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<html>
<body>
<form method="post" action="egw.php">
<font face="Century Gothic" size="-1">Nom :</font> <br /> <input type="text" name="nom" />
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<font face="Century Gothic" size="-1">Prénom :</font> <br /> <input type="text" name="prenom" />
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<font face="Century Gothic" size="-1">Entreprise :</font> <br /> <input type="text" name="entreprise" />
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<font face="Century Gothic" size="-1">Objet de la demande :</font> <br /> <input type="text" name="objet" />
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<font face="Century Gothic" size="-1">Description du problème :</font> <br /> <textarea cols="45" rows="8" name="description" onfocus="if (this.value == 'Entrez votre texte ici') this.value=''">Entrez votre texte ici</textarea>
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<font face="Century Gothic" size="-1">Ce message est-il privé ?</font> <br /> <input type="radio" name="prive" value="non" id="non" checked="checked" />
<label for="non">Non</label>
<input type="radio" name="prive" value="oui" id="oui">
<label for="oui">Oui</label>
<br />
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<font face="Century Gothic" size="-1">Son degrès de priorité :</font> <br /> <select name="prio">
<option value="1">1 - Bas</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5 - Moyen</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9 - Haut</option>
</select>
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<input type="submit" value="Envoyer" /> <input type="reset" value="Annuler" name="Annuler" />
</form>
</body>
</html> |
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