// JavaScript Document
document.write('<form id="contact" name="contact" method="post" action="http://apps.wesa.info/Formulaires/contact.php">');
document.write('<table width="400" border="0" cellspacing="0" cellpadding="6">');
document.write('<tr>');
document.write('<td width="33%">Nom : </td>');
document.write('<td>');
document.write('<input name="nom" type="text" id="nom" />');
document.write('</td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td> Pr&eacute;nom : </td>');
document.write('<td><input name="prenom" type="text" id="prenom" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>Adresse Compl&egrave;te : </td>');
document.write('<td><textarea name="adresse" id="adresse"></textarea></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>T&eacute;l&eacute;phone : </td>');
document.write('<td><input name="telephone" type="text" id="telephone" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>Fax : </td>');
document.write('<td><input name="fax" type="text" id="fax" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>E-mail : </td>');
document.write('<td><input name="email" type="text" id="email" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="2">Sujet de votre message : </td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="2"><input name="sujet" type="text" id="sujet" size="55" /></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="2">Votre message : </td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td colspan="2"><textarea name="message" cols="55" rows="4" id="message"></textarea></td>');
document.write('</tr>');
document.write('<tr>');
document.write('<td>&nbsp;</td>');
document.write('<td align="center"><input type="hidden" name="destinataire" value="' + destinataire + '" /><input type="hidden" name="societe" value="' + societe + '" /><input type="hidden" name="siteinternet" value="' + siteinternet + '" /><input type="submit" name="Submit" value="Envoyer" /></td>');
document.write('</tr>');
document.write('</table>');
document.write('</form>');