document.write('<FORM name="form1" action="/reqform/formproc.php" method="post" onsubmit="return chkForm();">')
document.write('<center>');

document.write('<table border="1" width="100%"  border="0" cellpadding="0" cellspacing="0">')
document.write('<tr>')
document.write('<td class="text10"> <span>* Nombre </spna> </td>')
document.write('<td class="text10" align="center"><input name="nm" type="text"  id="nm"></td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"> <span>* Pais</span> </td>')
document.write('<td class="text10" align="center"><input name="country" type="text"  id="country"></td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"><span >* Mail </span></td>')
document.write('<td class="text10" align="center"><input name="email" type="text"  id="email"></td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"><span>* Teléfono</span> </td>')
document.write('<td class="text10" align="center"><input name="telephone" type="text" id="telephone" ></td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"><span>* N° de personas</span> </td>')
document.write('<td class="text10" align="center"><input name="nop" type="text" id="nop" ></td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"><span>* Fecha</span> </td>')
document.write('<td class="text10" align="center"><input name="dot" type="text" id="dot" ></td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"><span>&nbsp; Hotel Preferido</span> </td>')
document.write('<td align="center" class="text10"><select name="hotel" size="1" id="hotel"> <option value=""> Selectione</option> <option value="5* Moderno">5* Moderno</option>  <option value="5* Palacios">5* Palacios</option> <option value="Hoteles Heritage">Hoteles Heritage</option> <option value="Hoteles economicos">Hoteles economicos</option></select></td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"><span>* Budget Par Personne hors Vols Internationaux</span> </td>')
document.write('<td align="center" class="text10"><select name="budget" size="1" id="budget"> <option value=""> Selectione</option> <option value="jusqu\'a 800 &euro; pp">jusqu\'a 800 &euro; pp</option> <option value="800 à 1500 &euro; pp">800 à 1500 &euro; pp</option> <option value="1500 à 2500 &euro; pp">1500 à 2500 &euro; pp</option> <option value="2500 à 4000 &euro; pp">2500 à 4000 &euro; pp</option> <option value="4000 à 7000 &euro; pp">4000 à 7000 &euro; pp</option> <option value="plus de 7000 &euro; pp">plus de 7000 &euro; pp</option> </select></td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"><span>* Mensaje</Span></td>')
document.write('<td align="center" class="text10"><textarea name="des" id="textarea10" ></textarea></td>')
document.write('</tr>')

/*
document.write('<tr>')
document.write('<td class="text10"><span>&nbsp; Validation Anti-Spam</Span></td>')
document.write('<td class="text10"><img id="querycaptchaimg" width="80px" height="30px" src="/reqform/visual-captcha.php" alt="captcha code" style="width: 80px; height: 30px;"> <br> <a href="javascript:void(0)" onclick="refreshCaptcha(\'querycaptcha\');return false;">Actualiser</a> </td>')
document.write('</tr>')

document.write('<tr>')
document.write('<td class="text10"><span>* Merci de saisir les 4 caractères de l\'image</Span></td>')
document.write('<td align="center" class="text10"><input name="captchatxt" type="text" id="querycaptchatxt" autocomplete="off"></td>')
document.write('</tr>')
*/

document.write('<tr class="text10">')
document.write('<td>&nbsp;</td>')
document.write('<td align="center"><input name="Submit" type="submit" value=" Someter "></td>')
document.write('</tr>')
document.write('</table>')
document.write('</center>');
document.write('</form>')

function refreshCaptcha(componentId){
	document.getElementById(componentId+'img').src = '/reqform/visual-captcha.php?rand=' + Math.random();
	document.getElementById(componentId+'txt').value='';
	document.getElementById(componentId+'txt').focus();
}

function chkForm()
{
	if( (document.form1.nm.value == "")        || (document.form1.country.value == "")    || (document.form1.email.value == "") ||
		(document.form1.telephone.value == "") || (document.form1.nop.value == "")        || (document.form1.dot.value == "")   ||
		(document.form1.des.value == "")       || (document.form1.captchatxt.value == "") || (document.form1.budget.value == "")
	  )
	{
		alert("Please fill in the fields marked with * ");
		return(false);
	}
	
if(document.form1.email.value.indexOf(" ") >= 0)
{
	alert("Please enter your email-id without any white space character.");
	document.form1.email.focus();
	return (false);
}
if ( (document.form1.email.value.indexOf("@") == -1) || (document.form1.email.value.indexOf(".") == -1) )
{
	alert("Please enter your valid email-id");
	document.form1.email.focus();
	return (false);
}


BeforeAtRate = document.form1.email.value.substring(0,document.form1.email.value.indexOf("@"));
AfterAtRate = document.form1.email.value.substring(document.form1.email.value.indexOf("@")+1,document.form1.email.value.length);

if (AfterAtRate.indexOf(".") == -1)
{
	alert("Please enter a valid email-id");
	document.form1.email.focus();
	return (false);
}

middle = AfterAtRate.substring(0, AfterAtRate.indexOf("."))
last = AfterAtRate.substring(AfterAtRate.indexOf(".") + 1,AfterAtRate.length)

if (BeforeAtRate.length == 0 || middle.length == 0 || last.length == 0)
{
	alert("Please enter a valid email-id"); 
	document.form1.email.focus();
	return (false);
}
}


function disableselect(e){ 
return false; 
} 
function reEnable(){ 
return true; 
} 
document.onselectstart=new Function ("return false"); 
if (window.sidebar){ 
document.onmousedown=disableselect; 
document.onclick=reEnable; 
} 
function droit(e) {
if (navigator.appName == 'Netscape' && (e.which == 3 || e.which == 2)) {
alert('© Copyright - Tour Passion');
return false;
}else if (navigator.appName == 'Microsoft Internet Explorer' &&
(event.button == 2 || event.button == 3)) {
alert('© Copyright - Tour passion');
return false;
}
return true;
}
document.onmousedown=droit;
if (document.layers) window.captureEvents(Event.MOUSEDOWN);