<style type="text/css">
<!--
.style1 {color: #000000}
.style2 {
font-family: Arial, Helvetica, sans-serif;
font-size: 10px;
}
.style7 {font-size: 16px; }
.style8 {
font-size: 14;
font-weight: bold;
}
.style9 {font-size: 16px; font-weight: bold; }
.style10 {font-family: Arial, Helvetica, sans-serif; font-size: 16px; font-weight: bold; }
-->
</style>
<form name="form1" method="post" action="donate/gravar.php">
<p><strong><br />
</strong></p>
<table width="563" border="0" cellspacing="1">
<tr>
<td class="style8">Assunto:</td>
<td><span class="style1">
<select name="assunto" id="assunto">
<option selected="selected">Confirmação do deposito</option>
</select>
</span></td>
</tr>
<tr>
<td class="style8">Valor:</td>
<td><font face="Arial, Helvetica, sans-serif">
<input name="valor" type="text" id="valor" />
</font></td>
</tr>
<tr>
<td class="style8">E-mail para contato:</td>
<td><font face="Arial, Helvetica, sans-serif">
<input name="email" type="text" id="valor" /> <font color="red">* <b>email valido</font></b>
</font></td>
</tr>
<tr>
<td class="style8">Hora: </td>
<td><font face="Arial, Helvetica, sans-serif">
<input name="hora1" type="text" id="hora1" />
</font></td>
</tr>
<tr>
<td class="style8">Data:</td>
<td><font face="Arial, Helvetica, sans-serif">
<input name="data1" type="text" id="data1" />
</font></td>
</tr>
<tr>
<td class="style2"><p class="style8">Especifique o nome do seu character -Especifique se a doação é para VIP e/ou Poker Coins (Ex: 10,00 para VIP 5,00 para poker coins) </p>
<br /></td>
<td><textarea name="mensagem" cols="50" rows="10" id="mensagem"></textarea>
<br />
<br /></td>
</tr>
<tr>
<td>
<div align="right">
<input name="Submit" type="submit" class="style2" value=" Enviar Comprovante " />
</div></td>
<td><input name="reset" type="reset" class="style2" value=" Limpar " /></td>
</tr>
</table>
<p> </p>
<p> </p>
</form>
<p class="style1"></p>