Bon de commande

<body topmargin="0" alink="#ff0000" bgcolor="#ccffcc" link="#fcca00" vlink="#ffffff"> <p align="center"><font color="#008000"><a href="index.html"><img src="images/logo.gif" border="0" height="37" width="51"></a><font face="Arial" size="2"><b> </b></font></font><b><font color="#008000" face="Arial" size="2"> </font><font face="Arial" size="3">Bon de commande </font><font color="#008000" face="Arial" size="2">à adresser à la Coopérative  du Haricot Tarbais <br> Zone de Bastillac Nord - 65000 TARBES</font></b></p> <p><b><font face="Arial" size="2">Nos prix s'entendent TTC, départ Tarbes. En sus, forfait préparation et frais de transport : </font><font color="#008000">15 €</font><font face="Arial" size="2"> </font><font face="Arial" size="2">  sur le territoire français - <font color="#800000"><span style="color: rgb(255, 0, 0);"> Minimum de facturation :</span> </font></font><font color="#008000">67 €</font><font face="Arial" size="2"> - <span style="color: rgb(255, 0, 0);">Expédition à réception de votre commande accompagnée de votre règlement par chèque.</span></font></b></p> <script Language="JavaScript" Type="text/javascript"></script><form action="http://www.haricot-tarbais.com/cgi-bin/formulaire.pl" method="post" onsubmit="return FrontPage_Form1_Validator(this)" name="FrontPage_Form1" style="margin-top: 0pt; margin-bottom: 0pt;" language="JavaScript"> <input name="email" size="0" value="contact@haricot-tarbais.com" type="hidden"><input name="redirection" size="0" value="http://www.haricot-tarbais.com/confirmation.htm" type="hidden"> <table border="1" cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td align="right" width="15%"><font face="Arial" size="2"><b>Nom, Prénom </b></font></td> <td width="69%"><font face="Arial" size="2"><b><input name="NomComplet" size="102" type="text"> </b></font> </td> </tr> <tr> <td align="right" width="15%"><font face="Arial" size="2"><b>Adresse  </b></font></td> <td width="69%"><font face="Arial" size="2"><b><input name="Adresse" size="102" type="text"></b></font> </td> </tr> <tr> <td align="right" width="15%"><font face="Arial" size="2"><b>Code Postal  </b></font></td> <td width="69%"><input name="CP_ville" size="15" type="text"> <font face="Arial" size="2"><b>   Ville <input name="T1" size="47" type="text"></b></font> </td> </tr> <tr> <td align="right" width="15%"><font face="Arial" size="2"><b>Téléphone  </b></font></td> <td width="69%"><font face="Arial" size="2"><b><input name="Telephone" size="15" maxlength="25" type="text">     Mail   <input name="Adresse_electronique" size="20" type="text"> </b></font></td> </tr> </tbody> </table> <table border="1" cellpadding="0" cellspacing="0" height="216" width="100%"> <tbody> <tr> <td align="center" height="16" width="4%"> <p align="center"><font face="Arial" size="2"><b><i>Qté</i></b></font></p> </td> <td align="center" height="16" width="25%"><font face="Arial" size="2"><b><i>Désignation</i></b></font></td> <td colspan="2" align="center" height="16" width="7%"><font face="Arial" size="2"><b><i>             Prix Unitaire</i></b></font></td> <td align="center" height="16" width="15%"> <p align="center"><font face="Arial" size="2"><b><i>Total</i></b></font></p> </td> </tr> <tr> <td align="center" height="23" width="4%"><font face="Arial" size="2"><b><input name="sachet_500_g" size="2" type="text"></b></font></td> <td height="23" width="44%"><b><font face="Arial" size="2"> Sachet Haricots Tarbais secs Label Rouge                   500 g</font></b></td> <td align="center" height="23" width="8%">   <font color="#008000"><b>6,95</b></font><font color="#008000"><b></b></font><font color="#008000"><b>  </b></font><font color="#008000"><b>€</b></font></td> <td align="right" height="23" width="18%"> <p align="center"><font face="Arial" size="2"><b><input name="total_sachet_500" size="15" type="text"></b></font></p> </td> </tr> <tr> <td align="center" height="23" width="4%"><font face="Arial" size="2"><b><input name="sachet_1_kilo" size="2" type="text"></b></font></td> <td height="23" width="44%"><b><font face="Arial" size="2"> Sachet Haricots Tarbais secs Label Rouge                    1 kg</font></b></td> <td align="center" height="23" width="8%">  <font color="#008000"><b>11,95 €</b></font></td> <td align="right" height="23" width="18%"> <p align="center"><font face="Arial" size="2"><b><input name="total_sachet_1_kilo" size="15" type="text"></b></font></p> </td> </tr> <tr> <td align="center" height="23" width="4%"><font face="Arial" size="2"><b><input name="poche_5_kilos" size="2" type="text"></b></font></td> <td height="23" width="44%"><font face="Arial" size="2"><b> Poche Haricots Tarbais secs Label Rouge                     5 kg</b></font></td> <td align="center" height="23" width="8%"> <p align="center"><font color="#008000"><b>  52,00 €</b></font></p> </td> <td align="right" height="23" width="18%"> <p align="center"><font face="Arial" size="2"><b><input name="total_poche_5_kilos" size="15" type="text"></b></font></p> </td> </tr> <tr> <td style="vertical-align: top; text-align: center;"><font face="Arial" size="2"><b><input name="boite semence-150g" size="2"></b></font></td> <td style="vertical-align: top;"><font face="Arial" size="2"><b> Boîte Semence Alaric                                                  150 g<br> </b></font></td> <td style="vertical-align: top;">    <span style="color: rgb(0, 128, 0); font-weight: bold;">   4,00 €</span><br> </td> <td style="vertical-align: top;"> <p align="center"><font face="Arial" size="2"><b><input name="total_poche_5_kilos" size="15" type="text"></b></font></p> </td> </tr> <tr> <td align="center" height="23" width="4%"><font face="Arial" size="2"><b><input name="ht_cuisines_500_g" size="2" type="text"></b></font></td> <td height="23" width="44%"><font face="Arial" size="2"><b> Bocal Haricots Tarbais cuisinés (net 375 g)                  500 g</b></font></td> <td align="center" height="23" width="8%"> <p align="center"><font color="#008000"><b>  4,10 €</b></font></p> </td> <td align="right" height="23" width="18%"> <p align="center"><font face="Arial" size="2"><b><input name="total_cuisine_500_g" size="15" type="text"></b></font></p> </td> </tr> <tr> <td align="center" height="23" width="4%"><font face="Arial" size="2"><b><input name="ht_cuisine_1_kilo" size="2" type="text"></b></font></td> <td height="23" width="44%"><font face="Arial" size="2"><b> Bocal Haricots Tarbais cuisinés (net 770 g)                    1 kg </b></font></td> <td align="center" height="23" width="8%">  <font color="#008000"><b>7,55 €</b></font></td> <td align="right" height="23" width="18%"> <p align="center"><font face="Arial" size="2"><b><input name="total_cuisine_1_kilo" size="15" type="text"></b></font></p> </td> </tr> <tr> <td align="center" height="21" width="4%"><font face="Arial" size="2"><b><input name="ht_cuisine_5_kilos" size="2" type="text"></b></font></td> <td height="21" width="44%"><font face="Arial" size="2"><b> Boîte Haricots Tarbais cuisinés (net 3800 g)                   5 kg</b></font></td> <td align="center" height="21" width="8%"> <font color="#008000"><b>24,90 €</b></font></td> <td align="right" height="21" width="18%"> <p align="center"><font face="Arial" size="2"><b><input name="total_cuisine_5_kilos" size="15" type="text"></b></font></p> </td> </tr> <tr> <td align="center" height="23" width="4%"><font face="Arial" size="2"><b><input name="cassoulet" size="2" type="text"></b></font></td> <td height="23" width="44%"><b><font face="Arial" size="2"> Bocal Cassoulet aux Haricots Tarbais (net 780 g)           1 kg</font></b></td> <td align="center" height="23" width="8%">  <font color="#008000"><b>8,50 €</b></font></td> <td align="right" height="23" width="18%"> <p align="center"><font face="Arial" size="2"><b><input name="total_cassoulet" size="15" type="text"></b></font></p> </td> </tr> <tr> <td align="center" height="23" width="4%"><font face="Arial" size="2"><b><input name="garbure" size="2" type="text"></b></font></td> <td height="23" width="44%"> <b><font face="Arial" size="2">Bocal Garbure aux Haricots Tarbais (net 760 g)             1 kg</font></b></td> <td align="center" height="23" width="8%">  <font color="#008000"><b>7,80 €</b></font></td> <td align="right" height="23" width="18%"> <p align="center"><font face="Arial" size="2"><b><input name="total_garbure" size="15" type="text"></b></font></p> </td> </tr> <tr> <td align="center" height="23" width="4%"><br> </td> <td height="23" width="44%"> <p align="right"><b><font color="#800000" face="Arial" size="2"><span style="color: rgb(255, 0, 0);"><br> Forfait préparation et transport :</span>  <br> <br> </font></b></p> </td> <td colspan="2" height="23" width="18%"> <p align="center"><font face="Arial" size="2"><b>       <br>  <span style="color: rgb(255, 0, 0);">+ </span><font style="color: rgb(255, 0, 0);" color="#008000">15 €  </font></b><font color="#008000"><br> </font><b></b></font><b><font face="Arial" size="2"><br> </font></b></p> </td> <td align="right" height="23" width="15%"> <p align="center"><font face="Arial" size="2"><b><input name="transport" size="15" type="text"></b></font> </p> </td> </tr> <tr> <td align="center" height="23" width="4%"><br> </td> <td colspan="3" height="23" width="62%"> <p align="right"><b><font color="#800000" face="Arial" size="3">Total à Payer </font></b> </p> </td> <td align="right" height="23" width="15%"> <p align="center"><font face="Arial" size="2"><b><input name="total_paiement" size="17" type="text"></b></font> </p> </td> </tr> </tbody> </table> <table style="margin-bottom: 1px;" border="1" cellpadding="0" cellspacing="0" height="171" width="100%"> <tbody> <tr> <td height="23" valign="middle" width="67%"> <br> </td> <td height="23" valign="middle" width="30%"> <p> <b><font color="#800000" size="3">Minimum de facturation :</font><font color="#008000" size="1">   </font><font color="#008000" face="Arial" size="2">67</font><font color="#800000" size="3"> </font><font color="#008000" face="Arial" size="2">€</font><font color="#800000" size="3">  </font></b> </p> </td> </tr> <tr> <td colspan="2" height="54" width="97%"> <p align="center"><b><font color="#000000" face="Arial" size="2">Commentaires :<br> <textarea rows="3" name="commentaires" cols="56"></textarea></font></b> </p> <p align="center"><b> <font face="Arial" size="2"><input value="Envoyer" style="font-weight: bold; background-color: rgb(187, 94, 0); color: rgb(255, 255, 255);" type="submit">            <input value="Effacer" type="reset"> <br> </font><font color="#ff0000" face="Arial" size="1">Cliquez 1 seule fois <br> et attendre la confirmation</font> </b></p> </td> </tr> </tbody> </table> <onsubmit ="return FrontPage_Form1_Validator(this)" name="FrontPage_Form1"> <input name="submit_to" value="commande@haricot-tarbais.com" type="hidden"><input name="ok_url" value="http://www.haricot-tarbais.com/ok.htm" type="hidden"> </onsubmit> <p>  </p> </form> </body> </html>