form-data">
<input type='hidden' name='recipient' value='
[email protected]'>
<input type='hidden' name='subject' value='3r Energias y Servicios'>
<input type='hidden' name='redirect' value='3renergiasyservicios.com/gracias.htm'>
<table width="793" height="32" border="0" cellspacing="0">
<tr>
<td width="33"> </td>
<td width="756"><p class="Estilo4 Estilo5">Si desea recibir más información
sobre Proyectos de Ingeniería 63 S.L. ,
remítanos el siguiente formulario cumplimentado o bien llámenos
al teléfono 91 xxx xx xxó envíenos un fax al 91 xxx xx
xx. </p> </td>
</tr>
</table>
<TABLE height=215 cellSpacing=5 cellPadding=0 border=0>
<TBODY>
<TR>
<TD width="114" height=25 align=right><span class="Estilo3"><FONT face=Verdana size=1>Nombre</FONT></span></TD>
<TD width="150" height=25><span class="Estilo4">
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size=25 name = Nombre nombre>
</span></TD>
<TD width="81" height=25 align=right><span class="Estilo4"><FONT face=Verdana size=1><B>Apellidos</B></FONT></span></TD>
<TD width="154" height=25><span class="Estilo4">
<INPUT
style="BORDER-RIGHT: #2e73b4 1px solid; BORDER-TOP: #2e73b4 1px solid; FONT-WEIGHT: bold; FONT-SIZE: 10px; BORDER-LEFT: #2e73b4 1px solid; COLOR: #000000; BORDER-BOTTOM: #2e73b4 1px solid; FONT-FAMILY: Verdana; BACKGROUND-COLOR: #ffffff"
size=25 name = Apellidos>
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<TD width="1"> </TD>
</TR>
<TR>
<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>Dirección</B></FONT></span></TD>
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size=25 name = Direccion>
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<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>Localidad</B></FONT></span></TD>
<TD height=25><span class="Estilo4">
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name = Localidad>
</span></TD>
<TD> </TD>
</TR>
<TR>
<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>Código
Postal</B></FONT></span></TD>
<TD height=25><span class="Estilo4">
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size=15 name = CodigoPostal>
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<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>Provincia</B></FONT></span></TD>
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size=25 name = Provincia>
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<TD> </TD>
</TR>
<TR>
<TD align=right height=25><span class="Estilo4"><FONT
face="Verdana, Arial, Helvetica, sans-serif" size=1><B>País</B></FONT></span></TD>
<TD height=25><span class="Estilo4">
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size=25 name = Pais>
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<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>Teléfono</B></FONT></span></TD>
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size=25 name = Telefono>
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<TD> </TD>
</TR>
<TR>
<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>E-Mail</B></FONT></span></TD>
<TD height=25><span class="Estilo4">
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size=25 name = EMail>
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<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>Titulación</B></FONT></span></TD>
<TD height=25><span class="Estilo4">
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size=25 name = Titulación>
</span></TD>
<TD> </TD>
</TR>
<TR>
<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>Experiencia</B></FONT></span></TD>
<TD height=25><span class="Estilo4">
<INPUT
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size=25 name = Experiencia>
</span></TD>
<TD align=right height=25><span class="Estilo4"><FONT face=Verdana size=1><B>C.
Vitae </B></FONT></span></TD>
<TD height=25><input type="file" name="file"></TD>
<TD> </TD>
</TR>
<TR>
<TD align=right colSpan=4 height=34>
<P align=center>
<table width="19%" border="0" align="center">
<tr>
<td width="11%"><div align="center">
<input type="reset" name="Submit2" value="Borrar">
</div></td>
<td width="89%"><div align="center">
<input type="submit" name="Submit" value="Enviar">
</div></td>
</tr>
</table>
<div align="center"></div>
<P align=center><FONT color=#000000> </FONT></P></TD>
<TD> </TD>
</TR>
</TBODY>
</TABLE>
</form>