<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"> <html><head> <meta content="text/html; charset=ISO-8859-1" http-equiv="content-type"> <meta name="description" content="Casa Nossa Senhora da Conceio"> <meta name="keywords" content="casa, senhora, conceio, calheta, alojamento"><title>Casa Nossa Senhora da Conceio - Reservas</title> <link rel="SHORTCUT ICON" href="favicon.ico"> <style type="text/css"> <!--a:link { color: #ffffff; text-decoration: none; font-weight: bold; font-style: normal; } a:visited { color: #ffffff; text-decoration: none; font-weight: bold; font-style: normal; } a:hover { color: #00ff00; text-decoration: normal; color: #00ff00; font-weight: bold; font-style: normal; } a:active { color: #ffffff; text-decoration: none; font-weight: bold; font-style: normal; } --> </style> </head> <body style="color: rgb(0, 0, 0); background-color: transparent;" alink="#000099" link="#000099" vlink="#990099"> <center> <table style="text-align: left; width: 1000px;" border="0" cellpadding="0" cellspacing="0"> <tbody> <tr> <td style="vertical-align: top; width: 30px;"><img style="width: 30px; height: 840px;" alt="" src="Imagens/Lateral1.jpg"></td> <td style="vertical-align: top; width: 940px; background-color: rgb(200, 255, 200);"> <table style="text-align: left; width: 932px; height: 68px;" border="0" cellpadding="0" cellspacing="0"> <tbody> <tr> <td><img style="width: 940px; height: 122px;" alt="" src="Imagens/banner.jpg"></td> </tr> <tr> <td> <table style="text-align: left; width: 940px;" border="0" cellpadding="1" cellspacing="2"> <tbody> <tr> <td style="text-align: center; width: 123px; background-color: rgb(0, 153, 0);"><a href="index_en.html"><span style="font-weight: bold; font-family: Verdana; font-size: 10pt;">Home</span></a></td> <td style="text-align: center; background-color: rgb(0, 153, 0); width: 122px;"><a href="facilidades_en.html"><span style="font-weight: bold; font-family: Verdana; font-size: 10pt;">Facilities</span></a></td> <td style="color: rgb(255, 255, 255); text-align: center; width: 170px; background-color: rgb(0, 153, 0);"> <a href="precos_en.html"><span style="font-weight: bold; font-family: Verdana; font-size: 10pt;">Rates /&nbsp;Special offers</span></a> </td> <td style="text-align: center; width: 120px; background-color: rgb(0, 102, 0);"><span style="font-weight: bold; font-family: Verdana; font-size: 10pt; color: white;">Reservations</span></td> <td style="text-align: center; background-color: rgb(0, 153, 0); width: 118px;"><a href="actividades_en.html"><span style="font-weight: bold; font-family: Verdana; font-size: 10pt;">Activities</span></a></td> <td style="text-align: center; background-color: rgb(0, 153, 0); width: 117px;"><a href="mapa_en.html"><span style="font-weight: bold; font-family: Verdana; font-size: 10pt;">Map</span></a></td> <td style="text-align: center; background-color: rgb(0, 153, 0); width: 126px;"><a href="hist_en.html"><span style="font-weight: bold; font-family: Verdana; font-size: 10pt;">Brief History</span></a></td> </tr> </tbody> </table> </td> </tr> <tr> <td> <table style="text-align: left; width: 940px;" border="0" cellpadding="0" cellspacing="0"> <tbody> <tr> <td style="width: 300px;"></td> <td style="width: 20px;"></td> <td style="text-align: right; width: 604px;"><a href="reservas.html"><img style="border: 0px solid ; width: 37px; height: 18px;" alt="" src="Imagens/pt.gif"></a></td> </tr> <tr> <td style="width: 604px;" colspan="3" rowspan="1"> <hr style="width: 100%; height: 2px;"></td> </tr> <tr> <td style="vertical-align: top; width: 300px;"><img style="width: 307px; height: 230px;" alt="" src="Imagens/P1010022.JPG"><br> <hr style="width: 100%; height: 2px;"><img style="width: 307px; height: 409px;" alt="" src="Imagens/P1010243.JPG"><br> </td> <td style="vertical-align: top; text-align: center; width: 20px;"><img style="width: 1px; height: 450px;" alt="" src="Imagens/separador.gif"></td> <td style="vertical-align: top; text-align: justify; width: 604px;"><span style="font-family: Verdana; font-size: 10pt; font-weight: bold; text-decoration: underline;">Reservations.</span><span style="font-family: Verdana; font-size: 10pt;"><br> </span><span style="font-family: Verdana;"><br> </span><span style="font-family: Verdana; font-size: 10pt;">Please fill the form below. You will soon be contact by us to confirm our reservation.<br> <br> </span><span style="font-family: Verdana; font-size: 10pt;"><!-- STEP 1: Put the full URL to formmail.php on your website in the 'action' value. --> <form method="post" action="./script/formmail.php" name="SampleForm"> <input name="env_report" value="REMOTE_HOST,REMOTE_ADDR,HTTP_USER_AGENT,AUTH_TYPE,REMOTE_USER" type="hidden"><!-- STEP 2: Put your email address in the 'recipients' value. Note that you also have to allow this email address in the $TARGET_EMAIL setting within formmail.php! --><input name="recipients" value="geral@casansconceicao.com" type="hidden"><!-- STEP 3: Specify required fields in the 'required' value --><input name="required" value="email:Your email address" type="hidden"><!-- STEP 4: Put your subject line in the 'subject' value. --><input name="subject" value="Reservas via web" type="hidden"><input name="good_url" value="../index.html" type="hidden"> <table border="1" cellspacing="5%"> <tbody> <tr> <td colspan="2"> <span style="font-family: Verdana; font-size: 10pt;"><span style="font-family: Verdana; font-size: 10pt;"> <strong>Identification </strong></span></span></td> </tr> <tr> <td style="width: 190px;"> <p><span style="font-family: Verdana; font-size: 10pt;">Name:</span></p> </td> <td style="width: 495px;"><input name="Nome" style="width: 488px;"> </td> </tr> <tr> <td style="width: 190px;"><span style="font-family: Verdana; font-size: 10pt;"><span style="font-family: Verdana; font-size: 10pt;"><span style="font-family: Verdana; font-size: 10pt;">Address:</span></span></span></td> <td style="width: 495px;"><span style="font-family: Verdana; font-size: 10pt;"><input name="Endereo" style="width: 486px;"></span></td> </tr> <tr> <td style="width: 190px;"><span style="font-family: Verdana; font-size: 10pt;"><span style="font-family: Verdana; font-size: 10pt;"><span style="font-family: Verdana; font-size: 10pt;">ZIP:</span></span></span></td> <td style="width: 495px;"><span style="font-family: Verdana; font-size: 10pt;"><input name="Codigo postal"></span></td> </tr> <tr style="font-size: 10pt;"> <td style="width: 190px;"> Phone:</td> <td style="width: 495px;"><input name="Telefone"></td> </tr> <tr style="font-size: 10pt;"> <td style="width: 190px;">Mobile:</td> <td style="width: 495px;"><input name="Telemovel" type="text"></td> </tr> <tr style="font-size: 10pt;"> <td style="width: 190px;"> Fax:</td> <td style="width: 495px;"><input name="Fax" type="text"></td> </tr> <tr style="font-size: 10pt;"> <td style="width: 190px;"> Email:</td> <td style="width: 495px;"><input name="email" style="width: 490px;"></td> </tr> <tr> <td style="width: 190px;"> </td> <td style="width: 495px;"> </td> </tr> <tr style="font-size: 10pt;"> <td colspan="2"> <strong>Reservation:</strong></td> </tr> <tr style="font-size: 10pt;"> <td style="width: 190px;"> Room</td> <td style="width: 495px;"> <select id="Select1" name="Tipo de quarto" style="width: 228px;"><option selected="selected" value="twin ">twin room</option><option value="duplo">Double room</option><option value="duplo com varanda">Double room with balcony</option><option value="Apartamento">Double room  Palheiro </option><option></option></select> </td> </tr> <tr style="font-size: 10pt;"> <td style="width: 190px;"> Start Date:</td> <td style="width: 495px;"> <input name="Data Inicio" type="text"></td> </tr> <tr style="font-size: 10pt;"> <td style="width: 190px;"> End Date:</td> <td style="width: 495px;"> <input name="Data Fim" type="text"></td> </tr> <tr style="font-size: 10pt;"> <td style="width: 190px;"> Persons:</td> <td style="width: 495px;"> 1<input id="Checkbox1" name="Numero de pessoas 1" type="checkbox">&nbsp; 2<input id="Checkbox2" name="Numero de pessoas 2" type="checkbox"> &nbsp; Baby (0-2 years)<input id="Checkbox3" name="Com bb" type="checkbox"> </td> </tr> <tr style="font-size: 10pt;"> <td colspan="2"> </td> </tr> <tr style="font-size: 10pt;"> <td colspan="2"> Thank You ! (please press send)</td> </tr> <tr style="font-size: 10pt;"> <td colspan="2"> </td> </tr> <tr> <td style="width: 190px;"><input value="Send" type="submit"></td> <td style="text-align: right; width: 495px;"> <input id="Reset1" value="Reset" type="reset"></td> </tr> </tbody> </table> </form> </span></td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </td> <td style="vertical-align: top; width: 30px;"><img style="width: 30px; height: 840px;" alt="" src="Imagens/Lateral2.jpg"></td> </tr> </tbody> </table> <br> </center> </body></html>