Code : Tout sélectionner
<table class="table28">
<form method="post" action="ici ma page"></form>
<tr>
<td class="td29">Nom :</td>
<td class="td30"><input class="Style1" name="nom" size="26" onkeyup="javascript:this.value=this.value.toUpperCase();" type="text"></td>
</tr>
<tr>
<td class="td31">Prénom :</td>
<td class="td32"><input class="Style1" name="prenom" size="26" onkeyup="javascript:this.value=this.value.toLowerCase();" type="text"></td>
</tr>
<tr>
<td class="td29">Organisation (Ne pas remplir si particulier) :</td>
<td class="td30"><input class="Style1" name="organisation" size="26" onkeyup="javascript:this.value=this.value.toUpperCase();" type="text"></td>
</tr>
<tr>
<td class="td31">Forme juridique :</td>
<td class="td32">
<select class="Style1" name="forme_juridique" style="width: 187px;">
<option value="societe">Société
</option><option value="association">Association
</option><option value="particulier" selected="selected">Particulier
</option><option value="autre">Autre
</option></select></td>
</tr>
</table>
<br><hr width="70%"><br>
<table class="table28">
<tr>
<td class="td29">Adresse :</td>
<td class="td30"><input class="Style1" name="adresse" size="26" onkeyup="javascript:this.value=this.value.toLowerCase();" type="text"></td>
</tr>
<tr>
<td class="td31">Code postal :</td>
<td class="td32"><input class="Style1" name="code_postal" size="26" type="text"></td>
</tr>
<tr>
<td class="td29">Ville :</td>
<td class="td30"><input class="Style1" name="ville" size="26" onkeyup="javascript:this.value=this.value.toUpperCase();" type="text"></td>
</tr>
<tr>
<td class="td31">Pays :</td>
<td class="td32"><input class="Style1" name="pays" size="26" onkeyup="javascript:this.value=this.value.toUpperCase();" type="text"></td>
</tr>
<tr>
<td class="td29">Adresse e-mail :</td>
<td class="td30"><input class="Style1" name="email" size="26" onkeyup="javascript:this.value=this.value.toLowerCase();" type="text"></td>
</tr>
<tr>
<td class="td31">Téléphone :</td>
<td class="td32"><input class="Style1" name="tel" size="26" type="text"></td>
</tr>
</table>
<br><hr width="70%"><br>
<table class="table28">
<tr>
<td class="td31">DNS primaire :</td>
<td class="td32"><input class="Style1" name="dns1" size="26" value="ns1.performant-heberg.com" type="text"></td>
</tr>
<tr>
<td class="td31">DNS secondaire :</td>
<td class="td32"><input class="Style1" name="dns2" size="26" value="ns2.performant-heberg.com" type="text"></td>
</tr>
</table>
<br><hr width="70%"><br>
<table class="table28">
<tr>
<td class="td29">Nom du compte :</td>
<td class="td30"><input class="Style1" name="compte" size="26" onkeyup="javascript:this.value=this.value.toLowerCase();" type="text"></td>
</tr>
<tr>
<td class="td31">Mot de passe :</td>
<td class="td32"><input class="Style1" name="pass" size="26" onkeyup="javascript:this.value=this.value.toLowerCase();" type="password"></td>
</tr>
<tr>
<td class="td29">Confirmation :</td>
<td class="td30"><input class="Style1" name="pass2" size="26" onkeyup="javascript:this.value=this.value.toLowerCase();" type="password"></td>
</tr>
</table>
<br><hr width="70%"><br>
<table class="table28">
<tr>
<td class="td29">Moyen de paiement :</td>
<td class="td30">
<select class="Style1" name="duree" style="width: 187px;">
<option value="1" selected="selected">8 Allopass/an
</option><option value="3">8€ Paypal/an
</option></select></td>
</tr>
</table>
<br><hr width="70%"><br>
<table class="table28">
<tr>
<td class="td31">Commentaires éventuel :</td>
<td class="td30">
<textarea class="Style1" name="commentaire" rows="4" cols="25"></textarea>
</tr>
</table>
<br>
<b><p style="color: rgb(192, 0, 0);" class="Style1">*Le paiement s'effectue après la validation de votre commande par notre système.</b></p>
<p><center><input name="validation" value="Valider ma commande" type="submit"></center></p>