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

Software: Apache. PHP/5.5.15 

uname -a: Windows NT SVR-DMZ 6.1 build 7600 (Windows Server 2008 R2 Enterprise Edition) i586 

SYSTEM 

Safe-mode: OFF (not secure)

E:\nuevo\htdocs\BLA\boletinlegal\registro\   drwxrwxrwx
Free 9.42 GB of 239.26 GB (3.94%)
Detected drives: [ a ] [ c ] [ d ] [ e ] [ f ]
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Viewing file:     index.php (2.73 KB)      -rw-rw-rw-
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<?php include("inicio.php");
include_once("../analyticstracking.php");
?> 
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <title>Registro</title>

        <style type="text/css">
            @import url('assets/css/contact.css');
            @import url('assets/css/lay.css');
        .style1 {color: #FFFFFF}
        </style>

    </head>
    <body>
        <div id="contact">
            <div id="top">
                <h1>Registro</h1>
            </div>
            <div id="center">
        <div id="contact_form">
            <form method="post" action="<?php echo $_SERVER['PHP_SELF']; ?>" id="contactForm">
                <div class="error" id="error">Ha ocurrido un error en el registro y no se ha podido realizar</div>
                <div class="success" id="success">El Registro es Exitoso!<br />Gracias por registrar.</div>

                    <span class="input">
<label for="name"><b>Nombre:</b> </label>
<input  type="text" id="name" name="name" />
<div class="warning" id="nameError">Este campo no puede estar vacio!</div>
</span>

<span class="input">
<label for="email"><b>Correo:</b> </label>
<input  type="text" id="email" name="email" />
<div class="warning" id="emailError">Este campo no puede estar vacio!</div>
</span>

<span class="input">
<label for="sales"><b>Usuario:</b> </label>
<select id="sales" name="sales">
<option value="Interno">Interno</option>
<option value="Externo">Externo</option>

</select>
</span><span class="input">
<label for="security_code"><b>Validación:</b> </label>
<input name="tmptxt" type="text" style="width:100px">
<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="captcha.php" width="100" height="30">
<div class="warning" id="security_codeError">El codigo de validación no coincide!</div>
</span>

<span class="input">
          
          
          
          <input name="action" type="hidden" value="checkdata">
<div class="warning" id="phoneError">Digite solo numeros!</div>
</span>
<span id="submit" class="input">
                    <label for="submit"></label>
                    <p id="ajax_loader" style="text-align:center;"><img src="assets/img/contact/ajax-loader.gif" /></p>
                    <input name="action" type="hidden" value="checkdata">
                    <input id="send" type="submit" value="REGISTRARME" name="registro" />
                    </span>

                </form>
                </div>
            </div>
            <div id="bot"><!--bottom--></div>
  
        </div>
       
</body>
</html>

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