<img alt="" width="650" height="120" src="http://www.freesegur.com.br/imgs/atendimento.jpg" /><br />
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VOC&Ecirc; PODE LIGAR NOS FONES ABAIXO OU ENVIAR SUA MESAGEM:<br />
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(31) 2512-2711<br />
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(31) 2512-9711<br />
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(31) 9918-5171<br />
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(31) 9993-8336&nbsp;</span><br />
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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <span style="color: #000000"><span style="font-size: x-small"><strong>Todos os campos marcados com * s&atilde;o obrigat&oacute;rios :</strong></span></span><strong><font size="2" face="Arial"><br />
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<form enctype="multipart/form-data" method="post" action="http://www.geraweb.com/geraform/form1280682870form_process.php" target="_BLANK">
    <table border="0" align="center">
        <tbody>
            <tr>
            </tr>
            <tr>
            </tr>
            <tr>
                <td><span style="color: #000000"><span style="font-size: x-small">NOME:*</span></span></td>
                <td><span style="color: #000000"><span style="font-size: x-small">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; <input name="NOME" type="text" /></span></span></td>
            </tr>
            <tr>
                <td>
                <p><span style="color: #000000"><span style="font-size: x-small">&nbsp;</span></span></p>
                <p><span style="color: #000000"><span style="font-size: x-small">TELEFONE:*</span></span></p>
                </td>
                <td>
                <p><span style="color: #000000"><span style="font-size: x-small">&nbsp;</span></span></p>
                <p><span style="color: #000000"><span style="font-size: x-small">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <input name="TELEFONE" type="text" /></span></span></p>
                </td>
            </tr>
            <tr>
                <td>
                <p><span style="color: #000000"><span style="font-size: x-small">&nbsp;</span></span></p>
                <p><span style="color: #000000"><span style="font-size: x-small">&nbsp;E-MAIL:</span></span></p>
                </td>
                <td>
                <p>&nbsp;</p>
                <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <input autocomplete="OFF" name="EMAIL" type="text" />&nbsp;</p>
                </td>
            </tr>
            <tr>
                <td>&nbsp;</td>
                <td>
                <p><span style="font-family: Arial">&nbsp;</span></p>
                <p><span style="font-family: Arial">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span><span style="color: #000000"><span style="font-family: Arial">DIGITE SUA MENSAGEM:</span></span></p>
                <p><span style="color: #000000"><textarea rows="10" cols="30" name="DIGITESUAMENSAGEM"></textarea></span></p>
                <p><span style="color: #000000">&nbsp;</span></p>
                <p><span style="color: #000000">&nbsp;</span></p>
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    <div style="text-align: center"><input type="submit" value="Enviar" /></div>
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