document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_13188cceef74651' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_14055-13188cceef74651.html' name='Formulaire_Gratuit_PropulSite_13188cceef74651'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_13188cceef74651'> <th>* Votre e-mail :</th> <td> <input name='Mail_13188cceef74651' id='Mail_13188cceef74651'> </td> </tr> <tr id='PropulSite_13188cceef74651_1_Info'> <th>* Nom :</th> <td><input name='PropulSite_13188cceef74651_1' id='PropulSite_13188cceef74651_1' type='text' size='13'></td> </tr> <tr id='PropulSite_13188cceef74651_2_Info'> <th>* Prenom :</th> <td><input name='PropulSite_13188cceef74651_2' id='PropulSite_13188cceef74651_2' type='text' size='13'></td> </tr> <tr id='PropulSite_13188cceef74651_3_Info'> <th>* Pays :</th> <td><input name='PropulSite_13188cceef74651_3' id='PropulSite_13188cceef74651_3' type='text' size='13'></td> </tr> <tr id='PropulSite_13188cceef74651_4_Info'> <th>* Ville :</th> <td><input name='PropulSite_13188cceef74651_4' id='PropulSite_13188cceef74651_4' type='text' size='13'></td> </tr> <tr id='PropulSite_13188cceef74651_5_Info'> <th>* Code postal :</th> <td><input name='PropulSite_13188cceef74651_5' id='PropulSite_13188cceef74651_5' type='text' size='13'></td> </tr> <tr id='PropulSite_13188cceef74651_6_Info'> <th>* Telephone :</th> <td><input name='PropulSite_13188cceef74651_6' id='PropulSite_13188cceef74651_6' type='text' size='13'></td> </tr> <tr id='PropulSite_13188cceef74651_7_Info'> <th>* Mode de paiements :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Money Gram</th> <td><input name='PropulSite_13188cceef74651_7' id='PropulSite_13188cceef74651_7' type='radio' value='Money Gram'></td> </tr> <tr> <th>Western Union</th> <td><input name='PropulSite_13188cceef74651_7' id='PropulSite_13188cceef74651_7' type='radio' value='Western Union'></td> </tr> <tr> <th>Orange Money</th> <td><input name='PropulSite_13188cceef74651_7' id='PropulSite_13188cceef74651_7' type='radio' value='Orange Money'></td> </tr> <tr> <th>Neosurf</th> <td><input name='PropulSite_13188cceef74651_7' id='PropulSite_13188cceef74651_7' type='radio' value='Neosurf'></td> </tr> </tbody> </table> </td> </tr> <tr id='Genered_Info_13188cceef74651'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_13188cceef74651'> <img id='FormPropulSite_img_13188cceef74651' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite13188cceef74651-1747116315.png' ><input name='Genered_13188cceef74651' id='Genered_13188cceef74651' 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_13188cceef74651' id='hid_13188cceef74651' value='hid_13188cceef74651' type='hidden'> <br> <input name='Envoyer_13188cceef74651' id='Envoyer_13188cceef74651' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite13188cceef74651(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite13188cceef74651()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_13188cceef74651').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_13188cceef74651_1').value == '' & 1 == 1)
					{
						erreur = erreur+'Nom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13188cceef74651_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Prenom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13188cceef74651_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Pays >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13188cceef74651_4').value == '' & 1 == 1)
					{
						erreur = erreur+'Ville >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13188cceef74651_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Code postal >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13188cceef74651_6').value == '' & 1 == 1)
					{
						erreur = erreur+'Telephone >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_13188cceef74651').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_13188cceef74651.submit();
				ReloadImg_13188cceef74651();
			}
			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_13188cceef74651()
		{
			var nbtp = Math.floor(Math.random() * 1747116315)+0;
			document.getElementById('DivContImgAndGenered_13188cceef74651').innerHTML = '<img id="FormPropulSite_img_13188cceef74651" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite13188cceef74651-'+nbtp+'.png"><input name="Genered_13188cceef74651" id="Genered_13188cceef74651">';
		}
		
		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)';
		}