CINXE.COM
Formulario de Intereses
<!DOCTYPE html> <html lang="es"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0-alpha1/dist/css/bootstrap.min.css"> <title>Formulario de Intereses</title> </head> <body> <style> .custom-bg { background-color: #2C3E50; /* Color de fondo similar al del segundo formulario */ } .container.mt-5 { background-image: linear-gradient(to bottom, #CCCCCC, #CCCCCC); /* Gradiente de verde a azul */ border: 1px solid #ced4da; /* Color del borde */ border-radius: 10px; /* Radio de borde */ padding: 20px; /* Espaciado interno */ width: 80%; /* Ajusta el ancho del contenedor */ } .btn-primary { width: 200px; /* Ajusta el ancho del bot贸n */ } </style> <nav class="navbar custom-bg"> <div class="container"> <a class="navbar-brand" href="#"> <img src="../imagenes/s3v2.png" alt="s3" width="70" height="40"> </a> </div> </nav> <div class="container mt-5 bg-primary custom-bg"> <h2 class="text-center">Informaci贸n de nuestros servicios</h2> <form class="custom-form" action="serviciosGuarda.php" method="POST"> <div class="row"> <div class="col-md-6"> <div class="mb-3"> <label for="nombre" class="form-label">Nombre</label> <input type="text" class="form-control" id="nombre" name="nombre" placeholder="Ingrese su nombre" required> </div> <div class="mb-3"> <label for="empresa" class="form-label">Empresa o Instituci贸n</label> <input type="text" class="form-control" id="empresa" name="empresa" placeholder="Ingrese el nombre de su empresa o instituci贸n" required> </div> <div class="mb-3"> <label for="telefono" class="form-label">Tel茅fono</label> <input type="tel" class="form-control" id="telefono" name="telefono" placeholder="Ingrese su tel茅fono" required> </div> <div class="mb-3"> <label for="correo" class="form-label">Correo Electr贸nico</label> <input type="email" class="form-control" id="correo" name="correo" placeholder="Ingrese su correo electr贸nico" required> </div> </div> <div class="col-md-6"> <div class="mb-3"> <label for="servicio" class="form-label">Servicio de Inter茅s</label> <select class="form-select" id="servicio" name="servicio" required> <option value="">Seleccione...</option> <option value="1">Microscop铆a electr贸nica</option> <option value="2">Difracci贸n de Rayos X</option> <option value="3">FTIR</option> <option value="4">Perfilometr铆a</option> <option value="5">An谩lisis Qu铆mico ICP - EOS</option> <option value="6">An谩lisis T茅rmico - DSC</option> <option value="7">Espectroscop铆a XPS</option> <option value="8">Metalograf铆a</option> <option value="0">Otro</option> </select> </div> <div class="mb-3"> <label for="descripcion" class="form-label">Descripci贸n</label> <textarea class="form-control" id="descripcion" name="descripcion" rows="3" placeholder="Escriba una breve descripci贸n" required></textarea> </div> </div> </div> <!-- Captcha --> <div class="mb-3"> <div class="g-recaptcha" data-sitekey="6LdVMu4SAAAAACZIZnrSWmJr9NsaNfbbKRYnSkWF"></div> </div> <button type="submit" class="btn btn-primary">Enviar</button> </form> </div> <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0-alpha1/dist/js/bootstrap.bundle.min.js"></script> <script src="https://www.google.com/recaptcha/api.js" async defer></script> </body> </html>