redcomani.org/portalcautivo/cutof.html

  <!-- <div class="form-group">
      <input type="text" class="form-control" placeholder="First Name *" value="" />
  </div>
  <div class="form-group">
      <input type="text" class="form-control" placeholder="Last Name *" value="" />
  </div>
  <div class="form-group">
      <input type="password" class="form-control" placeholder="Password *" value="" />
  </div>
  <div class="form-group">
      <input type="password" class="form-control"  placeholder="Confirm Password *" value="" />
  </div>
  <div class="form-group">
      <div class="maxl">
          <label class="radio inline">
              <input type="radio" name="gender" value="male" checked>
              <span> Male </span>
          </label>
          <label class="radio inline">
              <input type="radio" name="gender" value="female">
              <span>Female </span>
          </label>
      </div>
  </div> -->

<!-- <div class="col-md-6">
    <div class="form-group">
        <input type="email" class="form-control" placeholder="Your Email *" value="" />
    </div>
    <div class="form-group">
        <input type="text" minlength="10" maxlength="10" name="txtEmpPhone" class="form-control" placeholder="Your Phone *" value="" />
    </div>
    <div class="form-group">
        <select class="form-control">
            <option class="hidden"  selected disabled>Please select your Sequrity Question</option>
            <option>What is your Birthdate?</option>
            <option>What is Your old Phone Number</option>
            <option>What is your Pet Name?</option>
        </select>
    </div>
    <div class="form-group">
        <input type="text" class="form-control" placeholder="Enter Your Answer *" value="" />
    </div>
    <input type="submit" class="btnRegister"  value="Register"/>
</div> -->




                                <!--    <div class="col-md-6">
                                        <div class="form-group">
                                            <input type="text" class="form-control" placeholder="First Name *" value="" />
                                        </div>
                                        <div class="form-group">
                                            <input type="text" class="form-control" placeholder="Last Name *" value="" />
                                        </div>
                                        <div class="form-group">
                                            <input type="email" class="form-control" placeholder="Email *" value="" />
                                        </div>
                                        <div class="form-group">
                                            <input type="text" maxlength="10" minlength="10" class="form-control" placeholder="Phone *" value="" />
                                        </div>


                                    </div>
                                    <div class="col-md-6">
                                        <div class="form-group">
                                            <input type="password" class="form-control" placeholder="Password *" value="" />
                                        </div>
                                        <div class="form-group">
                                            <input type="password" class="form-control" placeholder="Confirm Password *" value="" />
                                        </div>
                                        <div class="form-group">
                                            <select class="form-control">
                                                <option class="hidden"  selected disabled>Please select your Sequrity Question</option>
                                                <option>What is your Birthdate?</option>
                                                <option>What is Your old Phone Number</option>
                                                <option>What is your Pet Name?</option>
                                            </select>
                                        </div>
                                        <div class="form-group">
                                            <input type="text" class="form-control" placeholder="`Answer *" value="" />
                                        </div>
                                        <input type="submit" class="btnRegister"  value="Register"/>
                                    </div>
                                </div> -->

                                <!-- <button type="button" class="btn btn-default btn-circle btn-xl"><i class="glyphicon glyphicon-ok"></i></button>
<button type="button" class="btn btn-primary btn-circle btn-xl"><i class="glyphicon glyphicon-list"></i></button>
<button type="button" class="btn btn-success btn-circle btn-xl"><i class="fas fa-images"></i></i></button>
<button type="button" class="btn btn-info btn-circle btn-xl"><i class="fab fa-wikipedia-w"></i></i></button>
<button type="button" class="btn btn-warning btn-circle btn-xl"><i class="glyphicon glyphicon-remove"></i></button>
<button type="button" class="btn btn-danger btn-circle btn-xl"><i class="fab fa-youtube"></i></button> -->