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<html>
<head>
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    <title>Nouveau prospect</title>

    

</head>
<body>

				
			
	
	
<form method="post" action="clientcreer.php" name="demande">

	
		
	<div class="rTable">
	
		<div class="rTableRow"> 
			<div class="rTableHead" style='width: 50%'><strong>Nouveau Client</strong></div> <div class="rTableHead" ><span style="font-weight: bold;"></span></div> 
			
	<div class="rTableRow"> 
			<div class="rTableCellodd" style="padding-top: 10px;" >Nom de la société :</div> <div class="rTableCellodd" style='width: 50%'><input class="w3-input w3-hover-greyscale"		 size="30" id="coldonodd"
name="SOC" value="<?php echo $SOC ?>"></div>  </div> 
		
		<div class="rTableRow">
		<div class="rTableCelleven"><select name="titre" class="a-btn a-block"> >
            
           
            
<option value="M."  <?php if ($TITRE=='M.') { ?>selected="selected"<?php } ?>  >M.  </option>
<option value="Mme." <?php if ($TITRE=='Mme.') { ?>selected="selected"<?php } ?>  >Mme.  </option>
<option value="M.&amp;Mme." <?php if ($TITRE=='M.&Mme.') { ?>selected="selected"<?php } ?> >M.&amp;Mme.  </option>
</select></div> <div class="rTableCelleven" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="nom1" id="coldoneven" value="<?php echo $NOM1 ?>"></div> </div>
			
			
			
			<div class="rTableRow" > 
			<div class="rTableCellodd" style="padding-top: 10px;">Adresse :</div> <div class="rTableCellodd" style="width:50%" ><input class="w3-input w3-hover-greyscale" size="60"
name="nom2" id="coldonodd" value="<?php echo $NOM2 ?>"></div>  </div> 
			
			
			<div class="rTableRow"> 
			<div class="rTableCellodd"></div> <div class="rTableCellodd" style='width: 50%' ><input class="w3-input w3-hover-greyscale"size="30"
name="nom3" id="coldonodd" value="<?php echo $NOM3 ?>"></div>  </div> 
			
			
		
			<div class="rTableRow"> 
			<div class="rTableCellodd"></div> <div class="rTableCellodd" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="nom4" id="coldonodd" value="<?php echo $NOM4 ?>"></div>  </div> 
			
			<div class="rTableRow"> 
			<div class="rTableCellodd"></div> <div class="rTableCellodd" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="nom5" id="coldonodd" value="<?php echo $NOM5 ?>"></div>  </div> 
			
			
			<div class="rTableRow"> 
			<div class="rTableCelleven" style="padding-top: 10px;">Objet :</div> <div class="rTableCelleven" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="o1" id="coldoneven" value="<?php echo $O1 ?>"></div>  </div> 
			
			<div class="rTableRow"> 
			<div class="rTableCelleven"></div> <div class="rTableCelleven" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="o2"  id="coldoneven" value="<?php echo $O2 ?>"></div>  </div> 
			
			<div class="rTableRow"> 
			<div class="rTableCelleven"></div> <div class="rTableCelleven" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="o3" id="coldoneven" value="<?php echo $O3 ?>"></div>  </div> 
			
			<div class="rTableRow"> 
			<div class="rTableCellodd" style="padding-top: 10px;">Tel. :</div> <div class="rTableCellodd" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="tel" id="coldonodd" value="<?php echo $TEL ?>"></div>  </div> 
			
			<div class="rTableRow"> 
			<div class="rTableCelleven" style="padding-top: 10px;" >GSM :</div> <div class="rTableCelleven" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="gsm" id="coldoneven" value="<?php echo $GSM ?>"></div>  </div> 
			
			<div class="rTableRow"> 
			<div class="rTableCellodd" style="padding-top: 10px;" >Mail </div> <div class="rTableCellodd" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="mail" id="coldonodd" value="<?php echo $MAIL ?>"></div>  </div> 
			
			<div class="rTableRow"> 
			<div class="rTableCelleven" style="padding-top: 10px">Adresse chantier :</div> <div class="rTableCelleven" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="ac1" id="coldoneven" value="<?php echo $AC1 ?>"></div>  </div> 
			
			
			<div class="rTableRow"> 
			<div class="rTableCelleven"></div> <div class="rTableCelleven" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="ac2" id="coldoneven" value="<?php echo $AC2 ?>"></div>  </div> 
			
			<div class="rTableRow"> 
			<div class="rTableCellodd" style="padding-top: 10px;" >Source :</div> <div class="rTableCellodd" style='width: 50%'><input class="w3-input w3-hover-greyscale" size="30"
name="pub" id="coldonodd" value="<?php echo $PUB ?>"></div>  </div> 
			
			
			
	<div class="rTableRow"> 
		<div class="rTableCell"></div>
	<div class="rTableCell" style="text-align: right;width: 50%">
<input value="Valider" class="form-control" type="submit"><br>

	
	</form>
			</div>  </div> 
			
			
			
	</div>



	


</body>
</html>
