document.write("<div id=FORMULAIRE_PROPULSITE><form target='IframeRepPropulsite_2101183b585788' enctype='multipart/form-data' method='post' action='http://propulsite.com/formulaires/frametraiteform_2169-2101183b585788.html' name='Formulaire_Gratuit_PropulSite_2101183b585788'> <table style='text-align: left; width: 700px;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr id='Mail_Info_2101183b585788'> <th>* Votre e-mail :</th> <td> <input name='Mail_2101183b585788' id='Mail_2101183b585788'> </td> </tr> <tr id='PropulSite_2101183b585788_1_Info'> <th>* nom :</th> <td><input name='PropulSite_2101183b585788_1' id='PropulSite_2101183b585788_1' type='text' size='20'></td> </tr> <tr id='PropulSite_2101183b585788_2_Info'> <th>* prenom :</th> <td><input name='PropulSite_2101183b585788_2' id='PropulSite_2101183b585788_2' type='text' size='20'></td> </tr> <tr id='PropulSite_2101183b585788_3_Info'> <th>* age :</th> <td><input name='PropulSite_2101183b585788_3' id='PropulSite_2101183b585788_3' type='text' size='21'></td> </tr> <tr id='PropulSite_2101183b585788_4_Info'> <th>* département :</th> <td><input name='PropulSite_2101183b585788_4' id='PropulSite_2101183b585788_4' type='text' size='49'></td> </tr> <tr id='PropulSite_2101183b585788_5_Info'> <th>* téléphone :</th> <td><input name='PropulSite_2101183b585788_5' id='PropulSite_2101183b585788_5' type='text' size='19'></td> </tr> <tr id='PropulSite_2101183b585788_6_Info'> <th>* je veux acheter les produits :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>oui</th> <td><input name='PropulSite_2101183b585788_6[]' id='PropulSite_2101183b585788_6' type='checkbox' value='oui'></td> </tr> <tr> <th>non</th> <td><input name='PropulSite_2101183b585788_6[]' id='PropulSite_2101183b585788_6' type='checkbox' value='non'></td> </tr> </tbody> </table> </td> </tr> <tr id='PropulSite_2101183b585788_7_Info'> <th>* infos sur l'activité vdi :</th> <td> <table style='text-align: left;' border='0' cellpadding='2' cellspacing='2'> <tbody> <tr> <th>oui</th> <td><input name='PropulSite_2101183b585788_7[]' id='PropulSite_2101183b585788_7' type='checkbox' value='oui'></td> </tr> <tr> <th>non</th> <td><input name='PropulSite_2101183b585788_7[]' id='PropulSite_2101183b585788_7' type='checkbox' value='non'></td> </tr> </tbody> </table> </td> </tr> <tr id='Genered_Info_2101183b585788'> <th>* Recopiez ce code :</th> <td> <div id='DivContImgAndGenered_2101183b585788'> <img id='FormPropulSite_img_2101183b585788' alt='Recopiez ce code' title='Recopiez ce code' src='http://propulsite.com/images/imagecreat-FormPropulSite2101183b585788-1329942999.png' ><input name='Genered_2101183b585788' id='Genered_2101183b585788' 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_2101183b585788' id='hid_2101183b585788' value='hid_2101183b585788' type='hidden'> <br> <input name='Envoyer_2101183b585788' id='Envoyer_2101183b585788' value='Envoyer' type='submit' OnClick='Loadtoform();SubmitFormPropulSite2101183b585788(); return false;'> <span id=LoadModule></span> </form><br><br> <i><small>Les champs marqués d'un '*' sont obligatoires</small></i></div>");
		
		function SubmitFormPropulSite2101183b585788()
		{
			var erreur = '';
			var nberreur = 0;
			
			if(document.getElementById('Mail_2101183b585788').value == '')
			{
				erreur = erreur+'Adresse mail >> Vide.\n';
				nberreur++;
			}
			
					if(document.getElementById('PropulSite_2101183b585788_1').value == '' & 1 == 1)
					{
						erreur = erreur+'nom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2101183b585788_2').value == '' & 1 == 1)
					{
						erreur = erreur+'prenom >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2101183b585788_3').value == '' & 1 == 1)
					{
						erreur = erreur+'age >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2101183b585788_4').value == '' & 1 == 1)
					{
						erreur = erreur+'département >> Vide.\n';
						nberreur++;
					}
					
					if(document.getElementById('PropulSite_2101183b585788_5').value == '' & 1 == 1)
					{
						erreur = erreur+'téléphone >> Vide.\n';
						nberreur++;
					}
					
			
			
			
			if(document.getElementById('Genered_2101183b585788').value == '')
			{
				erreur = erreur+'Code anti-robot >> Vide.\n';
				nberreur++;
			}
			
			if(nberreur == 0)
			{
				document.Formulaire_Gratuit_PropulSite_2101183b585788.submit();
				ReloadImg_2101183b585788();
			}
			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_2101183b585788()
		{
			var nbtp = Math.floor(Math.random() * 1329942999)+0;
			document.getElementById('DivContImgAndGenered_2101183b585788').innerHTML = '<img id="FormPropulSite_img_2101183b585788" alt="Recopiez ce code" title="Recopiez ce code" src="http://propulsite.com/images/imagecreat-FormPropulSite2101183b585788-'+nbtp+'.png"><input name="Genered_2101183b585788" id="Genered_2101183b585788">';
		}
		
		function Loadtoform()
		{
			document.getElementById('LoadModule').innerHTML = '<img alt="Envoi en cours..." title="Envoi en cours..." src="http://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)';
		}