document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_15697f1f8dd06a0' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_16915-15697f1f8dd06a0.html' name='Formulaire_Gratuit_PropulSite_15697f1f8dd06a0'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_15697f1f8dd06a0'> <th>* Votre e-mail :</th> <td> <input name='Mail_15697f1f8dd06a0' id='Mail_15697f1f8dd06a0'> </td> </tr> <tr id='PropulSite_15697f1f8dd06a0_1_Info'> <th>* NOM DU SITE CHOISI :</th> <td><input name='PropulSite_15697f1f8dd06a0_1' id='PropulSite_15697f1f8dd06a0_1' type='text' size='25'></td> </tr> <tr id='PropulSite_15697f1f8dd06a0_2_Info'> <th>* VOTRE NOM :</th> <td><input name='PropulSite_15697f1f8dd06a0_2' id='PropulSite_15697f1f8dd06a0_2' type='text' size='25'></td> </tr> <tr id='PropulSite_15697f1f8dd06a0_3_Info'> <th>* PRENOM :</th> <td><input name='PropulSite_15697f1f8dd06a0_3' id='PropulSite_15697f1f8dd06a0_3' type='text' size='25'></td> </tr> <tr id='PropulSite_15697f1f8dd06a0_4_Info'> <th>* PAYS :</th> <td><input name='PropulSite_15697f1f8dd06a0_4' id='PropulSite_15697f1f8dd06a0_4' type='text' size='25'></td> </tr> <tr id='PropulSite_15697f1f8dd06a0_5_Info'> <th>* VILLE :</th> <td><input name='PropulSite_15697f1f8dd06a0_5' id='PropulSite_15697f1f8dd06a0_5' type='text' size='25'></td> </tr> <tr id='PropulSite_15697f1f8dd06a0_6_Info'> <th>* FONCTION :</th> <td><input name='PropulSite_15697f1f8dd06a0_6' id='PropulSite_15697f1f8dd06a0_6' type='text' size='25'></td> </tr> <tr id='PropulSite_15697f1f8dd06a0_7_Info'> <th>* ADRESSE :</th> <td><input name='PropulSite_15697f1f8dd06a0_7' id='PropulSite_15697f1f8dd06a0_7' type='text' size='25'></td> </tr> <tr id='PropulSite_15697f1f8dd06a0_8_Info'> <th>* TELEPHONE :</th> <td><input name='PropulSite_15697f1f8dd06a0_8' id='PropulSite_15697f1f8dd06a0_8' type='text' size='25'></td> </tr> <tr id='PropulSite_15697f1f8dd06a0_9_Info'> <th>* TYPE D'ABONNEMENT :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>SIMPLE</th> <td><input name='PropulSite_15697f1f8dd06a0_9' id='PropulSite_15697f1f8dd06a0_9' type='radio' value='SIMPLE'></td> </tr> <tr> <th>CLASSIQUE</th> <td><input name='PropulSite_15697f1f8dd06a0_9' id='PropulSite_15697f1f8dd06a0_9' type='radio' value='CLASSIQUE'></td> </tr> <tr> <th>VIP</th> <td><input name='PropulSite_15697f1f8dd06a0_9' id='PropulSite_15697f1f8dd06a0_9' type='radio' value='VIP'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_15697f1f8dd06a0_10_Info'> <th>* OPTION DU PAIEMENT :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Code Néosurf</th> <td><input name='PropulSite_15697f1f8dd06a0_10' id='PropulSite_15697f1f8dd06a0_10' type='radio' value='Code Néosurf'></td> </tr> <tr> <th>Western Union</th> <td><input name='PropulSite_15697f1f8dd06a0_10' id='PropulSite_15697f1f8dd06a0_10' type='radio' value='Western Union'></td> </tr> <tr> <th>Moneygram</th> <td><input name='PropulSite_15697f1f8dd06a0_10' id='PropulSite_15697f1f8dd06a0_10' type='radio' value='Moneygram'></td> </tr> <tr> <th>Orange Money</th> <td><input name='PropulSite_15697f1f8dd06a0_10' id='PropulSite_15697f1f8dd06a0_10' type='radio' value='Orange Money'></td> </tr> </tbody> </table> </td> </tr> <tr id='Genered_Info_15697f1f8dd06a0'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_15697f1f8dd06a0'> <img id='FormPropulSite_img_15697f1f8dd06a0' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite15697f1f8dd06a0-1715859266.png' ><input name='Genered_15697f1f8dd06a0' id='Genered_15697f1f8dd06a0' 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_15697f1f8dd06a0' id='hid_15697f1f8dd06a0' value='hid_15697f1f8dd06a0' type='hidden'> <br> <input name='Envoyer_15697f1f8dd06a0' id='Envoyer_15697f1f8dd06a0' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite15697f1f8dd06a0(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite15697f1f8dd06a0()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_15697f1f8dd06a0').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_15697f1f8dd06a0_1').value == '' & 1 == 1)
					{
						erreur = erreur+'NOM DU SITE CHOISI >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15697f1f8dd06a0_2').value == '' & 1 == 1)
					{
						erreur = erreur+'VOTRE NOM >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15697f1f8dd06a0_3').value == '' & 1 == 1)
					{
						erreur = erreur+'PRENOM >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15697f1f8dd06a0_4').value == '' & 1 == 1)
					{
						erreur = erreur+'PAYS >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15697f1f8dd06a0_5').value == '' & 1 == 1)
					{
						erreur = erreur+'VILLE >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15697f1f8dd06a0_6').value == '' & 1 == 1)
					{
						erreur = erreur+'FONCTION >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15697f1f8dd06a0_7').value == '' & 1 == 1)
					{
						erreur = erreur+'ADRESSE >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_15697f1f8dd06a0_8').value == '' & 1 == 1)
					{
						erreur = erreur+'TELEPHONE >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_15697f1f8dd06a0').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_15697f1f8dd06a0.submit();
				ReloadImg_15697f1f8dd06a0();
			}
			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_15697f1f8dd06a0()
		{
			var nbtp = Math.floor(Math.random() * 1715859266)+0;
			document.getElementById('DivContImgAndGenered_15697f1f8dd06a0').innerHTML = '<img id="FormPropulSite_img_15697f1f8dd06a0" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite15697f1f8dd06a0-'+nbtp+'.png"><input name="Genered_15697f1f8dd06a0" id="Genered_15697f1f8dd06a0">';
		}
		
		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)';
		}