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| 1 | <span style="background-color:#3399ff;"><span style="color: rgb(255, 240, 245);"><strong><span style="font-size: 14px;"><span style="color: rgb(255, 240, 245);"><strong><span style="font-size: 14px;"></span></strong></span>קבל עוד היום הצעה אטרקטיבית בכל תחום!</span></strong></span></span> | |
| 2 | | |
| 3 | <div class="input-container"> | |
| 4 | <p><span style="font-size:18px;"><span style="color: rgb(255, 240, 245);"><span style="background-color: rgb(51, 102, 204);"><strong>שם מלא</strong></span></span></span><br /> | |
| 5 | | |
| 6 | [text* your-name] </p> | |
| 7 | | |
| 8 | <p><span style="font-size:18px;"><span style="color: rgb(255, 240, 245);"><span style="background-color: rgb(51, 102, 204);"><strong>מספר טלפון</strong></span></span></span><br /> | |
| 9 | | |
| 10 | [tel* tel-364] </p> | |
| 11 | </div> | |
| 12 | <p><span style="font-size:18px;"><span style="color: rgb(255, 240, 245);"><span style="background-color: rgb(51, 102, 204);"><strong>קטגוריה</strong></span></span></span><br /> | |
| 13 | | |
| 14 | [checkbox* checkbox-553 "מכוני כושר" "ביטוח" "אסתטיקה"] </p> | |
| 15 | | |
| 16 | <p><span style="font-size:18px;"><span style="color: rgb(255, 240, 245);"><span style="background-color: rgb(51, 102, 204);"><strong>חברה</strong></span></span></span><br /> | |
| 17 | | |
| 18 | [checkbox checkbox-554 "מכוני כושר - Go Active" "מכוני כושר - Holmes Place"] </p> | |
| 19 | <p>----------------------------------------------------</p> | |
| 20 | <p>[checkbox checkbox-87 "ביטוח - AIG"]</p> | |
| 21 | <p>----------------------------------------------------</p> | |
| 22 | <p>[checkbox checkbox-730 "אסתטיקה - פרופורציה" "אסתטיקה - Care" "אסתטיקה - אמריקן לייזר"]</p> | |
| 23 | ||
| 24 | <p>[submit "שלח"]</p> |
