!C99Shell v. 1.0 pre-release build #13!

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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<title>Formulario de Autoliquidaci&oacute;n de Servicios de Evaluaci&oacute;n 
o Seguimiento Ambiental</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<style type="text/css">
<!--
-->
</style>
</head>

<body topmargin="0">
<table width="100%" border="0">
  <tr>
    <td><font color="#FFFFFF">aaaaaaaaa</font></td>
    <td> <form name="form1" method="post" action="../php/requireauto.php">
        <table width="100%" border="0" cellpadding="5">
          <tr> 
            <td width="38%"> <div align="left"><img src="banner.gif" width="319" height="150"></div></td>
            <td width="62%" valign="top"> <p><img src="banner1.gif" width="522" height="56"></p>
              <table width="100%" border="0" cellpadding="5">
                <tr> 
                  <td><div align="right"><img src="bot1.gif" width="106" height="28"><img src="bot2.gif" width="129" height="28"><img src="bot3.gif" width="133" height="28"></div></td>
                </tr>
              </table></td>
          </tr>
          <tr bgcolor="#BEE2F8"> 
            <td><div align="left"><font size="5" face="Verdana, Arial, Helvetica, sans-serif"><img src="pun.gif" width="16" height="16"> 
                1er. Paso</font></div></td>
            <td bgcolor="#BEE2F8">
<div align="right"> 
                <p align="left"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><strong><font size="1">Informaci&oacute;n 
                  general del beneficiario de la licencia, plan de manejo, permiso 
                  o autorizaci&oacute;n. </font></strong></font><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><br>
                  Relacione los datos b&aacute;sicos de qui&eacute;n se registrar&aacute; 
                  como el responsable y beneficiario del proceso, los datos remarcados 
                  con<font color="#FF0000"> (*)</font> son obligatorios.</font></p>
              </div></td>
          </tr>
          <tr bgcolor="#F8F8EF"> 
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><img src="p.gif" width="10" height="10"> 
              Proyecto, obra o actividad:</font><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><font color="#FF0000">*</font></font></td>
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"> 
              <input name="pro" type="text" id="pro" size="40">
              </font></td>
          </tr>
          <tr bgcolor="#F8F8EF"> 
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><img src="p.gif" width="10" height="10"> 
              Nombre o raz&oacute;n social del beneficiario:</font><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><font color="#FF0000">*</font></font></td>
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"> 
              <input name="name" type="text" id="name" size="40">
              </font></td>
          </tr>
          <tr bgcolor="#F8F8EF"> 
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><img src="p.gif" width="10" height="10"> 
              Ubicaci&oacute;n del proyecto, obra o actividad:</font><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><font color="#FF0000">*</font></font></td>
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"> 
              <input name="ubi" type="text" id="ubi" size="40">
              </font></td>
          </tr>
          <tr bgcolor="#F8F8EF"> 
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><img src="p.gif" width="10" height="10"> 
              Direcci&oacute;n de correspondencia:</font></td>
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"> 
              <input name="ubi1" type="text" id="ubi1" size="40">
              </font></td>
          </tr>
          <tr bgcolor="#F8F8EF"> 
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><img src="p.gif" width="10" height="10"> 
              Tel:</font><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><font color="#FF0000">*</font></font><font size="2" face="Verdana, Arial, Helvetica, sans-serif"> 
              <input name="tel" type="text" id="tel" size="15">
              </font></td>
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><img src="p.gif" width="10" height="10"> 
              Fax:</font><font size="2" face="Verdana, Arial, Helvetica, sans-serif">
<input name="fax" type="text" id="fax" size="15">
              </font></td>
          </tr>
          <tr bgcolor="#F8F8EF"> 
            <td colspan="2"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><img src="p.gif" width="10" height="10"> 
              Tipo Documento:</font><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><font color="#FF0000">*</font></font><font size="2" face="Verdana, Arial, Helvetica, sans-serif"> 
              <select name="typedoc" id="typedoc">
                <option value="CC">C&eacute;dula de Ciudadan&iacute;a</option>
                <option value="NIT">N&uacute;mero de Id. Tributaria</option>
                <option value="CE">C&eacute;dula de Extranjer&iacute;a</option>
                <option value="PA">Pasaporte</option>
                <option value="RI">Resol. Integraci&oacute;n</option>
                <option value="PJ">Personer&iacute;a Jur&iacute;dica</option>
              </select>
              </font><font size="2" face="Verdana, Arial, Helvetica, sans-serif">N&uacute;mero:</font><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><font color="#FF0000">*</font></font><font size="2" face="Verdana, Arial, Helvetica, sans-serif"> 
              <input name="num" type="text" id="num" size="12">
              </font></td>
          </tr>
          <tr bgcolor="#F8F8EF">
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif"><img src="p.gif" width="10" height="10"> 
              Correo Electr&oacute;nico:</font></td>
            <td><font size="2" face="Verdana, Arial, Helvetica, sans-serif">
              <input name="mail" type="text" id="mail" size="40">
              </font></td>
          </tr>
          <tr bgcolor="#F8F8EF"> 
            <td bgcolor="#FFFFFF" class="hiden">&nbsp;</td>
            <td bgcolor="#BEE2F8">
<div align="center"><font size="2" face="Verdana, Arial, Helvetica, sans-serif"> 
                <input type="reset" name="Submit2" value="Borrar">
                <font color="#BEE2F8">i</font> 
                <input type="submit" name="Submit" value="Continuar....">
                </font></div></td>
          </tr>
        </table>
      </form>
      <p align="center"><img src="lin.gif" width="640" height="25"><br>
        <font size="1" face="Verdana, Arial, Helvetica, sans-serif">Desarrollado 
        por el DAMA, Todos los Derechos Reservados, 2003<br>
        Bogot&aacute;, Colombia.</font></p>
      <p>&nbsp;</p></td>
    <td><font color="#FFFFFF">aaaaaaaaa</font></td>
  </tr>
</table>
</body>
</html>

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