<table cellpadding=0 cellspacing=0 style=width:100%>
	<tbody>
		<tr>
			<td>Dados da Solicita&ccedil;&atilde;o</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td>
			<table cellpadding=0 cellspacing=12 style=width:800px>
				<tbody>
					<tr>
						<td>
						<table cellpadding=0 cellspacing=0 style=width:100%>
							<tbody>
								<tr>
									<td>
									<table cellpadding=0 cellspacing=0>
										<tbody>
											<tr>
												<td>Assist&ecirc;ncia</td>
												<td rowspan=3>&nbsp;</td>
												<td>Solicita&ccedil;&atilde;o</td>
												<td rowspan=3>&nbsp;</td>
												<td>Produto</td>
												<td rowspan=3>&nbsp;</td>
												<td>Data solicita&ccedil;&atilde;o</td>
												<td rowspan=3>&nbsp;</td>
												<td>Prazo</td>
											</tr>
											<tr>
												<td>&nbsp;</td>
											</tr>
											<tr>
												<td><input name=ctl00$ContentPlaceHolder1$txtAssistencia type=text value=6022150 /></td>
												<td><input name=ctl00$ContentPlaceHolder1$txtSolicitacao type=text value=2 /></td>
												<td><input name=ctl00$ContentPlaceHolder1$txtProduto type=text value=LIBERTY /></td>
												<td><input name=ctl00$ContentPlaceHolder1$txtDataSolicitacao type=text value=18/04/2023 /></td>
												<td><input name=ctl00$ContentPlaceHolder1$txtPrazo type=text /></td>
											</tr>
										</tbody>
									</table>
									</td>
								</tr>
								<tr>
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td>
									<table cellpadding=0 cellspacing=0>
										<tbody>
											<tr>
												<td>Servi&ccedil;o(s)</td>
											</tr>
											<tr>
												<td>&nbsp;</td>
											</tr>
											<tr>
												<td><input name=ctl00$ContentPlaceHolder1$txtServico type=text value=LIMPEZA /></td>
											</tr>
										</tbody>
									</table>
									</td>
								</tr>
								<tr>
									<td>
									<table cellpadding=0 cellspacing=0>
										<tbody>
											<tr>
												<td>&nbsp;</td>
											</tr>
											<tr>
												<td>Cliente</td>
											</tr>
											<tr>
												<td>&nbsp;</td>
											</tr>
											<tr>
												<td><input name=ctl00$ContentPlaceHolder1$txtNomeCliente type=text value=WAGNER /></td>
											</tr>
										</tbody>
									</table>
									</td>
								</tr>
								<tr>
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td><strong>RESID&Ecirc;NCIA</strong></td>
								</tr>
								<tr>
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td>
									<table cellpadding=0 cellspacing=0>
										<tbody>
											<tr>
												<td>Endere&ccedil;o</td>
												<td rowspan=3>&nbsp;</td>
												<td>Complemento</td>
											</tr>
											<tr>
												<td>&nbsp;</td>
											</tr>
											<tr>
												<td><input name=ctl00$ContentPlaceHolder1$txtEndereco type=text value=R. /></td>
												<td><input name=ctl00$ContentPlaceHolder1$txtComplemento type=text value=casa /></td>
											</tr>
										</tbody>
									</table>
									</td>
								</tr>
								<tr>
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td>
									<table cellpadding=0 cellspacing=0>
										<tbody>
											<tr>
												<td>Bairro</td>
												<td rowspan=3>&nbsp;</td>
												<td>Cidade</td>
												<td rowspan=3>&nbsp;</td>
												<td>Estado</td>
												<td rowspan=3>&nbsp;</td>
												<td>CEP</td>
											</tr>
											<tr>
												<td>&nbsp;</td>
											</tr>
											<tr>
												<td><input name=ctl00$ContentPlaceHolder1$txtBairro type=text value=Bom /></td>
												<td><input name=ctl00$ContentPlaceHolder1$txtCidade type=text value=Curitiba /></td>
												<td><input name=ctl00$ContentPlaceHolder1$txtEstado type=text value=PR /></td>
												<td><input name=ctl00$ContentPlaceHolder1$txtCep type=text value=80520340 /></td>
											</tr>
										</tbody>
									</table>
									</td>
								</tr>
								<tr>
									<td>&nbsp;</td>
								</tr>
								<tr>
									<td>
									<table cellpadding=0 cellspacing=0>
										<tbody>
											<tr>
												<td>Refer&ecirc;ncias</td>
											</tr>
										</tbody>
									</table>
									</td>
								</tr>
							</tbody>
						</table>
						</td>
					</tr>
				</tbody>
			</table>
			</td>
		</tr>
	</tbody>
</table>
