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<p><font face="verdana"><a href="dema02.htm"><span class="Style2">Visualiser mes tarifs</span></a></font></p>
<p><span class="Style11">Demande de Devis</span> <font size='2' face='verdana'><br></b>Pour recevoir un devis, veuillez remplir le formulaire ci-dessous.</font></p>
</div>
</div>
<form name="form1" method="post" action="../php/mail.php3" enctype='multipart/form-data'>
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<td colspan="4"><div align="center"><span class="Style1"><img src="../images/picto01.gif" width="6" height="6"> <span class="Style2">I</span>nterlocuteur</span><br>
<br>
</div></td>
</tr>
<tr valign="middle">
<td width="85" nowrap><div align="right">Nom* :</div></td>
<td width="146" height="31" nowrap><div align="left"><input name="nom" type="text" id="nom" size="20">
</div></td>
<td width="80" nowrap><div align="right">Prénom :</div></td>
<td width="120" nowrap><input name="prenom" type="text" id="prenom" size="20"></td>
</tr>
<tr valign="middle">
<td nowrap><div align="right">Société*:</div></td>
<td height="33" nowrap>
<div align="left">
<input name="societe" type="text" id="societe" size="20">
</div></td>
<td nowrap><div align="right">Activité :</div></td>
<td nowrap><input name="activite" type="text" id="activite" size="20"></td>
</tr>
<tr valign="middle">
<td nowrap><div align="right">Adresse*: </div></td>
<td height="37" nowrap>
<div align="left">
<textarea name="adresse" cols="20" rows="2" id="adresse"></textarea>
</div></td>
<td nowrap><div align="right">Pays : </div></td>
<td nowrap><input name="pays" type="text" id="pays" size="20"></td>
</tr>
<tr valign="middle">
<td nowrap><div align="right">Code Postal :</div></td>
<td height="41" nowrap>
<div align="left">
<input name="code" type="text" id="code" size="5">
</div></td>
<td nowrap><div align="right">Ville :</div></td>
<td nowrap><input name="ville" type="text" id="ville" size="20"></td>
</tr>
<tr valign="middle">
<td nowrap><div align="right">Téléphone :</div></td>
<td height="24" nowrap>
<div align="left">
<input name="telephone" type="text" id="telephone" size="20">
</div></td>
<td nowrap><div align="right">Fax : </div></td>
<td nowrap><input name="fax" type="text" id="fax" size="20"></td>
</tr>
<tr>
<td nowrap><div align="right">E-mail*: </div></td>
<td height="38" nowrap>
<div align="left">
<input name="email" type="text" id="email" size="20">
</div></td>
<td nowrap> </td>
<td nowrap> </td>
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<td colspan="4"><div align="center">
<p><span class="Style1"><br>
<img src="../images/picto01.gif" width="6" height="6"> <span class="Style2">T</span>raduction de documents<br>
(manuel d'utilisation, notice, brevet,...) <br>
</span><br>
</p>
</div></td>
</tr>
<tr>
<td height="40" colspan="2"><div align="right">Type de traduction : </div></td>
<td colspan="2">de
<select name="langue" id="langue">
<option value="francais">Français</option>
<option value="anglais">Anglais</option>
</select>
vers Italien </td>
</tr>
<tr>
<td colspan="2" valign="top"><div align="right">Type de document : </div></td>
<td colspan="2"><input name="type" type="text" id="type" size="20"></td>
</tr>
<tr>
<td colspan="2" valign="top"><div align="right">Fichier à traduire : </div></td>
<td colspan="2"><input name='attach' type='file' id="attach" value='parcourir' size='20'>
<br></td>
</tr>
<tr>
<td colspan="2" valign="top"><div align="right">Message d'accompagnement : </div></td>
<td colspan="2" valign="top"><textarea name="message" cols="20" rows="2" id="message"></textarea></td>
</tr>
<tr>
<td colspan="4"><div align="center">
<p>* : champs obligatoires </p>
</div></td>
</tr>
<tr>
<td colspan="4">
<div align="center">
<input type="reset" name="Submit" value="Effacer">
<input type="submit" name="Submit2" value="Envoyer">
</div></td>
</tr>
</table>
</form> <p> </p> </td>
</tr>
</table>
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