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<HEAD>
   
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<BODY BGCOLOR="#FF8000">
<FORM action="http://perso.wanadoo.fr/bin/formulaire.cgi" method="POST">

<P><HTML><HEAD><TITLE>Formulaire e-mail</TITLE><META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=iso-8859-1"></HEAD>
</P>

<P><B><FONT SIZE="+2" COLOR="#0033CC">Formulaire de petite
annonce</FONT></B></P>

<P>Merci de bien vouloir renseigner les champs suivants et d'appuyer
sur le boutton <B>ENVOYER</B> :<BR>

</P>

<P>(les champs marqu&eacute;s d'une <B><FONT
COLOR="#FF0000">*</FONT></B> doivent obligatoirement &ecirc;tre
renseign&eacute;s) <TABLE BORDER=0 CELLSPACING=0 CELLPADDING=0
WIDTH=527 bordercolor="#3333CC">
   <TR>
      <TD bgcolor="#3333CC" HEIGHT=40>
         <P><B><FONT COLOR="#FFFFFF">Nom</FONT></B>
      </TD><TD bgcolor="#3333CC" HEIGHT=40>
         <P><INPUT TYPE="text" NAME="*Nom" VALUE="" SIZE=35><B><FONT
         COLOR="#FF0000">*</FONT></B><BR>
         
      
      </TD></TR>
   <TR>
      <TD bgcolor="#FFFFCC" HEIGHT=40>
         <P><B>E-mail</B>
      </TD><TD bgcolor="#FFFFCC" HEIGHT=40>
         <P><INPUT TYPE="text" NAME="Société" VALUE="" SIZE=35>
      </TD></TR>
   <TR>
      <TD bgcolor="#3333CC" HEIGHT=40>
         <P><B><FONT COLOR="#FFFFFF">Adresse</FONT></B>
      </TD><TD bgcolor="#3333CC" HEIGHT=40>
         <P><FONT COLOR="#FF0000"><INPUT TYPE="text" NAME="*Adresse"
         VALUE="" SIZE=35></FONT><B><FONT
         COLOR="#FF0000">*</FONT></B><BR>
         
      
      </TD></TR>
   <TR>
      <TD bgcolor="#FFFFCC" HEIGHT=40>
         <P><B>Ville</B>
      </TD><TD bgcolor="#FFFFCC" HEIGHT=40>
         <P><INPUT TYPE="text" NAME="*Ville" VALUE=""
         SIZE=35><B><FONT COLOR="#FF0000">*</FONT></B><BR>
         
      
      </TD></TR>
   <TR>
      <TD bgcolor="#3333CC" HEIGHT=40>
         <P><B><FONT COLOR="#FFFFFF">D&eacute;partement</FONT></B>
      </TD><TD bgcolor="#3333CC" HEIGHT=40>
         <P><INPUT TYPE="text" NAME="Département" VALUE=""
         SIZE=35><BR>
         
      
      </TD></TR>
   <TR>
      <TD bgcolor="#FFFFCC" HEIGHT=40>
         <P><B>Code postal</B>
      </TD><TD bgcolor="#FFFFCC" HEIGHT=40>
         <P><INPUT TYPE="text" NAME="*Codepostal" VALUE=""
         SIZE=35><B><FONT COLOR="#FF0000">*</FONT></B><BR>
         
      
      </TD></TR>
   <TR>
      <TD bgcolor="#3333CC" HEIGHT=40>
         <P><B><FONT COLOR="#FFFFFF">Pays</FONT></B>
      </TD><TD bgcolor="#3333CC" HEIGHT=40>
         <P><INPUT TYPE="text" NAME="Pays" VALUE="" SIZE=35><BR>
         
      
      </TD></TR>
   <TR>
      <TD bgcolor="#FFFFCC" HEIGHT=120>
         <P><B>annonce</B>
      </TD><TD bgcolor="#FFFFCC" HEIGHT=120>
         <P><TEXTAREA NAME="commentaires" ROWS=6 COLS=30></TEXTAREA>
      </TD></TR>
</TABLE><INPUT TYPE="hidden" NAME="email"
VALUE="wheelinger@wanadoo.fr"><INPUT TYPE="hidden" NAME="url"
VALUE="form.htm"><INPUT TYPE="hidden" NAME="sujet"
VALUE="Formulaire des Pages Perso"><BR>

<BR>

<INPUT TYPE="submit" NAME="submit"
VALUE="Envoyer"><INPUT TYPE="reset" VALUE="Effacer" name="reset">
</P>
</FORM>
</BODY>
</HTML>
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