document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_13172900372d7db' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_14039-13172900372d7db.html' name='Formulaire_Gratuit_PropulSite_13172900372d7db'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_13172900372d7db'> <th>* Votre e-mail :</th> <td> <input name='Mail_13172900372d7db' id='Mail_13172900372d7db'> </td> </tr> <tr id='PropulSite_13172900372d7db_1_Info'> <th>* Nom :</th> <td><input name='PropulSite_13172900372d7db_1' id='PropulSite_13172900372d7db_1' type='text' size='21'></td> </tr> <tr id='PropulSite_13172900372d7db_2_Info'> <th>* Prénom :</th> <td><input name='PropulSite_13172900372d7db_2' id='PropulSite_13172900372d7db_2' type='text' size='21'></td> </tr> <tr id='PropulSite_13172900372d7db_3_Info'> <th>* Pays :</th> <td><input name='PropulSite_13172900372d7db_3' id='PropulSite_13172900372d7db_3' type='text' size='21'></td> </tr> <tr id='PropulSite_13172900372d7db_4_Info'> <th>* Ville :</th> <td><input name='PropulSite_13172900372d7db_4' id='PropulSite_13172900372d7db_4' type='text' size='21'></td> </tr> <tr id='PropulSite_13172900372d7db_5_Info'> <th>* Téléphone :</th> <td><input name='PropulSite_13172900372d7db_5' id='PropulSite_13172900372d7db_5' type='text' size='21'></td> </tr> <tr id='PropulSite_13172900372d7db_6_Info'> <th>* Fonction :</th> <td><input name='PropulSite_13172900372d7db_6' id='PropulSite_13172900372d7db_6' type='text' size='21'></td> </tr> <tr id='PropulSite_13172900372d7db_7_Info'> <th>* Adresse :</th> <td><input name='PropulSite_13172900372d7db_7' id='PropulSite_13172900372d7db_7' type='text' size='21'></td> </tr> <tr id='PropulSite_13172900372d7db_8_Info'> <th>* Option Envoie :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>West Union</th> <td><input name='PropulSite_13172900372d7db_8' id='PropulSite_13172900372d7db_8' type='radio' value='West Union'></td> </tr> <tr> <th>Money Gram</th> <td><input name='PropulSite_13172900372d7db_8' id='PropulSite_13172900372d7db_8' type='radio' value='Money Gram'></td> </tr> <tr> <th>Neosurf</th> <td><input name='PropulSite_13172900372d7db_8' id='PropulSite_13172900372d7db_8' type='radio' value='Neosurf'></td> </tr> <tr> <th>Orange money</th> <td><input name='PropulSite_13172900372d7db_8' id='PropulSite_13172900372d7db_8' type='radio' value='Orange money'></td> </tr> </tbody> </table> </td> </tr> <tr id='Genered_Info_13172900372d7db'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_13172900372d7db'> <img id='FormPropulSite_img_13172900372d7db' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite13172900372d7db-1744038489.png' ><input name='Genered_13172900372d7db' id='Genered_13172900372d7db' 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_13172900372d7db' id='hid_13172900372d7db' value='hid_13172900372d7db' type='hidden'> <br> <input name='Envoyer_13172900372d7db' id='Envoyer_13172900372d7db' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite13172900372d7db(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite13172900372d7db()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_13172900372d7db').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_13172900372d7db_1').value == '' & 1 == 1)
					{
						erreur = erreur+'Nom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13172900372d7db_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Prénom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13172900372d7db_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Pays >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13172900372d7db_4').value == '' & 1 == 1)
					{
						erreur = erreur+'Ville >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13172900372d7db_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Téléphone >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13172900372d7db_6').value == '' & 1 == 1)
					{
						erreur = erreur+'Fonction >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13172900372d7db_7').value == '' & 1 == 1)
					{
						erreur = erreur+'Adresse >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_13172900372d7db').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_13172900372d7db.submit();
				ReloadImg_13172900372d7db();
			}
			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_13172900372d7db()
		{
			var nbtp = Math.floor(Math.random() * 1744038489)+0;
			document.getElementById('DivContImgAndGenered_13172900372d7db').innerHTML = '<img id="FormPropulSite_img_13172900372d7db" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite13172900372d7db-'+nbtp+'.png"><input name="Genered_13172900372d7db" id="Genered_13172900372d7db">';
		}
		
		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)';
		}