<form onSubmit="return(ValidateForm(this));" action="formulaire.php" method="POST">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td colspan="2">
<p class="texte"><br />Remplissez ce
formulaire en prenant soin de ne pas
oublier de champs et validez-le.
:</p><br />
</td>
</tr>
<tr>
<td width="153"> </td>
<td> </td>
</tr>
<tr>
<td width="153">
<p class="texte">Titre :</p>
</td>
<td><input style="width:100%" type="text" name="titre" size="30"></td>
</tr>
<tr height="5">
<td colspan="2" height="5"><img src="images/empty.gif" height="5" width="1" border="0"></td>
</tr>
<tr>
<td width="153">
<p class="texte">Nom :</p>
</td>
<td><input style="width:100%" type="text" name="nom" size="25"></td>
</tr>
<tr height="5">
<td colspan="2" height="5"><img src="images/empty.gif" height="5" width="1" border="0"></td>
</tr>
<tr height="5">
<td colspan="2" height="5"><img src="images/empty.gif" height="5" width="1" border="0"></td>
</tr>
<tr>
<td width="153">
<p class="texte">Prénom :</p>
</td>
<td><input style="width:100%" type="text" name="prenom" size="25"></td>
</tr>
<tr height="5">
<td colspan="2" height="5"><img src="images/empty.gif" height="5" width="1" border="0"></td>
</tr>
<tr height="5">
<td colspan="2" height="5"><img src="images/empty.gif" height="5" width="1" border="0"></td>
</tr>
<tr>
<td width="153">
<p class="texte">Email:</p>
</td>
<td><input style="width:100%" type="text" name="email" size="25"></td>
</tr>
<tr height="5">
<td colspan="2" height="5"><img src="images/empty.gif" height="5" width="1" border="0"></td>
</tr>
<tr>
<td width="153">
<p class="texte">Votre question :</p>
</td>
<td><textarea style="width:100%" name="question" rows="3" cols="30"></textarea></td>
</tr>
<tr height="10">
<td colspan="2" height="10"><img src="images/empty.gif" height="10" width="1" border="0"></td>
</tr>
<tr>
<td class="texte" width="153"></td>
<td align="right"><input style="font-size: 10px" type="submit" name="_" value="Envoyer votre demande"> <input style="font-size: 10px" type="reset" name="effacer" value="Effacer"></td>
</tr>
</table>
<input type="hidden" name="prov" value="epicerie" />
</form>
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