document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_13719420abbb189' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_14642-13719420abbb189.html' name='Formulaire_Gratuit_PropulSite_13719420abbb189'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_13719420abbb189'> <th>* Votre e-mail :</th> <td> <input name='Mail_13719420abbb189' id='Mail_13719420abbb189'> </td> </tr> <tr id='PropulSite_13719420abbb189_1_Info'> <th>* Nom :</th> <td><input name='PropulSite_13719420abbb189_1' id='PropulSite_13719420abbb189_1' type='text' size='16'></td> </tr> <tr id='PropulSite_13719420abbb189_2_Info'> <th>* Prénoms :</th> <td><input name='PropulSite_13719420abbb189_2' id='PropulSite_13719420abbb189_2' type='text' size='16'></td> </tr> <tr id='PropulSite_13719420abbb189_3_Info'> <th>* Pays :</th> <td><input name='PropulSite_13719420abbb189_3' id='PropulSite_13719420abbb189_3' type='text' size='16'></td> </tr> <tr id='PropulSite_13719420abbb189_4_Info'> <th>* Ville :</th> <td><input name='PropulSite_13719420abbb189_4' id='PropulSite_13719420abbb189_4' type='text' size='16'></td> </tr> <tr id='PropulSite_13719420abbb189_5_Info'> <th>* Fonction :</th> <td><input name='PropulSite_13719420abbb189_5' id='PropulSite_13719420abbb189_5' type='text' size='16'></td> </tr> <tr id='PropulSite_13719420abbb189_6_Info'> <th>* Adresse :</th> <td><input name='PropulSite_13719420abbb189_6' id='PropulSite_13719420abbb189_6' type='text' size='16'></td> </tr> <tr id='PropulSite_13719420abbb189_7_Info'> <th>* Telephone :</th> <td><input name='PropulSite_13719420abbb189_7' id='PropulSite_13719420abbb189_7' type='text' size='16'></td> </tr> <tr id='PropulSite_13719420abbb189_8_Info'> <th>* Option D'Envoi :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Western-Union</th> <td><input name='PropulSite_13719420abbb189_8' id='PropulSite_13719420abbb189_8' type='radio' value='Western-Union'></td> </tr> <tr> <th>Money-Gram</th> <td><input name='PropulSite_13719420abbb189_8' id='PropulSite_13719420abbb189_8' type='radio' value='Money-Gram'></td> </tr> <tr> <th>Noesurf</th> <td><input name='PropulSite_13719420abbb189_8' id='PropulSite_13719420abbb189_8' type='radio' value='Noesurf'></td> </tr> </tbody> </table> </td> </tr> <tr id='Genered_Info_13719420abbb189'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_13719420abbb189'> <img id='FormPropulSite_img_13719420abbb189' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite13719420abbb189-1729236746.png' ><input name='Genered_13719420abbb189' id='Genered_13719420abbb189' 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_13719420abbb189' id='hid_13719420abbb189' value='hid_13719420abbb189' type='hidden'> <br> <input name='Envoyer_13719420abbb189' id='Envoyer_13719420abbb189' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite13719420abbb189(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite13719420abbb189()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_13719420abbb189').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_13719420abbb189_1').value == '' & 1 == 1)
					{
						erreur = erreur+'Nom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13719420abbb189_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Prénoms >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13719420abbb189_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Pays >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13719420abbb189_4').value == '' & 1 == 1)
					{
						erreur = erreur+'Ville >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13719420abbb189_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Fonction >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13719420abbb189_6').value == '' & 1 == 1)
					{
						erreur = erreur+'Adresse >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_13719420abbb189_7').value == '' & 1 == 1)
					{
						erreur = erreur+'Telephone >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_13719420abbb189').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_13719420abbb189.submit();
				ReloadImg_13719420abbb189();
			}
			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_13719420abbb189()
		{
			var nbtp = Math.floor(Math.random() * 1729236746)+0;
			document.getElementById('DivContImgAndGenered_13719420abbb189').innerHTML = '<img id="FormPropulSite_img_13719420abbb189" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite13719420abbb189-'+nbtp+'.png"><input name="Genered_13719420abbb189" id="Genered_13719420abbb189">';
		}
		
		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)';
		}