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    <title>Eureka</title>
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                                <h2>NOUS CONTACTER</h2>
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                                    <div class="col-sm-12">
                                <span>E Santé Technology</span>
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                                <span>542,avenue F.D Roosevelt</span>
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                                <span>62400 Béthune</span>
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                                <span>France</span>
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                                <span>Tél: +33 (0)3 21 56 29 30</span>
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                                <span>Mail: contact@e-santetechnology.com</span>
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                             <form name="apibundle_contact" method="post" id="myeureka_form_contact" class="form-horizontal form-horizontal" enctype="multipart/form-data">


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                                    <input type="text" id="apibundle_contact_contactName" name="apibundle_contact[contactName]" placeholder="Nom et Prénom :" class="form-control" />
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                                    <input type="text" id="apibundle_contact_contactNameEtb" name="apibundle_contact[contactNameEtb]" placeholder="Nom établissement / Société" class="form-control" />
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                            <div class="form-group form-md-line-input">
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                                    <input type="text" id="apibundle_contact_contactCodePostal" name="apibundle_contact[contactCodePostal]" required="required" placeholder="Code postal" minlength="2" maxlength="11" class="form-control" />
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                            <div class="form-group form-md-line-input">
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                                    <input type="text" id="apibundle_contact_contactVille" name="apibundle_contact[contactVille]" placeholder="Ville" class="form-control" />
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                            <div class="form-group form-md-line-input">
                                <div class="col-md-8">
                                    <input type="text" id="apibundle_contact_contactPhone" name="apibundle_contact[contactPhone]" placeholder="Téléphone mobile" class="form-control" />
                                    <div class="form-control-focus"></div>
                                    
                                </div>
                            </div>


                            <div class="form-group form-md-line-input">
                                <div class="col-md-8">
                                    <input type="text" id="apibundle_contact_contactEmail" name="apibundle_contact[contactEmail]" placeholder="Mail" class="form-control" />
                                    <div class="form-control-focus"></div>
                                    
                                </div>
                            </div>

                            <div class="form-group form-md-line-input">
                                <div class="col-md-8">
                                    <select id="apibundle_contact_contactSujet" name="apibundle_contact[contactSujet]" required="required" class="form-control"><option value="" selected="selected">email</option><option value="rdv">Demande de rendez-vous commercial</option><option value="inforamtion">Demande d&#039;information produit, de documentation</option><option value="aide">Demande d&#039;aide à l&#039;utilisation</option><option value="sav">Demande de SAV</option><option value="autre">Autre</option></select>
                                    <div class="form-control-focus"></div>
                                    
                                </div>
                            </div>

                            <div class="form-group form-md-line-input">
                                <div class="col-md-8">
                                    <textarea id="apibundle_contact_contactMessage" name="apibundle_contact[contactMessage]" required="required" placeholder="Demande" class="form-control"></textarea>
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                            <div class="form-group form-md-line-input">
                                <div class="col-md-8">
                                    <input type="file" id="apibundle_contact_contactAttachment" name="apibundle_contact[contactAttachment]" placeholder="Pièce jointe" />
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                            <div class="form-group form-md-line-input">
                                <div class="col-md-8">
                                    <button type="submit" id= 'contact_submit_button' class="btn btn-success">Envoyer</button>
                                </div>
                            </div>

                                <input type="hidden" id="apibundle_contact__token" name="apibundle_contact[_token]" value="koMPPhj-6u9Qjq5EYvkaPN1NxUAmfF_azA0bmrNmSEo" /></form>
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                <p>Copyright © 2013 - 2018 - Tous droits réservés.</p>

                <p>Version : 1.01.000
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