		 <div id="contact-form">
									<form action="" method="post" id="form-reclamos" class="group">
						<div class="form-reclamos-left">
							<p>
								<input type="text" name="ct_nombre" value="" id="ct_nombre" class="required" tabindex="1" placeholder="Nombre(s)*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_apellido_paterno" value="" id="ct_apellido_paterno" class="required" tabindex="2" placeholder="Apellido Paterno*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_apellido_materno" value="" id="ct_apellido_materno" class="required" tabindex="3" placeholder="Apellido Materno*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>Tipo de documento.</p>	
							<p>
								<select name="ct_tipo_doc" id="ct_tipo_doc" tabindex="4">
									<option value="DNI">DNI</option>
									<option value="RUC">RUC</option>
									<option value="Pasaporte">Nro. Pasaporte</option>
								</select>
								<em>Ingrese una dirección de email válida.</em>
							</p>
							<p>
								<input type="text" name="ct_nro_doc" value="" id="ct_nro_doc" class="required" tabindex="5" placeholder="Nro. de Documento*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_direccion" value="" id="ct_direccion" class="required" tabindex="6" placeholder="Dirección*">
								<em>Este campo es obligatorio.</em>
							</p>
						</div>
						
						<div class="form-reclamos-right">
							<p>
								<input type="text" name="ct_departamento" value="" id="ct_departamento" class="required" tabindex="7" placeholder="Departamento*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_provincia" value="" id="ct_provincia" class="required" tabindex="8" placeholder="Provincia*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_distrito" value="" id="ct_distrito" class="required" tabindex="9" placeholder="Distrito*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_telefono" value="" id="ct_telefono" class="required" tabindex="10" placeholder="Teléfono*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_fecha_incidencia" value="" id="ct_fecha_incidencia" class="required" tabindex="11" placeholder="Fecha de incidencia*">
								<em>Este campo es obligatorio.</em>
							</p>
		
							<p>
								<input type="text" name="ct_email" value="" id="ct_email" class="required email" tabindex="12" placeholder="Email*">
								<em>Ingrese una dirección de email válida.</em>
							</p>
						</div>
						
						<p>
							<textarea id="ct_comentario" rows="8" cols="45" name="ct_comentario" id="ct_comentario" class="required" tabindex="13" placeholder="Escriba aquí su reclamo"></textarea>
							<em>Este campo es obligatorio.</em>
						</p>
						<p><input type="submit" value="Enviar" name="ct_submit" id="ct_submit" class="button b_submit" tabindex="14"></p>
					</form>
							</div><!-- #contact-form -->
					 <div id="contact-form">
									<form action="" method="post" id="form-reclamos" class="group">
						<div class="form-reclamos-left">
							<p>
								<input type="text" name="ct_nombre" value="" id="ct_nombre" class="required" tabindex="1" placeholder="Nombre(s)*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_apellido_paterno" value="" id="ct_apellido_paterno" class="required" tabindex="2" placeholder="Apellido Paterno*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_apellido_materno" value="" id="ct_apellido_materno" class="required" tabindex="3" placeholder="Apellido Materno*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>Tipo de documento.</p>	
							<p>
								<select name="ct_tipo_doc" id="ct_tipo_doc" tabindex="4">
									<option value="DNI">DNI</option>
									<option value="RUC">RUC</option>
									<option value="Pasaporte">Nro. Pasaporte</option>
								</select>
								<em>Ingrese una dirección de email válida.</em>
							</p>
							<p>
								<input type="text" name="ct_nro_doc" value="" id="ct_nro_doc" class="required" tabindex="5" placeholder="Nro. de Documento*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_direccion" value="" id="ct_direccion" class="required" tabindex="6" placeholder="Dirección*">
								<em>Este campo es obligatorio.</em>
							</p>
						</div>
						
						<div class="form-reclamos-right">
							<p>
								<input type="text" name="ct_departamento" value="" id="ct_departamento" class="required" tabindex="7" placeholder="Departamento*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_provincia" value="" id="ct_provincia" class="required" tabindex="8" placeholder="Provincia*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_distrito" value="" id="ct_distrito" class="required" tabindex="9" placeholder="Distrito*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_telefono" value="" id="ct_telefono" class="required" tabindex="10" placeholder="Teléfono*">
								<em>Este campo es obligatorio.</em>
							</p>
							<p>
								<input type="text" name="ct_fecha_incidencia" value="" id="ct_fecha_incidencia" class="required" tabindex="11" placeholder="Fecha de incidencia*">
								<em>Este campo es obligatorio.</em>
							</p>
		
							<p>
								<input type="text" name="ct_email" value="" id="ct_email" class="required email" tabindex="12" placeholder="Email*">
								<em>Ingrese una dirección de email válida.</em>
							</p>
						</div>
						
						<p>
							<textarea id="ct_comentario" rows="8" cols="45" name="ct_comentario" id="ct_comentario" class="required" tabindex="13" placeholder="Escriba aquí su reclamo"></textarea>
							<em>Este campo es obligatorio.</em>
						</p>
						<p><input type="submit" value="Enviar" name="ct_submit" id="ct_submit" class="button b_submit" tabindex="14"></p>
					</form>
							</div><!-- #contact-form -->
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