document.write ( '<div class="post-contact">' );
document.write ( '	<div id="form">' );
document.write ( '		<table border="0" cellpadding="0" cellspacing="0" valign="top">' );
document.write ( '			<tbody><tr>' );
document.write ( '				<td>&nbsp;&nbsp;&nbsp;</td>' );
if (screen.width >= 1250)
	document.write ('<td class="post-intertitrecontact" width="103">' );
else
	document.write ('<td class="post-intertitrecontact" width="63">' );
document.write ( '<b>Contactez</b>&nbsp;<br /><b>nous</b>&nbsp;</td>' );
document.write ( '	<td id="sidebarContact">' );
document.write ( '<ul><li></li><li></li><li></li><li></li><li></li></ul>' );
document.write ( '</td>' );
document.write ( '<td valign="top">' );
document.write ( '<form id="inscrire" action="">' );
document.write ( '<table>' );
document.write ( '<tbody><tr><td></td></tr><tr><td></td></tr><tr><td></td></tr><tr><td></td></tr>' );
document.write ( '<tr>' );
	if(screen.width >= 1250)
	{
		scdebtd = '<td>&nbsp;&nbsp;&nbsp;';
		scfintd = '&nbsp;:</td>';
	}
	else
	{
		scdebtd = '<td>&nbsp;&nbsp;&nbsp;';
		scfintd = '&nbsp;</td>';
	}
document.write ( scdebtd + 'Nom' + scfintd );

document.write ( '<td><input name="nom" style="background: rgb(70, 100, 109) none repeat scroll 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; color: rgb(244, 244, 244);" size="19" type="text"></td>' );

document.write ( scdebtd + 'Entreprise' + scfintd );

document.write ( '<td><input name="compagnie" style="background: rgb(70, 100, 109) none repeat scroll 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; color: rgb(244, 244, 244);" size="19" type="text"></td>' );

document.write ( scdebtd + 'Email' + scfintd );

document.write ( '<td><input name="email" style="background: rgb(70, 100, 109) none repeat scroll 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; color: rgb(244, 244, 244);" size="19" type="text"></td>' );
                     
document.write ( '</tr>' );
document.write ( '<tr>' );

document.write ( scdebtd + 'Pr&eacute;nom' + scfintd );

document.write ( '<td><input name="prenom" style="background: rgb(70, 100, 109) none repeat scroll 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; color: rgb(244, 244, 244);" size="19" type="text"></td>' );

document.write ( scdebtd + 'T&eacute;l&eacute;phone' + scfintd );

document.write ( '<td><input name="tel" style="background: rgb(70, 100, 109) none repeat scroll 0%; -moz-background-clip: -moz-initial; -moz-background-origin: -moz-initial; -moz-background-inline-policy: -moz-initial; color: rgb(244, 244, 244);" size="19" type="text"></td>' );

document.write ( '<td>' );
document.write ( '<input name="modele" value="ucatchit_referencement_contact_ok.php" type="hidden">' );
document.write ( '<input name="tag_uci" value="" type="hidden">' );
document.write ( '</td>' );
document.write ( '<td colspan="3" align="right"><a href="javascript:verifieform()"><img src="/ucatchit_referencement_images/suite.gif" alt="Suite"></a></td>' );
document.write ( '</tr>' );
document.write ( '</tbody></table></form></td></tr></tbody></table>' );

document.write ( '</div>' );
document.write ( '</div>' );