<div class="eaKeep"><SCRIPT src="../../../third-parties/yav/js_compact/yav.js"> </SCRIPT> <SCRIPT src="../../../third-parties/yav/js_compact/yav-config-fr.js"> </SCRIPT> <SCRIPT>
var rules=new Array();
rules[0]='email|required|E-mail';
rules[1]='email|email|e-mail: Veuillez vérifier votre adresse e-mail ';
rules[2]='prenom|required|Prenom';
rules[3]='nom|required|Nom';
rules[4]='telephone|required|Telephone';
rules[5]='chambre|required|Chambre';
rules[6]='arrivee|required|Date d\'arrivée';
rules[7]='depart|required|Date de départ';
function swapDisplay (id){
if (getStyleObject(id).display=='block'){
hideCompById(id);
} else {
showCompById(id);
}
}
</SCRIPT>
<form class="fckForm" style="margin: 0pt;" onsubmit="return performCheck('contactForm', rules, 'classic');" action="../../../iw/core/main/sendForm.jsp" name="contactForm">
<table width="460" class="fckTable">
<tbody>
<tr>
<th colspan="4">Réservation</th>
</tr>
<tr>
<td colspan="4"><strong>Information personnelles<br />
</strong></td>
</tr>
<tr>
<td width="80">Prénom*</td>
<td> <input type="text" style="width: 150px;" name="prenom" /></td>
<td width="80">Nom*</td>
<td> <input type="text" style="width: 150px;" name="nom" /></td>
</tr>
<tr>
<td width="80">Ville</td>
<td> <input type="text" style="width: 150px;" name="ville" /></td>
<td width="80">Pays</td>
<td> <input type="text" style="width: 150px;" name="pays" /></td>
</tr>
<tr>
<td width="80">Téléphone*</td>
<td> <input type="text" style="width: 150px;" name="telephone" /> </td>
<td width="80">Portable</td>
<td> <input type="text" style="width: 150px;" name="portable" /></td>
</tr>
<tr>
<td width="80">Fax</td>
<td> <input type="text" style="width: 150px;" name="fax" /></td>
<td width="80">E-mail*</td>
<td> <input type="text" style="width: 150px;" name="email" /></td>
</tr>
</tbody>
</table>
<table width="460" class="fckTable">
<tbody>
<tr>
<td colspan="2"><strong>Demande de réservation<br />
</strong></td>
</tr>
<tr>
<td width="150">Chambre*</td>
<td><select name="chambre">
<option selected="" value="select...">sélect...</option>
<option value="simple">simple</option>
<option value="double">double</option>
<option value="triple">triple</option>
</select></td>
</tr>
<tr>
<td width="150">Arrivée*</td>
<td><input type="text" style="width: 150px;" name="arrivee" /> (jj/mm/aa)</td>
</tr>
<tr>
<td width="150">Départ*</td>
<td><input type="text" style="width: 150px;" name="depart" /></td>
</tr>
<tr>
<td colspan="2">Notes</td>
</tr>
<tr>
<td colspan="2"><input type="text" style="width: 500px; height: 100px;" name="notes" /> <input type="hidden" value="Contact direct" name="formTitle" /></td>
</tr>
<tr>
<td colspan="4">
<p>La réservation ne sera prise en compte qu'après une confirmation téléphonique. Vérifiez le numéro de téléphone.</p>
</td>
</tr>
<tr>
<td colspan="4"><input type="submit" style="float: right;" value="Envoyer" /></td>
</tr>
</tbody>
</table>
</form>
</div>
