document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_141235c42e32270' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_15228-141235c42e32270.html' name='Formulaire_Gratuit_PropulSite_141235c42e32270'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_141235c42e32270'> <th>* Votre e-mail :</th> <td> <input name='Mail_141235c42e32270' id='Mail_141235c42e32270'> </td> </tr> <tr id='PropulSite_141235c42e32270_1_Info'> <th>* NOM ET PRENOM :</th> <td><input name='PropulSite_141235c42e32270_1' id='PropulSite_141235c42e32270_1' type='text' size='30'></td> </tr> <tr id='PropulSite_141235c42e32270_2_Info'> <th>* TELEPHONE :</th> <td><input name='PropulSite_141235c42e32270_2' id='PropulSite_141235c42e32270_2' type='text' size='30'></td> </tr> <tr id='PropulSite_141235c42e32270_3_Info'> <th>* ABONNEMENT :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>1 MOIS 100 EUROS</th> <td><input name='PropulSite_141235c42e32270_3[]' id='PropulSite_141235c42e32270_3' type='checkbox' value='1 MOIS 100 EUROS'></td> </tr> <tr> <th>2 MOIS 280 EUROS</th> <td><input name='PropulSite_141235c42e32270_3[]' id='PropulSite_141235c42e32270_3' type='checkbox' value='2 MOIS 280 EUROS'></td> </tr> <tr> <th>3 MOIS 400 EUROS</th> <td><input name='PropulSite_141235c42e32270_3[]' id='PropulSite_141235c42e32270_3' type='checkbox' value='3 MOIS 400 EUROS'></td> </tr> <tr> <th>AUTRES</th> <td><input name='PropulSite_141235c42e32270_3[]' id='PropulSite_141235c42e32270_3' type='checkbox' value='AUTRES'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_141235c42e32270_4_Info'> <th>* SUJET :</th> <td><input name='PropulSite_141235c42e32270_4' id='PropulSite_141235c42e32270_4' type='text' size='50'></td> </tr> <tr id='PropulSite_141235c42e32270_5_Info'> <th>* MESSAGE :</th> <td><textarea name='PropulSite_141235c42e32270_5' id='PropulSite_141235c42e32270_5' cols='50' rows='10'></textarea></td> </tr> <tr id='Genered_Info_141235c42e32270'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_141235c42e32270'> <img id='FormPropulSite_img_141235c42e32270' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite141235c42e32270-1714323029.png' ><input name='Genered_141235c42e32270' id='Genered_141235c42e32270' 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_141235c42e32270' id='hid_141235c42e32270' value='hid_141235c42e32270' type='hidden'> <br> <input name='Envoyer_141235c42e32270' id='Envoyer_141235c42e32270' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite141235c42e32270(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite141235c42e32270()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_141235c42e32270').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_141235c42e32270_1').value == '' & 1 == 1)
					{
						erreur = erreur+'NOM ET PRENOM >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_141235c42e32270_2').value == '' & 1 == 1)
					{
						erreur = erreur+'TELEPHONE >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_141235c42e32270_4').value == '' & 1 == 1)
					{
						erreur = erreur+'SUJET >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_141235c42e32270_5').value == '' & 1 == 1)
					{
						erreur = erreur+'MESSAGE >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_141235c42e32270').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_141235c42e32270.submit();
				ReloadImg_141235c42e32270();
			}
			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_141235c42e32270()
		{
			var nbtp = Math.floor(Math.random() * 1714323029)+0;
			document.getElementById('DivContImgAndGenered_141235c42e32270').innerHTML = '<img id="FormPropulSite_img_141235c42e32270" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite141235c42e32270-'+nbtp+'.png"><input name="Genered_141235c42e32270" id="Genered_141235c42e32270">';
		}
		
		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)';
		}