var audit='';
audit+='<img src="/images/site/rectangle-audit.gif" vspace="10">';
audit+='<div id="divAudit">';
audit+='<form name="formAudit" method="post" onsubmit="sendInformationsAudit(this.name); return false;" action="">';
audit+='<table width="405">';
audit+='<tr><td width="105" class="N12" align="left" valign="top">Prénom/NOM :</td><td width="180" align="left" valign="top"><input type="text" name="prenom_nom" size="28"></td><td rowspan="9" width="115" align="right" valign="top"><img src="/images/site/liberte-egalite-fraternite-audit.gif" alt="Site conforme aux derniers textes de loi publiés dans le domaine de la défiscalisation immobilière"></td></tr>';
audit+='<tr><td width="105" class="N12" align="left" valign="top">Email :</td><td width="180" align="left" valign="top"><input type="text" name="email" size="28"></td></tr>';
audit+='<tr><td width="105" class="N12" align="left" valign="top">Téléphone :</td><td width="180" align="left" valign="top"><input type="text" name="telephone" size="28"></td></tr>';
audit+='<tr><td width="105" class="N12" align="left" valign="top">Ville :</td><td width="180" align="left" valign="top"><input type="text" name="ville" size="28"></td></tr>';
audit+='<tr><td width="105" class="N12" align="left" valign="top">Code postal :</td><td width="180" align="left" valign="top"><input type="text" name="cp" size="28"></td></tr>';
audit+='<tr>';
audit+='<td width="105" class="N12 paddH20" align="left">Vos impôts :</td>';
audit+='<td width="180" class="paddH20" align="left" valign="top">';
audit+='<select name="imposition">'+optionsImposition+'</select>';
audit+='</td>';
audit+='</tr>';
audit+='<tr>';
audit+='<td width="105" class="N12" align="left" valign="top">Vos revenus :</td>';
audit+='<td width="180" align="left" valign="top">';
audit+='<select name="revenus">'+optionsRevenus+'</select>';
audit+='</td>';
audit+='</tr>';
audit+='<tr>';
audit+='<td width="105" class="N12" align="left" valign="top">Nb de parts :</td>';
audit+='<td width="180" align="left" valign="top">';
audit+='<select name="nombreparts">'+optionsNombreparts+'</select>';
audit+='</td>';
audit+='</tr>';
audit+='<tr><td>&nbsp;</td><td class="paddH10" align="left"><input type="submit" value="obtenir mon audit"></td></tr>';
audit+='<tr><td colspan="3" class="N9 txtGrs20 paddH10" align="left">Les informations demandées sont indispensables pour traiter votre demande.<br>Elles restent confidentielles et sans engagement.</td></tr>';
audit+='</table>';
audit+='</form>';
audit+='</div>';
document.write(audit);