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<div id="WFItem5774203" class="wf-formTpl"> <form accept-charset="utf-8" action="https://app.getresponse.com/add_contact_webform.html?u=90mD" method="post"> <div class="wf-box"> <div id="WFIheader" class="wf-header el" style="height: 120px; display: block !important;"> <div class="actTinyMceElBodyContent"> <p> <strong> <span style="font-size: 24px;">Informe Confidencial</span> </strong> </p> </div> <em class="clearfix clearer"></em> </div> <div id="WFIcenter" class="wf-body"> <ul class="wf-sortable" id="wf-sort-id"> <li class="wf-name" rel="undefined" style="display: block !important;"> <div class="wf-contbox"> <div class="wf-labelpos"> <label class="wf-label">Nombre:</label> </div> <div class="wf-inputpos"> <input class="wf-input" type="text" name="name"></input> </div> <em class="clearfix clearer"></em> </div> </li> <li class="wf-email" rel="undefined" style="display: block !important;"> <div class="wf-contbox"> <div class="wf-labelpos"> <label class="wf-label">Email:</label> </div> <div class="wf-inputpos"> <input class="wf-input wf-req wf-valid__email" type="text" name="email"></input> </div> <em class="clearfix clearer"></em> </div> </li> <li class="wf-submit" rel="undefined" style="display: block !important;"> <div class="wf-contbox"> <div class="wf-inputpos"> <input type="submit" class="wf-button" name="submit" value="Quiero saber" style="display: inline !important; width: 143px !important;"></input> </div> <em class="clearfix clearer"></em> </div> </li> <li class="wf-counter" rel="undefined" style="display: none !important;"> <div class="wf-contbox"> <div> <span style="padding: 4px 6px 8px 24px; background: url(https://app.getresponse.com/images/core/webforms/countertemplates.png) 0% 0px no-repeat;" class="wf-counterbox"> <span class="wf-counterboxbg" style="padding: 4px 12px 8px 5px; background: url(https://app.getresponse.com/images/core/webforms/countertemplates.png) 100% -36px no-repeat;"> <span class="wf-counterbox0" style="padding: 5px 0px;">suscriptor(es):</span> <span style="padding: 5px;" name="https://app.getresponse.com/display_subscribers_count.js?campaign_name=01_centroproductos&var=0" class="wf-counterbox1 wf-counterq">0</span> <span style="padding: 5px 0px;" class="wf-counterbox2"></span> </span> </span> </div> </div> </li> <li class="wf-captcha" rel="undefined" style="display: none !important;"> <div class="wf-contbox wf-captcha-1" id="wf-captcha-1" wf-captchaword="Ingrese las palabras de arriba:" wf-captchasound="Ingrese los números que oiga:" wf-captchaerror="Incorrecto por favor intente nuevamente"></div> </li> <li class="wf-privacy" rel="undefined" style="display: block !important;"> <div class="wf-contbox"> <div> <a class="wf-privacy wf-privacyico" href="http://www.getresponse.es/permission-seal?lang=es" target="_blank" style="height: 21px !important; display: inline !important;">Respetamos tu privacidad<em class="clearfix clearer"></em></a> </div> <em class="clearfix clearer"></em> </div> </li> <li class="wf-poweredby" rel="temporary" style="display: none !important;"> <div class="wf-contbox"> <div> <span class="wf-poweredby wf-poweredbyico" style="display: none !important;"> <a class="wf-poweredbylink wf-poweredby" href="http://www.getresponse.es/" target="_blank" style="display: inline !important;">Email Marketing</a>by GetResponse</span> </div> </div> </li> </ul> </div> <div id="WFIfooter" class="wf-footer el" style="height: 25px; display: none !important;"> <div class="actTinyMceElBodyContent"></div> <em class="clearfix clearer"></em> </div> </div> <input type="hidden" name="webform_id" value="5774203" /> </form> </div> <script type="text/javascript" src="http://app.getresponse.com/view_webform.js?wid=5774203&mg_param1=1&u=90mD"></script>