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<head>
<body>
<div class="maintext">
<strong>
Déposer votre annonce sur BROCTOUS.FR est totalement (GRATUIT).
</strong>
</div>
<br/>
<form method="post" enctype="text/plain" action='mailto:broctous@live.fr'>
<input type="hidden" name="To" value="le sujet de votre courrier">
</div>
Entrez votre Pseudo:<br>
<input type="text" name="question:" size="50" maxlength="100"><br><br>
Entrez votre adresse email:<br>
<input type="text" name="question:" size="50" maxlength="100"><br><br>
Téléphone:<br/>
<input type="text" name="question:" size="50" maxlength="100"><br><br>
<div class="labelform">
<label>Code postal</label>
</div>
<div class="adinput">
<input name="zipcode" size="6" maxlength="5" type="text" value="" /><br />
<b>Indiquez le code postal ou se trouve l'objet.</b>
<div id="err_zipcode" style="display: none;">
<span class="error" id="err_msg_zipcode"></span>
<br />
<br />
</div>
<div id="info_zipcode" class="warning" style="display:none; clear:both; float:none"></div>
</div>
<br/>
Régions:
<div class="adinput">
<select name="region" onchange="showDepartment('region');" id="region">
<option value="0">;Choisissez la région;</option>
<option value="1" >Alsace</option>
<option value="2" >Aquitaine</option>
<option value="3" >Auvergne</option>
<option value="4" >Basse-Normandie</option>
<option value="5" >Bourgogne</option>
<option value="6" >Bretagne</option>
<option value="7" >Centre</option>
<option value="8" >Champagne-Ardenne</option>
<option value="9" >Corse</option>
<option value="10" >Franche-Comté</option>
<option value="11" >Haute-Normandie</option>
<option value="12" >Ile-de-France</option>
<option value="13" >Languedoc-Roussillon</option>
<option value="14" >Limousin</option>
<option value="15" >Lorraine</option>
<option value="16" >Midi-Pyrénées</option>
<option value="17" >Nord-Pas-de-Calais</option>
<option value="18" >Pays de la Loire</option>
<option value="19" >Picardie</option>
<option value="20" >Poitou-Charentes</option>
<option value="21" >Provence-Alpes-Côte d'Azur</option>
<option value="22" >Rhône-Alpes</option>
<option value="23" >Guadeloupe</option>
<option value="24" >Martinique</option>
<option value="25" >Guyane</option>
<option value="26" >Réunion</option>
</select>
<div id="err_region" style="display: none;">
<span class="error" id="err_msg_region"></span>
</div>
<div id="info_region" class="warning" style="display:none; clear:both; float:none">
</div>
</div>
Choix:<br>
<input type="radio" name="votre question 1"value="Yes">Dons<BR>
<input type="radio" name="votre question 1"value="No">Ventes<br>
Type:<br>
<input type="radio" name="votre question 2"value="Yes">Particuliers<BR>
<input type="radio" name="votre question 2"value="No">Professionels<br><br>
<div class="labelform">
<label>Première photo</label>
</div>
<div class="adinput">
<input type="file" name="image" size="35" id="image" />
<br />
<div id="err_image" style="display: none;">
<span class="error" id="err_msg_image"></span>
</div>
</div>
<br />
<div class="labelform">
<label>Deuxièmes photo</label>
</div>
<div class="adinput">
<input type="file" name="image" size="35" id="image" />
<br />
<div id="err_image" style="display: none;">
<span class="error" id="err_msg_image"></span>
</div>
</div>
<br />
<div class="labelform">
<label>Troisièmes photo</label>
</div>
<div class="adinput">
<input type="file" name="image" size="35" id="image" />
<br />
<div id="err_image" style="display: none;">
<span class="error" id="err_msg_image"></span>
</div>
</div>
<br />
<div class="labelform">
<label>Quatrièmes photo</label>
</div>
<div class="adinput">
<input type="file" name="image" size="35" id="image" />
<br />
<div id="err_image" style="display: none;">
<span class="error" id="err_msg_image"></span>
</div>
<br/>
</br>
<form method="POST" name="Formulaire de contact" action="--WEBBOT-SELF--">
<!--webbot bot="SaveResults" U-File="../_private/form_results.txt"
S-Format="TEXT/CSV" S-Label-Fields="TRUE" S-Email-Address="broctous@live.fr"
S-Email-Format="TEXT/PRE" -->
<p style="text-indent: 30">
<p style="text-indent: 30"><input type="submit" value="Envoyer" name="B1"><input type="reset" value="Rétablir" name="B2"></p>
</form>
</body>
</head>
</html> |
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