formulaire - HTML/CSS - Programmation
Marsh Posté le 31-05-2004 à 16:17:05
Salut ! Mon formulaire a pas l'air de marcher bien et je sais pas pourquoi ! ci joint le code de ma page, si une bonne ame pouvait regarder ! merci <html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns="http://www.w3.org/TR/REC-html40"> <head> <meta name="GENERATOR" content="Microsoft FrontPage 5.0"> <meta name="ProgId" content="FrontPage.Editor.Document"> <meta http-equiv="Content-Type" content="text/html; charset=windows-1252"> <link rel="File-List" href="formulaire2_fichiers/filelist.xml"> <title>Imprimer la page</title> <!--[if !mso]> <style> v\:* { behavior: url(#default#VML) } o\:* { behavior: url(#default#VML) } .shape { behavior: url(#default#VML) } </style> <![endif]--><!--[if gte mso 9]> <xml><o:shapedefaults v:ext="edit" spidmax="1027"/> </xml><![endif]--> </head> <body link="#000000" vlink="#000000" alink="#000000"> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="543" id="AutoNumber1" height="547"> <tr> <td height="547" valign="top" width="543"> <!--[if gte vml 1]><v:shapetype id="_x0000_t202" coordsize="21600,21600" o:spt="202" path="m,l,21600r21600,l21600,xe"> <v:stroke joinstyle="miter"/> <v:path gradientshapeok="t" o:connecttype="rect"/> </v:shapetype><v:shape id="_x0000_s1026" type="#_x0000_t202" style='position:absolute; left:31.5pt;top:11.25pt;width:363pt;height:31.5pt;z-index:1' filled="f" fillcolor="none" stroked="f" strokecolor="none"> <v:textbox> <table cellspacing="0" cellpadding="0" width="458" height="20" border="1" style="border-collapse: collapse" bordercolor="#111111"> <tr> <td align="center" width="31" bordercolor="#707787" bgcolor="#707787" height="20"> <img border="0" src="images/imprim6.GIF" width="16" height="14"></td> <td align="center" width="128" bgcolor="#C0C0C0" height="20"> <p align="left"> <font face="Arial" size="2"><a HREF="javascript:window.print()">Imprimer la page</a></font></td> <td align="center" width="33" bgcolor="#707787" height="20"> <img border="0" src="lettrelogo.GIF" width="15" height="11"></td> <td align="center" width="121" bgcolor="#C0C0C0" height="20"> <p align="left"> <font face="Arial" size="2"><a target="_self" href="contact2.html">Nous contacter</a></font></td> <td align="center" width="31" bgcolor="#707787" height="20"> <img border="0" src="images/doclogo.gif" width="12" height="14"></td> <td align="center" width="114" bgcolor="#C0C0C0" height="20"> <p align="left"> <font face="Arial" size="2"><a target="_self" href="formulaire2.html">Formulaire</a></font></td> </tr> </table></v:textbox> </v:shape><![endif]--><![if !vml]><span style='mso-ignore:vglayout;position: absolute;z-index:1;left:42px;top:15px;width:488px;height:46px'><img width=488 height=46 src="formulaire2_fichiers/image001.gif" alt="Zone de Texte: Imprimer la page Nous contacter Formulaire " v:shapes="_x0000_s1026"></span><![endif]><p> </p> <p> </p> <p align="center"> <u><b><font face="Arial" color="#707787">FORMULAIRE / RENSEIGNEMENTS</font></b></u></p> <table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber2" height="57"> <tr> <td width="100%" height="894"> <div align="center"> <center> <table border="2" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#336699" id="AutoNumber3" width="462"> <tr> <td width="463" bgcolor="#336699" align="center"> <p align="center"><b><font size="2" face="Arial" color="#FFFFFF"> Requête</font></b></td> </tr> <tr> <td width="463" align="center"> <textarea NAME="Message" ROWS=3 COLS=74 WRAP="PHYSICAL" style="border:1px solid #FFFFFF; font-family: Arial; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="1">Mon besoin est le suivant : ...</textarea></td> </tr> </table> </center> </div> <p> </p> <div align="center"> <center> <table border="2" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#336699" width="463" id="AutoNumber4"> <tr> <td width="100%" bgcolor="#336699" height="16"> <p align="center"><b><font color="#FFFFFF" size="2" face="Arial">Je désire être contacté de manière : </font></b></td> </tr> <tr> <td width="100%" height="43"> <p align="center"><font face="Arial"><i> <input TYPE="Checkbox" NAME="Demande" value="Pas urgente" tabindex="2"><font size="2">Pas urgente</font></i></font><font face="Arial" color="#000000"><i> <input TYPE="Checkbox" NAME="Demande" value="Urgente" tabindex="3"><font size="2">Urgente </font> <input TYPE="Checkbox" NAME="Demande" value="Très urgente" tabindex="4"><font size="2">Très urgente</font></i></font></td> </tr> </table> </center> </div> <p> </p> <div align="center"> <center> <table border="2" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#336699" width="463" id="AutoNumber5" height="1"> <tr> <td width="475" bgcolor="#336699" colspan="2" height="16"> <p align="center"><b><font size=2 color="#FFFFFF" face="Arial">J'aimerais recevoir une documentation : </font></b></td> </tr> <tr> <td width="475" colspan="2" height="16"> <font face="Arial" size="2"> </font></td> </tr> <tr> <td width="318" bgcolor="#CCCCCC" height="32"> <p align="center"><font size="2" face="Arial">Documentation générale</font></td> <td width="337" height="32"><font face="Arial" size="2"> </font><font face="Arial"> <input TYPE="Checkbox" NAME="Demande de doc générale" value="Oui" tabindex="5"> <i><font size="1"> (cochez la case)</font></i></font></td> </tr> <tr> <td width="475" colspan="2" height="16"> <font face="Arial" size="2"> </font></td> </tr> <tr> <td width="318" bgcolor="#CCCCCC" height="1"> <p align="center"><font face="Arial" size="2">Documentation spécifique</font></td> <td width="342" height="1" align="right"><!--webbot bot="Validation" s-display-name="aucun" b-disallow-first-item="TRUE" --><select size="2" name="D1" style="padding:0; border:1px solid #FFFFFF; " tabindex="6"> <option selected value="Aucun">Aucun</option> <option>Prédécroché, attente, répondeur...</option> <option>Dispositif de secret</option> <option>Déport E/S par fibre optique</option> <option>Discriminateur d'appel téléphonique</option> <option>Centrale détection fluide 4 zones</option> <option>Centrale détection fluide 1 zone</option> <option>TA32A et TA32B</option> <option>TATDB (rack)</option> <option>TATDB (mural)</option> <option>Coffret marche en dégradé</option> <option>Rack adaptation</option> <option>Répartiteur d'alimentation pour haut de baie</option> <option>Coffret distribution 48V TCD SM1 + boitier 48V SM1</option> <option>Kit bornier TCD 48V</option> <option>Bornier TB01</option> <option>Module de commutation de ligne</option> <option>Interface auto</option> <option>Platine, répartiteur, conjoncteur...</option> <option>Téléphone rouge</option> <option>Meuble interface plancher technique...</option> <option>Plastron télécom</option> <option>Relais de découplage</option> <option>Intégration de matériel EDF</option> <option>SANTA</option> </select><font face="Arial" size="2"> </font></td> </tr> <tr> <td width="475" colspan="2" height="16"> <p align="center"> </td> </tr> </table> </center> </div> <p> </p> <div align="center"> <center> <table border="2" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#336699" width="463" id="AutoNumber6" height="373"> <tr> <td width="461" bgcolor="#336699" colspan="2" height="16"> <p align="center"><b><font face="Arial" size="2" color="#FFFFFF"> Renseignements divers</font></b></td> </tr> <tr> <td width="461" colspan="2" align="center" height="36"> <input TYPE="Checkbox" NAME="Etat Civil" value="Mademoiselle" tabindex="7"><font color="#000000"><font size="2" face="Arial">Melle</font><font face="Arial"> <input TYPE="Checkbox" NAME="Etat Civil" value="Madame" tabindex="8"></font><font size="2" face="Arial">Mme</font><font face="Arial"> <input TYPE="Checkbox" NAME="Etat Civil" value="Monsieur" tabindex="9"></font><font size="2" face="Arial">Mr</font></font></td> </tr> <tr> <td width="115" bgcolor="#CCCCCC" height="19"> <font size="2" face="Arial"> Nom</font></td> <td width="345" height="19"><font color="#000000"> <input NAME="Nom" value="" SIZE=46 MAXLENGTH=40 style="border:1px solid #FFFFFF; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="10"></font></td> </tr> <tr> <td width="461" colspan="2" height="19"> </td> </tr> <tr> <td width="115" bgcolor="#CCCCCC" height="19"> <font face="Arial" size="2"> Fonction</font></td> <td width="345" height="19"> <input NAME="Fonction" value="" SIZE=46 MAXLENGTH=40 style="border:1px solid #FFFFFF; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="11"></td> </tr> <tr> <td width="461" colspan="2" height="19"> </td> </tr> <tr> <td width="115" bgcolor="#CCCCCC" height="19"> <font face="Arial" size="2"> Société</font></td> <td width="345" height="19"> <input NAME="Société" value="" SIZE=46 MAXLENGTH=40 style="border:1px solid #FFFFFF; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="12"></td> </tr> <tr> <td width="461" colspan="2" height="19"> </td> </tr> <tr> <td width="115" bgcolor="#CCCCCC" height="19"> <font face="Arial" size="2"> Domaine d'activité</font></td> <td width="345" height="19"> <input NAME="Domaine d'activité" value="" SIZE=46 MAXLENGTH=40 style="border:1px solid #FFFFFF; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="13"></td> </tr> <tr> <td width="461" colspan="2" height="19"> </td> </tr> <tr> <td width="115" bgcolor="#CCCCCC" height="19"> <font face="Arial" size="2"> Adresse</font></td> <td width="345" height="19"> <textarea NAME="Adresse" ROWS=2 COLS=54 WRAP="PHYSICAL" style="border:1px solid #FFFFFF; font-family: Arial; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="14"></textarea></td> </tr> <tr> <td width="461" colspan="2" height="19"> </td> </tr> <tr> <td width="115" bgcolor="#CCCCCC" height="19"> <font face="Arial" size="2"> Téléphone</font></td> <td width="345" height="19"> <input NAME="Téléphone" value="" SIZE=16 MAXLENGTH=20 style="border: 1px solid #FFFFFF" tabindex="15"></td> </tr> <tr> <td width="461" colspan="2" height="19"> </td> </tr> <tr> <td width="115" bgcolor="#CCCCCC" height="19"> <font face="Arial" size="2"> Fax</font></td> <td width="345" height="19"> <input NAME="Fax" value="" SIZE=16 MAXLENGTH=20 style="border: 1px solid #FFFFFF" tabindex="16"></td> </tr> <tr> <td width="461" colspan="2" height="19"> </td> </tr> <tr> <td width="115" bgcolor="#CCCCCC" height="19"> <font face="Arial" size="2"> Email</font></td> <td width="345" height="19"> <input NAME="E-mail" value="" SIZE=46 MAXLENGTH=46 style="border: 1px solid #FFFFFF" tabindex="17"></td> </tr> <tr> <td width="461" colspan="2" height="19"> </td> </tr> </table> </center> </div> <p> </td> </tr> <tr> <td width="100%" height="57" align="center" valign="top"> <span style="background-color: #336699"> <input TYPE="submit" VALUE="Envoyer" style="color: #FFFFFF; font-weight: bold; font-size: 10pt; background-color: #336699"></span><input TYPE="reset" VALUE="Annuler" style="font-size: 10pt; color: #FFFFFF; font-weight: bold; background-color: #336699"></td> </tr> </table></td> </tr> </table> </body> </html>
Make sure you enter the(*)required information where indicate.HTML code is not allowed
Marsh Posté le 31-05-2004 à 16:17:05
Salut !
Mon formulaire a pas l'air de marcher bien et je sais pas pourquoi ! ci joint le code de ma page, si une bonne ame pouvait regarder !
merci
<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta name="GENERATOR" content="Microsoft FrontPage 5.0">
<meta name="ProgId" content="FrontPage.Editor.Document">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<link rel="File-List" href="formulaire2_fichiers/filelist.xml">
<title>Imprimer la page</title>
<!--[if !mso]>
<style>
v\:* { behavior: url(#default#VML) }
o\:* { behavior: url(#default#VML) }
.shape { behavior: url(#default#VML) }
</style>
<![endif]--><!--[if gte mso 9]>
<xml><o:shapedefaults v:ext="edit" spidmax="1027"/>
</xml><![endif]-->
</head>
<body link="#000000" vlink="#000000" alink="#000000">
<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="543" id="AutoNumber1" height="547">
<tr>
<td height="547" valign="top" width="543">
<!--[if gte vml 1]><v:shapetype id="_x0000_t202"
coordsize="21600,21600" o:spt="202" path="m,l,21600r21600,l21600,xe">
<v:stroke joinstyle="miter"/>
<v:path gradientshapeok="t" o:connecttype="rect"/>
</v:shapetype><v:shape id="_x0000_s1026" type="#_x0000_t202" style='position:absolute;
left:31.5pt;top:11.25pt;width:363pt;height:31.5pt;z-index:1' filled="f"
fillcolor="none" stroked="f" strokecolor="none">
<v:textbox>
<table cellspacing="0" cellpadding="0" width="458" height="20" border="1" style="border-collapse: collapse" bordercolor="#111111">
<tr>
<td align="center" width="31" bordercolor="#707787" bgcolor="#707787" height="20">
<img border="0" src="images/imprim6.GIF" width="16" height="14"></td>
<td align="center" width="128" bgcolor="#C0C0C0" height="20">
<p align="left"> <font face="Arial" size="2"><a HREF="javascript:window.print()">Imprimer la page</a></font></td>
<td align="center" width="33" bgcolor="#707787" height="20">
<img border="0" src="lettrelogo.GIF" width="15" height="11"></td>
<td align="center" width="121" bgcolor="#C0C0C0" height="20">
<p align="left"> <font face="Arial" size="2"><a target="_self" href="contact2.html">Nous contacter</a></font></td>
<td align="center" width="31" bgcolor="#707787" height="20">
<img border="0" src="images/doclogo.gif" width="12" height="14"></td>
<td align="center" width="114" bgcolor="#C0C0C0" height="20">
<p align="left"> <font face="Arial" size="2"><a target="_self" href="formulaire2.html">Formulaire</a></font></td>
</tr>
</table></v:textbox>
</v:shape><![endif]--><![if !vml]><span style='mso-ignore:vglayout;position:
absolute;z-index:1;left:42px;top:15px;width:488px;height:46px'><img width=488
height=46 src="formulaire2_fichiers/image001.gif"
alt="Zone de Texte: Imprimer la page Nous contacter Formulaire "
v:shapes="_x0000_s1026"></span><![endif]><p> </p>
<p> </p>
<p align="center">
<u><b><font face="Arial" color="#707787">FORMULAIRE / RENSEIGNEMENTS</font></b></u></p>
<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="100%" id="AutoNumber2" height="57">
<tr>
<td width="100%" height="894">
<div align="center">
<center>
<table border="2" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#336699" id="AutoNumber3" width="462">
<tr>
<td width="463" bgcolor="#336699" align="center">
<p align="center"><b><font size="2" face="Arial" color="#FFFFFF">
Requête</font></b></td>
</tr>
<tr>
<td width="463" align="center">
<textarea NAME="Message" ROWS=3 COLS=74 WRAP="PHYSICAL" style="border:1px solid #FFFFFF; font-family: Arial; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="1">Mon besoin
est le suivant : ...</textarea></td>
</tr>
</table>
</center>
</div>
<p> </p>
<div align="center">
<center>
<table border="2" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#336699" width="463" id="AutoNumber4">
<tr>
<td width="100%" bgcolor="#336699" height="16">
<p align="center"><b><font color="#FFFFFF" size="2" face="Arial">Je désire être
contacté de manière : </font></b></td>
</tr>
<tr>
<td width="100%" height="43">
<p align="center"><font face="Arial"><i>
<input TYPE="Checkbox" NAME="Demande" value="Pas urgente" tabindex="2"><font size="2">Pas
urgente</font></i></font><font face="Arial" color="#000000"><i>
<input TYPE="Checkbox" NAME="Demande" value="Urgente" tabindex="3"><font size="2">Urgente
</font>
<input TYPE="Checkbox" NAME="Demande" value="Très urgente" tabindex="4"><font size="2">Très
urgente</font></i></font></td>
</tr>
</table>
</center>
</div>
<p> </p>
<div align="center">
<center>
<table border="2" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#336699" width="463" id="AutoNumber5" height="1">
<tr>
<td width="475" bgcolor="#336699" colspan="2" height="16">
<p align="center"><b><font size=2 color="#FFFFFF" face="Arial">J'aimerais recevoir une documentation
: </font></b></td>
</tr>
<tr>
<td width="475" colspan="2" height="16">
<font face="Arial" size="2"> </font></td>
</tr>
<tr>
<td width="318" bgcolor="#CCCCCC" height="32">
<p align="center"><font size="2" face="Arial">Documentation
générale</font></td>
<td width="337" height="32"><font face="Arial" size="2"> </font><font face="Arial">
<input TYPE="Checkbox" NAME="Demande de doc générale" value="Oui" tabindex="5">
<i><font size="1"> (cochez la case)</font></i></font></td>
</tr>
<tr>
<td width="475" colspan="2" height="16">
<font face="Arial" size="2"> </font></td>
</tr>
<tr>
<td width="318" bgcolor="#CCCCCC" height="1">
<p align="center"><font face="Arial" size="2">Documentation
spécifique</font></td>
<td width="342" height="1" align="right"><!--webbot bot="Validation" s-display-name="aucun" b-disallow-first-item="TRUE" --><select size="2" name="D1" style="padding:0; border:1px solid #FFFFFF; " tabindex="6">
<option selected value="Aucun">Aucun</option>
<option>Prédécroché, attente, répondeur...</option>
<option>Dispositif de secret</option>
<option>Déport E/S par fibre optique</option>
<option>Discriminateur d'appel téléphonique</option>
<option>Centrale détection fluide 4 zones</option>
<option>Centrale détection fluide 1 zone</option>
<option>TA32A et TA32B</option>
<option>TATDB (rack)</option>
<option>TATDB (mural)</option>
<option>Coffret marche en dégradé</option>
<option>Rack adaptation</option>
<option>Répartiteur d'alimentation pour haut de baie</option>
<option>Coffret distribution 48V TCD SM1 + boitier 48V SM1</option>
<option>Kit bornier TCD 48V</option>
<option>Bornier TB01</option>
<option>Module de commutation de ligne</option>
<option>Interface auto</option>
<option>Platine, répartiteur, conjoncteur...</option>
<option>Téléphone rouge</option>
<option>Meuble interface plancher technique...</option>
<option>Plastron télécom</option>
<option>Relais de découplage</option>
<option>Intégration de matériel EDF</option>
<option>SANTA</option>
</select><font face="Arial" size="2">
</font></td>
</tr>
<tr>
<td width="475" colspan="2" height="16">
<p align="center">
</td>
</tr>
</table>
</center>
</div>
<p> </p>
<div align="center">
<center>
<table border="2" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#336699" width="463" id="AutoNumber6" height="373">
<tr>
<td width="461" bgcolor="#336699" colspan="2" height="16">
<p align="center"><b><font face="Arial" size="2" color="#FFFFFF">
Renseignements divers</font></b></td>
</tr>
<tr>
<td width="461" colspan="2" align="center" height="36">
<input TYPE="Checkbox" NAME="Etat Civil" value="Mademoiselle" tabindex="7"><font color="#000000"><font size="2" face="Arial">Melle</font><font face="Arial">
<input TYPE="Checkbox" NAME="Etat Civil" value="Madame" tabindex="8"></font><font size="2" face="Arial">Mme</font><font face="Arial">
<input TYPE="Checkbox" NAME="Etat Civil" value="Monsieur" tabindex="9"></font><font size="2" face="Arial">Mr</font></font></td>
</tr>
<tr>
<td width="115" bgcolor="#CCCCCC" height="19">
<font size="2" face="Arial"> Nom</font></td>
<td width="345" height="19"><font color="#000000">
<input NAME="Nom" value="" SIZE=46 MAXLENGTH=40 style="border:1px solid #FFFFFF; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="10"></font></td>
</tr>
<tr>
<td width="461" colspan="2" height="19"> </td>
</tr>
<tr>
<td width="115" bgcolor="#CCCCCC" height="19">
<font face="Arial" size="2"> Fonction</font></td>
<td width="345" height="19">
<input NAME="Fonction" value="" SIZE=46 MAXLENGTH=40 style="border:1px solid #FFFFFF; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="11"></td>
</tr>
<tr>
<td width="461" colspan="2" height="19"> </td>
</tr>
<tr>
<td width="115" bgcolor="#CCCCCC" height="19">
<font face="Arial" size="2"> Société</font></td>
<td width="345" height="19">
<input NAME="Société" value="" SIZE=46 MAXLENGTH=40 style="border:1px solid #FFFFFF; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="12"></td>
</tr>
<tr>
<td width="461" colspan="2" height="19"> </td>
</tr>
<tr>
<td width="115" bgcolor="#CCCCCC" height="19">
<font face="Arial" size="2"> Domaine d'activité</font></td>
<td width="345" height="19">
<input NAME="Domaine d'activité" value="" SIZE=46 MAXLENGTH=40 style="border:1px solid #FFFFFF; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="13"></td>
</tr>
<tr>
<td width="461" colspan="2" height="19"> </td>
</tr>
<tr>
<td width="115" bgcolor="#CCCCCC" height="19">
<font face="Arial" size="2"> Adresse</font></td>
<td width="345" height="19">
<textarea NAME="Adresse" ROWS=2 COLS=54 WRAP="PHYSICAL" style="border:1px solid #FFFFFF; font-family: Arial; padding-left: 4; padding-right: 4; padding-top: 1; padding-bottom: 1" tabindex="14"></textarea></td>
</tr>
<tr>
<td width="461" colspan="2" height="19"> </td>
</tr>
<tr>
<td width="115" bgcolor="#CCCCCC" height="19">
<font face="Arial" size="2"> Téléphone</font></td>
<td width="345" height="19">
<input NAME="Téléphone" value="" SIZE=16 MAXLENGTH=20 style="border: 1px solid #FFFFFF" tabindex="15"></td>
</tr>
<tr>
<td width="461" colspan="2" height="19"> </td>
</tr>
<tr>
<td width="115" bgcolor="#CCCCCC" height="19">
<font face="Arial" size="2"> Fax</font></td>
<td width="345" height="19">
<input NAME="Fax" value="" SIZE=16 MAXLENGTH=20 style="border: 1px solid #FFFFFF" tabindex="16"></td>
</tr>
<tr>
<td width="461" colspan="2" height="19"> </td>
</tr>
<tr>
<td width="115" bgcolor="#CCCCCC" height="19">
<font face="Arial" size="2"> Email</font></td>
<td width="345" height="19">
<input NAME="E-mail" value="" SIZE=46 MAXLENGTH=46 style="border: 1px solid #FFFFFF" tabindex="17"></td>
</tr>
<tr>
<td width="461" colspan="2" height="19"> </td>
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</center>
</div>
<p> </td>
</tr>
<tr>
<td width="100%" height="57" align="center" valign="top">
<span style="background-color: #336699">
<input TYPE="submit" VALUE="Envoyer" style="color: #FFFFFF; font-weight: bold; font-size: 10pt; background-color: #336699"></span><input TYPE="reset" VALUE="Annuler" style="font-size: 10pt; color: #FFFFFF; font-weight: bold; background-color: #336699"></td>
</tr>
</table></td>
</tr>
</table>
</body>
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