document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_9671c2a627b9c7' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_10181-9671c2a627b9c7.html' name='Formulaire_Gratuit_PropulSite_9671c2a627b9c7'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_9671c2a627b9c7'> <th>* Votre e-mail :</th> <td> <input name='Mail_9671c2a627b9c7' id='Mail_9671c2a627b9c7'> </td> </tr> <tr id='PropulSite_9671c2a627b9c7_1_Info'> <th>* Titre :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Mr</th> <td><input name='PropulSite_9671c2a627b9c7_1[]' id='PropulSite_9671c2a627b9c7_1' type='checkbox' value='Mr'></td> </tr> <tr> <th>Mlle</th> <td><input name='PropulSite_9671c2a627b9c7_1[]' id='PropulSite_9671c2a627b9c7_1' type='checkbox' value='Mlle'></td> </tr> <tr> <th>Mme</th> <td><input name='PropulSite_9671c2a627b9c7_1[]' id='PropulSite_9671c2a627b9c7_1' type='checkbox' value='Mme'></td> </tr> <tr> <th>Couple</th> <td><input name='PropulSite_9671c2a627b9c7_1[]' id='PropulSite_9671c2a627b9c7_1' type='checkbox' value='Couple'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_9671c2a627b9c7_2_Info'> <th>* Nom :</th> <td><input name='PropulSite_9671c2a627b9c7_2' id='PropulSite_9671c2a627b9c7_2' type='text' size='30'></td> </tr> <tr id='PropulSite_9671c2a627b9c7_3_Info'> <th>* Prénoms :</th> <td><input name='PropulSite_9671c2a627b9c7_3' id='PropulSite_9671c2a627b9c7_3' type='text' size='30'></td> </tr> <tr id='PropulSite_9671c2a627b9c7_4_Info'> <th>* Date de naissance :</th> <td><input name='PropulSite_9671c2a627b9c7_4' id='PropulSite_9671c2a627b9c7_4' type='text' size='30'></td> </tr> <tr id='PropulSite_9671c2a627b9c7_5_Info'> <th>* Profession :</th> <td><input name='PropulSite_9671c2a627b9c7_5' id='PropulSite_9671c2a627b9c7_5' type='text' size='30'></td> </tr> <tr id='PropulSite_9671c2a627b9c7_6_Info'> <th>Adresse :</th> <td><textarea name='PropulSite_9671c2a627b9c7_6' id='PropulSite_9671c2a627b9c7_6' cols='23' rows='3'></textarea></td> </tr> <tr id='PropulSite_9671c2a627b9c7_7_Info'> <th>* E-mail :</th> <td><input name='PropulSite_9671c2a627b9c7_7' id='PropulSite_9671c2a627b9c7_7' type='text' size='30'></td> </tr> <tr id='PropulSite_9671c2a627b9c7_8_Info'> <th>* Téléphone :</th> <td><input name='PropulSite_9671c2a627b9c7_8' id='PropulSite_9671c2a627b9c7_8' type='text' size='30'></td> </tr> <tr id='PropulSite_9671c2a627b9c7_9_Info'> <th>* Date du chantier :</th> <td><input name='PropulSite_9671c2a627b9c7_9' id='PropulSite_9671c2a627b9c7_9' type='text' size='30'></td> </tr> <tr id='PropulSite_9671c2a627b9c7_10_Info'> <th>* Code du chantier :</th> <td><input name='PropulSite_9671c2a627b9c7_10' id='PropulSite_9671c2a627b9c7_10' type='text' size='30'></td> </tr> <tr id='PropulSite_9671c2a627b9c7_11_Info'> <th>* Motivation :</th> <td><textarea name='PropulSite_9671c2a627b9c7_11' id='PropulSite_9671c2a627b9c7_11' cols='23' rows='10'></textarea></td> </tr> <tr id='PropulSite_9671c2a627b9c7_12_Info'> <th>* Activités :</th> <td><input name='PropulSite_9671c2a627b9c7_12' id='PropulSite_9671c2a627b9c7_12' type='text' size='30'></td> </tr> <tr id='Genered_Info_9671c2a627b9c7'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_9671c2a627b9c7'> <img id='FormPropulSite_img_9671c2a627b9c7' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite9671c2a627b9c7-1716341891.png' ><input name='Genered_9671c2a627b9c7' id='Genered_9671c2a627b9c7' maxlength='5' size='5'></div> </td> </tr> <tr> <th>Options d'envoi :</th> <td> <div id=IdOptionSend> <small><a href='javascript:afficheoptions();'>Afficher les options d'envoi.</a></small></td> </div> </tr> </tbody> </table> <input name='hid_9671c2a627b9c7' id='hid_9671c2a627b9c7' value='hid_9671c2a627b9c7' type='hidden'> <br> <input name='Envoyer_9671c2a627b9c7' id='Envoyer_9671c2a627b9c7' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite9671c2a627b9c7(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite9671c2a627b9c7()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_9671c2a627b9c7').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_9671c2a627b9c7_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Nom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Prénoms >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_4').value == '' & 1 == 1)
					{
						erreur = erreur+'Date de naissance >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Profession >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_7').value == '' & 1 == 1)
					{
						erreur = erreur+'E-mail >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_8').value == '' & 1 == 1)
					{
						erreur = erreur+'Téléphone >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_9').value == '' & 1 == 1)
					{
						erreur = erreur+'Date du chantier >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_10').value == '' & 1 == 1)
					{
						erreur = erreur+'Code du chantier >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_11').value == '' & 1 == 1)
					{
						erreur = erreur+'Motivation >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_9671c2a627b9c7_12').value == '' & 1 == 1)
					{
						erreur = erreur+'Activités >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_9671c2a627b9c7').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_9671c2a627b9c7.submit();
				ReloadImg_9671c2a627b9c7();
			}
			else
			{
				if(nberreur == 1)
				{
					alert('Une erreur à été trouvée :\n\n'+erreur+' ');
				}
				else
				{
					alert(nberreur+' erreurs ont été trouvées :\n\n'+erreur+' ');
				}
			}
			
			
			return false;
		}
		
		function ReloadImg_9671c2a627b9c7()
		{
			var nbtp = Math.floor(Math.random() * 1716341891)+0;
			document.getElementById('DivContImgAndGenered_9671c2a627b9c7').innerHTML = '<img id="FormPropulSite_img_9671c2a627b9c7" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite9671c2a627b9c7-'+nbtp+'.png"><input name="Genered_9671c2a627b9c7" id="Genered_9671c2a627b9c7">';
		}
		
		function Loadtoform()
		{
			document.getElementById('LoadModule').innerHTML = '<img alt="Envoi en cours..." title="Envoi en cours..." src="https://propulsite.com/images/attend.gif">';
		}
		
		function afficheoptions()
		{
			document.getElementById('IdOptionSend').innerHTML = '<input name="copie" value="1" type="checkbox"> Recevoir une copie de ce message.<br><input name="confirm" value="1" type="checkbox"> Recevoir une confirmation de lecture.<br><input name="newsletter" value="1" type="checkbox"> Recevoir la newsletter de PropulSite.com (1 à 2/an)';
		}