document.write("<div align='center'><table width='440' border='0' cellspacing='0' bgcolor='#a8caff'>");document.write("<tr><td><div align='center' style='color: #100004;'>");document.write("<p><strong>SERVIVEà LA PERSONNE</strong></p>");document.write("<p align='center' style='color: #080002;' ><em><strong>Envie d'un service à domicile entre particuliers ? mon tarif : à partir de 12 Euro net/h</strong></em><br /><br /><br />");document.write("</p></div></td></tr><tr><td><form id='form1' name='form1' method='post' target='blanck'  action='http://www.monsitegratuit.com/services/cybermail/validation_form1.php?coe=castagnet33@wanadoo.fr&cos=http://travail33.wifeo.com/&cfd=a8caff&ctx=080002'>");document.write("<table width='100%' border='0' cellspacing='5'>");document.write("<tr><td width='35%' valign='top' style='color: #080002;'><div align='left' ><label><strong>Nom : </strong></div></td><td><div align='left'><input name='form_nom' style='background-color: #8dff88;' type='text' id='form_nom' size='38' maxlength='40' /></label></div></td></tr>");document.write("<tr><td width='35%' valign='top' style='color: #080002;'><div align='left'><label><strong>Pr&eacute;nom : </strong></div></td><td><div align='left'><input name='form_prenom' style='background-color: #8dff88;' type='text' id='form_prenom' size='38' maxlength='40' /></label></div></td></tr>");document.write("<tr><td width='35%' valign='top' style='color: #080002;'><div align='left'><label><strong>Email : </strong></div></td><td><div align='left'><input name='form_email' style='background-color: #8dff88;' type='text' id='form_email' size='38' maxlength='50' /></label></div></td></tr>");document.write("<tr><td width='35%' valign='top' style='color: #080002;'><div align='left'><label><strong>Code Postal : </strong></div></td><td><div align='left'><input name='form_code_post' style='background-color: #8dff88;' type='text' id='form_code_post' size='38' maxlength='50' /</label>></div></td></tr>");document.write("<tr><td width='35%' valign='top' style='color: #080002;'><div align='left'><label><strong>T&eacute;l&eacute;phone : </strong></div></td><td><div align='left'><input name='form_tel' style='background-color: #8dff88;' type='text' id='form_tel' size='10' maxlength='15' /></label></div></td></tr>");document.write("<tr><td valign='top' style='color: #080002;'><div align='left'><label><strong>Sujet du message : </strong></div></td><td><div align='left'><input name='form_sujet' style='background-color: #8dff88;' type='text' id='form_sujet' size='38' maxlength='150' /></label></div></td></tr>");document.write("<tr><td valign='top' style='color: #080002;'><div align='left'><label><strong>Votre message : </strong></div></td><td><div align='left'><p><textarea name='form_texte' style='background-color: #8dff88;' cols='35' rows='7' id='form_texte'></textarea></label></p></div></td></tr>");document.write("<tr><td colspan='2' valign='top'><label><div align='center'><input type='submit' name='Submit' value='Envoyer' /> <input type='reset' name='Submit2' value='Réinitialiser' /><br /></div></label></td></tr></table></form></td></tr>");document.write(" <tr><td><div align='center'><p><a href='http://www.monsitegratuit.com/' ><img src='http://www.monsitegratuit.com/cclleemm_banniere1.png' alt='Cclleemm Graphic's : Formulaire gratuit --&gt; Services Webmasters' width='400' height='50' border='0'/><br /></a></p></div></td></tr>");document.write("<tr><td height='5'>&nbsp;</td></tr></table></div>");