{embed="includes/head"}
	{embed="includes/header_eng"}
					<!-- Breadcrumb -->
					<div class="grid-3" id="breadcrumb">
						<div class="text">
							<img src="{site_url}images/site/img1.jpg" alt="" />
							<h2 style="font-size: 40px;">Request an Stimate</h2>
							<div class="cl">&nbsp;</div>
						</div>
					</div>
					<!-- END Breadcrumb -->
					<div class="cl">&nbsp;</div>
				</div>
				<!-- END Neccessary For All Pages -->
				<div id="left-gray" class="container-3 tos">
					<div class="grid-1">
						<div class="spacer" style="padding-top: 15px;">
							<p>Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse elit arcu, condimentum nec hendrerit eget, aliquam id mauris. Phasellus consectetur dignissim metus commodo consectetur. Curabitur vel nisl odio. Sed erat ligula, rhoncus nec porta ullamcorper, tincidunt pharetra massa.</p>
						</div>
					</div>
					<div class="grid-2">
						<form action="" method="post" class="main-form">
							<fieldset>
								<h2>1. About You:</h2>
								<div class="row">
									<label class="first-label">Name</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Company</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">City</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" style="width: 146px;" />
									<label class="left" style="width: 65px;">Estate</label>
									<input type="text" class="field right" style="width: 50px;" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Postal / Zip Code</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Country</label>
									<div class="cl">&nbsp;</div>
									<select class="field" style="width: 158px;">
										<option>United States</option>
									</select>
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Phone</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Email</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
							</fieldset>
							<fieldset class="color">
								<h2>2. Importer:</h2>
								<div class="row">
									<label class="first-label">Name</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Company</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">City</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" style="width: 129px;" />
									<label class="left" style="width: 100px;">Estate</label>
									<input type="text" class="field right" style="width: 50px;" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Postal / Zip Code</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Country</label>
									<div class="cl">&nbsp;</div>
									<select class="field" style="width: 158px;">
										<option>United States</option>
									</select>
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Phone</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Email</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
							</fieldset>
							<fieldset>
								<h2>2. Exporter:</h2>
								<div class="row">
									<label class="first-label">Name</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Company</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">City</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" style="width: 129px;" />
									<label class="left" style="width: 100px;">Estado</label>
									<input type="text" class="field right" style="width: 50px;" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Postal / Zip Code</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Country</label>
									<div class="cl">&nbsp;</div>
									<select class="field" style="width: 158px;">
										<option>Colombia</option>
									</select>
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Phone</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Email</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
							</fieldset>
							<fieldset class="color">
								<h2>4. What kind of management is needed?</h2>
								<div class="row">
									<label class="check"><input type="checkbox" class="checkbox" />Import</label>
									<label class="check"><input type="checkbox" class="checkbox" />Export</label>
								</div>
							</fieldset>
							<fieldset>
								<h2>5. Product</h2>
								<div class="row">
									<label class="first-label">Name</label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Packaging Type: </label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Annual Activity Period: </label>
									<div class="cl">&nbsp;</div>
									<label class="left" style="width: 60px; text-align: left;">From :</label>
									<select class="field left" style="width: 65px;">
										<option>01</option>
										<option>02</option>
										<option>03</option>
										<option>04</option>
										<option>04</option>
										<option>05</option>
										<option>06</option>
										<option>07</option>
										<option>08</option>
										<option>09</option>
										<option>10</option>
										<option>11</option>
										<option>12</option>
										<option>13</option>
										<option>14</option>
										<option>15</option>
										<option>16</option>
										<option>17</option>
										<option>18</option>
										<option>19</option>
										<option>20</option>
										<option>21</option>
										<option>22</option>
										<option>23</option>
										<option>24</option>
										<option>25</option>
										<option>26</option>
										<option>27</option>
										<option>28</option>
										<option>29</option>
										<option>30</option>
										<option>31</option>
									</select>
									<select class="field right" style="width: 165px;">
										<option>January</option>
										<option>February</option>
										<option>March</option>
										<option>April</option>
										<option>May</option>
										<option>June</option>
										<option>July</option>
										<option>August</option>
										<option>September</option>
										<option>October</option>
										<option>November</option>
										<option>December</option>
									</select>
									<div class="cl">&nbsp;</div>
									<br />
									<label class="left" style="width: 60px; text-align: left;">From :</label>
									<select class="field left" style="width: 65px;">
										<option>01</option>
										<option>02</option>
										<option>03</option>
										<option>04</option>
										<option>04</option>
										<option>05</option>
										<option>06</option>
										<option>07</option>
										<option>08</option>
										<option>09</option>
										<option>10</option>
										<option>11</option>
										<option>12</option>
										<option>13</option>
										<option>14</option>
										<option>15</option>
										<option>16</option>
										<option>17</option>
										<option>18</option>
										<option>19</option>
										<option>20</option>
										<option>21</option>
										<option>22</option>
										<option>23</option>
										<option>24</option>
										<option>25</option>
										<option>26</option>
										<option>27</option>
										<option>28</option>
										<option>29</option>
										<option>30</option>
										<option>31</option>
									</select>
									<select class="field right" style="width: 165px;">
										<option>January</option>
										<option>February</option>
										<option>March</option>
										<option>April</option>
										<option>May</option>
										<option>June</option>
										<option>July</option>
										<option>August</option>
										<option>September</option>
										<option>October</option>
										<option>November</option>
										<option>December</option>
									</select>
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label" style="white-space: nowrap;">Frequency within the period: </label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
							</fieldset>
							<fieldset class="color">
								<h2>6. Route: </h2>
								<div class="row">
									<label class="first-label">From: </label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">To: </label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
							</fieldset>
							<fieldset>
								<h2>7. General:</h2>
								<div class="row">
									<label class="first-label">Value of Event: </label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Name of Carrier: </label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="row">
									<label class="first-label">Comments: </label>
									<div class="cl">&nbsp;</div>
									<input type="text" class="field" />
									<div class="cl">&nbsp;</div>
								</div>
								<br /><br />
								<div class="row">
									<input type="submit" class="button-submit" value="Send" />
									<div class="cl">&nbsp;</div>
								</div>
								<div class="cl">&nbsp;</div>
							</fieldset>
						</form>
					</div>
					<div class="cl">&nbsp;</div>
				</div>
				{embed="includes/footer_eng"}