| 1 | {{{ |
| 2 | #!html |
| 3 | <h1 style="text-align: left; color: blue">Demande d'achat de bouteilles de gaz</h1> |
| 4 | <br><br> |
| 5 | |
| 6 | <form action='mailto:melot@in2p3.fr'> |
| 7 | <table border=0> |
| 8 | |
| 9 | <tr><td>Votre nom : </td><td><input name='nom'></td></tr> |
| 10 | |
| 11 | <tr><td>Votre groupe / service / projet : </td><td><input name='groupe'></td></tr> |
| 12 | |
| 13 | <tr><td>Type de bouteilles : </td><td><select name='type_bouteille'> |
| 14 | <option>B1</option> |
| 15 | <option>B2</option> |
| 16 | <option>B04</option> |
| 17 | <option>B5</option> |
| 18 | <option>B10</option> |
| 19 | <option>B11</option> |
| 20 | <option>B20</option> |
| 21 | <option>B20-Altop</option> |
| 22 | <option>B25</option> |
| 23 | <option>B50</option> |
| 24 | <option>B50-Altop</option> |
| 25 | <option>Autre</option> |
| 26 | </select></td></tr> |
| 27 | |
| 28 | <tr><td>Type de molécule : </td><td><select name='molecule'> |
| 29 | <option>Hélium</option> |
| 30 | <option>Méthane</option> |
| 31 | <option>Hydrogène</option> |
| 32 | <option>Argon</option> |
| 33 | <option>Azote</option> |
| 34 | <option>Oxygène</option> |
| 35 | <option>Deutérium</option> |
| 36 | <option>Acétylène</option> |
| 37 | <option>Néon</option> |
| 38 | <option>Arcal</option> |
| 39 | <option>C2H6</option> |
| 40 | <option>SF6</option> |
| 41 | <option>N2RH5</option> |
| 42 | <option>CO</option> |
| 43 | <option>CF4</option> |
| 44 | <option>Kr</option> |
| 45 | <option>iso C4H10</option> |
| 46 | <option>Ar/C2H6</option> |
| 47 | <option>Ar/C2H6/CF4</option> |
| 48 | <option>He/Ar/iso C4H10</option> |
| 49 | <option>He/iso C4H10/Xe</option> |
| 50 | <option>Autre</option> |
| 51 | </select></td></tr> |
| 52 | |
| 53 | <tr><td>Pureté : </td><td><select name='purete'> |
| 54 | <option>AlphaGaz</option> |
| 55 | <option>AlphaGaz 1</option> |
| 56 | <option>AlphaGaz 2</option> |
| 57 | <option>N2</option> |
| 58 | <option>N25</option> |
| 59 | <option>N30</option> |
| 60 | <option>N40</option> |
| 61 | <option>N46</option> |
| 62 | <option>N47</option> |
| 63 | <option>N48</option> |
| 64 | <option>N50</option> |
| 65 | <option>N55</option> |
| 66 | <option>N56</option> |
| 67 | <option>isotope3</option> |
| 68 | </select></td></tr> |
| 69 | |
| 70 | <tr><td>Nombre de bouteilles : </td><td><input name='nb' size='2'></td></tr> |
| 71 | |
| 72 | <tr><td>Commentaire : </td><td><textarea name='comment'></textarea></td></tr> |
| 73 | |
| 74 | <tr><td colspan='2' align='center'><input type='submit' name='soumettre'></td></tr> |
| 75 | |
| 76 | </table> |
| 77 | </form> |
| 78 | }}} |