document.write('<table width="100%"  border="0" cellpadding="1" cellspacing="1">')
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document.write('<td><a href="mailto:reveindien@yahoo.fr" class="left">SCRIVETECI</a></td>')
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document.write('<tr> ')
document.write('<td><marquee scrollamount="2" behavior="alternate"><a href="ananda_himalayas.html" class="left">ANANDA &nbsp; IN THE HIMALAYAS</a></marquee></td>')
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document.write('</table>')
document.write('<br>')

document.write('<form name="form1" method="post" action="/reqform/formproc.php" onsubmit="return chkForm();">')
document.write('<table width="100%"  border="0" cellpadding="1" cellspacing="1">')

document.write('<tr>')
document.write('<td colspan="3">')
document.write('<table width="100%" border="0" cellspacing="0" cellpadding="0">')

document.write('<tr>')
document.write('<td><span class="style3">Compila la richiesta per richiedere un preventivo senza impegno</span> </td>')
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document.write('</td>')
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document.write('<tr>')
document.write('<td width="40%"> <span class="calltxt">* Nome </spna> </td>')
document.write('<td><input name="nm" type="text"  id="name"></td>')
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document.write('<tr>')
document.write('<td> <span class="calltxt">* Paese</span> </td>')
document.write('<td><input name="country" type="text"  id="country"></td>')
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document.write('<td><span class="calltxt">* Email </span></td>')
document.write('<td><input name="email" type="text"  id="email"></td>')
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document.write('<tr>')
document.write('<td><span class="calltxt">* Telefono</span> </td>')
document.write('<td><input name="telephone" type="text" id="telephone" ></td>')
document.write('</tr>')


document.write('<tr>')
document.write('<td><span class="calltxt">* Numero di persone</span> </td>')
document.write('<td><input name="nop" type="text" id="nop" ></td>')
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document.write('<tr>')
document.write('<td><span class="calltxt">* Data di viaggio</span> </td>')
document.write('<td><input name="dot" type="text" id="dot" ></td>')
document.write('</tr>')


document.write('<tr>')
document.write('<td><span class="calltxt">&nbsp; Alberghi Preferiti</span> </td>')
document.write('<td><select name="hotel" size="1" id="hotel"> <option value=""> Scegliere </option> <option value="5* moderni">5* moderni</option>  <option value="5* Palazzi">5* Palazzi</option> <option value="Alberghi Heritage">Alberghi Heritage</option> <option value="Economici Ma Puliti">Economici Ma Puliti</option></select></td>')
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document.write('<tr>')
document.write('<td><span class="calltxt">* Budget Par Personne hors Vols Internationaux</span> </td>')
document.write('<td><select name="budget" size="1" id="budget"> <option value=""> Scegliere </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>')
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document.write('<td><span class="calltxt">* Messaggio</Span></td>')
document.write('<td><textarea name="des" id="textarea" style="width:100%"></textarea></td>')
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document.write('<tr>')
document.write('<td><span class="calltxt">&nbsp; Validation Anti-Spam</span></td>')
document.write('<td><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>')
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document.write('<tr>')
document.write('<td><span class="calltxt">* Merci de saisir les 4 caractères de l\'image</span></td>')
document.write('<td><input name="captchatxt" type="text" id="querycaptchatxt" autocomplete="off" ></td>')
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document.write('<tr>')
document.write('<td>&nbsp;</td>')
document.write('<td><input name="Submit" type="submit" value=" Invia La Richiesta "></td>')
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document.write('</table>')
document.write('</form>')



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document.write('<tr> ')
document.write('<td align="center"><a href="http://www.tourpassion.com" class="flag" target="_blank"><img src="inglese.gif" width="35" height="23"></a> </td>')
document.write(' <td align="center"><a href="http://fr.tourpassion.in" class="flag" target="_blank"><img src="francese.gif" width="35" height="23"></a> </td>')
document.write(' <td align="center"><a href="http://www.indien.co.in" class="flag" target="_blank"><img src="tedesco.gif" width="35" height="23"></a> </td>')
document.write('</tr>')
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