<div id="reg_lan_house_dialog">
      		<form method="post" id="anunciar_form">

<table width="100%" cellspacing="0" cellpadding="0" border="0">
  <tbody><tr>
    <td height="95"><table width="741" cellspacing="0" cellpadding="0" border="0" background="img/w01.png" align="center">
      <tbody><tr>
        <td width="644" height="95"> </td>
        <td width="97"/>
      </tr>
    </tbody></table></td>
  </tr>
  <tr>
    <td><table width="741" cellspacing="0" cellpadding="0" border="0" background="img/w02.png" align="center">
      <tbody><tr>
        <td height="50" class="HeaGreen2"><div align="center" class="HeaGreen2">Signup as Lan House seller</div></td>
      </tr>

    </tbody></table></td>
  </tr>
</tbody></table>
<table width="741" cellspacing="0" cellpadding="0" border="0" align="center">
  <tbody><tr>
    <td background="img/w03.png"><div align="center"><img width="44" height="13" src="img/intern_arrow.gif"/></div></td>
  </tr>
  <tr>
    <td background="img/w03.png"><table width="93%" cellspacing="5" cellpadding="0" border="0" align="center">
      <tbody><tr>
        <td align="center">
          <p>Please fill this information and your submission will be sent.</p>
          <p> </p>

            <table width="90%" cellspacing="5" cellpadding="7" border="0">
              <tbody><tr>
                <td width="222" align="right" class="TBlack">Nome</td>
                <td width="293" class="TxField2"><div align="center">
                  <input type="text" id="textfield" class="LogField2" name="textfield"/>
                </div></td>
                <td width="76"> </td>
              </tr>
             <tr>
                <td width="222" align="right" class="TBlack">Nome da empresa</td>
                <td width="293" class="TxField2"><div align="center">
                  <input type="text" id="textfield" class="LogField2" name="textfield"/>
                </div></td>
                <td width="76"> </td>
              </tr>
<tr>
                <td width="222" align="right" class="TBlack">E-mail</td>
                <td width="293" class="TxField2"><div align="center">
                  <input type="text" id="textfield" class="LogField2" name="textfield"/>
                </div></td>
                <td width="76"> </td>
              </tr>
<tr>
                <td width="222" align="right" class="TBlack">Telefone</td>
                <td width="293" class="TxField2"><div align="center">
                  <input type="text" id="textfield" class="LogField2" name="textfield"/>
                </div></td>
                <td width="76"> </td>
              </tr>
<tr>
                <td width="222" align="right" class="TBlack">Endereço</td>
                <td width="293" class="TxField2"><div align="center">
                  <input type="text" id="textfield" class="LogField2" name="textfield"/>
                </div></td>
                <td width="76"> </td>
              </tr>
<tr>
                <td width="222" align="right" class="TBlack">Cidade</td>
                <td width="293" class="TxField2"><div align="center">
                  <input type="text" id="textfield" class="LogField2" name="textfield"/>
                </div></td>
                <td width="76"> </td>
              </tr>
<tr>
                <td width="222" align="right" class="TBlack">Número de computadores</td>
                <td width="293" class="TxField2"><div align="center">
                  <input type="text" id="textfield" class="LogField2" name="textfield"/>
                </div></td>
                <td width="76"> </td>
              </tr>
              <tr>
                <td width="222" align="right" class="TBlack">O que você vende na sua lan house?</td>

                <td width="293" align="left">
                  <select style="width: 290px; margin-left: -5px;">
                </select></td>
                <td width="76"> </td>
              </tr>
              <tr>
                <td width="222" align="right" class="TBlack">Melhor momento para entrar em contato com você</td>
                <td width="293" class="TxField2" style="background-position: left center;"><div align="center">
                  <input type="text" id="textfield" class="LogField2" name="textfield"/>
                </div></td>
                <td width="76"> </td>
              </tr>
              <tr>
                <td align="right" class="TBlack"> </td>
                <td><label>
                  <input type="submit" value="Submit" id="button" class="GenButton" name="button"/>
                </label></td>
                <td> </td>
              </tr>
              </tbody></table>
          </td>
          <p> </p>
          <p> </p></tr>
      </tbody>
    </table></td></tr>
  </tbody>
  <tr>
    <td><img width="741" height="26" src="img/w04.png"/></td>
  </tr>
</table></form>
</div>