document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_165380e3c050d9e' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_17811-165380e3c050d9e.html' name='Formulaire_Gratuit_PropulSite_165380e3c050d9e'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_165380e3c050d9e'> <th>* Votre e-mail :</th> <td> <input name='Mail_165380e3c050d9e' id='Mail_165380e3c050d9e'> </td> </tr> <tr id='PropulSite_165380e3c050d9e_1_Info'> <th>* Noms :</th> <td><input name='PropulSite_165380e3c050d9e_1' id='PropulSite_165380e3c050d9e_1' type='text' size='25'></td> </tr> <tr id='PropulSite_165380e3c050d9e_2_Info'> <th>* Prénoms :</th> <td><input name='PropulSite_165380e3c050d9e_2' id='PropulSite_165380e3c050d9e_2' type='text' size='25'></td> </tr> <tr id='PropulSite_165380e3c050d9e_3_Info'> <th>* Fonction :</th> <td><input name='PropulSite_165380e3c050d9e_3' id='PropulSite_165380e3c050d9e_3' type='text' size='25'></td> </tr> <tr id='PropulSite_165380e3c050d9e_4_Info'> <th>* Pays :</th> <td><input name='PropulSite_165380e3c050d9e_4' id='PropulSite_165380e3c050d9e_4' type='text' size='25'></td> </tr> <tr id='PropulSite_165380e3c050d9e_5_Info'> <th>* Contacts :</th> <td><input name='PropulSite_165380e3c050d9e_5' id='PropulSite_165380e3c050d9e_5' type='text' size='25'></td> </tr> <tr id='PropulSite_165380e3c050d9e_6_Info'> <th>* Option :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>Moov money</th> <td><input name='PropulSite_165380e3c050d9e_6' id='PropulSite_165380e3c050d9e_6' type='radio' value='Moov money'></td> </tr> <tr> <th>Mtn money</th> <td><input name='PropulSite_165380e3c050d9e_6' id='PropulSite_165380e3c050d9e_6' type='radio' value='Mtn money'></td> </tr> <tr> <th>Orange money</th> <td><input name='PropulSite_165380e3c050d9e_6' id='PropulSite_165380e3c050d9e_6' type='radio' value='Orange money'></td> </tr> <tr> <th>Money Gram</th> <td><input name='PropulSite_165380e3c050d9e_6' id='PropulSite_165380e3c050d9e_6' type='radio' value='Money Gram'></td> </tr> <tr> <th>Western union</th> <td><input name='PropulSite_165380e3c050d9e_6' id='PropulSite_165380e3c050d9e_6' type='radio' value='Western union'></td> </tr> <tr> <th>Express union</th> <td><input name='PropulSite_165380e3c050d9e_6' id='PropulSite_165380e3c050d9e_6' type='radio' value='Express union'></td> </tr> </tbody> </table> </td> </tr> <tr id='Genered_Info_165380e3c050d9e'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_165380e3c050d9e'> <img id='FormPropulSite_img_165380e3c050d9e' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite165380e3c050d9e-1744970857.png' ><input name='Genered_165380e3c050d9e' id='Genered_165380e3c050d9e' 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_165380e3c050d9e' id='hid_165380e3c050d9e' value='hid_165380e3c050d9e' type='hidden'> <br> <input name='Envoyer_165380e3c050d9e' id='Envoyer_165380e3c050d9e' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite165380e3c050d9e(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite165380e3c050d9e()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_165380e3c050d9e').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_165380e3c050d9e_1').value == '' & 1 == 1)
					{
						erreur = erreur+'Noms >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_165380e3c050d9e_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Prénoms >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_165380e3c050d9e_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Fonction >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_165380e3c050d9e_4').value == '' & 1 == 1)
					{
						erreur = erreur+'Pays >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_165380e3c050d9e_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Contacts >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_165380e3c050d9e').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_165380e3c050d9e.submit();
				ReloadImg_165380e3c050d9e();
			}
			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_165380e3c050d9e()
		{
			var nbtp = Math.floor(Math.random() * 1744970857)+0;
			document.getElementById('DivContImgAndGenered_165380e3c050d9e').innerHTML = '<img id="FormPropulSite_img_165380e3c050d9e" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite165380e3c050d9e-'+nbtp+'.png"><input name="Genered_165380e3c050d9e" id="Genered_165380e3c050d9e">';
		}
		
		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)';
		}