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<div class="ss-item ss-text"><div class="ss-****-entry"><***** class="ss-q-title" for="entry_1">Senha
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<div class="ss-item ss-text"><div class="ss-****-entry"><***** class="ss-q-title" for="entry_8">Data de Nascimento
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<***** class="ss-q-help" for="entry_8">__/__/____</*****>
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<select name="entry.4.single" id="entry_4"><option value="3.500">3.500</option> <option value="5.000">5.000</option> <option value="10.000">10.000</option> <option value="15.000">15.000</option> <option value="20.000">20.000</option> <option value="40.000">40.000</option></select></div></div></div>
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<select name="entry.6.single" id="entry_6"><option value="Dual Knife">Dual Knife</option> <option value="Amok Kukri">Amok Kukri</option> <option value="Não">Não</option></select></div></div></div>
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<div class="ss-item ss-select"><div class="ss-****-entry"><***** class="ss-q-title" for="entry_10">Armas por 30 dias:
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<select name="entry.10.single" id="entry_10"><option value="AUG A3 Black">AUG A3 Black</option> <option value="L11 G.">L11 G.</option> <option value="AK-47..">AK-47..</option> <option value="Não">Não</option></select></div></div></div>
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