<h2>Formulario Contacto (Modelo)</h2>		
<!DOCTYPE html>
<html lang="es">  
  <head>  
    <title></title>    
    <meta charset="UTF-8">
    <meta name="title" content="">
    <meta name="description" content="">    
    <link href=" " rel="stylesheet" type="text/css"/>  
    <style>
/* Style inputs, select elements and textareas */
input[type=text], input[type=email], input[type=tel], select, radio, textarea, checkbox{
  width: 100%;
  padding: 12px;
  border: 1px solid #ccc;
  border-radius: 4px;
  box-sizing: border-box;
  resize: vertical;
  background-color: #ffffff;
  font-family: 'Roboto';
  font-size: 14px;
}
label {font-family: 'Roboto'; font-size: 14px;}
input[type=radio] {
    margin-left: 20px;
}
/* Style the label to display next to the inputs */
label {
  padding: 12px 12px 12px 12px;
  display: inline-block;
}
/* Style the submit button */
input[type=submit] .button#submitButton.btn.btn-primary{
  background-color: #002457;
  color: white;
  padding: 12px 20px;
  border: none;
  border-radius: 4px;
  cursor: pointer;
  float: left;
}
input[type=submit]:hover {
  background-color: #CB4F19;
}
/* Style the container */
.container {
  border-radius: 5px;
  background-color: #f2f2f2;
  padding: 20px;
  width: 800px;
  margin: auto;
}
/* Floating column for labels: 50% width */
.col-6 {
  float: left;
  width: 50%;
  margin-top: 6px;
  font-family: 'Roboto';
  font-size: 14px;
}
/* Floating column for inputs: 100% width */
.col-12 {
  float: left;
  width: 100%;
  margin-top: 6px;
  font-family: 'Roboto';
  font-size: 14px;
}
/* Clear floats after the columns */
.row:after {
  content: "";
  display: table;
  clear: both;
}
/* Responsive layout - when the screen is less than 600px wide, make the two columns stack on top of each other instead of next to each other */
@media screen and (max-width: 600px) {
  .col-6, .col-12, input[type=submit] {
    width: 100%;
    margin-top: 6px;
  }
  .container {
  width: 300px;
  margin: auto;
  height: 900px;
}
}
</style> 
  </head> 
  <body>
  <form id="formrut" method="post" >
  This is a success alert—check it out!
 <input class = "form-control" style="width:25%;" type="hidden" id="medios" value="prueba medio">
    <input class = "form-control" style="width:25%;" type="hidden" id="otros" value="prueba otro">
      <input class = "form-control" style="width:25%;" type="hidden" id="proyecto" value="las pataguas">
        <label style="display:none;" for="nombre">Nombre</label>
        <input type="text" id="nombre" name="nombre" required placeholder="Nombre">
        <label style="display:none;" for="apellido">Apellido</label>
        <input type="text" id="apellido" name="apellido" required placeholder="Apellido">
        <label style="display:none;" for="correo">Correo electrónico</label>
        <input type="email" id="correo" name="correo" pattern="[a-zA-Z0-9_]+([.][a-zA-Z0-9_]+)*@[a-zA-Z0-9_]+([.][a-zA-Z0-9_]+)*[.][a-zA-Z]{1,5}" required placeholder="Correo electrónico">
        <label style="display:none;" for="telefono">Telefono</label>
        <input type="tel" id="telefono" name="telefono" pattern="[0-9]{9}" required placeholder="Teléfono (formato 9XXXXXXXX)">
        <label style="display:none;" for="rut">Rut</label>
        <input type="text"  id="rut" name="rut" required oninput="checkRut(this)" placeholder="Ingrese RUT">
        <label for="comuna">Comuna</label>
        <select id="comuna" name="comuna" required >
          <option value="">Elige tu Comuna</option>
            <option value="Algarrobo">Algarrobo</option>
            <option value="Alhué">Alhué</option>
            <option value="Alto Biobío">Alto Biobío</option>
            <option value="Alto del Carmen">Alto del Carmen</option>
            <option value="Alto Hospicio">Alto Hospicio</option>
            <option value="Ancud">Ancud</option>
            <option value="Andacollo">Andacollo</option>
            <option value="Angol">Angol</option>
            <option value="Antártica">Antártica</option>
            <option value="Antofagasta">Antofagasta</option>
            <option value="Antuco">Antuco</option>
            <option value="Arauco">Arauco</option>
            <option value="Arica">Arica</option>
            <option value="Aysén">Aysén</option>
            <option value="Buin">Buin</option>
            <option value="Bulnes">Bulnes</option>
            <option value="Cabildo">Cabildo</option>
            <option value="Cabo de Hornos">Cabo de Hornos</option>
            <option value="Cabrero">Cabrero</option>
            <option value="Calama">Calama</option>
            <option value="Calbuco">Calbuco</option>
            <option value="Caldera">Caldera</option>
            <option value="Calera de Tango">Calera de Tango</option>
            <option value="Calle Larga">Calle Larga</option>
            <option value="Camarones">Camarones</option>
            <option value="Camiña">Camiña</option>
            <option value="Canela">Canela</option>
            <option value="Cañete">Cañete</option>
            <option value="Carahue">Carahue</option>
            <option value="Cartagena">Cartagena</option>
            <option value="Casablanca">Casablanca</option>
            <option value="Castro">Castro</option>
            <option value="Catemu">Catemu</option>
            <option value="Cauquenes">Cauquenes</option>
            <option value="Cerrillos">Cerrillos</option>
            <option value="Cerro Navia">Cerro Navia</option>
            <option value="Chaitén">Chaitén</option>
            <option value="Chanco">Chanco</option>
            <option value="Chañaral">Chañaral</option>
            <option value="Chépica">Chépica</option>
            <option value="Chiguayante">Chiguayante</option>
            <option value="Chile Chico">Chile Chico</option>
            <option value="Chillán">Chillán</option>
            <option value="Chillán Viejo">Chillán Viejo</option>
            <option value="Chimbarongo">Chimbarongo</option>
            <option value="Cholchol">Cholchol</option>
            <option value="Chonchi">Chonchi</option>
            <option value="Cisnes">Cisnes</option>
            <option value="Cobquecura">Cobquecura</option>
            <option value="Cochamó">Cochamó</option>
            <option value="Cochrane">Cochrane</option>
            <option value="Codegua">Codegua</option>
            <option value="Coelemu">Coelemu</option>
            <option value="Coihueco">Coihueco</option>
            <option value="Coinco">Coinco</option>
            <option value="Colbún">Colbún</option>
            <option value="Colchane">Colchane</option>
            <option value="Colina">Colina</option>
            <option value="Collipulli">Collipulli</option>
            <option value="Coltauco">Coltauco</option>
            <option value="Combarbalá">Combarbalá</option>
            <option value="Concepción">Concepción</option>
            <option value="Conchalí">Conchalí</option>
            <option value="Concón">Concón</option>
            <option value="Constitución">Constitución</option>
            <option value="Contulmo">Contulmo</option>
            <option value="Copiapó">Copiapó</option>
            <option value="Coquimbo">Coquimbo</option>
            <option value="Coronel">Coronel</option>
            <option value="Corral">Corral</option>
            <option value="Coyhaique">Coyhaique</option>
            <option value="Cunco">Cunco</option>
            <option value="Curacautín">Curacautín</option>
            <option value="Curacaví">Curacaví</option>
            <option value="Curaco de Vélez">Curaco de Vélez</option>
            <option value="Curanilahue">Curanilahue</option>
            <option value="Curarrehue">Curarrehue</option>
            <option value="Curepto">Curepto</option>
            <option value="Curicó">Curicó</option>
            <option value="Dalcahue">Dalcahue</option>
            <option value="Diego de Almagro">Diego de Almagro</option>
            <option value="Doñihue">Doñihue</option>
            <option value="El Bosque">El Bosque</option>
            <option value="El Carmen">El Carmen</option>
            <option value="El Monte">El Monte</option>
            <option value="El Quisco">El Quisco</option>
            <option value="El Tabo">El Tabo</option>
            <option value="Empedrado">Empedrado</option>
            <option value="Ercilla">Ercilla</option>
            <option value="Estación Central">Estación Central</option>
            <option value="Florida">Florida</option>
            <option value="Freire">Freire</option>
            <option value="Freirina">Freirina</option>
            <option value="Fresia">Fresia</option>
            <option value="Frutillar">Frutillar</option>
            <option value="Futaleufú">Futaleufú</option>
            <option value="Futrono">Futrono</option>
            <option value="Galvarino">Galvarino</option>
            <option value="General Lagos">General Lagos</option>
            <option value="Gorbea">Gorbea</option>
            <option value="Graneros">Graneros</option>
            <option value="Guaitecas">Guaitecas</option>
            <option value="Hijuelas">Hijuelas</option>
            <option value="Hualaihué">Hualaihué</option>
            <option value="Hualañe">Hualañe</option>
            <option value="Hualpén">Hualpén</option>
            <option value="Hualqui">Hualqui</option>
            <option value="Huara">Huara</option>
            <option value="Huasco">Huasco</option>
            <option value="Huechuraba">Huechuraba</option>
            <option value="Illapel">Illapel</option>
            <option value="Independencia">Independencia</option>
            <option value="Iquique">Iquique</option>
            <option value="Isla de Maipo">Isla de Maipo</option>
            <option value="Isla de Pascua">Isla de Pascua</option>
            <option value="Juan Fernández">Juan Fernández</option>
            <option value="La Calera">La Calera</option>
            <option value="La Cisterna">La Cisterna</option>
            <option value="La Cruz">La Cruz</option>
            <option value="La Estrella">La Estrella</option>
            <option value="La Florida">La Florida</option>
            <option value="La Granja">La Granja</option>
            <option value="La Higuera">La Higuera</option>
            <option value="La Ligua">La Ligua</option>
            <option value="La Pintana">La Pintana</option>
            <option value="La Reina">La Reina</option>
            <option value="La Serena">La Serena</option>
            <option value="La Unión">La Unión</option>
            <option value="Lago Ranco">Lago Ranco</option>
            <option value="Lago Verde">Lago Verde</option>
            <option value="Laguna Blanca">Laguna Blanca</option>
            <option value="Laja">Laja</option>
            <option value="Lampa">Lampa</option>
            <option value="Lanco">Lanco</option>
            <option value="Las Cabras">Las Cabras</option>
            <option value="Las Condes">Las Condes</option>
            <option value="Lautaro">Lautaro</option>
            <option value="Lebu">Lebu</option>
            <option value="Licantén">Licantén</option>
            <option value="Limache">Limache</option>
            <option value="Linares">Linares</option>
            <option value="Litueche">Litueche</option>
            <option value="Llaillay">Llaillay</option>
            <option value="Llanquihue">Llanquihue</option>
            <option value="Lo Barnechea">Lo Barnechea</option>
            <option value="Lo Espejo">Lo Espejo</option>
            <option value="Lo Prado">Lo Prado</option>
            <option value="Lolol">Lolol</option>
            <option value="Loncoche">Loncoche</option>
            <option value="Longaví">Longaví</option>
            <option value="Lonquimay">Lonquimay</option>
            <option value="Los Álamos">Los Álamos</option>
            <option value="Los Andes">Los Andes</option>
            <option value="Los Ángeles">Los Ángeles</option>
            <option value="Los Lagos">Los Lagos</option>
            <option value="Los Muermos">Los Muermos</option>
            <option value="Los Sauces">Los Sauces</option>
            <option value="Los Vilos">Los Vilos</option>
            <option value="Lota">Lota</option>
            <option value="Lumaco">Lumaco</option>
            <option value="Machalí">Machalí</option>
            <option value="Macul">Macul</option>
            <option value="Máfil">Máfil</option>
            <option value="Maipú">Maipú</option>
            <option value="Malloa">Malloa</option>
            <option value="Marchihue">Marchihue</option>
            <option value="María Elena">María Elena</option>
            <option value="María Pinto">María Pinto</option>
            <option value="Mariquina">Mariquina</option>
            <option value="Maule">Maule</option>
            <option value="Maullín">Maullín</option>
            <option value="Mejillones">Mejillones</option>
            <option value="Melipeuco">Melipeuco</option>
            <option value="Melipilla">Melipilla</option>
            <option value="Molina">Molina</option>
            <option value="Monte Patria">Monte Patria</option>
            <option value="Mostazal">Mostazal</option>
            <option value="Mulchén">Mulchén</option>
            <option value="Nacimiento">Nacimiento</option>
            <option value="Nancagua">Nancagua</option>
            <option value="Natales">Natales</option>
            <option value="Navidad">Navidad</option>
            <option value="Negrete">Negrete</option>
            <option value="Ninhue">Ninhue</option>
            <option value="Nogales">Nogales</option>
            <option value="Nueva Imperial">Nueva Imperial</option>
            <option value="Ñiquén">Ñiquén</option>
            <option value="Ñuñoa">Ñuñoa</option>
            <option value="O'Higgins">O'Higgins</option>
            <option value="Olivar">Olivar</option>
            <option value="Ollagüe">Ollagüe</option>
            <option value="Olmué">Olmué</option>
            <option value="Osorno">Osorno</option>
            <option value="Ovalle">Ovalle</option>
            <option value="Padre Hurtado">Padre Hurtado</option>
            <option value="Padre Las Casas">Padre Las Casas</option>
            <option value="Paihuano">Paihuano</option>
            <option value="Paillaco">Paillaco</option>
            <option value="Paine">Paine</option>
            <option value="Palena">Palena</option>
            <option value="Palmilla">Palmilla</option>
            <option value="Panguipulli">Panguipulli</option>
            <option value="Panquehue">Panquehue</option>
            <option value="Papudo">Papudo</option>
            <option value="Paredones">Paredones</option>
            <option value="Parral">Parral</option>
            <option value="Pedro Aguirre Cerda">Pedro Aguirre Cerda</option>
            <option value="Pelarco">Pelarco</option>
            <option value="Pelluhue">Pelluhue</option>
            <option value="Pemuco">Pemuco</option>
            <option value="Pencahue">Pencahue</option>
            <option value="Penco">Penco</option>
            <option value="Peñaflor">Peñaflor</option>
            <option value="Peñalolén">Peñalolén</option>
            <option value="Peralillo">Peralillo</option>
            <option value="Perquenco">Perquenco</option>
            <option value="Petorca">Petorca</option>
            <option value="Peumo">Peumo</option>
            <option value="Pica">Pica</option>
            <option value="Pichidegua">Pichidegua</option>
            <option value="Pichilemu">Pichilemu</option>
            <option value="Pinto">Pinto</option>
            <option value="Pirque">Pirque</option>
            <option value="Pitrufquén">Pitrufquén</option>
            <option value="Placilla">Placilla</option>
            <option value="Portezuelo">Portezuelo</option>
            <option value="Porvenir">Porvenir</option>
            <option value="Pozo Almonte">Pozo Almonte</option>
            <option value="Primavera">Primavera</option>
            <option value="Providencia">Providencia</option>
            <option value="Puchuncaví">Puchuncaví</option>
            <option value="Pucón">Pucón</option>
            <option value="Pudahuel">Pudahuel</option>
            <option value="Puente Alto">Puente Alto</option>
            <option value="Puerto Montt">Puerto Montt</option>
            <option value="Puerto Octay">Puerto Octay</option>
            <option value="Puerto Varas">Puerto Varas</option>
            <option value="Pumanque">Pumanque</option>
            <option value="Punitaqui">Punitaqui</option>
            <option value="Punta Arenas">Punta Arenas</option>
            <option value="Puqueldón">Puqueldón</option>
            <option value="Purén">Purén</option>
            <option value="Purranque">Purranque</option>
            <option value="Putaendo">Putaendo</option>
            <option value="Putre">Putre</option>
            <option value="Puyehue">Puyehue</option>
            <option value="Queilén">Queilén</option>
            <option value="Quellón">Quellón</option>
            <option value="Quemchi">Quemchi</option>
            <option value="Quilaco">Quilaco</option>
            <option value="Quilicura">Quilicura</option>
            <option value="Quilleco">Quilleco</option>
            <option value="Quillón">Quillón</option>
            <option value="Quillota">Quillota</option>
            <option value="Quilpué">Quilpué</option>
            <option value="Quinchao">Quinchao</option>
            <option value="Quinta de Tilcoco">Quinta de Tilcoco</option>
            <option value="Quinta Normal">Quinta Normal</option>
            <option value="Quintero">Quintero</option>
            <option value="Quirihue">Quirihue</option>
            <option value="Rancagua">Rancagua</option>
            <option value="Ránquil">Ránquil</option>
            <option value="Rauco">Rauco</option>
            <option value="Recoleta">Recoleta</option>
            <option value="Renaico">Renaico</option>
            <option value="Renca">Renca</option>
            <option value="Rengo">Rengo</option>
            <option value="Requinoa">Requinoa</option>
            <option value="Retiro">Retiro</option>
            <option value="Rinconada">Rinconada</option>
            <option value="Río Bueno">Río Bueno</option>
            <option value="Río Claro">Río Claro</option>
            <option value="Río Hurtado">Río Hurtado</option>
            <option value="Río Ibáñez">Río Ibáñez</option>
            <option value="Río Negro">Río Negro</option>
            <option value="Río Verde">Río Verde</option>
            <option value="Romeral">Romeral</option>
            <option value="Saavedra">Saavedra</option>
            <option value="Sagrada Familia">Sagrada Familia</option>
            <option value="Salamanca">Salamanca</option>
            <option value="San Antonio">San Antonio</option>
            <option value="San Bernardo">San Bernardo</option>
            <option value="San Carlos">San Carlos</option>
            <option value="San Clemente">San Clemente</option>
            <option value="San Esteban">San Esteban</option>
            <option value="San Fabián">San Fabián</option>
            <option value="San Felipe">San Felipe</option>
            <option value="San Fernando">San Fernando</option>
            <option value="San Gregorio">San Gregorio</option>
            <option value="San Ignacio">San Ignacio</option>
            <option value="San Javier">San Javier</option>
            <option value="San Joaquín">San Joaquín</option>
            <option value="San José de Maipo">San José de Maipo</option>
            <option value="San Juan de la Costa">San Juan de la Costa</option>
            <option value="San Miguel">San Miguel</option>
            <option value="San Nicolás">San Nicolás</option>
            <option value="San Pablo">San Pablo</option>
            <option value="San Pedro">San Pedro</option>
            <option value="San Pedro de Atacama">San Pedro de Atacama</option>
            <option value="San Pedro de la Paz">San Pedro de la Paz</option>
            <option value="San Rafael">San Rafael</option>
            <option value="San Ramón">San Ramón</option>
            <option value="San Rosendo">San Rosendo</option>
            <option value="San Vicente">San Vicente</option>
            <option value="Santa Bárbara">Santa Bárbara</option>
            <option value="Santa Cruz">Santa Cruz</option>
            <option value="Santa Juana">Santa Juana</option>
            <option value="Santa María">Santa María</option>
            <option value="Santiago">Santiago</option>
            <option value="Santo Domingo">Santo Domingo</option>
            <option value="Sierra Gorda">Sierra Gorda</option>
            <option value="Talagante">Talagante</option>
            <option value="Talca">Talca</option>
            <option value="Talcahuano">Talcahuano</option>
            <option value="Taltal">Taltal</option>
            <option value="Temuco">Temuco</option>
            <option value="Teno">Teno</option>
            <option value="Teodoro Schmidt">Teodoro Schmidt</option>
            <option value="Tierra Amarilla">Tierra Amarilla</option>
            <option value="Tiltil">Tiltil</option>
            <option value="Timaukel">Timaukel</option>
            <option value="Tirúa">Tirúa</option>
            <option value="Tocopilla">Tocopilla</option>
            <option value="Toltén">Toltén</option>
            <option value="Tomé">Tomé</option>
            <option value="Torres del Paine">Torres del Paine</option>
            <option value="Tortel">Tortel</option>
            <option value="Traiguén">Traiguén</option>
            <option value="Treguaco">Treguaco</option>
            <option value="Tucapel">Tucapel</option>
            <option value="Valdivia">Valdivia</option>
            <option value="Vallenar">Vallenar</option>
            <option value="Valparaíso">Valparaíso</option>
            <option value="Vichuquén">Vichuquén</option>
            <option value="Victoria">Victoria</option>
            <option value="Vicuña">Vicuña</option>
            <option value="Vilcún">Vilcún</option>
            <option value="Villa Alegre">Villa Alegre</option>
            <option value="Villa Alemana">Villa Alemana</option>
            <option value="Villarrica">Villarrica</option>
            <option value="Viña del Mar">Viña del Mar</option>
            <option value="Vitacura">Vitacura</option>
            <option value="Yerbas Buenas">Yerbas Buenas</option>
            <option value="Yumbel">Yumbel</option>
            <option value="Yungay">Yungay</option>
            <option value="Zapallar">Zapallar</option>
        </select>
        <label style="display:none;" for="ingreso">Ingreso</label>
        <select id="ingreso" name="ingreso" required>
          <option value="">¿Cuál es tu ingreso mensual líquido?</option>
            <option value="Menos de $500.000">Menos de $500.000</option>
            <option value="$500.000 a $800.000">$500.000 a $800.000</option>
            <option value="$800.000 a $1.100.000">$800.000 a $1.100.000</option>
            <option value="$1.100.000 a $1.300.000">$1.100.000 a $1.300.000</option>
            <option value="$1.300.000 a $1.600.000">$1.300.000 a $1.600.000</option>
            <option value="$1.600.000 o más">$1.600.000 o más</option>
        </select>
        <label for="codeudor">¿Tienes codeudor?</label>
        <input type="radio" id="radiosi" name="codeudor" value="si" required> SI
        <input type="radio" id="radiono" name="codeudor" value="no" required> NO
        <label style="display:none;" for="rsh">RSH</label>
        <select id="rsh" name="rsh" required>
          <option value="">¿Tienes Registro Social de Hogares?</option>
            <option value="si">SI</option>
            <option value="no">NO</option>
        </select>
        <label style="display:none;" for="mensaje">Mensaje</label>
        <textarea id="mensaje" name="mensaje" placeholder="¿Cómo podemos ayudarte?" style="height:200px" required></textarea>
        <input type="checkbox" id="politicas" name="politicas" value="aceptar" required>
        <label for="politicas">Acepto los Términos de <a href="" target="_blank" rel="noopener">Políticas de Privacidad</a></label>
     <button id="submitButton" onclick="formrut()" disabled="disabled">Enviar</button>
  </form>
  </body>  
</html>
<!DOCTYPE html>
<html lang="es">  
  <head>  
    <title></title>    
    <meta charset="UTF-8">
    <meta name="title" content="">
    <meta name="description" content="">    
    <link href=" " rel="stylesheet" type="text/css"/>  
    <style>
/* Style inputs, select elements and textareas */
input[type=text], input[type=email], input[type=tel], select, radio, textarea, checkbox{
  width: 100%;
  padding: 12px;
  border: 1px solid #ccc;
  border-radius: 4px;
  box-sizing: border-box;
  resize: vertical;
  background-color: #ffffff;
  font-family: 'Roboto';
  font-size: 14px;
}
label {font-family: 'Roboto'; font-size: 14px;}
input[type=radio] {
    margin-left: 20px;
}
/* Style the label to display next to the inputs */
label {
  padding: 12px 12px 12px 12px;
  display: inline-block;
}
/* Style the submit button */
input[type=submit] .button#submitButton.btn.btn-primary{
  background-color: #002457;
  color: white;
  padding: 12px 20px;
  border: none;
  border-radius: 4px;
  cursor: pointer;
  float: left;
}
input[type=submit]:hover {
  background-color: #CB4F19;
}
/* Style the container */
.container {
  border-radius: 5px;
  background-color: #f2f2f2;
  padding: 20px;
  width: 800px;
  margin: auto;
}
/* Floating column for labels: 50% width */
.col-6 {
  float: left;
  width: 50%;
  margin-top: 6px;
  font-family: 'Roboto';
  font-size: 14px;
}
/* Floating column for inputs: 100% width */
.col-12 {
  float: left;
  width: 100%;
  margin-top: 6px;
  font-family: 'Roboto';
  font-size: 14px;
}
/* Clear floats after the columns */
.row:after {
  content: "";
  display: table;
  clear: both;
}
/* Responsive layout - when the screen is less than 600px wide, make the two columns stack on top of each other instead of next to each other */
@media screen and (max-width: 600px) {
  .col-6, .col-12, input[type=submit] {
    width: 100%;
    margin-top: 6px;
  }
  .container {
  width: 300px;
  margin: auto;
  height: 900px;
}
}
</style> 
<?php
$utm_source = $_GET['utm_source'];
$utm_medium = $_GET['utm_medium'];
$utm_campaign = $_GET['utm_campaign'];
$utm_term = $_GET['utm_term'];
$utm_content = $_GET['utm_content'];
?>  
  </head> 
  <body>
  <form id="formrut" method="post" >
  This is a success alert—check it out!
 <input class = "form-control" style="width:25%;" type="hidden" id="medios" value="prueba medio">
    <input class = "form-control" style="width:25%;" type="hidden" id="otros" value="prueba otro">
      <input class = "form-control" style="width:25%;" type="hidden" id="proyecto" value="las pataguas">
        <label style="display:none;" for="nombre">Nombre</label>
        <input type="text" id="nombre" name="nombre" required placeholder="Nombre">
        <label style="display:none;" for="apellido">Apellido</label>
        <input type="text" id="apellido" name="apellido" required placeholder="Apellido">
        <label style="display:none;" for="correo">Correo electrónico</label>
        <input type="email" id="correo" name="correo" pattern="[a-zA-Z0-9_]+([.][a-zA-Z0-9_]+)*@[a-zA-Z0-9_]+([.][a-zA-Z0-9_]+)*[.][a-zA-Z]{1,5}" required placeholder="Correo electrónico">
        <label style="display:none;" for="telefono">Telefono</label>
        <input type="tel" id="telefono" name="telefono" pattern="[0-9]{9}" required placeholder="Teléfono (formato 9XXXXXXXX)">
        <label style="display:none;" for="rut">Rut</label>
        <input type="text"  id="rut" name="rut" required oninput="checkRut(this)" placeholder="Ingrese RUT">
        <label for="comuna">Comuna</label>
        <select id="comuna" name="comuna" required >
          <option value="">Elige tu Comuna</option>
            <option value="Algarrobo">Algarrobo</option>
            <option value="Alhué">Alhué</option>
            <option value="Alto Biobío">Alto Biobío</option>
            <option value="Alto del Carmen">Alto del Carmen</option>
            <option value="Alto Hospicio">Alto Hospicio</option>
            <option value="Ancud">Ancud</option>
            <option value="Andacollo">Andacollo</option>
            <option value="Angol">Angol</option>
            <option value="Antártica">Antártica</option>
            <option value="Antofagasta">Antofagasta</option>
            <option value="Antuco">Antuco</option>
            <option value="Arauco">Arauco</option>
            <option value="Arica">Arica</option>
            <option value="Aysén">Aysén</option>
            <option value="Buin">Buin</option>
            <option value="Bulnes">Bulnes</option>
            <option value="Cabildo">Cabildo</option>
            <option value="Cabo de Hornos">Cabo de Hornos</option>
            <option value="Cabrero">Cabrero</option>
            <option value="Calama">Calama</option>
            <option value="Calbuco">Calbuco</option>
            <option value="Caldera">Caldera</option>
            <option value="Calera de Tango">Calera de Tango</option>
            <option value="Calle Larga">Calle Larga</option>
            <option value="Camarones">Camarones</option>
            <option value="Camiña">Camiña</option>
            <option value="Canela">Canela</option>
            <option value="Cañete">Cañete</option>
            <option value="Carahue">Carahue</option>
            <option value="Cartagena">Cartagena</option>
            <option value="Casablanca">Casablanca</option>
            <option value="Castro">Castro</option>
            <option value="Catemu">Catemu</option>
            <option value="Cauquenes">Cauquenes</option>
            <option value="Cerrillos">Cerrillos</option>
            <option value="Cerro Navia">Cerro Navia</option>
            <option value="Chaitén">Chaitén</option>
            <option value="Chanco">Chanco</option>
            <option value="Chañaral">Chañaral</option>
            <option value="Chépica">Chépica</option>
            <option value="Chiguayante">Chiguayante</option>
            <option value="Chile Chico">Chile Chico</option>
            <option value="Chillán">Chillán</option>
            <option value="Chillán Viejo">Chillán Viejo</option>
            <option value="Chimbarongo">Chimbarongo</option>
            <option value="Cholchol">Cholchol</option>
            <option value="Chonchi">Chonchi</option>
            <option value="Cisnes">Cisnes</option>
            <option value="Cobquecura">Cobquecura</option>
            <option value="Cochamó">Cochamó</option>
            <option value="Cochrane">Cochrane</option>
            <option value="Codegua">Codegua</option>
            <option value="Coelemu">Coelemu</option>
            <option value="Coihueco">Coihueco</option>
            <option value="Coinco">Coinco</option>
            <option value="Colbún">Colbún</option>
            <option value="Colchane">Colchane</option>
            <option value="Colina">Colina</option>
            <option value="Collipulli">Collipulli</option>
            <option value="Coltauco">Coltauco</option>
            <option value="Combarbalá">Combarbalá</option>
            <option value="Concepción">Concepción</option>
            <option value="Conchalí">Conchalí</option>
            <option value="Concón">Concón</option>
            <option value="Constitución">Constitución</option>
            <option value="Contulmo">Contulmo</option>
            <option value="Copiapó">Copiapó</option>
            <option value="Coquimbo">Coquimbo</option>
            <option value="Coronel">Coronel</option>
            <option value="Corral">Corral</option>
            <option value="Coyhaique">Coyhaique</option>
            <option value="Cunco">Cunco</option>
            <option value="Curacautín">Curacautín</option>
            <option value="Curacaví">Curacaví</option>
            <option value="Curaco de Vélez">Curaco de Vélez</option>
            <option value="Curanilahue">Curanilahue</option>
            <option value="Curarrehue">Curarrehue</option>
            <option value="Curepto">Curepto</option>
            <option value="Curicó">Curicó</option>
            <option value="Dalcahue">Dalcahue</option>
            <option value="Diego de Almagro">Diego de Almagro</option>
            <option value="Doñihue">Doñihue</option>
            <option value="El Bosque">El Bosque</option>
            <option value="El Carmen">El Carmen</option>
            <option value="El Monte">El Monte</option>
            <option value="El Quisco">El Quisco</option>
            <option value="El Tabo">El Tabo</option>
            <option value="Empedrado">Empedrado</option>
            <option value="Ercilla">Ercilla</option>
            <option value="Estación Central">Estación Central</option>
            <option value="Florida">Florida</option>
            <option value="Freire">Freire</option>
            <option value="Freirina">Freirina</option>
            <option value="Fresia">Fresia</option>
            <option value="Frutillar">Frutillar</option>
            <option value="Futaleufú">Futaleufú</option>
            <option value="Futrono">Futrono</option>
            <option value="Galvarino">Galvarino</option>
            <option value="General Lagos">General Lagos</option>
            <option value="Gorbea">Gorbea</option>
            <option value="Graneros">Graneros</option>
            <option value="Guaitecas">Guaitecas</option>
            <option value="Hijuelas">Hijuelas</option>
            <option value="Hualaihué">Hualaihué</option>
            <option value="Hualañe">Hualañe</option>
            <option value="Hualpén">Hualpén</option>
            <option value="Hualqui">Hualqui</option>
            <option value="Huara">Huara</option>
            <option value="Huasco">Huasco</option>
            <option value="Huechuraba">Huechuraba</option>
            <option value="Illapel">Illapel</option>
            <option value="Independencia">Independencia</option>
            <option value="Iquique">Iquique</option>
            <option value="Isla de Maipo">Isla de Maipo</option>
            <option value="Isla de Pascua">Isla de Pascua</option>
            <option value="Juan Fernández">Juan Fernández</option>
            <option value="La Calera">La Calera</option>
            <option value="La Cisterna">La Cisterna</option>
            <option value="La Cruz">La Cruz</option>
            <option value="La Estrella">La Estrella</option>
            <option value="La Florida">La Florida</option>
            <option value="La Granja">La Granja</option>
            <option value="La Higuera">La Higuera</option>
            <option value="La Ligua">La Ligua</option>
            <option value="La Pintana">La Pintana</option>
            <option value="La Reina">La Reina</option>
            <option value="La Serena">La Serena</option>
            <option value="La Unión">La Unión</option>
            <option value="Lago Ranco">Lago Ranco</option>
            <option value="Lago Verde">Lago Verde</option>
            <option value="Laguna Blanca">Laguna Blanca</option>
            <option value="Laja">Laja</option>
            <option value="Lampa">Lampa</option>
            <option value="Lanco">Lanco</option>
            <option value="Las Cabras">Las Cabras</option>
            <option value="Las Condes">Las Condes</option>
            <option value="Lautaro">Lautaro</option>
            <option value="Lebu">Lebu</option>
            <option value="Licantén">Licantén</option>
            <option value="Limache">Limache</option>
            <option value="Linares">Linares</option>
            <option value="Litueche">Litueche</option>
            <option value="Llaillay">Llaillay</option>
            <option value="Llanquihue">Llanquihue</option>
            <option value="Lo Barnechea">Lo Barnechea</option>
            <option value="Lo Espejo">Lo Espejo</option>
            <option value="Lo Prado">Lo Prado</option>
            <option value="Lolol">Lolol</option>
            <option value="Loncoche">Loncoche</option>
            <option value="Longaví">Longaví</option>
            <option value="Lonquimay">Lonquimay</option>
            <option value="Los Álamos">Los Álamos</option>
            <option value="Los Andes">Los Andes</option>
            <option value="Los Ángeles">Los Ángeles</option>
            <option value="Los Lagos">Los Lagos</option>
            <option value="Los Muermos">Los Muermos</option>
            <option value="Los Sauces">Los Sauces</option>
            <option value="Los Vilos">Los Vilos</option>
            <option value="Lota">Lota</option>
            <option value="Lumaco">Lumaco</option>
            <option value="Machalí">Machalí</option>
            <option value="Macul">Macul</option>
            <option value="Máfil">Máfil</option>
            <option value="Maipú">Maipú</option>
            <option value="Malloa">Malloa</option>
            <option value="Marchihue">Marchihue</option>
            <option value="María Elena">María Elena</option>
            <option value="María Pinto">María Pinto</option>
            <option value="Mariquina">Mariquina</option>
            <option value="Maule">Maule</option>
            <option value="Maullín">Maullín</option>
            <option value="Mejillones">Mejillones</option>
            <option value="Melipeuco">Melipeuco</option>
            <option value="Melipilla">Melipilla</option>
            <option value="Molina">Molina</option>
            <option value="Monte Patria">Monte Patria</option>
            <option value="Mostazal">Mostazal</option>
            <option value="Mulchén">Mulchén</option>
            <option value="Nacimiento">Nacimiento</option>
            <option value="Nancagua">Nancagua</option>
            <option value="Natales">Natales</option>
            <option value="Navidad">Navidad</option>
            <option value="Negrete">Negrete</option>
            <option value="Ninhue">Ninhue</option>
            <option value="Nogales">Nogales</option>
            <option value="Nueva Imperial">Nueva Imperial</option>
            <option value="Ñiquén">Ñiquén</option>
            <option value="Ñuñoa">Ñuñoa</option>
            <option value="O'Higgins">O'Higgins</option>
            <option value="Olivar">Olivar</option>
            <option value="Ollagüe">Ollagüe</option>
            <option value="Olmué">Olmué</option>
            <option value="Osorno">Osorno</option>
            <option value="Ovalle">Ovalle</option>
            <option value="Padre Hurtado">Padre Hurtado</option>
            <option value="Padre Las Casas">Padre Las Casas</option>
            <option value="Paihuano">Paihuano</option>
            <option value="Paillaco">Paillaco</option>
            <option value="Paine">Paine</option>
            <option value="Palena">Palena</option>
            <option value="Palmilla">Palmilla</option>
            <option value="Panguipulli">Panguipulli</option>
            <option value="Panquehue">Panquehue</option>
            <option value="Papudo">Papudo</option>
            <option value="Paredones">Paredones</option>
            <option value="Parral">Parral</option>
            <option value="Pedro Aguirre Cerda">Pedro Aguirre Cerda</option>
            <option value="Pelarco">Pelarco</option>
            <option value="Pelluhue">Pelluhue</option>
            <option value="Pemuco">Pemuco</option>
            <option value="Pencahue">Pencahue</option>
            <option value="Penco">Penco</option>
            <option value="Peñaflor">Peñaflor</option>
            <option value="Peñalolén">Peñalolén</option>
            <option value="Peralillo">Peralillo</option>
            <option value="Perquenco">Perquenco</option>
            <option value="Petorca">Petorca</option>
            <option value="Peumo">Peumo</option>
            <option value="Pica">Pica</option>
            <option value="Pichidegua">Pichidegua</option>
            <option value="Pichilemu">Pichilemu</option>
            <option value="Pinto">Pinto</option>
            <option value="Pirque">Pirque</option>
            <option value="Pitrufquén">Pitrufquén</option>
            <option value="Placilla">Placilla</option>
            <option value="Portezuelo">Portezuelo</option>
            <option value="Porvenir">Porvenir</option>
            <option value="Pozo Almonte">Pozo Almonte</option>
            <option value="Primavera">Primavera</option>
            <option value="Providencia">Providencia</option>
            <option value="Puchuncaví">Puchuncaví</option>
            <option value="Pucón">Pucón</option>
            <option value="Pudahuel">Pudahuel</option>
            <option value="Puente Alto">Puente Alto</option>
            <option value="Puerto Montt">Puerto Montt</option>
            <option value="Puerto Octay">Puerto Octay</option>
            <option value="Puerto Varas">Puerto Varas</option>
            <option value="Pumanque">Pumanque</option>
            <option value="Punitaqui">Punitaqui</option>
            <option value="Punta Arenas">Punta Arenas</option>
            <option value="Puqueldón">Puqueldón</option>
            <option value="Purén">Purén</option>
            <option value="Purranque">Purranque</option>
            <option value="Putaendo">Putaendo</option>
            <option value="Putre">Putre</option>
            <option value="Puyehue">Puyehue</option>
            <option value="Queilén">Queilén</option>
            <option value="Quellón">Quellón</option>
            <option value="Quemchi">Quemchi</option>
            <option value="Quilaco">Quilaco</option>
            <option value="Quilicura">Quilicura</option>
            <option value="Quilleco">Quilleco</option>
            <option value="Quillón">Quillón</option>
            <option value="Quillota">Quillota</option>
            <option value="Quilpué">Quilpué</option>
            <option value="Quinchao">Quinchao</option>
            <option value="Quinta de Tilcoco">Quinta de Tilcoco</option>
            <option value="Quinta Normal">Quinta Normal</option>
            <option value="Quintero">Quintero</option>
            <option value="Quirihue">Quirihue</option>
            <option value="Rancagua">Rancagua</option>
            <option value="Ránquil">Ránquil</option>
            <option value="Rauco">Rauco</option>
            <option value="Recoleta">Recoleta</option>
            <option value="Renaico">Renaico</option>
            <option value="Renca">Renca</option>
            <option value="Rengo">Rengo</option>
            <option value="Requinoa">Requinoa</option>
            <option value="Retiro">Retiro</option>
            <option value="Rinconada">Rinconada</option>
            <option value="Río Bueno">Río Bueno</option>
            <option value="Río Claro">Río Claro</option>
            <option value="Río Hurtado">Río Hurtado</option>
            <option value="Río Ibáñez">Río Ibáñez</option>
            <option value="Río Negro">Río Negro</option>
            <option value="Río Verde">Río Verde</option>
            <option value="Romeral">Romeral</option>
            <option value="Saavedra">Saavedra</option>
            <option value="Sagrada Familia">Sagrada Familia</option>
            <option value="Salamanca">Salamanca</option>
            <option value="San Antonio">San Antonio</option>
            <option value="San Bernardo">San Bernardo</option>
            <option value="San Carlos">San Carlos</option>
            <option value="San Clemente">San Clemente</option>
            <option value="San Esteban">San Esteban</option>
            <option value="San Fabián">San Fabián</option>
            <option value="San Felipe">San Felipe</option>
            <option value="San Fernando">San Fernando</option>
            <option value="San Gregorio">San Gregorio</option>
            <option value="San Ignacio">San Ignacio</option>
            <option value="San Javier">San Javier</option>
            <option value="San Joaquín">San Joaquín</option>
            <option value="San José de Maipo">San José de Maipo</option>
            <option value="San Juan de la Costa">San Juan de la Costa</option>
            <option value="San Miguel">San Miguel</option>
            <option value="San Nicolás">San Nicolás</option>
            <option value="San Pablo">San Pablo</option>
            <option value="San Pedro">San Pedro</option>
            <option value="San Pedro de Atacama">San Pedro de Atacama</option>
            <option value="San Pedro de la Paz">San Pedro de la Paz</option>
            <option value="San Rafael">San Rafael</option>
            <option value="San Ramón">San Ramón</option>
            <option value="San Rosendo">San Rosendo</option>
            <option value="San Vicente">San Vicente</option>
            <option value="Santa Bárbara">Santa Bárbara</option>
            <option value="Santa Cruz">Santa Cruz</option>
            <option value="Santa Juana">Santa Juana</option>
            <option value="Santa María">Santa María</option>
            <option value="Santiago">Santiago</option>
            <option value="Santo Domingo">Santo Domingo</option>
            <option value="Sierra Gorda">Sierra Gorda</option>
            <option value="Talagante">Talagante</option>
            <option value="Talca">Talca</option>
            <option value="Talcahuano">Talcahuano</option>
            <option value="Taltal">Taltal</option>
            <option value="Temuco">Temuco</option>
            <option value="Teno">Teno</option>
            <option value="Teodoro Schmidt">Teodoro Schmidt</option>
            <option value="Tierra Amarilla">Tierra Amarilla</option>
            <option value="Tiltil">Tiltil</option>
            <option value="Timaukel">Timaukel</option>
            <option value="Tirúa">Tirúa</option>
            <option value="Tocopilla">Tocopilla</option>
            <option value="Toltén">Toltén</option>
            <option value="Tomé">Tomé</option>
            <option value="Torres del Paine">Torres del Paine</option>
            <option value="Tortel">Tortel</option>
            <option value="Traiguén">Traiguén</option>
            <option value="Treguaco">Treguaco</option>
            <option value="Tucapel">Tucapel</option>
            <option value="Valdivia">Valdivia</option>
            <option value="Vallenar">Vallenar</option>
            <option value="Valparaíso">Valparaíso</option>
            <option value="Vichuquén">Vichuquén</option>
            <option value="Victoria">Victoria</option>
            <option value="Vicuña">Vicuña</option>
            <option value="Vilcún">Vilcún</option>
            <option value="Villa Alegre">Villa Alegre</option>
            <option value="Villa Alemana">Villa Alemana</option>
            <option value="Villarrica">Villarrica</option>
            <option value="Viña del Mar">Viña del Mar</option>
            <option value="Vitacura">Vitacura</option>
            <option value="Yerbas Buenas">Yerbas Buenas</option>
            <option value="Yumbel">Yumbel</option>
            <option value="Yungay">Yungay</option>
            <option value="Zapallar">Zapallar</option>
        </select>
        <label style="display:none;" for="ingreso">Ingreso</label>
        <select id="ingreso" name="ingreso" required>
          <option value="">¿Cuál es tu ingreso mensual líquido?</option>
            <option value="Menos de $500.000">Menos de $500.000</option>
            <option value="$500.000 a $800.000">$500.000 a $800.000</option>
            <option value="$800.000 a $1.100.000">$800.000 a $1.100.000</option>
            <option value="$1.100.000 a $1.300.000">$1.100.000 a $1.300.000</option>
            <option value="$1.300.000 a $1.600.000">$1.300.000 a $1.600.000</option>
            <option value="$1.600.000 o más">$1.600.000 o más</option>
        </select>
        <label for="codeudor">¿Tienes codeudor?</label>
        <input type="radio" id="radiosi" name="codeudor" value="si" required> SI
        <input type="radio" id="radiono" name="codeudor" value="no" required> NO
        <label style="display:none;" for="rsh">RSH</label>
        <select id="rsh" name="rsh" required>
          <option value="">¿Tienes Registro Social de Hogares?</option>
            <option value="si">SI</option>
            <option value="no">NO</option>
        </select>
        <label style="display:none;" for="mensaje">Mensaje</label>
        <textarea id="mensaje" name="mensaje" placeholder="¿Cómo podemos ayudarte?" style="height:200px" required></textarea>
        <input type="checkbox" id="politicas" name="politicas" value="aceptar" required>
        <label for="politicas">Acepto los Términos de <a href="" target="_blank" rel="noopener">Políticas de Privacidad</a></label>
     <button id="submitButton" onclick="formrut()" disabled="disabled">Enviar</button>
  </form>
  </body>  
</html>