function AffilieFormContact(id_affil) {
	chaine_Form = "";
	chaine_Form += '<form name="frm_ProA" method="post" action="http://www.annuaire-web-france.com/affiliations/pro-annonces/affilieProA.php" target="_blank">';
	chaine_Form += '<table width="550" border="0" align="center" cellpadding="1" cellspacing="1" style="border: 1px solid #333333; font-family: Verdana, Arial, Helvetica, sans-serif;	font-size: 10px; color: #333333;">';
	chaine_Form += '<tr>';
	chaine_Form += '<td colspan="2"><a href="http://www.pro-annonces.fr" target="_blank"><img src="http://www.annuaire-web-france.com/affiliations/pro-annonces/images/bandeau-pro-annonces-accueil.jpg" width="550" height="125" border="0"></a></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td height="72" colspan="2" style="font-family: Verdana, Arial, Helvetica, sans-serif;	font-size: 12px; font-weight: bold;	color: #333333;"><div align="justify">';
	chaine_Form += '<blockquote>';
	chaine_Form += '<p><br>';
	chaine_Form += 'Vous &ecirc;tes <strong style="font-size: 14px; color: #FF6600;">commer&ccedil;ant / artisan</strong> ou une <strong style="font-size: 14px; color: #FF6600;"> profession lib&eacute;rale</strong>, vous souhaitez trouver rapidement un repreneur pour votre activit&eacute; et transmettre votre entreprise, avec <a href="http://www.pro-annonces.fr" target="_blank">www.pro-annonces.fr</a> b&eacute;n&eacute;ficiez de la meilleur offre Internet globale du web, avec le meilleur de la technologie, alertes SMS, support personnalis&eacute; ... hotline efficace et disponible au <strong style="font-size: 14px; color: #FF6600;">0811 464 898</strong>  ... </p>';
	chaine_Form += '<p>Seul site partenaire des organismes de gestion et des sites institutionnels comme l&rsquo;APCE et l&rsquo;APEC, <a href="http://www.pro-annonces.fr" target="_blank">www.pro-annonces.fr</a> c&rsquo;est toujours plus d&rsquo;efficacit&eacute; et de rapidit&eacute; pour trouver un repreneur.<br>';
	chaine_Form += '<br>';
	chaine_Form += 'En remplissant ce formulaire de contact, un conseill&eacute; vous appelera sans engagement dans les meilleurs d&eacute;lais, et vous b&eacute;n&eacute;ficirez d\'une <span style="color: #FF6600; font-size: 16px; font-weight: bold;">r&eacute;duction de 10%</span> sur les tarifs HT de publication de  votre annonce et l\'ensemble des produits du site.<br>';      
	chaine_Form += '</p>';
	chaine_Form += '</blockquote>';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td colspan="2"><div align="center"><a href="http://www.pro-annonces.fr/pro-annonces/Tarifs-pro-annonces.php" target="_blank"><FONT color="#FF6600" face="Arial, Helvetica, sans-serif" style="font-size: 12px;	font-weight: bold;">[ consulter les tarifs ]</FONT></a><br>';
	chaine_Form += '<br>';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr bgcolor="#666666">';
	chaine_Form += '<td colspan="2" style="font-family: Verdana, Arial, Helvetica, sans-serif;	font-size: 12px;	font-weight: bold;	color: #FFFFFF;"><div align="left">... Vos informations </div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td bgcolor="#CCCCCC"><table width="100%" border="0" align="center" cellpadding="2" cellspacing="2" >';
	chaine_Form += '<tr>';
	chaine_Form += '<td><strong>Votre soci&eacute;t&eacute;</strong> <span style="color: #FF0000;">*</span></td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="societe" type="text" id="societe" size="50" style="background-color: #FFDBC4; font-weight: bold;">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td width="209"><strong>Votre activit&eacute;</strong> <span style="color: #FF0000;">*</span></td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="activite" type="text" id="adresse" size="50" style="background-color: #FFDBC4; font-weight: bold;">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td height="21"> <strong>Civilit&eacute; </strong><span style="color: #FF0000;">*</span></td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="civilite" type="radio" value="Mr" checked>';
	chaine_Form += 'Mr';
	chaine_Form += '<input type="radio" name="civilite" value="Mme">';
	chaine_Form += 'Mme';
	chaine_Form += '<input type="radio" name="civilite" value="Mlle">';
	chaine_Form += 'Mlle </div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td> Votre <strong>nom</strong> <span style="color: #FF0000;">*</span></td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="nom" type="text" id="nom" style="background-color: #FFDBC4; font-weight: bold;">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td>Votre <strong>pr&eacute;nom</strong> <span style="color: #FF0000;">*</span></td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="prenom" type="text" id="prenom" style="background-color: #FFDBC4; font-weight: bold;">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td> Adresse </td>';
	chaine_Form += '<td>';
	chaine_Form += '<div align="right">';
	chaine_Form += '<input name="adresse" type="text" size="50">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td> Code Postal </td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="cp" type="text"  size="10">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td> Ville </td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="ville" type="text">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td> <strong>T&eacute;l&eacute;phone</strong> <span style="color: #FF0000;">*</span></td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="tel" type="text" style="background-color: #FFDBC4; font-weight: bold;">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td> <strong>Email</strong> <span style="color: #FF0000;">*</span></td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<input name="email" type="text" size="30" style="background-color: #FFDBC4; font-weight: bold;">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td valign="top">&nbsp;</td>';
	chaine_Form += '<td>&nbsp;</td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td valign="top">Message</td>';
	chaine_Form += '<td><div align="right">';
	chaine_Form += '<textarea name="message" cols="44" rows="8" id="activite"></textarea>';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td valign="top">&nbsp;</td>';
	chaine_Form += '<td>&nbsp;</td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td colspan="2" valign="top"><div align="center">';
	chaine_Form += '<input name="idaffil" type="hidden" id="idaffil" value="'+id_affil+'">';
	chaine_Form += '<input type="button" name="Submit" value="Envoyer" onClick="if ( (document.frm_ProA.societe.value!=\'\') && (document.frm_ProA.activite.value!=\'\') && (document.frm_ProA.civilite.value!=\'\') && (document.frm_ProA.nom.value!=\'\') && (document.frm_ProA.prenom.value!=\'\') && (document.frm_ProA.tel.value!=\'\') && (document.frm_ProA.email.value!=\'\')){document.frm_ProA.submit();document.frm_ProA.reset();} else { alert(\'remplir tous les champs obligatoires !!!\'); }">';
	chaine_Form += '</div></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr>';
	chaine_Form += '<td colspan="2" valign="top"><span style="color: #FF0000;">*</span> champs obligatoires </td>';
	chaine_Form += '</tr>';
	chaine_Form += '</table></td>';
	chaine_Form += '</tr>';
	chaine_Form += '<tr bgcolor="#666666" height="4">';
	chaine_Form += '<td height="4" colspan="2"></td>';
	chaine_Form += '</tr>';
	chaine_Form += '</table>';
	chaine_Form += '<p align="center" style="font-family: Verdana, Arial, Helvetica, sans-serif;	font-size: 12px;	font-weight: bold;	color: #333333;">en partenariat avec<br>';
	chaine_Form += '<br>';
	chaine_Form += '<br>';
	chaine_Form += '<img src="http://www.annuaire-web-france.com/images/logo-annuaire-web-france.jpg" alt="Annuaire Web France" width="120" height="35"></p>';
	chaine_Form += '<p align="center" style="font-family: Verdana, Arial, Helvetica, sans-serif;	font-size: 12px;	font-weight: bold;	color: #333333;"><img src="http://www.annuaire-web-france.com/affiliations/pro-annonces/images/logo-AIRCGA.jpg" width="60" height="43" hspace="10" vspace="4"><img src="http://www.annuaire-web-france.com/affiliations/pro-annonces/images/logo-anprecega.jpg" width="50" height="51" hspace="10" vspace="4"><img src="http://www.annuaire-web-france.com/affiliations/pro-annonces/images/logo-APCE-long.jpg" width="60" height="50" hspace="10" vspace="4"><img src="http://www.annuaire-web-france.com/affiliations/pro-annonces/images/Logo-Apec-Quadri-FB-80px.jpg" width="80" height="50" hspace="10" vspace="4"><img src="http://www.annuaire-web-france.com/affiliations/pro-annonces/images/Transmission-TPE-240.jpg" width="214" height="47" hspace="10" vspace="4"><br>';
	chaine_Form += '<br>';
	chaine_Form += '</p>';
	chaine_Form += '</form>';
	document.write(chaine_Form);
}