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| <form method="POST" action="formmailicewave.php">
<div align="center">
<input type=hidden name=subject value=formulaire_icewave>
<p><font color="#faa21c" face="Trebuchet MS, Geneva, Arial, Helvetica, SunSans-Regular, sans-serif"><strong>UN SIMPLE TEST ? </strong></font><font size="2" color="#faa21c" face="Trebuchet MS, Geneva, Arial, Helvetica, SunSans-Regular, sans-serif"><strong>Pour recevoir la procédure, complétez puis envoyez ce formulaire.</strong></font></p>
<table align="center">
<tr>
<td><font face="Trebuchet MS, Geneva, Arial, Helvetica, SunSans-Regular, sans-serif"><font color="#247FA0">Nom :</font></td>
<td><input type=text name=realname size=30></td>
<td>
<div align="left">
<font face="Trebuchet MS, Geneva, Arial, Helvetica, SunSans-Regular, sans-serif"><font color="#247FA0"> Email : </font></font></div>
</td>
<td><input type="text" name="email" size="30" /></td>
</tr>
</table>
<br>
<input type=submit value=Envoyer></div>
</form> |
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