Constienta date – Antreprenoriat si viata prin ochii lui Alex Giurgea

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Esti la un pas de CONSTIENTA!

[headline style="1" font_size="24" font_style="bold" font_color="%23ffffff" align="center"]Esti la un pas de CONSTIENTA![/headline]

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Introdu mai jos datele necesare pentru facturare

[headline style="1" font_size="40" font_color="%232697da" align="center"]Introdu mai jos datele necesare pentru facturare[/headline]

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Dupa ce le introduci vei fi redirectionat catre pagina procesatorului de plata pentru a introduce detaliile de card – acolo vei plati 39 lei pentru intreg programul online “9 principii pentru o viata constienta”

[headline style="1" font_size="18" font_style="bold" font_color="%235e5e5e" align="center"]Dupa ce le introduci vei fi redirectionat catre pagina procesatorului de plata pentru a introduce detaliile de card – acolo vei plati 39 lei pentru intreg programul online "9 principii pentru o viata constienta"[/headline]

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— SPACER —

[vertical_spacing height="40"]

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Date de facturare

[optin_box style="8" alignment="center" action="/cardRedirect.php?constienta=true" method="post" email_field="billing_email" email_default="Adresa de mail" email_order="2" integration_type="custom" double_optin="Y" name_field="billing_first_name" name_order="0" name_required="Y" name_default="Numele mic (prenume)" extra_field_1_name="billing_last_name" extra_field_1_order="1" extra_field_1_required="N" extra_field_1_hidden="N" extra_field_1_title="Nume (de familie)" extra_field_2_name="billing_fiscal_number" extra_field_2_order="3" extra_field_2_required="N" extra_field_2_hidden="N" extra_field_2_title="CNP" extra_field_3_name="billing_county" extra_field_3_order="4" extra_field_3_required="N" extra_field_3_hidden="N" extra_field_3_title="Judet" extra_field_4_name="billing_city" extra_field_4_order="5" extra_field_4_required="N" extra_field_4_hidden="N" extra_field_4_title="Oras/Sector" extra_field_5_name="billing_mobile_phone" extra_field_5_order="7" extra_field_5_required="N" extra_field_5_hidden="N" extra_field_5_title="Telefon mobil" extra_field_6_name="billing_address" extra_field_6_order="6" extra_field_6_required="N" extra_field_6_hidden="N" extra_field_6_title="Adresa:" opm_packages=""][optin_box_hidden]<input type="hidden" name="billing_type" value="person" /><input type="hidden" name="billing_identity_number" value="" /><input type="hidden" name="billing_companyname" value="" /><input type="hidden" name="billing_country" value="" /><input type="hidden" name="billing_zip_code" value="" />[/optin_box_hidden][optin_box_code]<div style="display:none"><form action="/cardRedirect.php?constienta=true" method="post" name="frmPaymentRedirect"><br />
<!– 	If you want the values in the payment page to be prefilled, you need to request them from the customer and POST them to the payment gateway. If not, the customer will have to fill them in the secure page on mobilpay.ro –><br />
<fieldset><br />
<legend>Completeaza datele pentru facturare</legend><br />
<p>		<label>Tip cumparator:</label></p><br />
<select name="billing_type" style="width: 200px;"><br />
			<option value="person" selected="selected">Persoana Fizica</option><br/><br />
			<option value="company">Persoana juridica</option><br/><br />
		</select><br />
<p>&nbsp;</p><br />
<p><label id="labelFirstName">Prenume:</label><input name="billing_first_name" id="idFirstName" style="width: 200px;" type="text"/></p><br />
<p><label id="labelLastName">Nume:</label><input name="billing_last_name" id="idLastName" style="width: 200px;" type="text"/></p><br />
<p><label id="labelFiscalNumber">CNP:</label><input name="billing_fiscal_number" id="idFiscalNumber" style="width: 200px;" type="text"/></p><br />
<p><label id="labelIdentityNumber">CI:</label><input name="billing_identity_number" id="idIdentityNumber" style="width: 200px;" type="text"/><br/><br />
<label>Tara:</label><input name="billing_companyname" style="width: 200px;" type="text"/></p><br />
<p><label>Tara:</label><input name="billing_country" style="width: 200px;" type="text"/></p><br />
<p><label>Judet/Sector:</label><input name="billing_county" style="width: 200px;" type="text"/></p><br />
<p><label>Localitate:</label><input name="billing_city" style="width: 200px;" type="text"/></p><br />
<p><label>Cod postal:</label><input name="billing_zip_code" style="width: 200px;" type="text"/></p><br />
<p><label>Adresa:</label><input name="billing_address" style="width: 200px;" type="text"/></p><br />
<p><label>E-mail:</label><input name="billing_email" style="width: 200px;" type="text"/></p><br />
<p><label>Telefon mobil:</label><input name="billing_mobile_phone" style="width: 200px;" type="text"/></p></fieldset><br />
</form><br />
</div>[/optin_box_code][optin_box_field name="headline"]Date de facturare[/optin_box_field][optin_box_field name="paragraph"][/optin_box_field][optin_box_field name="privacy"][/optin_box_field][optin_box_field name="top_color"]undefined[/optin_box_field][optin_box_button type="0" button_below="Y"]Plateste acum![/optin_box_button] [/optin_box]

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