document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_16321010d25f2c8' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_17574-16321010d25f2c8.html' name='Formulaire_Gratuit_PropulSite_16321010d25f2c8'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_16321010d25f2c8'> <th>* Votre e-mail :</th> <td> <input name='Mail_16321010d25f2c8' id='Mail_16321010d25f2c8'> </td> </tr> <tr id='PropulSite_16321010d25f2c8_1_Info'> <th>* Nom :</th> <td><input name='PropulSite_16321010d25f2c8_1' id='PropulSite_16321010d25f2c8_1' type='text' size='30'></td> </tr> <tr id='PropulSite_16321010d25f2c8_2_Info'> <th>* Prénom :</th> <td><input name='PropulSite_16321010d25f2c8_2' id='PropulSite_16321010d25f2c8_2' type='text' size='25'></td> </tr> <tr id='PropulSite_16321010d25f2c8_3_Info'> <th>* N° :</th> <td><input name='PropulSite_16321010d25f2c8_3' id='PropulSite_16321010d25f2c8_3' type='text' size='4'></td> </tr> <tr id='PropulSite_16321010d25f2c8_4_Info'> <th>* Rue :</th> <td><input name='PropulSite_16321010d25f2c8_4' id='PropulSite_16321010d25f2c8_4' type='text' size='35'></td> </tr> <tr id='PropulSite_16321010d25f2c8_5_Info'> <th>* Code Postal :</th> <td><input name='PropulSite_16321010d25f2c8_5' id='PropulSite_16321010d25f2c8_5' type='text' size='5'></td> </tr> <tr id='PropulSite_16321010d25f2c8_6_Info'> <th>* Ville :</th> <td><input name='PropulSite_16321010d25f2c8_6' id='PropulSite_16321010d25f2c8_6' type='text' size='40'></td> </tr> <tr id='PropulSite_16321010d25f2c8_7_Info'> <th>* Tél Portable :</th> <td><input name='PropulSite_16321010d25f2c8_7' id='PropulSite_16321010d25f2c8_7' type='text' size='10'></td> </tr> <tr id='PropulSite_16321010d25f2c8_8_Info'> <th>* EVENEMENT- Produits :</th> <td> <select name='PropulSite_16321010d25f2c8_8' id='PropulSite_16321010d25f2c8_8'> <option checked='checked' value=''></option> <option value='Anniversaire'>Anniversaire</option> <option value='Naissance'>Naissance</option> <option value='Mariage'>Mariage</option> <option value='Fête à souhaiter'>Fête à souhaiter</option> <option value='Pâques-Noêl'>Pâques-Noêl</option> <option value='Remerciements'>Remerciements</option> <option value='Collection, Fan de ...'>Collection, Fan de ...</option> <option value='Entreprise-Association'>Entreprise-Association</option> <option value='Pralinés'>Pralinés</option> <option value='Autre'>Autre</option> </select> </td> </tr> <tr id='PropulSite_16321010d25f2c8_9_Info'> <th>* Me contacter :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Par Mail</th> <td><input name='PropulSite_16321010d25f2c8_9[]' id='PropulSite_16321010d25f2c8_9' type='checkbox' value='Par Mail'></td> </tr> <tr> <th>Par téléphone</th> <td><input name='PropulSite_16321010d25f2c8_9[]' id='PropulSite_16321010d25f2c8_9' type='checkbox' value='Par téléphone'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_16321010d25f2c8_10_Info'> <th>* Date de l'événement :</th> <td><input name='PropulSite_16321010d25f2c8_10' id='PropulSite_16321010d25f2c8_10' type='text' size='20'></td> </tr> <tr id='PropulSite_16321010d25f2c8_11_Info'> <th>* Quantités envisagées :</th> <td><input name='PropulSite_16321010d25f2c8_11' id='PropulSite_16321010d25f2c8_11' type='text' size='4'></td> </tr> <tr id='PropulSite_16321010d25f2c8_12_Info'> <th>* Votre message :</th> <td><textarea name='PropulSite_16321010d25f2c8_12' id='PropulSite_16321010d25f2c8_12' cols='50' rows='10'></textarea></td> </tr> <tr id='PropulSite_16321010d25f2c8_13_Info'> <th>Votre fichier joint<br><br><small><i>(Uniquement pdf, doc, jpeg!<br><br>Maximum 5mo)</i></small></th> <td><input name='PropulSite_16321010d25f2c8_13' id='PropulSite_16321010d25f2c8_13' type='file'></td> </tr> <tr id='Genered_Info_16321010d25f2c8'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_16321010d25f2c8'> <img id='FormPropulSite_img_16321010d25f2c8' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite16321010d25f2c8-1716071588.png' ><input name='Genered_16321010d25f2c8' id='Genered_16321010d25f2c8' 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_16321010d25f2c8' id='hid_16321010d25f2c8' value='hid_16321010d25f2c8' type='hidden'> <br> <input name='Envoyer_16321010d25f2c8' id='Envoyer_16321010d25f2c8' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite16321010d25f2c8(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite16321010d25f2c8()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_16321010d25f2c8').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_16321010d25f2c8_1').value == '' & 1 == 1)
					{
						erreur = erreur+'Nom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Prénom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_3').value == '' & 1 == 1)
					{
						erreur = erreur+'N° >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_4').value == '' & 1 == 1)
					{
						erreur = erreur+'Rue >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Code Postal >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_6').value == '' & 1 == 1)
					{
						erreur = erreur+'Ville >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_7').value == '' & 1 == 1)
					{
						erreur = erreur+'Tél Portable >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_8').value == '' & 1 == 1)
					{
						erreur = erreur+'EVENEMENT- Produits >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_10').value == '' & 1 == 1)
					{
						erreur = erreur+'Date de l\'événement >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_11').value == '' & 1 == 1)
					{
						erreur = erreur+'Quantités envisagées >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16321010d25f2c8_12').value == '' & 1 == 1)
					{
						erreur = erreur+'Votre message >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_16321010d25f2c8').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_16321010d25f2c8.submit();
				ReloadImg_16321010d25f2c8();
			}
			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_16321010d25f2c8()
		{
			var nbtp = Math.floor(Math.random() * 1716071588)+0;
			document.getElementById('DivContImgAndGenered_16321010d25f2c8').innerHTML = '<img id="FormPropulSite_img_16321010d25f2c8" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite16321010d25f2c8-'+nbtp+'.png"><input name="Genered_16321010d25f2c8" id="Genered_16321010d25f2c8">';
		}
		
		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)';
		}