(Continua)
<form action="<?=$PHP_SELF ?>" method="POST">
<table width="400" border="0" cellpadding="2" cellspacing="0" bgcolor="#003366">
<tr>
<td><font color="#FFFFFF" size="2" face="Verdana, Arial, Helvetica, sans-serif"><strong>Formulario
de Consulta</strong></font>
<table width="100%" border="0" cellspacing="1" cellpadding="4">
<tr bgcolor="#F8D480">
<td align="right"><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Nombre</font></td>
<td><input name="Cons[nombre]" type="text" ></td>
</tr>
<tr bgcolor="#F8D480">
<td align="right"><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Apellido</font></td>
<td><input type="text" name="Cons[apellido]"></td>
</tr>
<tr bgcolor="#F8D480">
<td align="right"><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Email</font></td>
<td><input type="text" name="Cons[email]"></td>
</tr>
<tr bgcolor="#F8D480">
<td align="right"><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Teléfono</font></td>
<td><input type="text" name="Cons[telefono]"></td>
</tr>
<tr bgcolor="#F8D480">
<td align="right"><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Ciudad</font></td>
<td><input type="text" name="Cons[ciudad]"></td>
</tr>
<tr bgcolor="#F8D480">
<td align="right"><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">País</font></td>
<td>
<select name="Cons[pais]">
<OPTION>Afganistán</OPTION>
<OPTION>Albania</OPTION>
<OPTION>Alemania</OPTION>
<OPTION>Andorra</OPTION>
<OPTION>Angola</OPTION>
<OPTION>Antigua y Barbuda</OPTION>
<OPTION>Arabia Saudita</OPTION>
<OPTION>Argelia</OPTION>
<OPTION selected>Argentina</OPTION>
<OPTION>Armenia</OPTION>
<OPTION>Australia</OPTION>
<OPTION>Austria</OPTION>
<OPTION>Azerbaiyán</OPTION>
<OPTION>Bahamas</OPTION>
<OPTION>Bahrein</OPTION>
<OPTION>Bangladesh</OPTION>
<OPTION>Barbados</OPTION>
<OPTION>Bélgica</OPTION>
<OPTION>Belice</OPTION>
<OPTION>Benín</OPTION>
<OPTION>Bielorrusia</OPTION>
<OPTION>Bolivia</OPTION>
<OPTION>Bosnia - Herzegovina</OPTION>
<OPTION>Botswana</OPTION>
<OPTION>Brasil</OPTION>
<OPTION>Brunei</OPTION>
<OPTION>Bulgaria</OPTION>
<OPTION>Burkina Faso</OPTION>
<OPTION>Burundi</OPTION>
<OPTION>Bután</OPTION>
<OPTION>Cabo Verde</OPTION>
<OPTION>Cambodia</OPTION>
<OPTION>Camerún</OPTION>
<OPTION>Canadá</OPTION>
<OPTION>Chad</OPTION>
<OPTION>Chile</OPTION>
<OPTION>China</OPTION>
<OPTION>Chipre</OPTION>
<OPTION>Comores</OPTION>
<OPTION>Colombia</OPTION>
<OPTION>Corea del Norte</OPTION>
<OPTION>Corea del Sur</OPTION>
<OPTION>Costa de Marfil</OPTION>
<OPTION>Costa Rica</OPTION>
<OPTION>Croacia</OPTION>
<OPTION>Cuba</OPTION>
<OPTION>Dinamarca</OPTION>
<OPTION>Djibouti</OPTION>
<OPTION>Dominica</OPTION>
<OPTION>Ecuador</OPTION>
<OPTION>Egipto</OPTION>
<OPTION>El Salvador</OPTION>
<OPTION>Emiratos Árabes Unidos</OPTION>
<OPTION>Eritrea</OPTION>
<OPTION>Eslovaquia</OPTION>
<OPTION>Eslovenia</OPTION>
<OPTION>España</OPTION>
<OPTION>Estados Unidos</OPTION>
<OPTION>Estonia</OPTION>
<OPTION>Etiopía</OPTION>
<OPTION>Fiji</OPTION>
<OPTION>Filipinas</OPTION>
<OPTION>Finlandia</OPTION>
<OPTION>Francia</OPTION>
<OPTION>Gabón</OPTION>
<OPTION>Gambia</OPTION>
<OPTION>Georgia</OPTION>
<OPTION>Ghana</OPTION>
<OPTION>Granada</OPTION>
<OPTION>Grecia</OPTION>
<OPTION>Guatemala</OPTION>
<OPTION>Guinea</OPTION>
<OPTION>Guinea Bissau</OPTION>
<OPTION>Guinea Ecuatorial</OPTION>
<OPTION>Guyana</OPTION>
<OPTION>Haití</OPTION>
<OPTION>Honduras</OPTION>
<OPTION>Hungría</OPTION>
<OPTION>India</OPTION>
<OPTION>Indonesia</OPTION>
<OPTION>Irán</OPTION>
<OPTION>Iraq</OPTION>
<OPTION>Irlanda</OPTION>
<OPTION>Islandia</OPTION>
<OPTION>Islas Feroe</OPTION>
<OPTION>Islas Marshall</OPTION>
<OPTION>Islas Salomón</OPTION>
<OPTION>Israel</OPTION>
<OPTION>Italia</OPTION>
<OPTION>Jamaica</OPTION>
<OPTION>Japón</OPTION>
<OPTION>Jordania</OPTION>
<OPTION>Kazajstán</OPTION>
<OPTION>Kenia</OPTION>
<OPTION>Kirguizistán</OPTION>
<OPTION>Kiribati</OPTION>
<OPTION>Kuwait</OPTION>
<OPTION>Laos</OPTION>
<OPTION>Lesotho</OPTION>
<OPTION>Letonia</OPTION>
<OPTION>Líbano</OPTION>
<OPTION>Liberia</OPTION>
<OPTION>Libia</OPTION>
<OPTION>Liechtenstein</OPTION>
<OPTION>Lituania</OPTION>
<OPTION>Luxemburgo</OPTION>
<OPTION>Macedonia</OPTION>
<OPTION>Madagascar</OPTION>
<OPTION>Malaisia</OPTION>
<OPTION>Malawi</OPTION>
<OPTION>Maldivas</OPTION>
<OPTION>Malí</OPTION>
<OPTION>Malta</OPTION>
<OPTION>Marruecos</OPTION>
<OPTION>Mauricio</OPTION>
<OPTION>Mauritania</OPTION>
<OPTION>México</OPTION>
<OPTION>Micronesia</OPTION>
<OPTION>Moldavia</OPTION>
<OPTION>Mónaco</OPTION>
<OPTION>Mongolia</OPTION>
<OPTION>Mozambique</OPTION>
<OPTION>Myamar</OPTION>
<OPTION>Namibia</OPTION>
<OPTION>Naurú</OPTION>
<OPTION>Nepal</OPTION>
<OPTION>Nicaragua</OPTION>
<OPTION>Níger</OPTION>
<OPTION>Nigeria</OPTION>
<OPTION>Noruega</OPTION>
<OPTION>Nueva Zelanda</OPTION>
<OPTION>Omán</OPTION>
<OPTION>Países Bajos</OPTION>
<OPTION>Pakistán</OPTION>
<OPTION>Palau</OPTION>
<OPTION>Paraguay</OPTION>
<OPTION>Panamá</OPTION>
<OPTION>Papúa - Nueva Guinea</OPTION>
<OPTION>Perú</OPTION>
<OPTION>Polonia</OPTION>
<OPTION>Portugal</OPTION>
<OPTION>Puerto Rico</OPTION>
<OPTION>Qatar</OPTION>
<OPTION>Reino Unido</OPTION>
<OPTION>República Centroafricana</OPTION>
<OPTION>República Checa</OPTION>
<OPTION>República del Congo</OPTION>
<OPTION>Congo</OPTION>
<OPTION>República Dominicana</OPTION>
<OPTION>República Sudafricana</OPTION>
<OPTION>Ruanda</OPTION>
<OPTION>Rumanía</OPTION>
<OPTION>Rusia</OPTION>
<OPTION>Sáhara Occidental</OPTION>
<OPTION>Samoa Occidental</OPTION>
<OPTION>San Cristóbal y Nevis</OPTION>
<OPTION>San Marino</OPTION>
<OPTION>San Vicente y Granadinas</OPTION>
<OPTION>Santa Lucía</OPTION>
<OPTION>Santo Tomé y Príncipe</OPTION>
<OPTION>Senegal</OPTION>
<OPTION>Seychelles</OPTION>
<OPTION>Sierra Leona</OPTION>
<OPTION>Singapur</OPTION>
<OPTION>Siria</OPTION>
<OPTION>Somalia</OPTION>
<OPTION>Sri Lanka</OPTION>
<OPTION>Sudán</OPTION>
<OPTION>Suecia</OPTION>
<OPTION>Suiza</OPTION>
<OPTION>Surinam</OPTION>
<OPTION>Swazilandia</OPTION>
<OPTION>Tailandia</OPTION>
<OPTION>Taiwán</OPTION>
<OPTION>Tanzania</OPTION>
<OPTION>Tayikistán</OPTION>
<OPTION>Togo</OPTION>
<OPTION>Tonga</OPTION>
<OPTION>Trinidad y Tobago</OPTION>
<OPTION>Túnez</OPTION>
<OPTION>Turkmenistán</OPTION>
<OPTION>Turquía</OPTION>
<OPTION>Tuvalú</OPTION>
<OPTION>Ucrania</OPTION>
<OPTION>Uganda</OPTION>
<OPTION>Uruguay</OPTION>
<OPTION>Uzbekistán</OPTION>
<OPTION>Vanuatú</OPTION>
<OPTION>Vaticano</OPTION>
<OPTION>Venezuela</OPTION>
<OPTION>Vietnam</OPTION>
<OPTION>Yemen</OPTION>
<OPTION>Yugoslavia</OPTION>
<OPTION>Zambia</OPTION>
<OPTION>Zimbabwe</OPTION>
</select>
</td>
</tr>
<tr bgcolor="#F8D480">
<td align="right"><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Área
de su consulta</font></td>
<td><select name="Cons[area]">
<option selected>Seleccione...</option>
<option>Adquirir Sub-Agencia</option>
<option>Billetes Quinielas y Loterias</option>
<option>Quini 6</option>
<option>Loto</option>
<option>Prode</option>
<option>Telekino</option>
<option>Tombola Uruguaya</option>
<option>Brinco</option>
<option>Telebingo</option>
<option>Toto bingo</option>
<option>Consultas en General</option>
</select></td>
</tr>
<tr bgcolor="#F8D480">
<td align="right" valign="top" nowrap><font color="#000000" size="2" face="Verdana, Arial, Helvetica, sans-serif">Detalle
de su consulta</font></td>
<td width="100%"><textarea name="Cons[consulta]" cols="30" rows="4"></textarea></td>
</tr>
<tr bgcolor="#F8D480">
<td> </td>
<input name="do" type="hidden" value="enviar">
<td><input type="submit" name="Submit" value="Enviar">
<input type="reset" name="Submit2" value="Cancelar" onClick="window.close()"></td>
</tr>
</table></td>
</tr>
</table>
</form>
</body>
<?php
} // Fin forma
?>