document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_12727965a1c6993' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_13550-12727965a1c6993.html' name='Formulaire_Gratuit_PropulSite_12727965a1c6993'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_12727965a1c6993'> <th>* Votre e-mail :</th> <td> <input name='Mail_12727965a1c6993' id='Mail_12727965a1c6993'> </td> </tr> <tr id='PropulSite_12727965a1c6993_1_Info'> <th>* Nom :</th> <td><input name='PropulSite_12727965a1c6993_1' id='PropulSite_12727965a1c6993_1' type='text' size='20'></td> </tr> <tr id='PropulSite_12727965a1c6993_2_Info'> <th>* Prénoms :</th> <td><input name='PropulSite_12727965a1c6993_2' id='PropulSite_12727965a1c6993_2' type='text' size='20'></td> </tr> <tr id='PropulSite_12727965a1c6993_3_Info'> <th>* Pays :</th> <td><input name='PropulSite_12727965a1c6993_3' id='PropulSite_12727965a1c6993_3' type='text' size='20'></td> </tr> <tr id='PropulSite_12727965a1c6993_4_Info'> <th>* Ville :</th> <td><input name='PropulSite_12727965a1c6993_4' id='PropulSite_12727965a1c6993_4' type='text' size='20'></td> </tr> <tr id='PropulSite_12727965a1c6993_5_Info'> <th>* Téléphone :</th> <td><input name='PropulSite_12727965a1c6993_5' id='PropulSite_12727965a1c6993_5' type='text' size='20'></td> </tr> <tr id='PropulSite_12727965a1c6993_6_Info'> <th>* Cartes :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Neosurf</th> <td><input name='PropulSite_12727965a1c6993_6[]' id='PropulSite_12727965a1c6993_6' type='checkbox' value='Neosurf'></td> </tr> <tr> <th>Pcs</th> <td><input name='PropulSite_12727965a1c6993_6[]' id='PropulSite_12727965a1c6993_6' type='checkbox' value='Pcs'></td> </tr> <tr> <th>Paysafecard</th> <td><input name='PropulSite_12727965a1c6993_6[]' id='PropulSite_12727965a1c6993_6' type='checkbox' value='Paysafecard'></td> </tr> <tr> <th>Neocode</th> <td><input name='PropulSite_12727965a1c6993_6[]' id='PropulSite_12727965a1c6993_6' type='checkbox' value='Neocode'></td> </tr> <tr> <th>Autres</th> <td><input name='PropulSite_12727965a1c6993_6[]' id='PropulSite_12727965a1c6993_6' type='checkbox' value='Autres'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_12727965a1c6993_7_Info'> <th>* Préciser pour autres :</th> <td><input name='PropulSite_12727965a1c6993_7' id='PropulSite_12727965a1c6993_7' type='text' size='20'></td> </tr> <tr id='PropulSite_12727965a1c6993_8_Info'> <th>* Sujet :</th> <td><textarea name='PropulSite_12727965a1c6993_8' id='PropulSite_12727965a1c6993_8' cols='25' rows='10'></textarea></td> </tr> <tr id='Genered_Info_12727965a1c6993'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_12727965a1c6993'> <img id='FormPropulSite_img_12727965a1c6993' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite12727965a1c6993-1716304854.png' ><input name='Genered_12727965a1c6993' id='Genered_12727965a1c6993' 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_12727965a1c6993' id='hid_12727965a1c6993' value='hid_12727965a1c6993' type='hidden'> <br> <input name='Envoyer_12727965a1c6993' id='Envoyer_12727965a1c6993' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite12727965a1c6993(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite12727965a1c6993()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_12727965a1c6993').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_12727965a1c6993_1').value == '' & 1 == 1)
					{
						erreur = erreur+'Nom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_12727965a1c6993_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Prénoms >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_12727965a1c6993_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Pays >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_12727965a1c6993_4').value == '' & 1 == 1)
					{
						erreur = erreur+'Ville >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_12727965a1c6993_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Téléphone >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_12727965a1c6993_7').value == '' & 1 == 1)
					{
						erreur = erreur+'Préciser pour autres >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_12727965a1c6993_8').value == '' & 1 == 1)
					{
						erreur = erreur+'Sujet >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_12727965a1c6993').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_12727965a1c6993.submit();
				ReloadImg_12727965a1c6993();
			}
			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_12727965a1c6993()
		{
			var nbtp = Math.floor(Math.random() * 1716304854)+0;
			document.getElementById('DivContImgAndGenered_12727965a1c6993').innerHTML = '<img id="FormPropulSite_img_12727965a1c6993" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite12727965a1c6993-'+nbtp+'.png"><input name="Genered_12727965a1c6993" id="Genered_12727965a1c6993">';
		}
		
		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)';
		}