ÿþ<html> <head> <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"> <title>Formular de înscriere în reteaua GANO EXCEL ROMANIA</title> <style> <!-- .style4 {color: #FD0006; font-weight: bold; font-size: 16px; } .style2 { color: #FD0006; font-weight: bold; } --> </style> </head><body> <table class="blue" id="table1" border="0" cellpadding="0" cellspacing="0" width="96%"> <!--DWLayoutTable--> <tbody><tr> <td class="black" height="39" valign="middle" width="712"><div align="center"> <p> <strong>GANO EXCEL ROMANIA</strong></p> <p> &nbsp;Nr.Reg.Com.:J40/11541/2006</p> <p> &nbsp;CUI: RO 18854073</p> <p> &nbsp;Adresa: </p> <p> Bucuresti-Blvd. Mircea Voda Nr.24, Etaj 4</p> <p> &nbsp;cod postal 030667 Bucuresti, sector 3</p> <p> &nbsp;(cladirea de sticla vizavi de nH Bucharest Hotel) </p> <form name="cauta" method="post" action="trimite.php" onsubmit="return (checkform(this.form));"> <input name="pagina" value="DA" type="hidden"> <table on="" id="table2" border="0" cellpadding="0" cellspacing="5" width="712" height="1396"> <!--DWLayoutTable--> <tr> <td colspan="2" align="left" height="20"><span align="left" class="style4"> Pasul 1</span> <span class="black">- Completaci cu atencie datele de mai jos </span></td> </tr> <tr> <td class="ci1" bgcolor="#000000" valign="middle"> <font color="#FFFFFF">1</font></td> <td class="ci1" bgcolor="#000000" height="26" valign="middle"> <font color="#FFFFFF">DATE PERSONALE DISTRIBUITOR </font> </td> </tr> <tr> <td colspan="2" class="black" height="147" valign="middle"> <table id="table3" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td class="black" colspan="2"><font color="#ff0000"> &nbsp;ATENbIE! </font>Pentru validarea corect a cererii dumneavoastr, v rugm s completaci cel pucin un numr de telefon &nbsp;(preferabil mobil) &nbsp;CNP obligatoriu (companiile vor introduce codul unic), adresa de mail.<br> <br> </td> </tr> <tr> <td class="black" width="63%"><strong>I. NUMELE PRENUMELE</strong></td> <td class="black" width="37%"><strong> Codul de DISTRIBUITOR </strong></td> </tr> <tr> <td> &nbsp;<!--webbot b-allow-letters="TRUE" bot="Validation" i-maximum-length="30" s-data-type="String" --><input name="nume" class="input_contract" size="25" maxlength="30" type="text"> <input name="prenume" class="input_contract" size="25" maxlength="30" type="text"> <input name="cod" value="" type="hidden"> <br> <span class="blue">(<em><strong>cum apare în actul de identitate</strong></em>)</span></td> <td align="left" valign="top"><label> <input name="coddistrib" class="input_contract" size="25" maxlength="15" value="FIRMA COMPLTEAZA CODUL" readonly="readonly" type="text"> </label></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" height="44" valign="middle"> <table class="black" id="table4" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td><strong>SERIA ^I NUMRUL ACTULUI DE IDENTITATE</strong></td> <td align="center"><strong>SEX</strong></td> <td align="left"><strong>DATA NA^TERII (zz-ll-aaaa) </strong></td> </tr> <tr> <td width="52%"> <!--webbot bot="Validation" i-maximum-length="12" s-data-type="Integer" s-number-separators="x" --><input name="seria" class="input_contract" size="15" maxlength="12" type="text"> </td> <td align="center" width="11%"> <input name="sex" value="M" checked="checked" type="radio">M<input name="sex" value="F" type="radio">F</td> <td align="left" width="37%"><input name="zz1" class="input_contract" size="2" maxlength="2" type="text"> - <input name="ll1" class="input_contract" size="2" maxlength="2" type="text"> - <input name="aa1" class="input_contract" size="4" maxlength="4" type="text"></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" height="42" valign="middle"> <table class="black" id="table5" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td><strong>NUMRUL DE TELEFON (acas) </strong></td> <td align="center">&nbsp;</td> <td align="left"><strong>NUMRUL DE TELEFON (MOBIL) </strong></td> </tr> <tr> <td width="52%"><input name="telacasa" class="input_contract" size="13" maxlength="13" type="text"></td> <td align="center" width="11%">&nbsp;</td> <td align="left" width="37%"><input name="telmobil" class="input_contract" size="13" maxlength="13" type="text"></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" height="42" valign="middle"> <table class="black" id="table6" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td><strong>COD NUMERIC PERSONAL (CNP) (sau CUI pt.companii)</strong></td> <td align="left"><strong>Email </strong></td> </tr> <tr> <td><input name="cnp" class="input_contract" size="15" maxlength="13" type="text"></td> <td align="left" width="37%"><input name="email" class="input_contract" size="30" maxlength="50" type="text"></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" height="86" valign="middle"> <table class="black" id="table7" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td colspan="2"><strong>DOMICILIU STABIL (adresa complet)&nbsp; </strong></td> <td width="82">&nbsp;</td> <td align="left" width="264">&nbsp;</td> </tr> <tr> <td colspan="2"><input name="adresa" class="input_contract" size="50" maxlength="50"></td> <td>&nbsp;</td> <td align="left">&nbsp;</td> </tr> <tr> <td width="179"><strong id="judetul"> Judecul <select name="judet" class="black" onchange="selectez_judet(document.cauta.judet.value);selectez_oras(document.cauta.judet.value);"> <option selected="selected" value="-"> - Selecteaza -</option> <option value="ALBA">Alba</option> <option value="ARAD">Arad</option> <option value="ARGES">Arges</option> <option value="BACAU">Bacau</option> <option value="BIHOR">Bihor</option> <option value="BISTRITA-NASAUD"> Bistrita-Nasaud</option> <option value="BOTOSANI">Botosani</option> <option value="BRAILA">Braila</option> <option value="BRASOV">Brasov</option> <option value="BUCURESTI">Bucuresti</option> <option value="BUZAU">Buzau</option> <option value="CALARASI">Calarasi</option> <option value="CARAS-SEVERIN"> Caras-Severin</option> <option value="CLUJ">Cluj</option> <option value="CONSTANTA">Constanta</option> <option value="COVASNA">Covasna</option> <option value="DAMBOVITA">Dambovita</option> <option value="DOLJ">Dolj</option> <option value="GALATI">Galati</option> <option value="GIURGIU">Giurgiu</option> <option value="GORJ">Gorj</option> <option value="HARGHITA">Harghita</option> <option value="HUNEDOARA">Hunedoara</option> <option value="IALOMITA">Ialomita</option> <option value="IASI">Iasi</option> <option value="ILFOV">Ilfov</option> <option value="MARAMURES">Maramures</option> <option value="MEHEDINTI">Mehedinti</option> <option value="MURES">Mures</option> <option value="NEAMT">Neamt</option> <option value="OLT">Olt</option> <option value="PRAHOVA">Prahova</option> <option value="SALAJ">Salaj</option> <option value="SATU MARE">Satu Mare</option> <option value="SIBIU">Sibiu</option> <option value="SUCEAVA">Suceava</option> <option value="TELEORMAN">Teleorman</option> <option value="TIMIS">Timis</option> <option value="TULCEA">Tulcea</option> <option value="VALCEA">Valcea</option> <option value="VASLUI">Vaslui</option> <option value="VRANCEA">Vrancea</option> </select></strong></td> <td align="left" width="175"> <strong id="orasul">Ora_ul&nbsp; </strong> <input name="oras" class="input_contract" size="30" maxlength="50" type="text"><strong id="orasul"> </strong> </td> <td align="right">&nbsp;</td> <td>&nbsp;</td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" height="5" valign="middle"> <img src="gano_excel_romania2_files/spacer.gif" height="1" width="1"></td> </tr> <tr> <td colspan="2" class="black" height="63" valign="middle"> <table class="black" id="table8" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td align="left" width="30%"><strong>Cont IBAN (orice banc) </strong></td> <td align="left" width="30%"><input name="codiban" class="input_contract" size="30" maxlength="30" type="text"></td> <td align="right" width="12%"><strong> BANCA</strong></td> <td width="28%"><input name="banca" class="input_contract" size="20" maxlength="50" type="text"></td> </tr> <tr> <td colspan="4"> <table id="table9" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td width="30%"><strong class="black"> SUCURSALA/AGENTIA (adresa)</strong></td> <td width="70%"><input name="adresabanca" class="input_contract" size="63" maxlength="63" type="text"></td> </tr> </tbody></table></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" height="149" valign="middle"> <table id="table10" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td class="black" width="56%">&nbsp;</td> <td class="black">&nbsp;</td> </tr> <tr> <td class="black" width="56%"><strong>II. NUMELE ^I PRENUMELE PARTENERULUI </strong> (<em><strong>sot/socie</strong></em>) </td> <td class="black" width="44%"><strong>DATA NA^TERII (zz-ll-aaaa) </strong></td> </tr> <tr> <td class="black"><input name="numelepartenerului" class="input_contract" size="50" maxlength="50" type="text"></td> <td align="left"><input name="zzp" class="input_contract" size="2" maxlength="2" type="text">-<input name="llp" class="input_contract" size="2" maxlength="2" type="text">-<input name="aap" class="input_contract" size="4" maxlength="4" type="text"></td> </tr> <tr> <td class="black"><strong>COD NUMERIC PERSONAL (CNP) PARTENER </strong></td> <td align="left"><strong class="black"> SERIA ^I NUMRUL ACTULUI DE IDENTITATE </strong></td> </tr> <tr> <td class="black"><input name="cnpp" class="input_contract" size="15" maxlength="13" type="text"></td> <td align="left"><input name="seriap" class="input_contract" size="15" maxlength="12" type="text"></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" valign="middle" height="2"> <img src="gano_excel_romania2_files/spacer.gif" alt="1" height="1" width="1"></td> </tr> <tr> <td class="ci1" bgcolor="#000000" valign="middle"> <font color="#FFFFFF">2</font></td> <td class="ci1" bgcolor="#000000" height="29" valign="middle"> <font color="#FFFFFF">PLASARE ÎN REbEA - SPONSOR DIRECT</font></td> </tr> <tr> <td colspan="2" class="black" height="69" valign="middle"> <table id="table12" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td class="black">&nbsp;</td> <td class="black">&nbsp;</td> </tr> <tr> <td class="black" width="56%"><strong> NUMELE ^I PRENUMELE SPONSORULUI </strong></td> <td class="black" width="44%"><strong>COD SPONSOR </strong></td> </tr> <tr> <td class="black" height="25"> <input name="numesd" class="input_contract" size="23" maxlength="50" type="text" value="Hala&#351;i Denis-Marcel" readonly></td> <td class="black" align="left"> <input name="codsd" class="input_contract" size="15" maxlength="30" type="text" value="ROM0016959" readonly></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" valign="middle" height="3"> <img src="gano_excel_romania2_files/spacer.gif" alt="2" height="1" width="1"></td> </tr> <tr> <td class="ci1" bgcolor="#000000" valign="middle"> <font color="#FFFFFF">3</font></td> <td class="black" bgcolor="#000000" height="40" valign="middle"><span class="ci1"> DATE PERSONALE BENEFICIAR<br> </span><font color="#ffffff"><span>(beneficiar contract în caz de renuncare,preluare de contract,deces,etc.)</span></font> </td> </tr> <tr> <td colspan="2" class="black" height="152" valign="middle"> <table id="table13" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td class="black" width="56%"><strong> NUMELE ^I PRENUMELE BENEFICIARULUI </strong></td> <td class="black" width="44%"><strong>DATA NA^TERII (zz-ll-aa) BENEFICIARULUI</strong></td> </tr> <tr> <td><input name="numelebeneficiarului" class="input_contract" size="50" maxlength="50" type="text"></td> <td align="left"><input name="zzb" class="input_contract" size="2" maxlength="2" type="text"> - <input name="llb" class="input_contract" size="2" maxlength="2" type="text"> - <input name="aab" class="input_contract" size="4" maxlength="4" type="text"></td> </tr> <tr> <td><strong class="black">COD NUMERIC PERSONAL (CNP) AL </strong><span class="black"><strong> BENEFICIARULUI</strong></span><strong> </strong></td> <td align="left"><strong class="black"> SERIA ^I NUMRUL ACTULUI DE IDENTITATE </strong></td> </tr> <tr> <td><input name="cnpb" class="input_contract" size="15" maxlength="13" type="text"></td> <td align="left"><input name="seriab" class="input_contract" size="15" maxlength="12" type="text"></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" height="43" valign="middle"> <table class="black" id="table14" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td width="33%"><strong>RELAbIA CU DISTRIBUITORUL &nbsp;&nbsp;&nbsp;</strong></td> <td width="67%"><input name="relatia" class="input_contract" size="21" maxlength="20" type="text"></td> </tr> </tbody></table></td> </tr> <tr> <td colspan="2" class="black" valign="middle" height="4"> <img src="gano_excel_romania2_files/spacer.gif" alt="1" height="1" width="1"></td> </tr> <tr> <td class="ci1" bgcolor="#000000" valign="middle" width="16"> <font color="#FFFFFF">4</font></td> <td class="black" bgcolor="#000000" height="31" valign="middle" width="681"> <font color="#FFFFFF">DECLARAbIE</font></td> </tr> <tr> <td colspan="2" class="black" height="291" valign="middle"> <table id="table15" border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td colspan="2" class="black" height="150"> <font face="TimesNewRomanPSMT" size="3"> <p ALIGN="LEFT"><b>Trimicând acest acest formular , confirm _i sunt de acord cu urmtoarele:</b></p> <p ALIGN="LEFT"><b>a)informaciile de mai sus sunt adevrate _i corecte;</b></p> <p ALIGN="LEFT"><b>b)am citit _i înceleg termenii _i condiciile codului etic al Companiei;</b></p> <p ALIGN="LEFT"><b>c)m oblig s respect temenii _i condiciile codului etic al Companiei;</b></p> <p ALIGN="LEFT"><b>Formularul de înscriere este valabil numai însocit de copia dup cartea de indentitate / buletinul distribuitorului.</b></p> <p><b>Taxa de înscriere este 79 lei care reprezint contravaloarea Starter Kit-ului.</b></font></td> </tr> <tr> <td class="black" align="center" bgcolor="#eac6c9" height="35" width="27%"><label></strong></label></td> <td class="black" align="center" bgcolor="#eac6c9" width="73%"><span class="style2"> INREGISTREAZA CEREREA</span> <input name="Submit" class="button" value=" Trimite " type="submit"></td> </tr> </tbody></table></td> </tr> </table> <p align="center"> <a target="_blank" href="http://ganoderma.bani-pe-internet.info/cod%20de%20etica%20si%20regulament.pdf"> Termenii _i condiciile contractului de colaborare cu Gano Excel</a></p> <ol> <li><b> <font color="#000000" face="Times New Roman"> Completaci <font color="#0000ff"> formularul de pre-înregistrare</font></font><font color="#0000ff" face="Times New Roman"> </font></b> <font color="#000000" face="Times New Roman"> on-line de mai sus _i faceci click pe TRIMTEbI MESAJUL!</font></li> <li> <font color="#000000" face="Times New Roman"> <b>Achitaci</b> suma de <b>79 RON</b> în contul IBAN, indicat pe formularul de comand, respectiv:</font><ul> <li> <font color="#000000" face="Times New Roman"> &nbsp;Titular: Hala<span lang="ro">_</span>i Denis-Marcel&nbsp;</font></li> <li> <font color="#000000" face="Times New Roman"> &nbsp;IBAN: RO36 INGB 0000 9999 0163 2579 (RON)</font></li> <li> <font color="#000000" face="Times New Roman"> &nbsp;ING Bank România</font></li> </ul> </li> </ol> <p>&nbsp;</p> </form> </td> </tr> </tbody></table> </body></html>