<form id="formulario" action="http://www.vivaminhacasa.com.br/tamara/insere/cadastro_insere.php" method="post">
<table style="width: 679px; height: 581px;" border="0" cellspacing="5" cellpadding="0">
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<td colspan="3"><span style="font-family: Arial; font-size: 40px; color: #ffffff;"> Faça sua inscrição:</span></td>
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<td colspan="3"><span style="font-family: Arial; font-size: 15px; color: #ffff00;">Autorização de pesquisa cadastral e ficha de inscrição para adquisição de imóveis do <br /> Programa Minha Casa Minha Vida.</span></td>
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<td colspan="3">
<table style="width: 100%;" border="0" cellspacing="0" cellpadding="0">
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<td rowspan="2" width="5%"><span style="font-family: Arial; font-size: 90px; color: #ffffff;"><strong>1</strong></span></td>
<td width="95%"><span style="font-family: Arial; font-size: 25px; color: #ffffff;">DADOS PESSOAIS</span></td>
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<td valign="top"><span style="font-family: Arial; color: #ffffff;">Campos com * são de preenchimento<br /> obrigatório.</span></td>
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</td>
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<td width="38%"><br /></td>
<td width="23%"><br /></td>
<td width="39%"><br /></td>
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<td colspan="3"><br /></td>
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<td><span style="color: #ffffff; font-weight: bold;">Nome * </span></td>
<td><br /></td>
<td><span style="color: #ffffff; font-weight: bold;">Cpf * </span></td>
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<td><input id="nome" name="nome" size="60" type="text" /></td>
<td><br /></td>
<td><input id="cpf" maxlength="17" name="cpf" size="18" type="text" /></td>
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<td><span style="color: #ffffff; font-weight: bold;">Endereço * </span></td>
<td><br /></td>
<td><span style="color: #ffffff; font-weight: bold;">Bairro * </span></td>
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<td><input id="endereco" name="endereco" size="60" type="text" /></td>
<td><br /></td>
<td><input id="bairro" name="bairro" size="35" type="text" /></td>
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<td><span style="color: #ffffff; font-weight: bold;">Telefone Móvel *</span></td>
<td><br /></td>
<td><span style="color: #ffffff; font-weight: bold;">Telefone Residencial * </span></td>
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<td><input id="dddcelular" name="dddcelular" size="3" type="text" /> <input id="celular" name="celular" size="15" type="text" /></td>
<td><br /></td>
<td><input id="dddtelefone" name="dddtelefone" size="3" type="text" /> <input id="telefone" name="telefone" size="15" type="text" /></td>
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<td><span style="color: #ffffff; font-weight: bold;">Email * </span></td>
<td><br /></td>
<td><span style="color: #ffffff; font-weight: bold;">Renda Familiar * </span></td>
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<td><input id="email" maxlength="30" name="email" size="60" type="text" /></td>
<td><br /></td>
<td><input id="rendafamiliar" maxlength="20" name="rendafamiliar" size="11" type="text" /></td>
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<td><span style="color: #ffffff; font-weight: bold;">Nome Conjuge</span></td>
<td><br /></td>
<td><span style="color: #ffffff; font-weight: bold;">Cpf Conjuge </span></td>
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<td><input id="nomeconjuge" name="nomeconjuge" size="60" type="text" /></td>
<td><br /></td>
<td><input id="cpfconjuge" name="cpfconjuge" size="12" type="text" /></td>
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<td><br /></td>
<td><br /></td>
<td><br /></td>
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<td colspan="2"><input name="imageField" src="/images/stories/tamara/btn.jpg" type="image" /></td>
<td><br /></td>
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<br />
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</tbody>
</table>
</form>