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* Required field
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<fieldset class="fieldset-01"><legend>Please register or renew my subscription to the following magazine(s):</legend>
<ul>
<li><label>Carcare Business </label><input name=choix type="radio" onclick="toggleDisplay(true, 'sub1', 'sub8');toggleDisplay(false, 'sub2', 'sub3', 'sub4', 'sub5', 'sub6', 'sub7')" value=ccb /></li>
<li><label>Tire News</label> <input name="choix" type="radio" value="2" onclick="toggleDisplay(true, 'sub2', 'sub8');toggleDisplay(false, 'sub1', 'sub3', 'sub4', 'sub5', 'sub6', 'sub7')" /></li>
<li><label>fleetdigest</label> <input name="choix" type="radio" value="3" onclick="toggleDisplay(true, 'sub3', 'sub8');toggleDisplay(false, 'sub2', 'sub1', 'sub4', 'sub5', 'sub6', 'sub7')"/></li>
<li><label>Le Garagiste</label> <input name="choix" type="radio" value="4" onclick="toggleDisplay(true, 'sub4', 'sub8');toggleDisplay(false, 'sub2', 'sub3', 'sub1', 'sub5', 'sub6', 'sub7')"/></li>
<li><label>Le Carrossier</label> <input name="choix" type="radio" value="5" onclick="toggleDisplay(true, 'sub5', 'sub8');toggleDisplay(false, 'sub2', 'sub3', 'sub4', 'sub1', 'sub6', 'sub7')"/></li>
<li><label>Pneu Mag</label> <input name="choix" type="radio" value="6" onclick="toggleDisplay(true, 'sub6', 'sub8');toggleDisplay(false, 'sub2', 'sub3', 'sub4', 'sub5', 'sub1', 'sub7')"/></li>
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</ul></fieldset>
<fieldset class="fieldset-02"><legend>General Inquiry</legend>
<ul>
<table border="0">
<tr>
<td><li><label>* First Name: </label><input name="firstName" type="text" /></li></td>
<td><li><label>* Name: </label><input name="name" type="text" /></li></td>
</tr>
<tr>
<td><li>
<label>* Address: </label>
<input name="address" type="text" />
</li></td>
<td><li>
<label>* City: </label>
<input name="city" type="text" />
</li></td>
</tr>
<tr>
<td><li>
<label>* Province: </label>
<input name="province" type="text" />
</li></td>
<td><li>
<label>* Postal code: </label>
<input name="postalCode" type="text" />
</li></td>
</tr>
<tr>
<td>
<li>
<label>Phone: </label>
<input name="phone" type="text" />
</li>
</td>
<td><li>
<label>Fax: </label>
<input name="fax" type="text" />
</li></td>
</tr>
<tr>
<td><li>
<label>* E-mail: </label>
<input name="email" type="text" id="email" />
</li></td>
<td><li>
<label>Color of your vehicle:</label>
<select name="colors">
<option value="choix" selected="selected">Select</option>
<option value="red">Red</option>
<option value="green">Green</option>
<option value="yellow">Yellow</option>
<option value="black">Black</option>
<option value="white">White</option>
<option value="blue">Blue</option>
<option value="orange">Orange</option>
<option value="beige">Beige</option>
<option value="grey / Silver">Grey / Silver</option>
<option value="gold">Gold</option>
<option value="bronze">Bronze</option>
</select>
</li></td>
</tr>
<tr>
<td colspan="2"><li>
<label>* Company: </label>
<input name="company" type="text" />
</li></td>
</tr>
<tr>
<td colspan="2"><li>
<label>Title/Occupation: </label>
<select name="occupation">
<option value="" selected="selected">Select</option>
<option value="(1) EXECUTIVE/OWNER/ADMINISTRATION">(1) EXECUTIVE/OWNER/ADMINISTRATION</option>
<option value="(2) MANAGEMENT">(2) MANAGEMENT</option>
<option value="(3) REPAIR AND SERVICE">(3) REPAIR AND SERVICE</option>
<option value="(4) TRAINING">(4) TRAINING</option>
<option value="(5) SALES">(5) SALES</option>
<option value="(6) Other">Other</option>
</select>
<input name="specify" type="text" id="specify" />
</li>
</td>
</tr>
</table>
</ul>
</fieldset>
<ol id="sub1">
<fieldset class="fieldset-03" ><legend>Please indicate your company's line of business</legend>
<p>
<label>* Please select: </label>
<select name="business_ccb" id="business_ccb">
<option value="" selected="selected" name"select">Select</option>
<option value="(1a) General Service and Repair Shop - Chain">(1a) General Service and Repair Shop - Chain</option>
<option value="(1b) General Service and Repair Shop - Independent">(1b) General Service and Repair Shop - Independent</option>
<option value="(2a) Specialized Service and Repair Shop - Chain">(2a) Specialized Service and Repair Shop - Chain</option>
<option value="(2b) Specialized Service and Repair Shop - Independent">(2b) Specialized Service and Repair Shop - Independent</option>
<option value="(2c) Specialized Service and Repair Shop - Specify">(2c) Specialized Service and Repair Shop - Specify</option>
<option value="(3) Car and Truck Dealer">(3) Car and Truck Dealer</option>
<option value="(4) Fleet with Repair Facilities">(4) Fleet with Repair Facilities</option>
<option value="(5) Wholesalers and Jobbers">(5) Wholesalers and Jobbers</option>
<option value="(6) Manufacturers and Distributors Agent">(6) Manufacturers and Distributors Agent</option>
<option value="(7) Automotive training">(7) Automotive training</option>
<option value="(8) Other allied to the Field">(8) Other allied to the Field"</option>
</select>
<input name="specify_ccb" type="text" id="specify_ccb" /></input>
</p>
</fieldset>
</br>
<fieldset class="fieldset-04"><legend>QUESTIONNAIRE</legend>
<p>
<label>* Number of enployees ? </label><select name="employees_ccb" id="employees_ccb">
<option value="" selected="selected">Select</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 and more</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Number of service bays ? </label><select name="bays_ccb" id="bays_ccb">
<option value="" selected="selected">Select</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 and more</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* How much do you invest in training annually ? </label><select name="training_ccb" id="training_ccb">
<option value="" selected="selected">Select</option>
<option value="$0-500">$0-500</option>
<option value="$501-2000">$501-2000</option>
<option value="$2001 and over">$2001 and over</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* How much do you invest in tools & equipment annually ? </label><select name="equipment_ccb" id="equipment_ccb">
<option value="" selected="selected">Select</option>
<option value="$0-5000">$0-5000</option>
<option value="$5001-15 000">$5001-15 000</option>
<option value="$15 001 and over">$15 001 and over</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* How many people have access to your magazine? </label><input name="magazine_ccb" type="text" id="magazine_ccb" /></input>
</p>
<p><label>* Comments </label>
<textarea name="comment_ccb" cols="30" id="comment_ccb"></textarea>
</p>
</fieldset>
</ol>
<ol id="sub2">
<fieldset class="fieldset-05"><legend>Please indicate your company's line of business</legend>
<p>
<label>* Please select: </label>
<select name="business_tire" id="business_tire">
<option value="" selected="selected" name"select">Select</option>
<option value="(1) Tire Dealers, Wholesalers and Distributor">(1) Tire Dealers, Wholesalers and Distributor</option>
<option value="(2) General Service and Repair Shop">(2) General Service and Repair Shop</option>
<option value="(3) Specialized Service and Repair Shop">(3) Specialized Service and Repair Shop</option>
<option value="(4) Car and Truck Dealer">(4) Car and Truck Dealer</option>
<option value="(5) Fleet">(5) Fleet</option>
<option value="(6) Other allied to the Field">(6) Other allied to the Field"</option>
</select>
<input name="specify_tire" type="text" id="specify_tire" /></input>
</p>
</fieldset>
</br>
<fieldset class="fieldset-06"><legend>QUESTIONNAIRE</legend>
<p>
<label>* Number of enployees ? </label><select name="employees_tire" id="employees_tire">
<option value="" selected="selected">Select</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 and more</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Number of service bays ? </label><select name="bays_tire" id="bays_tire">
<option value="" selected="selected">Select</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 and more</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* What percentage of your sales is related to tire ? </label><select name="sales_tire" id="sales_tire">
<option value="" selected="selected">Select</option>
<option value="1-20%">1-20%</option>
<option value="21-50%">21-50%</option>
<option value="51-100%">51-100%</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* How much do you invest in tools & equipment per year ? </label><select name="equipment_tire" id="equipment_tire">
<option value="" selected="selected">Select</option>
<option value="$0-5000">$0-5000</option>
<option value="$5001-15 000">$5001-15 000</option>
<option value="$15 001 and over">$15 001 and over</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* How many people have access to your magazine? </label><input name="magazine_tire" type="text" id="magazine_tire" /></input>
</p>
<p><label>* Comments </label>
<textarea name="comment_tire" cols="30" id="comment_tire"></textarea>
</p>
</fieldset>
</ol>
<ol id="sub3">
<fieldset class="fieldset-07"><legend>Please indicate your company's line of business</legend>
<p>
<label>* Please select: </label>
<select name="business_fleet" id="business_fleet">
<option value="" selected="selected" name"select">Select</option>
<option value="(1a) Corporate and Commercial Fleets - Construction">(1a) Corporate and Commercial Fleets - Construction</option>
<option value="(1b) Corporate and Commercial Fleets - Manufacturing Industries and Transformation">(1b) General Service and Repair Shop - Manufacturing Industries and Transformation</option>
<option value="(1c) Corporate and Commercial Fleets - Energy and Telecommunications">(1c) General Service and Repair Shop - Energy and Telecommunications</option>
<option value="(1d) Corporate and Commercial Fleets - Wholesalers and Retail Stores">(1d) General Service and Repair Shop - Wholesalers and Retail Stores</option>
<option value="(1e) Corporate and Commercial Fleets - Transportation, Storage and Courier">(1e) General Service and Repair Shop - Transportation, Storage and Courier</option>
<option value="(1f) Corporate and Commercial Fleets - Agriculture, Forest and Mines">(1f) General Service and Repair Shop - Agriculture, Forest and Mines</option>
<option value="(1g) Corporate and Commercial Fleets - Service and Consultation">(1g) General Service and Repair Shop - Service and Consultation</option>
<option value="(1g) Corporate and Commercial Fleets - Other (Specify)">(1g) General Service and Repair Shop - Other (Specify)</option>
<option value="(2a) Governement and Utilities - Federal">(2a) Governement and Utilities - Federal</option>
<option value="(2b) Governement and Utilities - Provincial">(2b) Governement and Utilities - Provincial</option>
<option value="(2c) Governement and Utilities - Municipalities">(2c) Governement and Utilities - Municipalities</option>
<option value="(2d) Governement and Utilities - Utilities">(2d) Governement and Utilities - Utilities</option>
<option value="(3a) Leasing and Rental - Fleet lessors">(3A) Leasing and Rental - Fleet lessors</option>
<option value="(3a) Leasing and Rental - Dayli Rental">(3A) Leasing and Rental - Daily Rental</option>
<option value="(4) Fleet Maintenance">(4) Fleet Maintenance</option>
<option value="(5) Car and Truck Dealers">(5) Car and Truck Dealers</option>
<option value="(8) Other allied to the Field">(4) Other allied to the Field"</option>
</select>
<input name="specify_fleet" type="text" id="specify_fleet" /></input>
</p>
</fieldset> </br>
<fieldset class="fieldset-08"><legend>QUESTIONNAIRE</legend>
<p>
<label>* Number of enployees ? </label><select name="employees_fleet" id="employees_fleet">
<option value="" selected="selected">Select</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 and more</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Number of vehicles in your fleet ? </label><select name="vehicule_fleet" id="vehicule_fleet">
<option value="" selected="selected">Select</option>
<option value="0-5">0-5</option>
<option value="6-20">6-20</option>
<option value="21 and more">21 and more</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Percentage of cars (versus trucks) in your fleet ? </label><input name="truckvscars_fleet" type="text" id="truckvscars_fleet" /></input>
</p>
<p><label>* Percentage of vehicles in your fleet changed yearly ? </label><input name="pc_fleet" type="text" id="pc_fleet" /></input>
</p>
<p><label>* Is the enviromental footprint important to your organization ? </label><select name="enviromental_fleet" id="enviromental_fleet">
<option value="" selected="selected">Select</option>
<option value="not important">not important</option>
<option value="somewhat important">somewhat important</option>
<option value="very important">very important</option>
</select> <p><label>* Combien de personnes ont accès à votre magazine ?</label><input name="magazine_fleet" type="text" id="magazine_fleet" /></input>
</p>
<p><label>* Comments </label>
<textarea name="comment_fleet" cols="30" id="comment_fleet"></textarea>
</p>
</fieldset>
</ol>
<ol id="sub4">
<fieldset class="fieldset-09"><legend>Please indicate your company's line of business</legend>
<p>
<label>* Sélectionner: </label>
<select name="business_lg" id="business_lg">
<option value="" selected="selected" name"select">Select</option>
<option value="(1a) Centre de Service et de Réparation Générale - Chaine">(1a) Centre de Service et de Réparation Générale - Chaine</option>
<option value="(1b) Centre de Service et de Réparation Générale - Independant">(1b) Centre de Service et de Réparation Générale - Independent</option>
<option value="(2a) Centre de Service et de Réparation Spécialisée - Chaine">(2a) Centre de Service et de Réparation Spécialisée - Chaine</option>
<option value="(2b) Centre de Service et de Réparation Spécialisée - Independant">(2b) Centre de Service et de Réparation Spécialisée - Independent</option>
<option value="(2c) Centre de Service et de Réparation Spécialisée - Autre (Preciser)">(2c) Centre de Service et de Réparation Spécialisée - Autre (Preciser)</option>
<option value="(3) Concessions de Voitures et de Camion">(3) Concessions de Voitures et de Camion</option>
<option value="(4) Parcs Auto avec Atelier de Réparation">(4) Parcs Auto avec Atelier de Réparation</option>
<option value="(5) Vente au détail et Grossistes">(5) Vente au détail et Grossistes</option>
<option value="(6) Manufacturiers et Distributeur">(6) Manufacturiers et Distributeur</option>
<option value="(7) Centre de Formation">(7) Centre de Formation</option>
<option value="(8) Autre reliés à l'Industrie (Preciser)">(4) Autre reliés à l'Industrie (Preciser)"</option>
</select>
<input name="specify_lg" type="text" id="specify_lg" /></input>
</p>
</fieldset> </br>
<fieldset class="fieldset-10"><legend>QUESTIONNAIRE</legend>
<p>
<label>* Nombre d'employés ? </label><select name="employees_lg" id="employees_lg">
<option value="" selected="selected">Select</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 et plus">11 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Nombre d'aires de service ? </label><select name="bays_lg" id="bays_lg">
<option value="" selected="selected">Selectionner</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 et plus">11 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Quel est votre budget annuel de formation ? </label><select name="formation_lg" id="formation_lg">
<option value="" selected="selected">Select</option>
<option value="$0-500">$0-500</option>
<option value="$501-2000">$5001-2000</option>
<option value="$2001 et plus">$2001 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Quelle est la somme investie annuellement pour les outils et l'équipement ? </label><select name="equipment_lg" id="equipment_lg">
<option value="" selected="selected">Select</option>
<option value="$0-5000">$0-5000</option>
<option value="$5001-15 000">$5001-15 000</option>
<option value="$15 001 et plus">$15 001 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Combien de personnes ont accès à votre magazine ? </label><input name="magazine_lg" type="text" id="magazine_lg" /></input>
</p>
<p><label>* Commentaires </label>
<textarea name="comment_lg" cols="30" id="comment_lg"></textarea>
</p>
</fieldset>
</ol>
<ol id="sub5">
<fieldset class="fieldset-11"><legend>Please indicate your company's line of business</legend>
<p>
<label>* Selectionner: </label>
<select name="business_lc" id="business_lc">
<option value="" selected="selected" name"select">Select</option>
<option value="(1a) Atelier de Carrosserie - Chaine">(1a) Atelier de Carrosserie - Chaine</option>
<option value="(1b) Atelier de Carrosserie - Independant">(1b) Atelier de Carrosserie - Independant</option>
<option value="(2) Concession de Voitures et de Camions (Preciser)">(2) Concession de Voitures et de Camions (Preciser)</option>
<option value="(3) Assurance et Evaluation">(3) Assurance et Evaluation</option>
<option value="(4) Centre de Service et de Reparation Specialisee">(4) Centre de Service et de Reparation Specialisee</option>
<option value="(5) Fournisseur de pieces et Grossistes">(5) Fournisseur de pieces et Grossistes</option>
<option value="(6) Manufacturiers et Distributeur">(6) Manufacturiers et Distributeur</option>
<option value="(7) Centre de Formation">(7) Centre de Formation</option>
<option value="(8) Autre relies a l'Industrie">(4) Autre relies a l'Industrie"</option>
</select>
<input name="specify_lc" type="text" id="specify_lc" /></input>
</p>
</fieldset> </br>
<fieldset class="fieldset-12"><legend>QUESTIONNAIRE</legend>
<p>
<label>* Nombre d'employés ? </label><select name="employees_lc" id="employees_lc">
<option value="" selected="selected">Selectionner</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Nombre de postes de travail ? </label><select name="bays_lc" id="bays_lc">
<option value="" selected="selected">Select</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and More">11 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Quel est votre budget annuel de formation ? </label><select name="formation_lc" id="formation_lc">
<option value="" selected="selected">Select</option>
<option value="$0-500">$0-500</option>
<option value="$501-2000">$501-2000</option>
<option value="$2001 and over">$2001 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Quelle est la somme investie annuellement pour les outils et l'équipement ? </label><select name="equipment_lc" id="equipment_lc">
<option value="" selected="selected">Select</option>
<option value="$0-5000">$0-5000</option>
<option value="$5001-15 000">$501-15 000</option>
<option value="$15 001 and over">$15 001 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Combien de personnes ont accès à votre magazine ? </label><input name="magazine_lc" type="text" id="magazine_lc" /></input>
</p>
<p><label>* Commentaires </label>
<textarea name="comment_lc" cols="30" id="comment_lc"></textarea>
</p>
</fieldset>
</ol>
<ol id="sub6">
<fieldset class="fieldset-13"><legend>Please indicate your company's line of business</legend>
<p>
<label>* Selectionner: </label>
<select name="business_pneu" id="business_pneu">
<option value="" selected="selected" name"select">Select</option>
<option value="(1) Detaillant, Distributeur et Manufacturiers de Pneus">(1) Detaillant, Distributeur et Manufacturiers de Pneus</option>
<option value="(2) Centre de Service et de Reparation Generale">(2) Centre de Service et de Reparation Generale</option>
<option value="(3) Centre de Service et de Reparation Specialisee">(3) Centre de Service et de Reparation Specialisee</option>
<option value="(4) Concession de Voitures et de Camions">(4) Concession de Voitures et de Camions</option>
<option value="(5) Parc Automobile">(5) Parc Automobile</option>
<option value="(6) Autre relies a l'industrie">(6) Autre relies a l'industrie</option>
<option value="(7) Automotive training">(7) Automotive training</option>
<option value="(8) Other allied to the Field">(4) Other allied to the Field"</option>
</select>
<input name="specify_pneu" type="text" id="specify_pneu" /></input>
</p>
</fieldset> </br>
<fieldset class="fieldset-14"><legend>QUESTIONNAIRE</legend>
<p>
<label>* Nombre d'employés ? </label><select name="employees_pneu" id="employees_pneu">
<option value="" selected="selected">Selectionner</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Nombre d'aires de service ? </label><select name="bays_pneu" id="bays_pneu">
<option value="" selected="selected">Selectionner</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Quel est le % de vos ventes relié aux pneus ? </label><select name="ventes_pneu" id="ventes_pneu">
<option value="" selected="selected">Selectionner</option>
<option value="1-20%">1-20%</option>
<option value="21-50%">21-50%</option>
<option value="51-100%">51-100%</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Quelle est la somme investie annuellement pour les outils et l'équipement ? </label><select name="equipment_pneu" id="equipment_pneu">
<option value="" selected="selected">Selectionner</option>
<option value="$0-5000">$0-5000</option>
<option value="$5001-15 000">$5001-15 000</option>
<option value="$15 001 and over">$15 001 and over</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Combien de personnes ont accès à votre magazine ? </label><input name="magazine_pneu" type="text" id="magazine_pneu" /></input>
</p>
<p><label>* Comments </label>
<textarea name="comment_pneu" cols="30" id="comment_pneu"></textarea>
</p>
</fieldset>
</ol>
<ol id="sub7">
<fieldset class="fieldset-15"><legend>Please indicate your company's line of business</legend>
<p>
<label>* Please select: </label>
<select name="business_cam" id="business_cam">
<option value="" selected="selected" name"select">Selectionner</option>
<option value="(1a) Parcs de véhicules, commerciaux et administratifs - Construction">(1a) Parcs de véhicules, commerciaux et administratifs - Construction</option>
<option value="(1b) Parcs de véhicules, commerciaux et administratifs - Industries manufacturières et de transformation">(1b) Parcs de véhicules, commerciaux et administratifs - Industries manufacturières et de transformation</option>
<option value="(1c) Parcs de véhicules, commerciaux et administratifs - Énergie et télécommunications">(1c) Parcs de véhicules, commerciaux et administratifs - Énergie et télécommunications</option>
<option value="(1d) Parcs de véhicules, commerciaux et administratifs - Grossistes et vente au détail">(1d) Parcs de véhicules, commerciaux et administratifs - Grossistes et vente au détail</option>
<option value="(1e) Parcs de véhicules, commerciaux et administratifs - Transport de biens, entreposage et messagerie">(1e) Parcs de véhicules, commerciaux et administratifs - Transport de biens, entreposage et messagerie</option>
<option value="(1f) Parcs de véhicules, commerciaux et administratifs - Agriculture, forêts et mines">(1f) Parcs de véhicules, commerciaux et administratifs - Agriculture, forêts et mines</option>
<option value="(1g) Parcs de véhicules, commerciaux et administratifs - Service et consultation">(1g) Parcs de véhicules, commerciaux et administratifs - Service et consultation</option>
<option value="(1g) Parcs de véhicules, commerciaux et administratifs - Autres (Preciser)">(1g) Parcs de véhicules, commerciaux et administratifs - Autres (Preciser)</option>
<option value="(2a) Gouvernement et services parapublics - Federal">(2a) Gouvernement et services parapublics - Federal</option>
<option value="(2b) Gouvernement et services parapublics - Provincial">(2b) Gouvernement et services parapublics - Provincial</option>
<option value="(2c) Gouvernement et services parapublics - Municipal">(2c) Gouvernement et services parapublics - Municipal</option>
<option value="(2d) Gouvernement et services parapublics - Services parapublics">(2d) Gouvernement et services parapublics - Services parapublics</option>
<option value="(3a) Crédit-bail et location - Crédit-bail à moyen et long terme">(3a) Crédit-bail et location - Crédit-bail à moyen et long terme</option>
<option value="(3b) Crédit-bail et location - Location à court terme">(3b) Crédit-bail et location - Location à court terme</option>
<option value="(4) Service et réparation pour parcs de véhicules">(4) Service et réparation pour parcs de véhicules</option>
<option value="(5) Concessionaires automobiles et camions">(5) Concessionaires automobiles et camions</option>
<option value="(6) Other allied to the Field">(6) Other allied to the Field"</option>
</select>
<input name="specify_cam" type="text" id="specify_cam" /></input>
</p>
</fieldset> </br>
<fieldset class="fieldset-16"><legend>QUESTIONNAIRE</legend>
<p>
<label>* Nombre d'employés ? </label><select name="employees_cam" id="employees_cam">
<option value="" selected="selected">Select</option>
<option value="1-3">1-3</option>
<option value="4-10">4-10</option>
<option value="11 and more">11 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Nombre de véhicules de votre parc ? </label><select name="parc_cam" id="parc_cam">
<option value="" selected="selected">Selectionner</option>
<option value="0-5">0-5</option>
<option value="6-20">6-20</option>
<option value="21 and more">21 et plus</option>
<option value="N/A">N/A</option>
</select></p>
<p><label>* Pourcentage d'automobiles vs camions de votre parc ?</label>
<label> </label><input name="truckvscar_cam" type="text" id="truckvscar_cam" /></input>
</p>
<p><label>* Pourcentage de véhicules de votre parc remplacés annuellement ?</label>
<label> </label><input name="vehicule_cam" type="text" id="vehicule_cam" /></input>
</p>
<p><label>* L'empreinte écologique est-elle importante pour l'entreprise ? </label><select name="eco_cam" id="eco_cam">
<option value="" selected="selected">Select</option>
<option value="Pas important">Pas importantt</option>
<option value="quelque peu important">quelque peu important</option>
<option value="tres important">tres important</option>
</select> <p><label>* Combien de personnes ont accès à votre magazine ? </label><input name="magazine_cam" type="text" id="magazine_cam" /></input>
</p>
<p><label>* Comments </label>
<textarea name="comment_cam" cols="30" id="comment_cam"></textarea>
</p>
</fieldset>
</ol>
<ol id="sub8">
<div align="center"> <input type="submit" name="Submit" value="send" onclick="javascript:checkall('Contact','choix',false)"/>
<input type="reset" name="Submit" value="reset"/> </div>
</ol>
</form>
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