document.write('<form action=\"http://delpha.niouzletter.com/inscription.php\" method=\"POST\" id=\"NLform\" onsubmit=\"return NLverifierInscription();\"><input type=\"hidden\" name=\"cle\" value=\"94a7b9a5f2b43e9950bfc79f5\" /><script src=\"http://delpha.niouzletter.com/js/formulaire.js\"></script><style type=\"text/css\">.form_erreur { border:2px solid #fdb33c !important; background-image:url(\'http://delpha.niouzletter.com/images/form/ic-form-erreur.gif\'); background-repeat:no-repeat; background-position:right;}.form_ok { background-image:url(\'http://delpha.niouzletter.com/images/form/ic-form-ok.gif\'); background-repeat:no-repeat; background-position:right;}#div_infoBulle { position:absolute; width:260px; height:69px; display:none;background-image:url(\'http://delpha.niouzletter.com.niouzletter.com/images2/form/etiquette-erreur.png\');}#div_infoBulle p { margin-left:50px; margin-top:8px; width:210px; height:30px; color:white; overflow:hidden;}</style><div class=\"NLConteneur\"><div align=\"center\">* Champs obligatoires</div><table align=\"center\" class=\"NLTable\">            <tr>                <td><span class=\"TXTnom_societe\">Nom société :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"nom_societe\"  id=\"NLnom_societe\" class=\"NLnom_societe\" />                </td></tr>   	<tr><td>		Civilité :	</td>	<td>				     <select name=\"champ_1\" id=\"NLchamp_1\" class=\"NLchamp_1\">				 <option value=\"\">Choisissez</option>					    <option value=\"Madame\"  >Madame</option>		    		    <option value=\"Mademoiselle\"  >Mademoiselle</option>		    		    <option value=\"Monsieur\"  >Monsieur</option>		    		    </select>		        </td></tr>               <tr>                <td><span class=\"TXTnom\">Nom :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"nom\"  id=\"NLnom\" class=\"NLnom\" />                </td></tr>               <tr>                <td><span class=\"TXTprenom\">Prénom :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"prenom\"  id=\"NLprenom\" class=\"NLprenom\" />                </td></tr>               <tr>                <td><span class=\"TXTadresse\">Adresse :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"adresse\"  id=\"NLadresse\" class=\"NLadresse\" />                </td></tr>   	<input type=\'hidden\' id=\'NLcp_oblig\' />	            <tr>                <td><span class=\"TXTcp\">Cp* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"cp\"  id=\"NLcp\" class=\"NLcp\" />                </td></tr>               <tr>                <td><span class=\"TXTville\">Ville :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"ville\"  id=\"NLville\" class=\"NLville\" />                </td></tr>   	<input type=\'hidden\' id=\'NLemail_oblig\' />	            <tr>                <td><span class=\"TXTemail\">Email* :</span></td>                <td>		<input type=\"text\" value=\"\" name=\"email\"  id=\"NLemail\" class=\"NLemail\" />                </td></tr>   	<tr><td>		Activité principale :	</td>	<td>				     <select name=\"champ_2\" id=\"NLchamp_2\" class=\"NLchamp_2\">				 <option value=\"\">Choisissez</option>					    <option value=\"Architecte\"  >Architecte</option>		    		    <option value=\"Autre\"  >Autre</option>		    		    <option value=\"Bureau etudes\"  >Bureau etudes</option>		    		    <option value=\"Distributeur\"  >Distributeur</option>		    		    <option value=\"Installateur\"  >Installateur</option>		    		    <option value=\"Particulier\"  >Particulier</option>		    		    <option value=\"Prescripteur\"  >Prescripteur</option>		    		    <option value=\"Promoteur / Constructeur\"  >Promoteur / Constructeur</option>		    		    </select>		        </td></tr>   	<tr><td>		Type de chantier :	</td>	<td>				     <select name=\"champ_3\" id=\"NLchamp_3\" class=\"NLchamp_3\">				 <option value=\"\">Choisissez</option>					    <option value=\"neuf\"  >neuf</option>		    		    <option value=\"rénovation\"  >rénovation</option>		    		    </select>		        </td></tr>   <tr><td colspan=\"2\"><button type=\"submit\" id=\"NLsubmit\">S\'inscrire</button></td></tr></table></div></form>')