{source}
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
"http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" lang="es" xml:lang="es">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
</head>

<body>
<h3> Comprueba el alcance de la fibra</h3> <br/>
<form name="fibra" method="post" action="355-conexion-base-de-datos">
<table>
<tr>
<td>
<label for="nombre">Nombre</label>
</td>
<td colspan="3">
<input type="text" name="nombre" maxlength="50" size="30" onKeyUp="this.value=this.value.toUpperCase();" required />
</td>
</tr>
<tr>
<td>
<label for="apellidos">Apellidos</label>
</td>
<td colspan="3">
<input type="text" name="apellidos" maxlength="50" size="30" onKeyUp="this.value=this.value.toUpperCase();" required />
</td>
</tr>
<tr>
<td>
<label for="telefono">Teléfono</label>
</td>
<td colspan="3">
<input type="text" name="telefono" maxlength="50" size="30" onKeyUp="this.value=this.value.toUpperCase();" required />
</td>
</tr>
<tr>
<td>
<label for="email">E-mail</label>
</td>
<td colspan="3">
<input type="text" name="email" maxlength="50" size="30" onKeyUp="this.value=this.value.toUpperCase();" required />
</td>
</tr>
<tr>
<td>
<label for="direccion">Dirección</label>
</td>
<td colspan="3">
<input type="text" name="direccion" maxlength="80" size="30" onKeyUp="this.value=this.value.toUpperCase();" required />
</td>
</tr>
<tr>
<td colspan="1">
<label for="num">Número</label>
</td>
<td colspan="1">
<input type="text" name="num" maxlength="10" size="10" onKeyUp="this.value=this.value.toUpperCase();" required />
</td>
<td colspan="1">
<label for="piso"> Piso </label>
</td>
<td colspan="1">
<input type="text" name="piso" maxlength="10" size="10" onKeyUp="this.value=this.value.toUpperCase();" />
</td>
</tr>
<tr>
<td>
<label for="localidad">Localidad</label>
</td>
<td colspan="3">
<input type="text" name="localidad" maxlength="80" size="30" onKeyUp="this.value=this.value.toUpperCase();" required />
</td>
</tr>
<tr>
<td>
<input type="submit" value="Enviar" />
</td>
</tr>
</table>
<h5>Acepto la <a href=\"index.php?option=com_content&amp;view=article&amp;id=308:politica-de-privacidad&amp;catid=31:productos\">pol&iacute;tica de privacidad de datos</a> <input type="checkbox" name="condiciones" id="condiciones" checked="checked" required /> </h5>
</form>
</body>
</html>

{/source}