[include css('forms.css')];

[html-page set-title("Request A Quote Spanish")];


<div id="product-container">
	<h2>Solicitar Cotraci&#243;n</h2>
	<h3>Customer Information</h3>
	<p>
		Favor de llenar la solicitud anexa para que nuestro representante pueda
		darle la information que necesita
	</p>
	
	<div style='display: [var error-display];' class='error-group'>
		[var error-message];
	</div>
	
	<form method='post' action="" id="contact-form" style='display: [var form-display];'>
		<input type="hidden" name="submitted" value="1">
		<input type="hidden" name="formType" value="quote">
		<input type="hidden" name="language" value="English">
		
		<table>
			<tr class='row'>
				<td class='group'>
					<label for='wholename'>Nombre:</label>
					<input type="text" name='wholename' id='wholename' class='std-field' value="[var name];">
				</td>
				
				<td class='group'>
					<label for='company'>Empresa:</label>
					<input type="text" name='company' id='company' class='std-field' value="[var company];">
				</td>
			</tr>
				
			<tr class='row'>
				<td class='group'>
					<label for='phone'>Tel&#233;fono:</label>
					<input type="text" name='phone' id='phone' class='std-field' value="[var phone];">
				</td>
				
				
				<td class='group'>
					<label for='fax'>Facs&#237;mil:</label>
					<input type="text" name='fax' id='fax' class='std-field' value="[var fax];">
				</td>
				
				<td class='group'>
					<label for='email'>Correo Electronic&#243;:</label>
					<input type="text" name='email' id='email' class='std-field' value="[var fax];">
				</td>
			</tr>
			
			<tr class='row'>
				
				<td class='group'>
					<label for='company'>Sociedad:</label>
					<input type="text" name='company' id='company' class='std-field'>
				</td>
				
				<td class='group'>
					<label for="state">localizaci&#243;n</label>
					<input type="text" name="state" id="state" class="std-field" value="[var state];">
				</td>
				
				
				<td class='group'>
					<label for='zip'>C&#243;digo postal:</label>
					<input type="text" name='zip' id='zip' class='std-field' value="[var zip];">
				</td>
			</tr>
		</table>
		
		<h3>Solicitud de Informaci&#243;n:</h3>
		<table>
			<tr class='row'>
				<td class='group'>
					<label for='manufacturer'>Fabricante:</label>
					<input type="text" name='manufacturer' id='manufacturer' class='std-field' value="[var manufacturer];">
				</td>
				
				<td class='group'>
					<label for='categories'>Categor&#237;a:</label>
					<input type="text" name='categories' id='categories' class='std-field' value="[var categories];">
				</td>
				
				<td class='group'>
					<label for='product'>Producto</label>
					<input type="text" name='product' id='product' class='std-field' value="[var product];">
				</td>
	
			</tr>
			
			<tr class='row'>
				<td colspan="3"class='group'>
					<label for='notes'>Area de Inter&#233;s</label><br/>
					<textarea name="additional-interests" id="notes" rows="5" class="std-field" style="width:521px;">[var additional-interests];</textarea>
				</td>
			</tr>	
							
			<tr class='row'>
				<td  colspan="3" class='group'>
					<label for='notes'>Otra informaci&#243;n solicitada - comentario:</label>
					<textarea name="notes" id="notes" rows="5" class="std-field" style="width:521px;">[var notes];</textarea>
				</td>
			</tr>			
		
		</table>
		<div class="field">
			<INPUT type='image' name="submit" src="/images/contact/submit.gif" title="Submit" alt='submit' class="actionbtn">
			<INPUT type='image' src="/images/contact/reset.gif" title="reset" alt='reset' class='otherbtn'
			onclick='(document.getElementById("contact-form")).reset(); return false;'>
		</div>	
	
	</form>
	<div class="float-catch"></div>
</div>