apremtg.fr Open in urlscan Pro
2001:41d0:1:1b00:213:186:33:17  Public Scan

Form analysis
1 forms found in the DOM

Name: form — POST https://www.emlsrv.fr/_v4/formulaires/save.php?serial=pPaR6qXE

<form action="https://www.emlsrv.fr/_v4/formulaires/save.php?serial=pPaR6qXE" method="POST" onsubmit="return Validate ();" name="form" id="form">
  <input type="hidden" name="formulaire" value="pPaR6qXE">
  <input type="hidden" name="ope" value="818348">
  <input type="hidden" name="date" value="11/06/2024 14:05">
  <input type="hidden" name="nonce" value="ReqXmvFZsrTuI498ul4g2Gyye">
  <table align="center" border="0" cellpadding="1" cellspacing="1" style="width:600px;">
    <tbody>
      <tr style="background-color:#f6f6f6;">
        <td align="center">
          <p>&nbsp;</p>
          <p><img alt="" src="http://mdworks.info/hebergement_formulaires/3780/logoxbte2.png" style="width: 300px; height: 135px;"></p>
        </td>
      </tr>
      <!--
		<tr style="background-color:#f6f6f6;">
			<td align="center"><span style="color:#097fb5;"><span style="font-size:36px;"><span style="font-family: arial, helvetica, sans-serif;">Mon devis t&eacute;l&eacute;phonique sur mesure</span></span></span></td>
		</tr>
-->
    </tbody>
  </table>
  <table align="center" border="0" cellpadding="1" cellspacing="0" style="width: 600px;background-color:#f6f6f6;">
    <tbody>
      <tr>
        <td style="background-color:#f6f6f6;">
          <table align="center" border="0" cellpadding="0" cellspacing="0" height="300px" width="550">
            <tbody>
              <tr height="20">
                <td style="background-color:#f6f6f6;"><span style="font-family: helvetica,arial,sans-serif; font-size: 16px;">&nbsp;&nbsp;&nbsp;</span></td>
                <td style="background-color:#f6f6f6;">&nbsp;</td>
                <td style="background-color:#f6f6f6;" width="15">&nbsp;</td>
              </tr>
              <tr height="20">
                <td style="background-color:#f6f6f6;"><span style="font-family: helvetica,arial,sans-serif; font-size: 16px;">&nbsp;&nbsp;&nbsp;<span style="font-family:verdana,geneva,sans-serif;">Société*</span></span></td>
                <td style="background-color:#f6f6f6;"><input type="text" name="champ_30867" id="champ_30867" value="" style="width:100%;"></td>
                <td style="background-color:#f6f6f6;" width="15">&nbsp;</td>
              </tr>
              <tr height="20">
                <td style="background-color:#f6f6f6;"><span style="font-family: helvetica,arial,sans-serif; font-size: 16px;">&nbsp;&nbsp;<span style="font-family:verdana,geneva,sans-serif;">&nbsp;Contact*</span></span></td>
                <td style="background-color:#f6f6f6;"><input type="text" name="champ_30868" id="champ_30868" value="" style="width:100%;"></td>
                <td style="background-color:#f6f6f6;" width="15">&nbsp;</td>
              </tr>
              <tr height="20">
                <td style="background-color:#f6f6f6;"><span style="font-family: helvetica,arial,sans-serif; font-size: 16px;">&nbsp;&nbsp;&nbsp;<span style="font-family:verdana,geneva,sans-serif;">Tél Fixe*</span></span></td>
                <td style="background-color:#f6f6f6;"><input type="text" name="champ_30869" id="champ_30869" value="" style="width:100%;"></td>
                <td style="background-color:#f6f6f6;" width="15">&nbsp;</td>
              </tr>
              <tr height="20">
                <td style="background-color:#f6f6f6;"><span style="font-family: helvetica,arial,sans-serif; font-size: 16px;">&nbsp;&nbsp;&nbsp;<span style="font-family:verdana,geneva,sans-serif;">Mobile*</span></span></td>
                <td style="background-color:#f6f6f6;"><input type="text" name="champ_30870" id="champ_30870" value="" style="width:100%;"></td>
                <td style="background-color:#f6f6f6;" width="15">&nbsp;</td>
              </tr>
              <tr height="20">
                <td style="background-color:#f6f6f6;"><span style="font-family: helvetica,arial,sans-serif; font-size: 16px;">&nbsp;&nbsp;&nbsp;<span style="font-family:verdana,geneva,sans-serif;">Adresse Email*</span></span></td>
                <td style="background-color:#f6f6f6;"><input type="text" name="champ_30873" id="champ_30873" value="" style="width:100%;"></td>
                <td style="background-color:#f6f6f6;" width="15">&nbsp;</td>
              </tr>
              <tr height="20">
                <td style="background-color:#f6f6f6;"><span style="font-family: helvetica,arial,sans-serif; font-size: 16px;">&nbsp;&nbsp;&nbsp;<span style="font-family:verdana,geneva,sans-serif;">Projet</span></span></td>
                <td style="background-color:#f6f6f6;"><select name="champ_30872" id="champ_30872">
                    <option value="">--Sélectionnez--</option>
                    <option value="Urgent">Urgent</option>
                    <option value="Non urgent">Non urgent</option>
                  </select></td>
                <td style="background-color:#f6f6f6;" width="15">&nbsp;</td>
              </tr>
            </tbody>
          </table>
        </td>
      </tr>
      <tr>
        <td style="height: 5px; background-color:#f6f6f6;">&nbsp;</td>
      </tr>
      <tr>
        <td style="text-align: center; background-color:#f6f6f6;">
          <p><input type="submit" value="Valider"></p>
          <p style="font-family:arial; font-size:10px">* Champ&nbsp;obligatoire</p>
        </td>
      </tr>
    </tbody>
  </table>
  <p style="text-align: center;">&nbsp;</p>
  <p>&nbsp;</p>
</form>

Text Content

 



           Société*      Contact*      Tél Fixe*      Mobile*      Adresse
Email*      Projet --Sélectionnez--UrgentNon urgent  

 



* Champ obligatoire