- @contact = @contact || Contact.new
=semantic_form_for [:public, @contact], :remote => true do |f|
  =f.inputs do
    .row
      .columns.span_8
        =f.hidden_field :raison_id
        =f.hidden_field :survey_set_id
        
        
        %table{:style => "border-collapse:collapse;width:100%;"}
          %tr
            %td{:style => "width:20%;vertical-align:top;"}
              =f.input :civilite, :label =>false, :as => :select, :collection => [[qit("don-particular-civilite-mme","Mme."), "Mme"], [qit("don-particular-civilite-m","M."), "M"]], :include_blank => false
            %td{:style => "width:40%;vertical-align:top;"}
          
              =f.input :name, :label => false, :placeholder => qit("contact nom","Nom*")
            
            %td{:style => "width:40%;vertical-align:top;"}
              =f.input :firstname, :label => false, :placeholder => qit("contact prenom","Prénom*")
      
      
      
      
      
        
        -if @contact.raison_id != 1
          =f.input :address, :label => false, :placeholder => qit("contact adresse","Adresse")
          %table{:style => "border-collapse:collapse;width:100%;"}
            %tr
              %td{:style => "width:35%;vertical-align:top;"}=f.input :cp, :label => false, :placeholder => qit("contact cp","Code postal")
              %td{:style => "width:65%;vertical-align:top;"}=f.input :city, :label =>false, :placeholder => qit("contact city","Ville")
          =f.input :country, :label => false, :priority_countries => ["FR", "CH", "BE"]
        
        
        
        =f.input :email, :label =>  false , :placeholder  =>"Email"
        =f.input :phone, :label => false, :placeholder => qit("contact tel","Téléphone")
        
        

        =f.input :message, :label =>false , :placeholder => "Message"
        
        
        .clear
        
        
        
      
        =f.submit "Envoyer", :class => "btn"
        
        
        
        
        
        
        %br
        %br
        
        
        
      .columns.span_4.button_container{:style => "padding-left:60px;"}
        .inner

            
        

          
          %p
            =ic(:phone)

            +33 (0)3 88 85 05 40
          %p
            =ic(:"envelope-o")

            =link_to "contact@jipe.fr", "mailto:contact@jipe.fr"
    .clear