crm

    <meta http-equiv="Content-Type" content="text/html;charset=UTF-8">
    <form id="__vtigerWebForm" name="CRMform1" action="https://sogesti.fr/gestionclient/modules/Webforms/capture.php" method="post" accept-charset="utf-8" enctype="multipart/form-data"><input name="__vtrftk" value="sid:dd54049309ef51e94990fb1b92f345d01fbd004e,1514819166" type="hidden">
        <input name="publicid" value="5c53db61264a92bf4237bbde2b0c650a" type="hidden">
        <input name="urlencodeenable" value="1" type="hidden">
        <input name="name" value="CRMform1" type="hidden">
                    <table>
                                                                                                                <tbody><tr>
                    <td><label>Nom*</label></td>                        <td>
                                                                                                                                                                            <input name="lastname" data-label="" value="" required="" type="text">                                                    </td></tr>
                                                                                                                    <tr>
                    <td><label>Société</label></td>                        <td>
                                                                                                                                                                            <input name="company" data-label="" value="" type="text">                                                    </td></tr>
                                                                                                                    <tr>
                    <td><label>Mobile</label></td>                        <td>
                                                                                                                                                                            <input name="mobile" data-label="" value="" type="text">                                                    </td></tr>
                                                                                                                    <tr>
                    <td><label>Téléphone*</label></td>                        <td>
                                                                                                                                                                            <input name="phone" data-label="" value="" required="" type="text">                                                    </td></tr>
                                                                                                                    <tr>
                    <td><label>Email*</label></td>                        <td>
                                                                                                                                                                            <input name="email" data-label="" value="" required="" type="email">                                                    </td></tr>
                                                                                                                    <tr>
                    <td><label>Secteur</label></td>                        <td>
                                                                                                                                                                                                                                                                                                                                                                                                                <select name="industry" data-label="industry">
                                <option value="">Choisir valeur</option>
                                                                        <option value="Apparel">Habillement</option>
                                                                        <option value="Banking">Banque</option>
                                                                        <option value="Biotechnology">Biotechnologie</option>
                                                                        <option value="Chemicals">Chimie</option>
                                                                        <option value="Communications">Communications</option>
                                                                        <option value="Construction">BTP</option>
                                                                        <option value="Consulting">Consulting</option>
                                                                        <option value="Education">Education</option>
                                                                        <option value="Electronics">Electronique</option>
                                                                        <option value="Energy">Energie</option>
                                                                        <option value="Engineering">Ingénierie</option>
                                                                        <option value="Entertainment">Divertissement</option>
                                                                        <option value="Environmental">Environnement</option>
                                                                        <option value="Finance">Finance</option>
                                                                        <option value="Food &amp; Beverage">Agro-alimentaire</option>
                                                                        <option value="Government">Secteur public</option>
                                                                        <option value="Healthcare">Santé</option>
                                                                        <option value="Hospitality">Hôpitaux</option>
                                                                        <option value="Insurance">Assurances</option>
                                                                        <option value="Machinery">Construction mécanique</option>
                                                                        <option value="Manufacturing">Fabrication</option>
                                                                        <option value="Media">Médias</option>
                                                                        <option value="Not For Profit">Associatif</option>
                                                                        <option value="Recreation">Récréatif</option>
                                                                        <option value="Retail">Détaillant</option>
                                                                        <option value="Shipping">Livreur</option>
                                                                        <option value="Technology">Technologie</option>
                                                                        <option value="Telecommunications">Télécommunications</option>
                                                                        <option value="Transportation">Transport</option>
                                                                        <option value="Utilities">Utilitaire</option>
                                                                        <option value="Other">Autre</option>
                                                                </select>
                                                </td></tr>
                                                                                                                    <tr>
                    <td><label>Pays*</label></td>                        <td>
                                                                                                                                                                            <input name="country" data-label="" value="" required="" type="text">                                                    </td></tr>
                                                                                                                    <tr>
                    <td><label>Description*</label></td>                        <td>
                                                                                        <textarea name="description" required=""></textarea>
                                                                                                        </td></tr>
                                                                                                                    <tr>
                    <td><label>Source du prospect</label></td>                        <td>
                                                                                                                                                                                                                                                                                                                                                                                                                <select name="leadsource" data-label="leadsource">
                                <option value="">Choisir valeur</option>
                                                                        <option value="Cold Call">Appel direct</option>
                                                                        <option value="Existing Customer">Client existant</option>
                                                                        <option value="Self Generated">Auto généré</option>
                                                                        <option value="Employee">Employée</option>
                                                                        <option value="Partner">Partenaire</option>
                                                                        <option value="Public Relations">Relation publique</option>
                                                                        <option value="Direct Mail">Email direct</option>
                                                                        <option value="Conference">Conférence</option>
                                                                        <option value="Trade Show">Salon</option>
                                                                        <option value="Web Site">Site Web</option>
                                                                        <option value="Word of mouth">Bouche à oreille</option>
                                                                        <option value="Other">Autre</option>
                                                                </select>
                                                </td></tr>
                            </tbody></table>
                        <noscript><iframe src="http://www.google.com/recaptcha/api/noscript?k=6Lchg-wSAAAAAIkV51_LSksz6fFdD2vgy59jwa38"height="300" width="500" frameborder="0"></iframe><br><textarea name="recaptcha_challenge_field" rows="3" cols="40"></textarea><input type="hidden" name="recaptcha_response_field" value="manual_challenge"></noscript>
            <input id="captchaUrl" value="https://sogesti.fr/gestionclient/modules/Settings/Webforms/actions/CheckCaptcha.php" type="hidden">
            <input id="recaptcha_validation_value" type="hidden">
                    <input value="Submit" type="submit">
    </form>