<script language="javascript" src="cadre.js"></SCRIPT>
<SCRIPT Language="javascript" Src="verifEtude.js"></SCRIPT>

<head>

<link href="index.css" rel=stylesheet type="text/css">
<form method="post" name=form action="recup.asp" OnSubmit="return verif();">
<input type=hidden name="TypeContact" value="etude">

</head>


<table>
<tr><td class="titre" width="100%">Bezpłatne studium</td></tr>
<tr><td class="debutpage">Żeby lepiej poznać Waszych klientów,
proponujemy Wam bezpłatną analizę. Prosimy o odpowiedź na następujące pytania :
</td></tr></table>
<table border="0">
<tr>
<td>
<table border="0">
  <tbody>
    <tr>
      <td width="351">
        <table class="ligne" border="0" height="141" width="344">
          <tbody>
            <tr>
              <td width="109" height="25">Spółka :</td>
              <td width="221" height="25"><input maxLength="50" name="societe" size="25"></td>
            </tr>
            <tr>
              <td width="109" height="25">Nazwisko, imię : <font color="#ff0000">*</font></td>
              <td width="221" height="25"><input maxLength="100" name="contact" size="25"></td>
            </tr>
            <tr>
              <td width="109" height="25">Telefon : <font color="#ff0000">*</font></td>
              <td width="221" height="25"><input maxLength="50" name="telephone" size="25"></td>
            </tr>
            <tr>
              <td width="109" height="25" class="ligne">Kra : <font color="#ff0000">*</font>&nbsp;</td>
              <td width="221" height="25" class="ligne">
	<select name="pays">
          <OPTION>ACORES  
          <OPTION>AFRIQUE DU SUD  
          <OPTION>ALASKA  
          <OPTION>ALBANIE  
          <OPTION>ALGERIE  
          <OPTION>ALLEMAGNE  
          <OPTION>ANDORRE  
          <OPTION>ANGOLA  
          <OPTION>ANGUILLA  
          <OPTION>ANTIGUA ET BARBUDA  
          <OPTION>ANTILLES NEERLANDAISES  
          <OPTION>ARABIE SAOUDITE  
          <OPTION>ARGENTINE  
          <OPTION>ARMENIE  
          <OPTION>ARUBA  
          <OPTION>ASCENSION  
          <OPTION>AUSTRALIE  
          <OPTION>AUTRICHE  
          <OPTION>AZERBAIDJAN  
          <OPTION>BAHAMAS  
          <OPTION>BAHREIN  
          <OPTION>BANGLADESH  
          <OPTION>BARBADE  
          <OPTION>BELARUS  
          <OPTION>BELGIQUE  
          <OPTION>BELIZE  
          <OPTION>BENIN  
          <OPTION>BERMUDES  
          <OPTION>BHOUTAN  
          <OPTION>BOLIVIE  
          <OPTION>BOSNIE-HERZEGOVINE  
          <OPTION>BOTSWANA  
          <OPTION>BRESIL  
          <OPTION>BRUNEI  
          <OPTION>BULGARIE  
          <OPTION>BURKINA FASO  
          <OPTION>BURUNDI  
          <OPTION>CAMBODGE  
          <OPTION>CAMEROUN  
          <OPTION>CANADA  
          <OPTION>CAP-VERT  
          <OPTION>CAYMAN (Iles)  
          <OPTION>CENTRAFRICAINE (Rep.)  
          <OPTION>CHILI  
          <OPTION>CHINE  
          <OPTION>CHYPRE  
          <OPTION>COLOMBIE  
          <OPTION>COMORES  
          <OPTION>CONGO  
          <OPTION>CONGO ZAIRE (Rep. Dem.)  
          <OPTION>COOK (Iles)  
          <OPTION>COREE (Rep. de)  
          <OPTION>COREE (Rep. Dem. Pop.)  
          <OPTION>COSTA RICA  
          <OPTION>COTE D'IVOIRE  
          <OPTION>CROATIE  
          <OPTION>CUBA  
          <OPTION>DANEMARK  
          <OPTION>DJIBOUTI  
          <OPTION>DOMINICAINE (Rep.)  
          <OPTION>DOMINIQUE  
          <OPTION>EGYPTE  
          <OPTION>EL SALVADOR  
          <OPTION>EMIRATS ARABES UNIS  
          <OPTION>EQUATEUR  
          <OPTION>ERYTHREE  
          <OPTION>ESPAGNE  
          <OPTION>ESTONIE  
          <OPTION>ETATS-UNIS (Sauf Alaska et Hawaii)  
          <OPTION>ETHIOPIE  
          <OPTION>FALKLAND (Iles)  
          <OPTION>FEROE (Iles)  
          <OPTION>FIDJI  
          <OPTION>FINLANDE  
          <OPTION>FRANCE  
          <OPTION>GABON  
          <OPTION>GAMBIE  
          <OPTION>GEORGIE  
          <OPTION>GHANA  
          <OPTION>GIBRALTAR  
          <OPTION>GRECE  
          <OPTION>GRENADE  
          <OPTION>GROENLAND  
          <OPTION>GUAM  
          <OPTION>GUATEMALA  
          <OPTION>GUINEE  
          <OPTION>GUINEE EQUATORIALE  
          <OPTION>GUINEE-BISSAU  
          <OPTION>GUYANA  
          <OPTION>HAITI  
          <OPTION>HAWAII  
          <OPTION>HONDURAS  
          <OPTION>HONGKONG  
          <OPTION>HONGRIE  
          <OPTION>INDE  
          <OPTION>INDONESIE  
          <OPTION>IRAK  
          <OPTION>IRAN (Rep. Isl.)  
          <OPTION>IRLANDE  
          <OPTION>ISLANDE  
          <OPTION>ISRAEL  
          <OPTION>ITALIE  
          <OPTION>JAMAIQUE  
          <OPTION>JAPON  
          <OPTION>JERSEY (Ile)  
          <OPTION>JORDANIE  
          <OPTION>KAZAKHSTAN  
          <OPTION>KENYA  
          <OPTION>KIRGHIZISTAN  
          <OPTION>KIRIBATI  
          <OPTION>KOWEIT  
          <OPTION>LAOS (Rep. dem. Pop. du)  
          <OPTION>LESOTHO  
          <OPTION>LETTONIE  
          <OPTION>LIBAN  
          <OPTION>LIBERIA  
          <OPTION>LIBYE  
          <OPTION>LIECHTENSTEIN  
          <OPTION>LITUANIE  
          <OPTION>LUXEMBOURG  
          <OPTION>MACAO  
          <OPTION>MACEDOINE  
          <OPTION>MADAGASCAR  
          <OPTION>MADERE  
          <OPTION>MALAISIE  
          <OPTION>MALAWI  
          <OPTION>MALDIVES  
          <OPTION>MALI  
          <OPTION>MALTE  
          <OPTION>MARIANNES (Iles)  
          <OPTION>MAROC  
          <OPTION>MARSHALL (Iles)  
          <OPTION>MAURICE  
          <OPTION>MAURITANIE  
          <OPTION>MEXIQUE  
          <OPTION>MOLDOVA  
          <OPTION>MONACO  
          <OPTION>MONGOLIE  
          <OPTION>MONTSERRAT  
          <OPTION>MOZAMBIQUE  
          <OPTION>MYANMAR  
          <OPTION>NAMIBIE  
          <OPTION>NAURU  
          <OPTION>NEPAL  
          <OPTION>NICARAGUA  
          <OPTION>NIGER  
          <OPTION>NIGERIA  
          <OPTION>NIUE  
          <OPTION>NORKOLK (Ile)  
          <OPTION>NORVEGE  
          <OPTION>NOUVELLE ZELANDE  
          <OPTION>OMAN  
          <OPTION>OUGANDA  
          <OPTION>OUZBESKISTAN  
          <OPTION>PAKISTAN  
          <OPTION>PALAU  
          <OPTION>PALESTINE  
          <OPTION>PANAMA  
          <OPTION>PAPOUASIE-NOUVELLE-GUINEE  
          <OPTION>PARAGUAY  
          <OPTION>PAYS BAS  
          <OPTION>PEROU  
          <OPTION>PHILIPPINES  
          <OPTION SELECTED>POLOGNE  
          <OPTION>PORTUGAL  
          <OPTION>PUERTO-RICO  
          <OPTION>QATAR  
          <OPTION>ROUMANIE  
          <OPTION>ROYAUME-UNI  
          <OPTION>RUSSIE  
          <OPTION>RWANDA  
          <OPTION>SAINTE-HELENE  
          <OPTION>SAINTE-LUCIE  
          <OPTION>SAINT-KITTS-ET-NEVIS  
          <OPTION>SAINT-MARIN  
          <OPTION>SAINT-VINCENT-ET-GRENADINES  
          <OPTION>SALOMON  
          <OPTION>SAMOA AMERICAINES  
          <OPTION>SAMOA-OCCIDENTAL  
          <OPTION>SAO TOME-ET-PRINCIPE  
          <OPTION>SENEGAL  
          <OPTION>SEYCHELLES  
          <OPTION>SIERRA LEONE  
          <OPTION>SINGAPOUR  
          <OPTION>SLOVAQUE (Rep.)  
          <OPTION>SLOVENIE  
          <OPTION>SOMALIE  
          <OPTION>SOUDAN  
          <OPTION>SRI LANKA  
          <OPTION>SUEDE  
          <OPTION>SUISSE  
          <OPTION>SURINAM  
          <OPTION>SWAZILAND  
          <OPTION>SYRIE  
          <OPTION>TADJIKISTAN (Rep. du)  
          <OPTION>TAIWAN  
          <OPTION>TANZANIE  
          <OPTION>TCHAD  
          <OPTION>TCHEQUE (Rep.)  
          <OPTION>THAILANDE  
          <OPTION>TIMOR ORIENTAL  
          <OPTION>TOGO  
          <OPTION>TONGA  
          <OPTION>TRINITE-ET-TOBAGO  
          <OPTION>TUNISIE  
          <OPTION>TURKMENISTAN  
          <OPTION>TURKS ET CAICOS (Iles)  
          <OPTION>TURQUIE  
          <OPTION>TUVALU  
          <OPTION>UKRAINE  
          <OPTION>URUGUAY  
          <OPTION>VANUATU  
          <OPTION>VENEZUELA  
          <OPTION>VIERGES AMERICAINES (Iles)  
          <OPTION>VIERGES BRITANIQUES (Iles)  
          <OPTION>VIET NAM  
          <OPTION>YEMEN (Rep.)  
          <OPTION>YOUGOSLAVIE (Rep. fed. de)  
          <OPTION>ZAMBIE  
          <OPTION>ZIMBABWE  
		</select>

		</td>
            </tr>
            <tr>
              <td width="109" height="21">E-mail : </td>
              <td width="221" height="21"><input maxLength="50" name="email" size="25"></td>
            </tr>
            <tr>
              <td width="109" height="25">NIP : <font color="#ff0000">*</font></td>
              <td width="221" height="25"><input maxLength="35" name="siret" size="25"></td>
            </tr>
            <tr>
              <td width="109" height="25">REGON : </td>
              <td width="221" height="25"><input maxLength="35" name="regon" size="25"></td>
            </tr>
          </tbody>
        </table>
      </td>
    </tr>
  </tbody>
</table>
&nbsp;
<table class="ligne" border=0 width="353">
  <tr>
    <td colspan="3">
      <p align="center"><b>Lista pięciu klientów w Polsce i /albo zagranicą</b>
    </td>
  </tr>
  <tr>
    <td><p align="center"><strong>Spółka klienta</strong></p></td>
    <td><p align="center"><b>NIP</b></p></td>
    <td><p align="center"><b>REGON</b></p></td>
    <td><p align="center"><b>Należności nieuregulowane (€)</b></p></td>
  </tr>
  <tr>
    <td><p align="center">n°1 <input maxLength="40" name="nomclient1" size="20"></p></td>
    <td valign=bottom align="center"><input maxLength="14" name="siren1" size="12"></td>
    <td valign=bottom align="center"><input maxLength="14" name="regon1" size="12"></td>
    <td valign=bottom align="center"><input maxLength="12" name="encours1" size="8"></td>
  </tr>
  <tr>
    <td>
      <p align="center">n°2 <input maxLength="40" name="nomclient2" size="20"></p>
    </td>
    <td valign=bottom align="center"><input maxLength="14" name="siren2" size="12"></td>
    <td valign=bottom align="center"><input maxLength="14" name="regon2" size="12"></td>
    <td valign=bottom align="center"><input maxLength="12" name="encours2" size="8"></td>
  </tr>
  <tr>
    <td>
      <p align="center">n°3 <input maxLength="40" name="nomclient3" size="20"></p>
    </td>
    <td valign=bottom align="center"><input maxLength="14" name="siren3" size="12"></td>
    <td valign=bottom align="center"><input maxLength="14" name="regon3" size="12"></td>
    <td valign=bottom align="center"><input maxLength="12" name="encours3" size="8"></td>
  </tr>
  <tr>
    <td>
      <p align="center">n°4 <input maxLength="40" name="nomclient4" size="20"></p>
    </td>
    <td valign=bottom align="center"><input maxLength="14" name="siren4" size="12"></td>
    <td valign=bottom align="center"><input maxLength="14" name="regon4" size="12"></td>
    <td valign=bottom align="center"><input maxLength="12" name="encours4" size="8"></td>
  </tr>
  <tr>
    <td>
      <p align="center">n°5 <input maxLength="40" name="nomclient5" size="20"></p>
    </td>
    <td valign=bottom align="center"><input maxLength="14" name="siren5" size="12"></td>
    <td valign=bottom align="center"><input maxLength="14" name="regon5" size="12"></td>
    <td valign=bottom align="center"><input maxLength="12" name="encours5" size="8"></td>
  </tr>
  <tr>
    <td align="middle" colSpan="3" 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>
</font></p>

      </td>
  </tr>
</table>
</form>
<td valign="top" align="left" width="375"><img border="0" src="../Images/fondmenu2.jpg"></td>
</tr>
</table>
<script language="javascript" src="cadreFIn.js"></SCRIPT>