document.write(" <fieldset class='fieldset'>");
document.write("   <legend>Informa&ccedil;&otilde;es necess&aacute;rias</legend>");
document.write("	<table cellpadding='0' cellspacing='$stylevar[formspacer]' border='0' width='400'>");
document.write("      <tr> ");
document.write("        <td align='right' colspan='2'><a target='_blank' href='http://www.canalmail.com.br'><img border='0' align='texttop' src='http://promociones.canalmail.com/pruebas/canalmailpastilla.gif'/></a></td> ");
document.write("      </tr> ");
document.write("      <tr> ");
document.write("        <td ><b>Pa&iacute;s:</b></td>");
document.write("        <td > ");
document.write("          <select name='pais' onchange='CargaProvincias()'>");
document.write("      		<option selected='' value=''>Selecione</option>");
document.write("   			<option value=''>------------------</option>");
document.write("     		<option value='BRA'>Brasil</option>");
document.write("     		<option value=''>------------------</option>");
document.write("     		<option value='POR'>Portugal</option>");
document.write("    		<option value='ESP'>Espanha</option>");
document.write("     		<option value='MEX' >M&eacute;xico</option>");
document.write("    		<option value='ARG' >Argentina</option>");
document.write("     		<option value='CHL' >Chile</option>");
document.write("   			<option value='PER' >Per&uacute;</option>");
document.write("     		<option value='COL' >Col&ocirc;mbia</option>");
document.write("    		<option value='VEN' >Venezuela</option>");
document.write("    		<option value='' >------------------</option>");
document.write("   			<option value='BOL' >Bol&iacute;via</option>");
document.write("     		<option value='ESP' >Espanha</option>");
document.write("    		<option value='CAB' >Cabo Verde</option>");
document.write("      		<option value='CRI' >Costa Rica</option>");
document.write("   			<option value='CUB' >Cuba</option>");
document.write("   			<option value='ECU' >Equador</option>");
document.write("   			<option value='ESA' >Salvador</option>");
document.write("     		<option value='FIL' >Filipinas</option>");
document.write("    		<option value='GUA' >Guatemala</option>");
document.write("    		<option value='HON' >Honduras</option>");
document.write("     		<option value='NIC' >Nicar&aacute;gua</option>");
document.write("   			<option value='PAN' >Panam&aacute;</option>");
document.write("    		<option value='PAR' >Paraguai</option>");
document.write("    		<option value='AND' >Andorra</option>");
document.write("   			<option value='PUE' >Porto Rico</option>");
document.write("   			<option value='DOM' >Rep. Dom</option>");
document.write("     		<option value='USA' >USA</option>");
document.write("     		<option value='URU' >Uruguai</option>");
document.write("     		<option value='' >------------------</option>");
document.write("     		<option value='ZZZ' >Outros</option>");
document.write("          </select>");
document.write("        </td>");
document.write("      </tr>");
document.write("      <tr> ");
document.write("        <td><b>Estado:</b></td>");
document.write("        <td> ");
document.write("          <select name='provincia' id='provincia'>");
document.write("            <option value='' selected>Selecione</option>");
document.write("            <option value=''>------------------</option>");
document.write("            <option value=''>Escolha um Estado</option>");
document.write("            <option value=''>------------------</option>");
document.write("            <option value='ACR'>Acre</option>");
document.write("            <option value='ALA'>Alagoas</option>");
document.write("            <option value='AMA'>Amapa</option>");
document.write("            <option value='AZ'>Amazonas</option>");
document.write("            <option value='BH'>Bahia</option>");
document.write("            <option value='CEA'>Ceara</option>");
document.write("            <option value='DF'>Distrito Federal</option>");
document.write("            <option value='ES'>Espirito Santo</option>");
document.write("            <option value='GL'>Goias</option>");
document.write("            <option value='MG'>Mato Grosso</option>");
document.write("            <option value='MGS'>Mato G. do Sul</option>");
document.write("            <option value='MA'>Maranh&atilde;o</option>");
document.write("            <option value='MN'>Minas Gerais</option>");
document.write("            <option value='PAA'>Para</option>");
document.write("            <option value='PRB'>Paraiba</option>");
document.write("            <option value='PRN'>Parana</option>");
document.write("            <option value='PEA'>Pernambuco</option>");
document.write("            <option value='PI'>Piaui</option>");
document.write("            <option value='RJ'>Rio de Janeiro</option>");
document.write("            <option value='RG'>Rio Grande do Norte</option>");
document.write("            <option value='RGS'>Rio Grande do Sul</option>");
document.write("            <option value='RO'>Rondonia</option>");
document.write("            <option value='ROR'>Roraima</option>");
document.write("            <option value='STC'>Santa Catarina</option>");
document.write("            <option value='SPA'>Sao Paulo</option>");
document.write("            <option value='SER'>Sergipe</option>");
document.write("            <option value='TOC'>Tocantins</option>");
document.write("          </select>");
document.write("        </td>");
document.write("      </tr>");
document.write("      <tr> ");
document.write("        <td><b>CEP:</b></td>");
document.write("        <td><input type='text' name='cp' size='15' maxlength='8' />");
document.write("         <a onclick=\"window.open('http://includes.canalmail.com/bra/busca_cep.htm', '', 'STATUS=NO, TOOLBAR=NO, LOCATION=NO, DIRECTORIES=NO, RESISABLE=NO, SCROLLBARS=YES, TOP=50, LEFT=50, WIDTH=360, HEIGHT=320');\" style='cursor:pointer;'><b>N&atilde;o sei o CEP</b></a></td> ");
document.write("      </tr> ");
document.write("      <tr> ");
document.write("        <td><b>Celular:</b></td>");
document.write("        <td><input type='text' name='movil' size='15' maxlength='12' /></td>");
document.write("      </tr>");
document.write("      <tr> ");
document.write("        <td ><b>Idade:</b></td>");
document.write("        <td > ");
document.write("          <select name='fec_ncto'>");
document.write("           <option value=''>Selecione</option> ");
document.write("           <option value='01-01-1946'>Maior de 62</option> ");
document.write("           <option value='01-01-1947'>62</option> ");
document.write("           <option value='01-01-1948'>61</option> ");
document.write("           <option value='01-01-1949'>60</option> ");
document.write("           <option value='01-01-1950'>59</option> ");
document.write("           <option value='01-01-1951'>58</option> ");
document.write("           <option value='01-01-1952'>57</option> ");
document.write("           <option value='01-01-1953'>56</option> ");
document.write("           <option value='01-01-1954'>55</option> ");
document.write("           <option value='01-01-1955'>54</option> ");
document.write("           <option value='01-01-1956'>53</option> ");
document.write("           <option value='01-01-1957'>52</option> ");
document.write("           <option value='01-01-1958'>51</option> ");
document.write("           <option value='01-01-1959'>50</option> ");
document.write("           <option value='01-01-1960'>49</option> ");
document.write("           <option value='01-01-1961'>48</option> ");
document.write("           <option value='01-01-1962'>47</option> ");
document.write("           <option value='01-01-1963'>46</option> ");
document.write("           <option value='01-01-1964'>45</option> ");
document.write("           <option value='01-01-1965'>44</option> ");
document.write("           <option value='01-01-1966'>43</option> ");
document.write("           <option value='01-01-1967'>42</option> ");
document.write("           <option value='01-01-1968'>41</option> ");
document.write("           <option value='01-01-1969'>40</option> ");
document.write("           <option value='01-01-1970'>39</option> ");
document.write("           <option value='01-01-1971'>38</option> ");
document.write("           <option value='01-01-1972'>37</option> ");
document.write("           <option value='01-01-1973'>36</option> ");
document.write("           <option value='01-01-1974'>35</option> ");
document.write("           <option value='01-01-1975'>34</option> ");
document.write("           <option value='01-01-1976'>33</option> ");
document.write("           <option value='01-01-1977'>32</option> ");
document.write("           <option value='01-01-1978'>31</option> ");
document.write("           <option value='01-01-1979'>30</option> ");
document.write("           <option value='01-01-1980'>29</option> ");
document.write("           <option value='01-01-1981'>28</option> ");
document.write("           <option value='01-01-1982'>27</option> ");
document.write("           <option value='01-01-1983'>26</option> ");
document.write("           <option value='01-01-1984'>25</option> ");
document.write("           <option value='01-01-1985'>24</option> ");
document.write("           <option value='01-01-1986'>23</option> ");
document.write("           <option value='01-01-1987'>22</option> ");
document.write("           <option value='01-01-1988'>21</option> ");
document.write("           <option value='01-01-1989'>20</option> ");
document.write("           <option value='01-01-1990'>19</option> ");
document.write("           <option value='01-01-1991'>18</option> ");
document.write("           <option value='01-01-1992'>17</option> ");
document.write("           <option value='01-01-1993'>16</option> ");
document.write("           <option value='01-01-1994'>15</option> ");
document.write("           <option value='01-01-1995'>Menor de 15</option> ");
document.write("         </select>");
document.write("       </td>");
document.write("     </tr>");
document.write("     <tr valign='top'>");
document.write("	   <td><b> Sexo:</b> </td>");
document.write("	   <td>");
document.write("         <select name='sexo' >");
document.write("           <option value='' >Selecione</option>");
document.write("           <option value='H' >Masculino</option>");
document.write("           <option value='M' >Feminino </option>");
document.write("         </select>");
document.write("	   </td>");
document.write("	 </tr>");
document.write("     <tr> ");
document.write("       <td><strong>Ocupa&ccedil;&atilde;o: </strong></td> ");
document.write("       <td> ");
document.write("         <select name='ocupacion'> ");
document.write("   		   <option value='' selected>Selecione</option> ");
document.write("   		   <option value='9' >Aposentado</option> ");
document.write("           <option value='12'>Aut&ocirc;nomo / Profissional liberal</option> ");
document.write("           <option value='97'>Diretor / Presidente</option> ");
document.write("		   <option value='5' >Dona de Casa</option> ");
document.write("		   <option value='98'>Empres&aacute;rio</option> ");
document.write("           <option value='6' >Estudante / Universit&aacute;rio</option> ");
document.write("           <option value='1' >Executivo</option> ");
document.write("		   <option value='3' >Funcion&aacute;rio Registrado</option> ");
document.write("		   <option value='8' >Funcion&aacute;rio P&uacute;blico</option> ");
document.write("		   <option value='7' >Prestador de Servi&ccedil;o</option> ");
document.write("		   <option value='99'>Outros</option> ");
document.write("         </select> ");
document.write("       </td> ");
document.write("     </tr> ");
document.write("     <tr> ");
document.write("     <td ><b>&Aacute;rea de Atua&ccedil;&atilde;o: </b></td>");
document.write("       <td> ");
document.write("         <select name='sector'> ");
document.write("		   <option value='' selected>Selecione</option> ");
document.write("		   <option value='1' >Administra&ccedil;&atilde;o / Finan&ccedil;as</option> ");
document.write("		   <option value='18'>Agroneg&oacute;cio</option> ");
document.write("		   <option value='19'>Alimentos e Bebidas</option> ");
document.write("		   <option value='7' >Arquitetura / Engenharia</option> ");
document.write("		   <option value='15'>Publicidade / Comunica&ccedil;&atilde;o / Marketing</option> ");
document.write("		   <option value='7' >Constru&ccedil;&atilde;o</option> ");
document.write("		   <option value='6' >Educa&ccedil;&atilde;o</option> ");
document.write("		   <option value='10'>Ind&uacute;stria - Produ&ccedil;&atilde;o / Fabrica&ccedil;&atilde;o</option> ");
document.write("		   <option value='2,3,4'>Inform&aacute;tica / Internet</option> ");
document.write("		   <option value='16'>Log&iacute;stica / Transportes</option> ");
document.write("		   <option value='5'>Recursos Humanos</option> ");
document.write("		   <option value='11'>Sa&uacute;de</option> ");
document.write("		   <option value='9'>Servi&ccedil;os jur&iacute;dicos</option> ");
document.write("		   <option value='8' >Setor P&uacute;blico / Governo</option> ");
document.write("		   <option value='17'>Turismo</option> ");
document.write("		   <option value='13'>Vendas / Com&eacute;rcio</option> ");            
document.write("		   <option value='14'>Outras</option> ");
document.write("         </select> ");
document.write("       </td> ");
document.write("     </tr> ");
document.write("     <tr> ");
document.write("       <td ><b>&Aacute;reas de Interesse:</b></td>");
document.write("     </tr>");
document.write("     <tr> ");
document.write("       <td  colspan='2'>");
document.write("         <table width='580' border='0' cellpadding='0' cellspacing='0' align='center' >");
document.write("           <tr> ");
document.write("             <td height='22' width='78' valign='top'>");
document.write("              <input type='checkbox' value='1160,1158,17' name='listas'/><a name='1'><b><font size='1'>Alimentos e Bebidas</font></b></a> ");
document.write("             </td> ");
document.write("       <td height='22' valign='top'> ");
document.write("         <input type='checkbox' value='1295,57,1254,691,1256' name='listas'/><a name='30'><b><font size='1'>Filhos</font></b></a> ");
document.write("       </td> ");
document.write("     </tr> ");

document.write("     <tr> ");
document.write("       <td height='22' width='78' valign='top'> ");
document.write("         <input type='checkbox' value='25,123,1210,28,489,1217' name='listas'/><a name='41'><b><font size='1'>Artigos Femininos</font></b></a> ");
document.write("       </td> ");
document.write("       <td width='83' valign='top'> ");
document.write("         <input type='checkbox' value='1133,4,4340,377' name='listas'/><a name='690'><b><font size='1'>Inform&aacute;tica</font></b></a> ");
document.write("       </td> ");
document.write("     </tr> ");

document.write("     <tr> ");
document.write("       <td width='83' valign='top'> ");
document.write("         <input type='checkbox' value='690,124,1249,1247,1251' name='listas'/><a name='7'><b><font size='1'>Artigos Masculinos</font></b></a> ");
document.write("       </td> ");
document.write("       <td width='83' valign='top'> ");
document.write("         <input type='checkbox' value='39,38,7378,7' name='listas'/><a name='690'><b><font size='1'>M&uacute;sica e Livros</font></b></a> ");
document.write("       </td> ");
document.write("     </tr> ");

document.write("     <tr> ");
document.write("       <td width='83' valign='top'> ");
document.write("         <input type='checkbox' value='41,615,107,4359,69,1195,614,56,14' name='listas'/><a name='8'><b><font size='1'>Automotivo</font></b></a> ");
document.write("       </td> ");
document.write("       <td width='83' valign='top'> ");
document.write("         <input type='checkbox' value='30,1395,1184,1391,1389,530,1186' name='listas'/><a name='690'><b><font size='1'>Neg&oacute;cios e Finan&ccedil;as</font></b></a> ");
document.write("       </td> ");
document.write("     </tr> ");

document.write("     <tr> ");
document.write("       <td valign='top'> ");
document.write("         <input type='checkbox' value='1164' name='listas'/><a name='90'><b><font size='1'>Casa e Contru&ccedil;&atilde;o</font></b></a> ");
document.write("       </td> ");
document.write("       <td height='22' valign='top'> ");
document.write("         <input type='checkbox' value='90' name='listas'/><a name='2418'><b><font size='1'>Ofertas de Emprego</font></b></a> ");
document.write("       </td> ");
document.write("     </tr> ");

document.write("     <tr> ");
document.write("       <td height='22' valign='top'> ");
document.write("         <input type='checkbox' value='13,1241,1243' name='listas'/><a name='2418'><b><font size='1'>Educa&ccedil;&atilde;o e Forma&ccedil;&atilde;o</font></b></a> ");
document.write("       </td> ");
document.write("       <td valign='top'> ");
document.write("         <input type='checkbox' value='8,2418,1165,1166' name='listas'/><a name='1133'><b><font size='1'>Promo&ccedil;&otilde;es</font></b></a> ");
document.write("       </td> ");
document.write("     </tr> ");

document.write("     <tr> ");
document.write("       <td height='22' valign='top'> ");
document.write("         <input type='checkbox' value='1169,37' name='listas'/><a name='2418'><b><font size='1'>Empr&eacute;stimos</font></b></a> ");
document.write("       </td> ");
document.write("       <td height='22' width='78' valign='top'> ");
document.write("         <input type='checkbox' value='5' name='listas'/><a name='691'><b><font size='1'>Sa&uacute;de e Bem Estar</font></b></a> ");
document.write("       </td> ");
document.write("     </tr> ");

document.write("     <tr> ");
document.write("       <td valign='top'> ");
document.write("         <input type='checkbox' value='21,23,8755,4418,24,4338,71,22,1,887' name='listas'/><a name='9'><b><font size='1'>Entretenimento</font></b></a> ");
document.write("       </td> ");
document.write("       <td width='83' valign='top'> ");
document.write("         <input type='checkbox' value='1154,1148,1150,2618,393' name='listas'/><a name='5'><b><font size='1'>Tecnologia e Multim&iacute;dia</font></b></a> ");
document.write("       </td> ");
document.write("     </tr> ");

document.write("     <tr> ");
document.write("       <td height='22' width='78' valign='top'> ");
document.write("         <input type='checkbox' value='1273,18,9,357,449,363,1266,4358,365' name='listas'/><a name='13'><b><font size='1'>Esportes</font></b></a> ");
document.write("       </td> ");
document.write("       <td valign='top'> ");
document.write("         <input type='checkbox' value='62,64,89,63,61,11,431' name='listas'/><a name='2420'><b><font size='1'>Viagem e Turismo</font></b></a> ");
document.write("       </td> ");
document.write("          </tr> ");
document.write("        </table>");
document.write("      </td>");
document.write("    </tr>");
document.write("  </table>");
document.write("</fieldset>");


