Quote Boat
Name
*
Postal code
*
Mail
*
date of birth (ddmmyy)
*
Date of permit
*
Profession
Comment
Yes:
No:
Yes:
No:
Yes:
No:
Your Boat
Name of the boat
*
*
Current coverage
*
HIN
*
SRA
*
*
Model
*
Year
*
Length
*
Date Started (ddmmyy)
*
Back
tion'].'" size="50" maxlength="150" />*
'; $form2 = '
'.$LNG['retour_accueil'][$langue].'
'; $form2 .= '
'; if ($_POST['envoyer']) { if ($obligatoire==15) { $mailTexteFrancais .= $form; $avertissement=@envoiMail($titreMailContact,$mailContact,$mailTexteFrancais,$HTTP_SERVER_VARS); $form2 = '
Retour Accueil
'; $form2 .= ''; }else{ $avertissement="
!!! Veuillez remplir les champs obligatoires !!!
"; } } print '
'; if ($avertissement) print '
'.$avertissement.'
'; print $form.$form2; print '
'; ?>
