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| <form id="formulaire" name="formulaire" method="post" action="contact_response.php">
<table cellpadding="0" cellspacing="0" border="0">
<tr>
<td width="180"><strong>Nom et Prénom *</strong></td>
<td align="left"><input style="WIDTH: 300px; HEIGHT: 18px" tabindex="1" type="Text" id="nom" name="nom" /></td>
</tr>
<tr><td height="8" colspan="5"></td></tr>
<tr>
<td><strong>Adresse *</strong></td>
<td width="141" valign="top">
<textarea style="TEXT-ALIGN: left; WIDTH: 300px; HEIGHT: 50px" tabindex="2" rows=3 cols=21 name="adresse"></textarea>
</td>
</tr>
<tr><td height="8" colspan="5"></td></tr>
<tr>
<td><strong>Code postal & Ville *</strong></td>
<td valign="top">
<INPUT style="TEXT-ALIGN: left; WIDTH: 72px; HEIGHT: 18px" size="5" tabindex="3" name="code_postal"> <INPUT style="TEXT-ALIGN: left; WIDTH: 219px; HEIGHT: 18px" tabindex="4" size="15" name="ville">
</td>
</tr>
<tr><td height="8" colspan="5"></td></tr>
<tr>
<td><strong>Téléphone</strong></td>
<td valign="top">
<input tabindex="5" type="Text" id="tel" name="tel" style="WIDTH: 300px; HEIGHT: 18px"/>
</td>
</tr>
<tr><td height="8" colspan="5"></td></tr>
<tr>
<td><strong>Email *</strong></td>
<td width="141" valign="top">
<input tabindex="6" type="Text" id="email" name="email" style="WIDTH: 300px; HEIGHT: 18px"/>
</td>
</tr>
<tr><td height="8" colspan="5"></td></tr>
<tr>
<td><strong>Objet de votre message *</strong></td>
<td width="141" valign="top">
<input tabindex="7" type="Text" id="objet" name="objet" style="WIDTH: 300px; HEIGHT: 18px"/>
</td>
</tr>
<tr><td height="20" colspan="5"></td></tr>
<tr>
<td colspan="3"><strong>Vos commentaires, suggestions ou questions *
<BR>
<BR>
<textarea style="TEXT-ALIGN: left; WIDTH: 478px; HEIGHT: 70px" tabindex="8" rows="4" cols="52" name="message"></textarea>
</strong></td>
</tr>
<tr><td height="8" colspan="5"></td></tr>
<tr>
<td><strong><br />
Code de sécurité :<br />
</strong></td>
<td valign="middle">
<div style="float:left; width:100px;">
<img src="securimage/securimage_show.php?sid=<?php echo md5(uniqid(time())); ?>" style="border:1px solid green" height="35" width="100" />
</div>
<div style="float:left; margin-left:10px; padding-top:10px;">
<input name="secure_code" tabindex="9" type="text" style="TEXT-ALIGN: left; WIDTH: 190px; HEIGHT: 18px" id="secure_code" value="" />
</div>
</td>
</tr>
<tr>
<td height="40"><br /></td>
<td height="40"><br /><input type="submit" class="button" tabindex="10" name="envoyer" id="envoyer" value="Envoyer" /></td>
</tr>
<tr>
<td height="40" colspan="2">* champs obligatoire</td>
</tr>
</table>
</form>
<script language="JavaScript" type="text/javascript">
//pour valider les champs
var frmvalidator = new Validator("formulaire");
frmvalidator.addValidation("nom","req","Veuillez saisir votre nom et prénom");
frmvalidator.addValidation("adresse","req","Veuillez saisir votre adresse");
frmvalidator.addValidation("code_postal","req","Veuillez saisir votre code postal");
frmvalidator.addValidation("code_postal","numeric","Veuillez saisir un code postal valide");
frmvalidator.addValidation("ville","req","Veuillez saisir votre ville");
frmvalidator.addValidation("email","req","Veuillez saisir votre email");
frmvalidator.addValidation("email","email","Veuillez saisir une adresse email valide");
frmvalidator.addValidation("objet","req","Veuillez saisir l'objet de votre message");
frmvalidator.addValidation("message","req","Veuillez saisir votre message");
frmvalidator.addValidation("secure_code","req","Veuillez saisir le code de sécurité");
</script> |
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