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Confirmação De Pagamento


pedroca80

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Gostaria de saber como eu posso adicionar esse formulario de confirmação de pagamento no meu website gesior (em buypoints)

<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/9QgB03w72YexGX3ck5dJ" name="emf-form">

<table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="transparent">

<tr>

<td style="" colspan="2">

<font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Confirmar Pagamento</b><br />

<br /></font>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Nome do Character:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<input id="element_0" name="element_0" value="" size="30" class="validate[required]" type="text" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Nome Real:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<input id="element_1" name="element_1" value="" size="30" class="validate[required]" type="text" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>E Mail:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<input id="element_2" name="element_2" class="validate[required,custom]" value="" size="30" type="text" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Forma de Pagamento:*</b></font>

</td>

</tr>

<tr>

<td style="">

<select id="element_3" name="element_3" class="validate[optional]">

<option value="Deposito">

Deposito

</option>

<option value="Pagseguro" selected="selected">

Pagseguro

</option>

</select>

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Account:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<input id="element_4" name="element_4" value="" size="30" class="validate[required]" type="text" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Valor Depositado:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<input id="element_5" name="element_5" value="" size="30" class="validate[required]" type="text" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Quantidade de Pontos:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Hora do deposito:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<input id="element_7" name="element_7" value="" size="30" class="validate[required]" type="text" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Data Do Deposito:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Dados do Comprovante</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<textarea id="element_9" name="element_9" cols="60" rows="5" class="validate[required]">

</textarea>

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Observação:</b></font> <span style="color:red;"><small>*</small></span>

</td>

</tr>

<tr>

<td style="">

<textarea id="element_10" name="element_10" cols="60" rows="5" class="validate[required]">

</textarea>

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr valign="top">

<td style="" align="">

<font face="Verdana" size="2" color="#000000"><b>Anexo do comprovante:</b></font>

</td>

</tr>

<tr>

<td style="">

<input id="element_11" name="element_11" class="validate[optional]" type="file" />

<div style="padding-bottom:8px;color:#000000;"></div>

</td>

</tr>

<tr>

<td colspan="2">

<table cellpadding="5" cellspacing="0" bgcolor="#FFFFFF" width="100%">

<tr bgcolor="#AAD6AA">

<td colspan="2">

<font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font>

</td>

</tr>

<tr>

<td style="padding:2px; width:100px;">

<img id="captcha_image" src="http://www.emailmeform.com/builder/captcha/index/e35c8030f3de137d947e0df0b945e451" alt="captcha" name="captcha_image" />

</td>

<td valign="top">

<div>

<font color="#FBAF5A">Please enter the text from the image</font>:<br />

<input type="text" id="captcha_code" name="captcha_code" maxlength="10" size="10" class="validate[required,funcCall[valid_captcha]]" /> [<a id="captcha_code_refresh" href=

"javascript:void(0);" onclick="document.getElementById('captcha_image').src = 'http://www.emailmeform.com/builder/captcha/index/'+Math.random();get_valid_captcha();return false;"

name="captcha_code_refresh">Refresh Image</a>] [<a id="captcha_code_about" href="javascript:void(0);" onclick=

"window.open('http://www.emailmeform.com/captcha-instruction.html','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;" name=

"captcha_code_about">What's This?</a>]

</div>

</td>

</tr>

</table>

</td>

</tr>

<tr>

<td colspan="2" align="right">

<input name="element_counts" value="12" type="hidden" /> <input name="embed" value="forms" type="hidden" /><input value="Send email" type="submit" /><input value="Clear" type="reset" />

</td>

</tr>

</table>

</form>

<div>

<font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src=

"http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF</font> <a style="text-decoration:none;" href="http://www.emailmeform.com"

target="_blank"><font face="Verdana" size="2" color="#000000">Online Form Builder</font></a>

</div><a style="line-height:20px;font-size:70%;text-decoration:none;" href="http://www.emailmeform.com/report-abuse.html?http://www.emailmeform.com/builder/form/9QgB03w72YexGX3ck5dJ" target=

"_blank"><font face="Verdana" size="2" color="#000000">Report Abuse</font></a>

Editado por pedroca08
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Bom, pra sua informação isso não é um formulário de confirmação é só de pagamento.

 

 

Vai ná pagina do gesior que você quer por e abre como bloco de notas e coloca dentro da variável $main_content .= '';

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Abre o arquivo buypoints.php e apaga tudo que estiver escrito e escreve isso:

 

<?php
$main_content .= '<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/9QgB03w72YexGX3ck5dJ" name="emf-form">
<table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="transparent">
<tr>
<td style="" colspan="2">
<font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Confirmar Pagamento</b><br />
<br /></font>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Nome do Character:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_0" name="element_0" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Nome Real:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_1" name="element_1" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>E Mail:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_2" name="element_2" class="validate[required,custom[email]]" value="" size="30" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Forma de Pagamento:*</b></font>
</td>
</tr>
<tr>
<td style="">
<select id="element_3" name="element_3" class="validate[optional]">
<option value="Deposito">
Deposito
</option>
<option value="Pagseguro" selected="selected">
Pagseguro
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Account:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_4" name="element_4" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Valor Depositado:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_5" name="element_5" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Quantidade de Pontos:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Hora do deposito:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_7" name="element_7" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Data Do Deposito:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Dados do Comprovante</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<textarea id="element_9" name="element_9" cols="60" rows="5" class="validate[required]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Observação:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<textarea id="element_10" name="element_10" cols="60" rows="5" class="validate[required]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Anexo do comprovante:</b></font>
</td>
</tr>
<tr>
<td style="">
<input id="element_11" name="element_11" class="validate[optional]" type="file" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr>
<td colspan="2">
<table cellpadding="5" cellspacing="0" bgcolor="#FFFFFF" width="100%">
<tr bgcolor="#AAD6AA">
<td colspan="2">
<font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font>
</td>
</tr>
<tr>
<td style="padding:2px; width:100px;">
<img id="captcha_image" src="http://www.emailmeform.com/builder/captcha/index/e35c8030f3de137d947e0df0b945e451" alt="captcha" name="captcha_image" />
</td>
<td valign="top">
<div> ';
$captcha_image = "'captcha_image'";
$link = "'http://www.emailmeform.com/builder/captcha/index/'";
$window_open = "'http://www.emailmeform.com/captcha-instruction.html','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100'";
$main_content .= '
<font color="#FBAF5A">Please enter the text from the image</font>:<br />
<input type="text" id="captcha_code" name="captcha_code" maxlength="10" size="10" class="validate[required,funcCall[valid_captcha]]" /> [<a id="captcha_code_refresh" href=
"javascript:void(0);" onclick="document.getElementById(.'$captcha_image'.).src = .'$link'.+Math.random();get_valid_captcha();return false;"
name="captcha_code_refresh">Refresh Image</a>] [<a id="captcha_code_about" href="javascript:void(0);" onclick=
"window.open(.'$window_open'.);return false;" name=
"captcha_code_about">Whats This?</a>]
</div>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="2" align="right">
<input name="element_counts" value="12" type="hidden" /> <input name="embed" value="forms" type="hidden" /><input value="Send email" type="submit" /><input value="Clear" type="reset" />
</td>
</tr>
</table>
</form>
<div>
<font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src=
"http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF</font> <a style="text-decoration:none;" href="http://www.emailmeform.com"
target="_blank"><font face="Verdana" size="2" color="#000000">Online Form Builder</font></a>
</div><a style="line-height:20px;font-size:70%;text-decoration:none;" href="http://www.emailmeform.com/report-abuse.html?http://www.emailmeform.com/builder/form/9QgB03w72YexGX3ck5dJ" target=
"_blank"><font face="Verdana" size="2" color="#000000">Report Abuse</font></a>';
?>

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Desculpe, erro meu. Use este:

 

<?php
$main_content .= '<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/9QgB03w72YexGX3ck5dJ" name="emf-form">
<table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="transparent">
<tr>
<td style="" colspan="2">
<font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Confirmar Pagamento</b><br />
<br /></font>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Nome do Character:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_0" name="element_0" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Nome Real:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_1" name="element_1" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>E Mail:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_2" name="element_2" class="validate[required,custom[email]]" value="" size="30" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Forma de Pagamento:*</b></font>
</td>
</tr>
<tr>
<td style="">
<select id="element_3" name="element_3" class="validate[optional]">
<option value="Deposito">
Deposito
</option>
<option value="Pagseguro" selected="selected">
Pagseguro
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Account:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_4" name="element_4" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Valor Depositado:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_5" name="element_5" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Quantidade de Pontos:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Hora do deposito:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_7" name="element_7" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Data Do Deposito:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Dados do Comprovante</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<textarea id="element_9" name="element_9" cols="60" rows="5" class="validate[required]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Observação:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<textarea id="element_10" name="element_10" cols="60" rows="5" class="validate[required]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Anexo do comprovante:</b></font>
</td>
</tr>
<tr>
<td style="">
<input id="element_11" name="element_11" class="validate[optional]" type="file" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr>
<td colspan="2">
<table cellpadding="5" cellspacing="0" bgcolor="#FFFFFF" width="100%">
<tr bgcolor="#AAD6AA">
<td colspan="2">
<font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font>
</td>
</tr>
<tr>
<td style="padding:2px; width:100px;">
<img id="captcha_image" src="http://www.emailmeform.com/builder/captcha/index/e35c8030f3de137d947e0df0b945e451" alt="captcha" name="captcha_image" />
</td>
<td valign="top">
<div> ';
$captcha_image = "'captcha_image'";
$link = "'http://www.emailmeform.com/builder/captcha/index/'";
$window_open = "'http://www.emailmeform.com/captcha-instruction.html','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100'";
$main_content .= '
<font color="#FBAF5A">Please enter the text from the image</font>:<br />
<input type="text" id="captcha_code" name="captcha_code" maxlength="10" size="10" class="validate[required,funcCall[valid_captcha]]" /> [<a id="captcha_code_refresh" href=
"javascript:void(0);" onclick="document.getElementById('.$captcha_image.').src = '.$link.'+Math.random();get_valid_captcha();return false;"
name="captcha_code_refresh">Refresh Image</a>] [<a id="captcha_code_about" href="javascript:void(0);" onclick=
"window.open('.$window_open.');return false;" name=
"captcha_code_about">Whats This?</a>]
</div>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="2" align="right">
<input name="element_counts" value="12" type="hidden" /> <input name="embed" value="forms" type="hidden" /><input value="Send email" type="submit" /><input value="Clear" type="reset" />
</td>
</tr>
</table>
</form>
<div>
<font face="Verdana" size="2" color="#000000">Powered by</font><span style="position: relative; padding-left: 3px; bottom: -5px;"><img src=
"http://www.emailmeform.com/builder/images/footer-logo.png" /></span><font face="Verdana" size="2" color="#000000">EMF</font> <a style="text-decoration:none;" href="http://www.emailmeform.com"
target="_blank"><font face="Verdana" size="2" color="#000000">Online Form Builder</font></a>
</div><a style="line-height:20px;font-size:70%;text-decoration:none;" href="http://www.emailmeform.com/report-abuse.html?http://www.emailmeform.com/builder/form/9QgB03w72YexGX3ck5dJ" target=
"_blank"><font face="Verdana" size="2" color="#000000">Report Abuse</font></a>';
?>

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Cara vlw mesmo.

Mais tipow tem como tirar aquelas coisas la embaixo .

Image Verification

captcha

Please enter the text from the image:

[Refresh Image] [Whats This?]

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Report Abuse

e pra onde que vai manda onde coloco o email meu para os players enviar.

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Cara vlw mesmo.

Mais tipow tem como tirar aquelas coisas la embaixo .

Image Verification

captcha

Please enter the text from the image:

[Refresh Image] [Whats This?]

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Report Abuse

e pra onde que vai manda onde coloco o email meu para os players enviar.

 

Isso eu não sei os dados ele manda por POST pra página http://www.emailmeform.com/builder/form/9QgB03w72YexGX3ck5dJ. Agora pra que e-mail ou sei lá não sei, ve quem fez este formulário pra você.

 

Tirei os treco ai pra você:

 

<?php
$main_content .= '<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/9QgB03w72YexGX3ck5dJ" name="emf-form">
<table style="text-align:left;" cellpadding="2" cellspacing="0" border="0" bgcolor="transparent">
<tr>
<td style="" colspan="2">
<font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">Confirmar Pagamento</b><br />
<br /></font>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Nome do Character:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_0" name="element_0" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Nome Real:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_1" name="element_1" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>E Mail:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_2" name="element_2" class="validate[required,custom[email]]" value="" size="30" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Forma de Pagamento:*</b></font>
</td>
</tr>
<tr>
<td style="">
<select id="element_3" name="element_3" class="validate[optional]">
<option value="Deposito">
Deposito
</option>
<option value="Pagseguro" selected="selected">
Pagseguro
</option>
</select>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Account:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_4" name="element_4" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Valor Depositado:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_5" name="element_5" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Quantidade de Pontos:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_6" name="element_6" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Hora do deposito:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_7" name="element_7" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Data Do Deposito:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Dados do Comprovante</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<textarea id="element_9" name="element_9" cols="60" rows="5" class="validate[required]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Observação:</b></font> <span style="color:red;"><small>*</small></span>
</td>
</tr>
<tr>
<td style="">
<textarea id="element_10" name="element_10" cols="60" rows="5" class="validate[required]">
</textarea>
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr valign="top">
<td style="" align="">
<font face="Verdana" size="2" color="#000000"><b>Anexo do comprovante:</b></font>
</td>
</tr>
<tr>
<td style="">
<input id="element_11" name="element_11" class="validate[optional]" type="file" />
<div style="padding-bottom:8px;color:#000000;"></div>
</td>
</tr>
<tr>
<td colspan="2" align="right">
<input name="element_counts" value="12" type="hidden" /> <input name="embed" value="forms" type="hidden" /><input value="Send email" type="submit" /><input value="Clear" type="reset" />
</td>
</tr>
</table>
</form>';
?>

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