1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55
| <form id="form" method="post" action="mail.php">
<input type=hidden name=subject value=formmail />
<div class="column1" style="width: 251px">
<div class="row">
<input name="nom" type="text" class="input" value="Nom:" />
</div>
<div class="row">
<input name="email" type="text" class="input" value="Email:" />
</div>
<div class="row">
<input name="prenom" type="text" class="input" value="Prénom:" />
</div>
<div class="row">
<input name ="tel" type="text" class="input" value="Téléphone:" />
</div>
<div class="row">
<input name="adresse" type="text" class="input" value="Adresse:" />
</div>
<div class="row">
<input name="profession" type="text" class="input" value="Profession:" />
</div>
<div class="row" style=>
Statut:
<select name="statut">
<option value="choix1">Particulier</option>
<option value="choix2">Société</option>
<option value="choix3">Groupe</option>
<option value="choix4">Agent immobilier</option>
</select>
</div>
<div class="row" style="width: 279px">
Type d'intérêt:
<select name="type">
<option value="choix1">Residence principale</option>
<option value="choix2">Residence secondaire</option>
<option value="choix3">Investissement Locatif</option>
<option value="choix4">Investissement financier</option>
<option value="choix5">Investissement</option>
<option value="choix6">Commerce</option>
</select>
</div>
</div>
<div class="column2">
<div class="">
<textarea cols="1" rows="1">Message:</textarea><br />
<div class="div">
<input type="submit" name="envoi" value="Envoyer le formulaire !" />
</div>
</div>
</div>
<div class="clear"></div>
</form> |
Partager