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| <html>
<head><title>Formulaire </title>
<body>
<FORM NAME="index.htm" ACTION="mailto:Monmail@tata.fr" METHOD="post" ENCTYPE="text/plain">
<p align="center"><font color="#2A2AFF">Fiche Informatique</font></p>
<p><b><i><u>Fiche créée le :</u></i></b>
<br>
<br>
<b><i><u>Par : </u></i></b><br>
<br>
<select size="1">
<option></option>
<option>Nom 1</option>
<option>Nom 2</option>
</select>
</p>
<p> <br/>
<b><i><u>Nature de l'opération </u></i></b> </p>
<table width="91%" border="0">
<tr>
<td width="13%"><input name="radio" type="radio" value="I">
Installation </td>
<td width="12%"> <div align="left">
<select name="select" size="1">
<option></option>
<option>service1</option>
<option>service 2</option>
<option>service 3</option>
</select>
</div></td>
<td width="75%"> </td>
</tr>
<tr>
<td><input name="radio" type="radio" value="D">
Déplacement </td>
<td><select name="select2" size="1">
<option></option>
<option>service1</option>
<option>service 2</option>
<option>service 3</option>
</select></td>
<td> Vers : <select name="select3" size="1">
<option></option>
<option>service1</option>
<option>service 2</option>
<option>service 3</option>
</select></td>
</tr>
<tr>
<td><input type="radio" name="radio" value="S"/>
Inventaire </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td><input type="radio" name="radio" value="V"/>
Personnel</td>
<td> </td>
<td> </td>
</tr>
<tr>
<td><input type="radio" name="radio" value="De"/>
Destruction</td>
<td> </td>
<td> </td>
</tr>
<tr>
</table>
<p> <em><strong><u>Informations</u></strong></em></p>
<table width="91%" height="135" border="0">
<tr align="left" valign="middle">
<td width="13%" height="26" valign="top">Nature du Matériel </td>
<td width="87%" valign="middle">
<select name="select4">
<option></option>
<option>Ecran</option>
<option>Imprimante</option>
</select>
</td>
</tr>
<tr>
<td height="24" valign="top">Numéro de série</td>
<td valign="middle">
<input type="text" name="textfield">
</td>
</tr>
<tr>
<td valign="top">Divers</td>
<td valign="middle">
<input type="text" name="textfield222"></td>
</tr>
</table>
<p><em><strong><u>Pour l'inventaire</u></strong></em></p>
<br />
<input type="submit" name="submit" value="Envoyer">
<br> <br>
<input type="reset" value="Nouveau Formulaire" name="reset">
</p>
</form>
</body>
</html> |
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