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| <P class=txt align=center><FONT class=Titre>Soumettre un ticket </FONT></P>
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<dd><font size="2"><p >Pour toute question veuillez soumettre un ticket.</p></font></dd>
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<b>*Avez-vous un compte jedeclare.com ?: </b></td><td>oui<input type="radio" name="genre" value="oui">non<input type="radio" name="genre" value="non" />
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<b>*Vous êtes :</b>
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Expert-comptable<input type="radio" name="genre" value="Expert-comptable"/>OGA<input type="radio" name="genre" value="OGA" />une Entreprise<input type="radio" name="genre" value="Entreprise" />
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<b>*Raison sociale :</b> <input type="text" name="from" value="">
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<BIG>Civilité :</BIG>
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<dd>*Nom : <input type="text" name="from" value=""></dd>
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<dd>*Prénom : <input type="text" name="from" value=""></dd>
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<p class="justify"> </p>
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<BIG>Coordonnées : </BIG>
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<dd> *E-mail : <input type="text" name="mail" value=""
onfocus='if (this.value=="e-mail") this.value=""' size="17"></dd>
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<DD>Téléphone: <input type="text" name="from" value=""></DD>
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<DD>Adresse : <input type="text" name="from" value=""></DD>
Ville : <input type="text" name="from" value="">
Code postal : <input type="text" name="from" value="">
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<BIG>Message :</BIG>
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<DD>Votre message concerne : <select name="message concerné"><option value="Autres">Autres<option value="Support technique">Support technique<option value="commercial">commercial<option value="Tarif">Tarif</select></p></DD>
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<DD>Niveau de priorité : <select name="niveau priorite"><option value="normal">normal<option value="urgent">urgent</select></p></DD>
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<p>*Message : Sujet: <input type="text" name="from" value="">
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<textarea name="message" rows="24" cols="80"></textarea></dd></p>
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<p class="justify"> </p>
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<form action="mailto:magali.mathieu@experian.fr?subject= message concerne" method=post enctype="text/plain">
<input type="submit" value="Envoyer" onClick="this.form.submit();this.disabled=true;this.value='Envoyer'" onclick="window.open('HTML','TRUC','toolbar=0, location=0, directories=0, status=0, scrollbars=0, resizable=0, copyhistory=0, menuBar=0, width=40, height=60');>
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<P><SMALL>* champs obligatoires</SMALL></P>
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