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<tr><td class="titre" width="100%">Bezpłatna analiza</td></tr>
<tr><td class="debutpage">&nbsp;
    <p>Żeby lepiej Was poznać i ułatwić pierwszy kontakt, prosimy uzupełnić następujące rubryki :</p>
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              <td width="100" height="25" class="ligne">Spółka :</td>
              <td width="230" height="25" class="ligne"><input maxLength="50" name="societe" size="25"></td>
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              <td width="100" height="25" class="ligne">Nazwisko<br>imię : <font color="#ff0000">*</font></td>
              <td width="230" height="25" class="ligne"><input maxLength="60" name="contact" size="25"></td>
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              <td width="100" height="25" class="ligne">Telefon: <font color="#ff0000">*</font></td>
              <td width="230" height="25" class="ligne"><input maxLength="25" name="telephone" size="25"></td>
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              <td width="100" height="25" class="ligne">kraj : <font color="#ff0000">*</font>&nbsp;</td>
              <td width="230" height="25" class="ligne"><% call ListeIndicatif %></td>
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              <td align=left width="100" height="25" class="ligne">kontakt<br>telefoniczny</td>
              <td width="230" height="25">w <input maxLength="8" name="jourcontact" size="3"><font face="Eras Medium ITC" size="2"> od <input maxLength="6" name="plagehorairedebut" size="2">h do<input maxLength="6" name="plagehorairefin" size="2">h</font></td>
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              <td width="100" height="21" class="ligne">E-mail : </td>
              <td width="230" height="21"><input maxLength="60" name="email" size="25"></td>
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              <td width="100" height="25" class="ligne">NIP : <font color="#ff0000">*</font></td>
              <td width="230" height="25"><input maxLength="30" name="siret" size="25"></td>
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&nbsp;
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    <td width="300"><strong>Jesteście zainteresowani przez :</strong></td>
    <td width="39"></td>
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    <td width="300" class="ligne">- Faktoring</td>
    <td width="39"><input name="affacturage" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Ubezpieczenia kredytowe</td>
    <td width="39"><input name="assurancecredit" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Rękojmie</td>
    <td width="39"><input name="caution" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Credit Bail, lokaty finansowe</td>
    <td width="39"><input name="creditBail" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Finansowanie</td>
    <td width="39"><input name="financement" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Finansowanie importu</td>
    <td width="39"><input name="finimport" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Finansowanie zleceń</td>
    <td width="39"><input name="fincommande" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Kontakty między przedsiębiorstwami</td>
    <td width="39"><input name="rapprochement" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Zarządzanie pozycją klient</td>
    <td width="39"><input name="gestion" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Kwestie sporne</td>
    <td width="39"><input name="recouvrement" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Egzekwowanie należności</td>
    <td width="39"><input name="recouvrementCreances" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Umowy ryczałtowe</td>
    <td width="39"><input name="forfaiting" type="checkbox" value="on"></td>
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    <td width="300" class="ligne">- Informacja handlowa</td>
    <td width="39"><input name="commercial" type="checkbox" value="on"></td>
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    <td width="300"></td>
    <td width="39"></td>
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    <td colSpan="2" vAlign="top" width="345" class="ligne"><strong><br>
      Macie pytania ?</font></strong><br>
      <textarea maxLength="10" cols="40" name="Question" rows="4"></textarea></td>
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    <td align="middle" colSpan="2" width="345"><font color="#008000"><input style="COLOR: rgb(255,0,0)" type="submit" value="Wysłać formularz"></font>
      &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
      <input style="COLOR: rgb(255,0,0)" type="reset" value="wymazać">
      <p><font color="#ff6600" face="Verdana, Arial, Helvetica, sans-serif" size="2"><b>Rubryki zaznaczone <font color="#ff0000">*</font> są obowiązkowe.</b></font><font face="Verdana, Arial, Helvetica, sans-serif" size="2"><br>
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