<?xml version="1.0" encoding="UTF-8"?>		
			 

	
																																																																
																
						
		
										
		
													
		
						
							
		
								
							
		
						
		
		
		
																																	
		
				
		
		
		
	
				
				

						
	
		
		
				
	
		
				
		
				
		
		
		
						
		
				
		
						

			
								
					
																	

		
						
		

		
																
		
		
		
		
		
						
		
																
		
																		
						
		
								
		
		
				
	
			<p>Error</p>
		
		<table summary="Contacta a tu Distribuidor">
			<col width="120"></col>
			<col width="261"></col>
			<tbody>
				<tr>
					<th><label for="contact_name">Nombre:</label></th>
					<td><input type="text" name="contact_name" id="contact_name" /></td>
				</tr>
				<tr>
					<th><label for="contact_email">Correo electrónico: <strong>*</strong></label></th>
					<td><input type="text" name="contact_email" id="contact_email" /></td>
				</tr>
				<tr>
					<th><label for="contact_message">Mensaje:</label></th>
					<td><textarea name="contact_message" id="contact_message" cols="39" rows="7"></textarea></td>
				</tr>
			</tbody>
		</table>
		<p>
			<input type="hidden" name="dealer" value="3" />
			<input type="hidden" name="topic_id" value="42" />
			<div class="contact_submit floatright"><span><input type="submit" value="Enviar" class="smallcaps contactsubmit" /></span></div>
		</p>
	
