<html>
<head>
<title>Stock APR : Demande de création d'un compte utilisateur</title>
<meta name=author content="Bernard Chardonneau - Logiciel libre">
<meta name=robots content="noindex,nofollow">
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
</head>
<body bgcolor="#FFE0C0">
<br>
<br>
<p align="center" style="font-size : 120%">
Demande de création d'un compte utilisateur
</p>
<br>
<form action=demande_compte.php method=post>
<table align="center" cellpadding=10>
<tr>
<td>Civilité</td>
<td>
<select name="civilite">
XXXOPTIONS
</select>
</td>
</tr>
<tr>
<td>Nom</td>
<td><input type="text" name="nom" maxlength="20" size="18" value="XXXNOM"></td>
</tr>
<tr>
<td>Prénom</td>
<td><input type="text" name="prenom" maxlength="20" size="18" value="XXXPRENOM"></td>
</tr>
<tr>
<td>Email</td>
<td><input type="text" name="email" maxlength="64" size="50" value="XXXEMAIL"></td>
</tr>
<tr>
<td>Tel (facultatif)</td>
<td><input type="text" name="tel" maxlength="14" size="12" value="XXXTEL"></td>
</tr>
</table>
<table align="center" cellpadding=10>
<tr><td> </td></tr>
<tr>
<td>Identifiant</td>
<td><input type="text" name="identif" maxlength="16" size="14" value="XXXIDENT"></td>
</tr>
<tr>
<td>Mot de passe</td>
<td><input type="password" name="password" maxlength="32" size="30"></td>
</tr>
<tr>
<td>Répéter mot de passe</td>
<td><input type="password" name="password2" maxlength="32" size="30"></td>
</tr>
<tr><td> </td></tr>
<tr>
<td align="center" colspan=2>
<button type="submit" name="demande" style="font-size : 100%">
Demander la création du compte</button>
</td>
</tr>
</table>
</form>
<font color="#FF0000">XXXERREUR</font>
</body>
</html>