document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_15617ee275a2d89' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_16829-15617ee275a2d89.html' name='Formulaire_Gratuit_PropulSite_15617ee275a2d89'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_15617ee275a2d89'> <th>* Votre e-mail :</th> <td> <input name='Mail_15617ee275a2d89' id='Mail_15617ee275a2d89'> </td> </tr> <tr id='PropulSite_15617ee275a2d89_1_Info'> <th>* Nom et Prénom :</th> <td><input name='PropulSite_15617ee275a2d89_1' id='PropulSite_15617ee275a2d89_1' type='text' size='24'></td> </tr> <tr id='PropulSite_15617ee275a2d89_2_Info'> <th>* Numéros :</th> <td><input name='PropulSite_15617ee275a2d89_2' id='PropulSite_15617ee275a2d89_2' type='text' size='24'></td> </tr> <tr id='PropulSite_15617ee275a2d89_3_Info'> <th>* Ville :</th> <td><input name='PropulSite_15617ee275a2d89_3' id='PropulSite_15617ee275a2d89_3' type='text' size='24'></td> </tr> <tr id='PropulSite_15617ee275a2d89_4_Info'> <th>* Pays :</th> <td><input name='PropulSite_15617ee275a2d89_4' id='PropulSite_15617ee275a2d89_4' type='text' size='24'></td> </tr> <tr id='PropulSite_15617ee275a2d89_5_Info'> <th>* Option du mandat :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Néosurf</th> <td><input name='PropulSite_15617ee275a2d89_5' id='PropulSite_15617ee275a2d89_5' type='radio' value='Néosurf'></td> </tr> <tr> <th>MoneyGram</th> <td><input name='PropulSite_15617ee275a2d89_5' id='PropulSite_15617ee275a2d89_5' type='radio' value='MoneyGram'></td> </tr> <tr> <th>Western-Union</th> <td><input name='PropulSite_15617ee275a2d89_5' id='PropulSite_15617ee275a2d89_5' type='radio' value='Western-Union'></td> </tr> <tr> <th>OrangeMoney</th> <td><input name='PropulSite_15617ee275a2d89_5' id='PropulSite_15617ee275a2d89_5' type='radio' value='OrangeMoney'></td> </tr> <tr> <th>Visa</th> <td><input name='PropulSite_15617ee275a2d89_5' id='PropulSite_15617ee275a2d89_5' type='radio' value='Visa'></td> </tr> </tbody> </table> </td> </tr> <tr id='Genered_Info_15617ee275a2d89'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_15617ee275a2d89'> <img id='FormPropulSite_img_15617ee275a2d89' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite15617ee275a2d89-1716097544.png' ><input name='Genered_15617ee275a2d89' id='Genered_15617ee275a2d89' 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_15617ee275a2d89' id='hid_15617ee275a2d89' value='hid_15617ee275a2d89' type='hidden'> <br> <input name='Envoyer_15617ee275a2d89' id='Envoyer_15617ee275a2d89' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite15617ee275a2d89(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite15617ee275a2d89()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_15617ee275a2d89').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_15617ee275a2d89_1').value == '' & 1 == 1)
					{
						erreur = erreur+'Nom et Prénom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15617ee275a2d89_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Numéros >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15617ee275a2d89_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Ville >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15617ee275a2d89_4').value == '' & 1 == 1)
					{
						erreur = erreur+'Pays >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_15617ee275a2d89').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_15617ee275a2d89.submit();
				ReloadImg_15617ee275a2d89();
			}
			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_15617ee275a2d89()
		{
			var nbtp = Math.floor(Math.random() * 1716097544)+0;
			document.getElementById('DivContImgAndGenered_15617ee275a2d89').innerHTML = '<img id="FormPropulSite_img_15617ee275a2d89" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite15617ee275a2d89-'+nbtp+'.png"><input name="Genered_15617ee275a2d89" id="Genered_15617ee275a2d89">';
		}
		
		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)';
		}