Soluciones Digitales                           (507) 202-1557  /  ventas@cdpdigital.com.pa

 

Información General
Nombre
Empresa*
Correo electrónico*
Número de teléfono*
Móvil
Horario de trabajo
Lunes a Viernes 8:00 Am - 5:00 PM
Sábados 8:00 Am - 12:00 PM
Dirección
Avenida Santa Elena, A lado de Barriga Auto Motores
Información
(507) 202-1555
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<!-- Note :
   - You can modify the font style and form style to suit your website. 
   - Code lines with comments “Do not remove this code”  are required for the form to work properly, make sure that you do not remove these lines of code. 
   - The Mandatory check script can modified as to suit your business needs. 
   - It is important that you test the modified form before going live.-->
<div id='crmWebToEntityForm' style='width:600px;margin:auto;'>
   <META HTTP-EQUIV ='content-type' CONTENT='text/html;charset=UTF-8'>
   <form action='https://crm.zoho.com/crm/WebToLeadForm' name=WebToLeads2585780000000149001 method='POST' onSubmit='javascript:document.charset="UTF-8"; return checkMandatory()' accept-charset='UTF-8'>
 
<!-- Do not remove this code. -->
<input type='text' style='display:none;' name='xnQsjsdp' value='31fd5417058041b146de23af51ecc3f1813f606ac76f87e50de266fe2d08fe35'/>
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<input type='text' style='display:none;' name='xmIwtLD' value='aa8963a4a1f0104ecaa375758237ee4cb575b822862ebff194e20c216cbeeaf9'/>
<input type='text' style='display:none;'  name='actionType' value='TGVhZHM='/>
 
<input type='text' style='display:none;' name='returnURL' value='https&#x3a;&#x2f;&#x2f;www.cdpdigital.com.pa&#x2f;formulario' /> 
<!-- Do not remove this code. -->
<style>
tr , td { 
padding:6px;
border-spacing:0px;
border-width:0px;
}
</style>
<table style='width:600px;background-color:white;color:black'>
 
<tr><td colspan='2' style='text-align:left;color:black;font-family:Arial;font-size:14px;'><strong>Informaci&oacute;n General</strong></td></tr>
 
<tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Nombre</td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='40' name='First Name' /></td></tr>
 
<tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Empresa<span style='color:red;'>*</span></td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='100' name='Company' /></td></tr>
 
<tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Correo electr&oacute;nico<span style='color:red;'>*</span></td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='100' name='Email' /></td></tr>
 
<tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>N&uacute;mero de tel&eacute;fono<span style='color:red;'>*</span></td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='80' name='Last Name' /></td></tr>
 
<tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>M&oacute;vil</td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='30' name='Mobile' /></td></tr>
 
<tr><td colspan='2' style='text-align:center; padding-top:15px;'>
<input style='font-size:12px;color:#131307' type='submit' value='Enviar' />
<input type='reset' style='font-size:12px;color:#131307' value='Restablecer' />
   </td>
</tr>
   </table>
<script>
   var mndFileds=new Array('Company','Last Name','Email');
   var fldLangVal=new Array('Empresa','Número de teléfono','Correo electrónico');
var name='';
var email='';
 
   function checkMandatory() {
for(i=0;i<mndFileds.length;i++) {
 var fieldObj=document.forms['WebToLeads2585780000000149001'][mndFileds[i]];
 if(fieldObj) {
if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length==0) {
if(fieldObj.type =='file')
alert('Seleccione un archivo para cargar.'); 
fieldObj.focus(); 
return false;
alert(fldLangVal[i] +' no puede estar vacío.'); 
         fieldObj.focus();
         return false;
}  else if(fieldObj.nodeName=='SELECT') {
      if(fieldObj.options[fieldObj.selectedIndex].value=='-None-') {
alert(fldLangVal[i] +' no puede ser nulo.'); 
fieldObj.focus();
return false;
  }
} else if(fieldObj.type =='checkbox'){
  if(fieldObj.checked == false){
alert('Please accept  '+fldLangVal[i]);
fieldObj.focus();
return false;
  } 
try {
    if(fieldObj.name == 'Last Name') {
name = fieldObj.value;
     }
} catch (e) {}
   }
}
    }
  
</script>
</form>
</div>