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Directory :  /home/computer3/lachocolateriedevirginie.fr/business/business/

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Current File : /home/computer3/lachocolateriedevirginie.fr/business/business/popup_pubqqqqqqq.tpl
<div id="popup_pub" class="modalDialogPub">              
<div style="text-align:center">            
<h2 style="margin-bottom: 10px;">DEMANDER UN DEVIS GRATUIT</h2>
<form class="form-horizontal Pub" id="Pub" name="Pub" method="post" action="rappel/submit_Pub.php"> 
<div style="text-align:center;font-size:10pt;margin-bottom:20px;line-height: 17px"> 
<p><i>En soumettant ce formulaire, j accepte que les informations saisies soient exploit&eacute;es dans le cadre de ma demande de devis et de la relation commerciale qui peut en d&eacute;couler.</p>
<p>Pour exercer vos droits, notamment de retrait de votre consentement, veuillez consulter <a style="font-size:10pt" href="mentions-legales">notre politique de confidentialit&eacute;</a></i></p>
</div>
			<div class="form-group" style="margin-bottom: 22px;margin-top: 5px;">
				<div class="input-group">
					<div class="input-group-addon" style="padding: 6px 14px;font-size:16pt">
						<i class="fa fa-user"></i>
					</div>
					<input type="text" name="nom" style="height:37px;font-size:14pt" placeholder="Votre pr&eacute;nom et nom *" value="{$rnom}" required class="form-control"/>
				</div>
			</div>
			<div class="form-group" style="margin-bottom: 22px;margin-top: 5px;">
				<div class="input-group">
					<div class="input-group-addon" style="padding: 6px 14px;font-size:16pt">
						<i class="fa fa-user"></i>
					</div>
					<input type="number" name="tel" style="height:37px;font-size:14pt"   placeholder="Votre t&eacute;l&eacute;phone *" value="{$rtel}" required class="form-control"/>
				</div>
			</div>
			<div class="form-group" style="margin-bottom: 22px;margin-top: 5px;">
				<div class="input-group">
					<div class="input-group-addon" style="padding: 6px 14px;font-size:16pt">
						<i class="fa fa-user"></i>
					</div>
					<input type="email" name="email"  style="height:37px;font-size:14pt" placeholder="Votre E-mail *" value="{$remail}" required class="form-control"/>
				</div>
			</div>
			<div class="form-group" style="margin-bottom: 22px;margin-top: 5px;">
				<div class="" style="padding: 0">
					<div style="text-align:center">
						<textarea class="form-control" style="width:100%" name="texte_message" id="texte_message" rows="3">{$rtexte_message}</textarea>
					</div>
				</div>
			</div>
<div class="row">
<div class="col-md-6" style="margin-bottom:10px">
<div class="btnn" style="min-width:220px">
<a href="" title="Fermer"><div style="width:160px">Plus tard</div></a>

</div>
</div>
<div class="col-md-6" style="margin-bottom:10px">
<div class="btnn" style="min-width:220px">
<button class="btnn" style="margin-top: 0" type="submit" name="envoi_message"><div style="width:160px">Valider</div></button>
</div>
</div>
</div>
</form>
</div>
</div>

Anon7 - 2022
AnonSec Team