111 lines
6.3 KiB
HTML
Executable File
111 lines
6.3 KiB
HTML
Executable File
<html>
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<head>
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<meta http-equiv="content-type" content="text/html;charset=iso-8859-1">
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<meta name="generator" content="Adobe GoLive 5">
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<title>Alternatis.com : la formation en alternance et en continue - bts, contrat de qualification.</title>
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<meta name="keywords" content="Alternatis, Alternance, Centre de Formation, Contrat de Qualification, BTS, Brevet de Technicien Supérieur, Meaux">
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<!--Vous pouvez vous inscrire dès à présent ; N'hésitez pas à contacter Alternatis au 0164350010.-->
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</head>
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<body link="#a0a8ff" text="#1a0c4b" vlink="#8983b5" alink="#fff343" bgcolor="#ccd1f8" leftmargin="3" marginwidth="3" topmargin="9" marginheight="9">
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<div align="center">
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<table border="0" cellpadding="0" cellspacing="0" width="512" height="460">
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<tr height="36">
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<td colspan="2" valign="top" height="36">
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<div align="center">
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<img src="../images/coordonnees_off.gif" width="283" height="24" border="0" alt="laissez nous vos coordonnées"></div>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<form action="(Empty Reference!)" method="get" name="Coordonnées des Internautes">
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<table border="0" cellpadding="0" cellspacing="0" width="512" background="../images/escaliers32.jpg" height="414">
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<tr height="19">
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<td width="24" height="19"></td>
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<td width="90" height="19"></td>
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<td width="386" height="19"></td>
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</tr>
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<tr height="38">
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<td width="24" height="38"></td>
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<td width="90" height="38"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">Statut</font></td>
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<td width="386" height="38"><select name="selectStatut" size="2">
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<option value="un">entreprise</option>
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<option value="trois">particulier</option>
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</select></td>
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</tr>
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<tr height="58">
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<td width="24" height="58"></td>
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<td width="90" height="58"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">Civilité</font></td>
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<td width="386" height="58"><select name="selectCivilité" size="3">
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<option value="un">monsieur</option>
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<option value="deux">madame</option>
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<option value="trois">mademoiselle</option>
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</select></td>
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</tr>
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<tr height="25">
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<td width="24" height="25"></td>
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<td width="90" height="25"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">Nom</font></td>
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<td width="386" height="25"><input type="text" name="textfieldNom" size="40"></td>
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</tr>
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<tr height="25">
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<td width="24" height="25"></td>
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<td width="90" height="25"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">Prénom</font></td>
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<td width="386" height="25"><input type="text" name="textfieldPrénom" size="40"></td>
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</tr>
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<tr height="25">
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<td width="24" height="25"></td>
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<td width="90" height="25"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">Age</font></td>
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<td width="386" height="25"><input type="text" name="textfieldAge" size="3" maxlength="3"> <font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman">ans</font></td>
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</tr>
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<tr height="25">
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<td width="24" height="25"></td>
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<td width="90" height="25"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">Adresse</font></td>
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<td width="386" height="25"><input type="text" name="textfieldAdresse1" size="50" maxlength="50"></td>
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</tr>
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<tr height="25">
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<td width="24" height="25"></td>
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<td width="90" height="25"></td>
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<td width="386" height="25"><input type="text" name="textfieldAdresse2" size="50" maxlength="50"></td>
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</tr>
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<tr height="25">
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<td width="24" height="25"></td>
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<td width="90" height="25"></td>
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<td width="386" height="25"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman">Code Postal <input type="text" name="textfieldCp" size="5" maxlength="5"> Ville <input type="text" name="textfieldVille" size="24"></font></td>
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</tr>
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<tr height="25">
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<td width="24" height="25"></td>
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<td width="90" height="25"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">Numéro</font></td>
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<td width="386" height="25">Fixe<font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman"> <input type="text" name="textfieldFixe" size="10" maxlength="10"> Portable <input type="text" name="textfieldPotable" size="10" maxlength="10"> Fax <input type="text" name="textfieldPotable" size="10" maxlength="10"></font></td>
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</tr>
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<tr height="25">
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<td width="24" height="25"></td>
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<td width="90" height="25"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">E-mail</font></td>
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<td width="386" height="25"><input type="text" name="textfieldMail" size="40"></td>
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</tr>
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<tr height="80">
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<td width="24" height="80"></td>
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<td width="90" height="80"><font face="Berlin Sans FB,Trebuchet MS,Verdana,Arial Rounded MT Bold,Lucida Sans Unicode,Times New Roman" size="+1">Objet</font></td>
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<td width="386" height="80"><textarea name="textareaObjet" cols="40" rows="4"></textarea></td>
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</tr>
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<tr height="19">
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<td width="24" height="19"></td>
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<td width="90" height="19"></td>
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<td width="386" height="19"></td>
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</tr>
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</table>
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</form>
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</td>
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</tr>
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<tr>
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<td colspan="2">
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<div align="center">
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<input type="submit" name="submit" value="envoyer"></div>
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</td>
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</tr>
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</table>
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</div>
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</body>
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</html> |