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<html>
<head>
<script>
<div class="formulaire">
<table width="599" border="0" class="texte_formulaire">
<form method="post" action="verif_test.php">
<tr><td> </td></tr>
<tr><td align="center" height="25" colspan="2" class="titre_formulaire"><b>Inscription de votre location</b></td></tr>
<tr><td> </td></tr>
<tr>
<td>Titre de votre location</td>
<td> <input type="text" name="nomGite" value="" maxlength="70" size="50"></td>
</tr>
<tr>
<td> </td>
</tr>
<tr>
<td>Description</td>
<td> <textarea name="descriptionGite" onKeyUp="limite(this,255);" onKeyDown="limite(this,255);" maxlenght="255" cols="49" rows="8"></textarea></td>
</tr>
<tr>
<td>Région</td>
<td> <select name="dptGite" size="1" >
<option>---------Région---------</option>
<option value="Alsace">Alsace</option>
<option value="Aquitaine">Aquitaine</option>
<option value="Auvergne">Auvergne</option>
<option value="Basse Normandie ">Basse Normandie </option>
<option value="Bourgogne">Bourgogne</option>
<option value="Bretagne">Bretagne</option>
</select></td>
</tr>
<tr>
<td>Département</td>
<td> <select name="regionGite" size="1" >
<option>----------Département----------</option>
<option value="Ain">Ain</option>
<option value="Aisne">Aisne</option>
</select></td>
</tr>
</tr>
<tr><td colspan="2" class="titre_formulaire">Contact</td></tr>
<tr>
<td >Nom</td>
<td><input type="text" name="nomProprio" value="" maxlength="50" size="50"></td>
</tr>
<tr>
<td>Mail</td>
<td><input type="text" name="mailProprio" value="" maxlength="70" size="50"></td>
</tr>
<tr>
<td>Téléphone</td>
<td> <input type="text" name="telProprio" value="" maxlength="20" size="50"></td>
</tr>
<tr>
<td>Site</td>
<td><input type="text" name="siteProprio" value="http://" maxlength="70" size="50"></td>
</tr>
<tr>
<tr><td> </td></tr>
<td colspan="2" align="center"><input type="submit" name="envoi" value="envoi!"></td>
</tr>
<tr><td> </td></tr> </form>
</table>
</div>
</body>
</html> |
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