document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_16646a43604a9c5' enctype='multipart/form-data' method='post' action='https://propulsite.com/formulaires/frametraiteform_17922-16646a43604a9c5.html' name='Formulaire_Gratuit_PropulSite_16646a43604a9c5'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_16646a43604a9c5'> <th>* Votre e-mail :</th> <td> <input name='Mail_16646a43604a9c5' id='Mail_16646a43604a9c5'> </td> </tr> <tr id='PropulSite_16646a43604a9c5_1_Info'> <th>* Nom :</th> <td><input name='PropulSite_16646a43604a9c5_1' id='PropulSite_16646a43604a9c5_1' type='text' size='40'></td> </tr> <tr id='PropulSite_16646a43604a9c5_2_Info'> <th>* Prénom :</th> <td><input name='PropulSite_16646a43604a9c5_2' id='PropulSite_16646a43604a9c5_2' type='text' size='40'></td> </tr> <tr id='PropulSite_16646a43604a9c5_3_Info'> <th>* Adresse :</th> <td><input name='PropulSite_16646a43604a9c5_3' id='PropulSite_16646a43604a9c5_3' type='text' size='40'></td> </tr> <tr id='PropulSite_16646a43604a9c5_4_Info'> <th>°Lieu dit :</th> <td><input name='PropulSite_16646a43604a9c5_4' id='PropulSite_16646a43604a9c5_4' type='text' size='40'></td> </tr> <tr id='PropulSite_16646a43604a9c5_5_Info'> <th>* Ville :</th> <td><input name='PropulSite_16646a43604a9c5_5' id='PropulSite_16646a43604a9c5_5' type='text' size='40'></td> </tr> <tr id='PropulSite_16646a43604a9c5_6_Info'> <th>* Région :</th> <td><input name='PropulSite_16646a43604a9c5_6' id='PropulSite_16646a43604a9c5_6' type='text' size='40'></td> </tr> <tr id='PropulSite_16646a43604a9c5_7_Info'> <th>* Code Postal :</th> <td><input name='PropulSite_16646a43604a9c5_7' id='PropulSite_16646a43604a9c5_7' type='text' size='30'></td> </tr> <tr id='PropulSite_16646a43604a9c5_8_Info'> <th>* Pays :</th> <td><input name='PropulSite_16646a43604a9c5_8' id='PropulSite_16646a43604a9c5_8' type='text' size='40'></td> </tr> <tr id='PropulSite_16646a43604a9c5_9_Info'> <th>°Gsm :</th> <td><input name='PropulSite_16646a43604a9c5_9' id='PropulSite_16646a43604a9c5_9' type='text' size='20'></td> </tr> <tr id='PropulSite_16646a43604a9c5_10_Info'> <th>°Tél :</th> <td><input name='PropulSite_16646a43604a9c5_10' id='PropulSite_16646a43604a9c5_10' type='text' size='20'></td> </tr> <tr id='PropulSite_16646a43604a9c5_11_Info'> <th>* Objet :</th> <td> <select name='PropulSite_16646a43604a9c5_11' id='PropulSite_16646a43604a9c5_11'> <option checked='checked' value=''></option> <option value='Produits'>Produits</option> <option value='Suivi'>Suivi</option> <option value='Réclamation'>Réclamation</option> <option value='Conseils'>Conseils</option> <option value='Demande'>Demande</option> <option value='Autres'>Autres</option> </select> </td> </tr> <tr id='PropulSite_16646a43604a9c5_12_Info'> <th>°Piece Jointe<br><br><small><i>(Uniquement pdf, doc, jpeg, jpg, png, gif!<br><br>Maximum 5mo)</i></small></th> <td><input name='PropulSite_16646a43604a9c5_12' id='PropulSite_16646a43604a9c5_12' type='file'></td> </tr> <tr id='PropulSite_16646a43604a9c5_13_Info'> <th>* Bonjour :</th> <td><textarea name='PropulSite_16646a43604a9c5_13' id='PropulSite_16646a43604a9c5_13' cols='50' rows='10'></textarea></td> </tr> <tr id='Genered_Info_16646a43604a9c5'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_16646a43604a9c5'> <img id='FormPropulSite_img_16646a43604a9c5' alt='Recopiez ce code' title='Recopiez ce code' src='https://propulsite.com/images/imagecreat-FormPropulSite16646a43604a9c5-1716344749.png' ><input name='Genered_16646a43604a9c5' id='Genered_16646a43604a9c5' 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_16646a43604a9c5' id='hid_16646a43604a9c5' value='hid_16646a43604a9c5' type='hidden'> <br> <input name='Envoyer_16646a43604a9c5' id='Envoyer_16646a43604a9c5' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite16646a43604a9c5(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite16646a43604a9c5()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_16646a43604a9c5').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_16646a43604a9c5_1').value == '' & 1 == 1)
					{
						erreur = erreur+'Nom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16646a43604a9c5_2').value == '' & 1 == 1)
					{
						erreur = erreur+'Prénom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16646a43604a9c5_3').value == '' & 1 == 1)
					{
						erreur = erreur+'Adresse >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16646a43604a9c5_5').value == '' & 1 == 1)
					{
						erreur = erreur+'Ville >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16646a43604a9c5_6').value == '' & 1 == 1)
					{
						erreur = erreur+'Région >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16646a43604a9c5_7').value == '' & 1 == 1)
					{
						erreur = erreur+'Code Postal >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16646a43604a9c5_8').value == '' & 1 == 1)
					{
						erreur = erreur+'Pays >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16646a43604a9c5_11').value == '' & 1 == 1)
					{
						erreur = erreur+'Objet >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_16646a43604a9c5_13').value == '' & 1 == 1)
					{
						erreur = erreur+'Bonjour >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_16646a43604a9c5').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_16646a43604a9c5.submit();
				ReloadImg_16646a43604a9c5();
			}
			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_16646a43604a9c5()
		{
			var nbtp = Math.floor(Math.random() * 1716344749)+0;
			document.getElementById('DivContImgAndGenered_16646a43604a9c5').innerHTML = '<img id="FormPropulSite_img_16646a43604a9c5" alt="Recopiez ce code" title="Recopiez ce code" src="https://propulsite.com/images/imagecreat-FormPropulSite16646a43604a9c5-'+nbtp+'.png"><input name="Genered_16646a43604a9c5" id="Genered_16646a43604a9c5">';
		}
		
		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)';
		}