http://www.mfa.fr/ Auto, Habitation, Taxi, Loisir, Retraite, Santé, Crédit. fr SPIP - www.spip.net http://www.mfa.fr/IMG/siteon0.gif http://www.mfa.fr/ 87 265 http://www.mfa.fr/Taxis.html http://www.mfa.fr/Taxis.html 2009-05-14T14:14:26Z text/html fr admin - <a href="http://www.mfa.fr/-Calculez-votre-tarif-en-ligne-.html" rel="directory">Calculez votre tarif en ligne :</a> <img src="IMG/arton625.png" alt="" align="right" width="89" height="53" onmouseover="this.src='IMG/artoff625.gif'" onmouseout="this.src='http://www.mfa.fr/IMG/arton625.png'" class="spip_logos" /> <div class='rss_texte'><a name='form6'></a> <div class='spip_forms form_6'> <div class='spip_descriptif titre_noir_12'>Devis automobile MFA</div> <form method='post' action='spip.php?page=backend&id_rubrique=98#form6' enctype='multipart/form-data'> <div> <input name='page' value='backend' type='hidden' /> <input name='id_rubrique' value='98' type='hidden' /> <input type='hidden' name='ajout_reponse' value='6' /> <input type='hidden' name='id_donnee' value='0' /> <input type='hidden' name='retour_form' value='' /> </div> <div id="form" style="display:none;"> <fieldset class='separateur_1'><legend>Identification du véhicule 1/4</legend> <div class='spip_form_champ date_1'> <span class='spip_form_label'> <label for="input-6-date_1">Date de 1ère mise en circulation</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='dateMiseEnCirculation'><input type="text" name='date_1' id='input-6-date_1' value="" class='date-picker date forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_18'> <span class='spip_form_label'> <label for="input-6-ligne_18">Type de véhicule</label> : </span> <div id='typeVehicule'><input type="text" name='ligne_18' id='input-6-ligne_18' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_6'> <span class='spip_form_label'> <label for="input-6-ligne_6">Marque</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='marque'><input type="text" name='ligne_6' id='input-6-ligne_6' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_7'> <span class='spip_form_label'> <label for="input-6-ligne_7">Gamme</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='gamme'><input type="text" name='ligne_7' id='input-6-ligne_7' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_8'> <span class='spip_form_label'> <label for="input-6-ligne_8">Carrosserie</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='carrosserie'><input type="text" name='ligne_8' id='input-6-ligne_8' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_9'> <span class='spip_form_label'> <label for="input-6-ligne_9">Energie</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='energie'><input type="text" name='ligne_9' id='input-6-ligne_9' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_10'> <span class='spip_form_label'> <label for="input-6-ligne_10">Version</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='version'><input type="text" name='ligne_10' id='input-6-ligne_10' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ texte_1'> <span class='spip_form_label'> <label for="input-6-texte_1">Complétez votre saisie</label> : </span> <div id='autreVehicule' class='hidden'><textarea name='texte_1' rows='10' class='formo ' cols='80' id='input-6-texte_1'></textarea></div> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_4'><legend>Zone et nature d'assurance 2/4</legend> <div class='spip_form_champ code_postal_1'> <span class='spip_form_label'> <label for="input-6-code_postal_1">Code postal</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='postalAuto'><input type="text" name='code_postal_1' id='input-6-code_postal_1' value="" class=' code_postal forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_5'> <span class='spip_form_label'> <label for="input-6-ligne_5">Commune</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='communeAuto'><input type="text" name='ligne_5' id='input-6-ligne_5' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_19'> <span class='spip_form_label'> <label for="input-6-ligne_19">Usage</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='usage'><input type="text" name='ligne_19' id='input-6-ligne_19' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_2'><legend>Conducteur 3/4</legend> <div class='spip_form_champ select_15'> <span class='spip_form_label'> <span class='label'>Sexe</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='sexe'> <select name='select_15' id='input-6-select_15' class='fondl'> <option value=''></option> <option value='select_15_1' > Homme </option> <option value='select_15_2' > Femme </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_2'> <span class='spip_form_label'> <label for="input-6-date_2">Date de naissance</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='dateNaissance'><input type="text" name='date_2' id='input-6-date_2' value="" class='date-picker date forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_3'> <span class='spip_form_label'> <label for="input-6-date_3">Date d'obtention du permis de conduire</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='datePermis'><input type="text" name='date_3' id='input-6-date_3' value="" class='date-picker date forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_12'> <span class='spip_form_label'> <label for="input-6-ligne_12">Permis de moins d'un an</label> : </span> <div id='flagPermisUnAn' class='hidden'><input type="text" name='ligne_12' id='input-6-ligne_12' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_6'> <span class='spip_form_label'> <span class='label'>Votre ancienneté d'assurance</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='anciennete'> <select name='select_6' id='input-6-select_6' class='fondl'> <option value=''></option> <option value='select_6_1' > Moins d'un an </option> <option value='select_6_2' > De un à deux ans </option> <option value='select_6_3' > Plus de deux ans </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_3'> <span class='spip_form_label'> <label for="input-6-num_3">Réduction - Majoration</label> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=6&champ=num_3&width=200" class="jTip" id='aide-6-num_3'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='bonus'><input type="text" name='num_3' id='input-6-num_3' value="" class=' num formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_11'> <span class='spip_form_label'> <span class='label'>Depuis combien d'années</span> : </span> <div id='bonus50' class='hidden'> <select name='select_11' id='input-6-select_11' class='fondo'> <option value=''></option> <option value='select_11_1' > Depuis 1 an </option> <option value='select_11_2' > Depuis 2 ans </option> <option value='select_11_3' > Depuis 3 ans et plus </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_1'> <span class='spip_form_label'> <label for="input-6-num_1">Nombres de sinistres responsables</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=6&champ=num_1&width=200" class="jTip" id='aide-6-num_1'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='nbSinistresResp'><input type="text" name='num_1' id='input-6-num_1' value="" class=' num forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_4'> <span class='spip_form_label'> <label for="input-6-date_4">Date du dernier sinistre responsable</label> : </span> <div id='dateSinistreResp' class='hidden'><input type="text" name='date_4' id='input-6-date_4' value="" class='date-picker date formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_2'> <span class='spip_form_label'> <label for="input-6-num_2">Nombres de sinistres non responsables</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=6&champ=num_2&width=200" class="jTip" id='aide-6-num_2'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='nbSinistresNonResp'><input type="text" name='num_2' id='input-6-num_2' value="" class=' num forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_13'> <span class='spip_form_label'> <span class='label'>Le véhicule est en leasing ou location avec option d'achat</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='leasing'> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_13' value='select_13_1' id='input-6-select_13_1' /> <label for='input-6-select_13_1'>Oui</label> </li> <li> <input type='radio' name='select_13' value='select_13_2' id='input-6-select_13_2' /> <label for='input-6-select_13_2'>Non</label> </li> </ul> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_20'> <span class='spip_form_label'> <label for="input-6-ligne_20">Calcul du tarif</label> : </span> <div id='flagCalcul' class='hidden'><input type="text" name='ligne_20' id='input-6-ligne_20' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_22'> <span class='spip_form_label'> <label for="input-6-ligne_22">Montant tarif</label> : </span> <div id='montantTarif' class='hidden'><input type="text" name='ligne_22' id='input-6-ligne_22' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_23'> <span class='spip_form_label'> <label for="input-6-ligne_23">Popup fermée</label> : </span> <div id='popupFermee' class='hidden'><input type="text" name='ligne_23' id='input-6-ligne_23' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_3'><legend>Informations complémentaires 4/4</legend> <div class='spip_form_champ select_16'> <span class='spip_form_label'> <span class='label'>Formule de garantie souhaitée</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='formule' class='hidden'> <select name='select_16' id='input-6-select_16' class='fondl'> <option value=''></option> <option value='select_16_1' > Auto Simple </option> <option value='select_16_2' > Auto Eco </option> <option value='select_16_3' > Auto Malin </option> <option value='select_16_4' > Auto Complet </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_7'> <span class='spip_form_label'> <span class='label'>Sociétaire MFA</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='societaire'> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_7' value='select_7_1' id='input-6-select_7_1' /> <label for='input-6-select_7_1'>Oui</label> </li> <li> <input type='radio' name='select_7' value='select_7_2' id='input-6-select_7_2' /> <label for='input-6-select_7_2'>Non</label> </li> </ul> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_11'> <span class='spip_form_label'> <label for="input-6-ligne_11">Numéro de sociétaire MFA</label> : </span> <div id='numSocietaire' class='hidden'><input type="text" name='ligne_11' id='input-6-ligne_11' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_10'> <span class='spip_form_label'> <span class='label'>Civilité</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='civilite'> <select name='select_10' id='input-6-select_10' class='fondl'> <option value=''></option> <option value='select_10_1' > M </option> <option value='select_10_2' > Mme </option> <option value='select_10_3' > Melle </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_2'> <span class='spip_form_label'> <label for="input-6-ligne_2">Nom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='nom'><input type="text" name='ligne_2' id='input-6-ligne_2' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_3'> <span class='spip_form_label'> <label for="input-6-ligne_3">Prénom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='prenom'><input type="text" name='ligne_3' id='input-6-ligne_3' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_14'> <span class='spip_form_label'> <span class='label'>Mode de réponse</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='modeReponse'> <select name='select_14' id='input-6-select_14' class='fondl'> <option value=''></option> <option value='select_14_1' > Courrier </option> <option value='select_14_2' > Mail </option> <option value='select_14_3' > Téléphone </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ email_1'> <span class='spip_form_label'> <label for="input-6-email_1">Adresse e-mail</label> : </span> <span class='spip_form_label_details'>Veuillez entrer une adresse e-mail valide (de type vous@fournisseur.com).</span> <div id='mail' class='hidden'><input type="text" name='email_1' id='input-6-email_1' value="" class=' email formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ telephone_1'> <span class='spip_form_label'> <label for="input-6-telephone_1">Numéro de téléphone</label> : </span> <div id='telephone' class='hidden'><input type="text" name='telephone_1' id='input-6-telephone_1' value="" class=' telephone formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_12'> <span class='spip_form_label'> <span class='label'>A quel moment souhaitez-vous être rappelé ?</span> : </span> <div id='horaire' class='hidden'> <select name='select_12' id='input-6-select_12' class='fondo'> <option value=''></option> <option value='select_12_1' > Matin </option> <option value='select_12_2' > Après-midi </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_15'> <span class='spip_form_label'> <label for="input-6-ligne_15">Adresse</label> : </span> <div id='adresse' class='hidden'><input type="text" name='ligne_15' id='input-6-ligne_15' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_16'> <span class='spip_form_label'> <label for="input-6-ligne_16">Complément</label> : </span> <div id='complement' class='hidden'><input type="text" name='ligne_16' id='input-6-ligne_16' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ code_postal_2'> <span class='spip_form_label'> <label for="input-6-code_postal_2">Code postal</label> : </span> <div id='postal'><input type="text" name='code_postal_2' id='input-6-code_postal_2' value="" class=' code_postal formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_17'> <span class='spip_form_label'> <label for="input-6-ligne_17">Commune</label> : </span> <div id='commune'><input type="text" name='ligne_17' id='input-6-ligne_17' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ email_2'> <span class='spip_form_label'> <label for="input-6-email_2">emailCommercial</label> : </span> <span class='spip_form_label_details'>Veuillez entrer une adresse e-mail valide (de type vous@fournisseur.com).</span> <div id='emailCommercial'><input type="text" name='email_2' id='input-6-email_2' value="" class=' email formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> </fieldset> <p style='display:none;'><label for="nobotnobot-6">Veuillez laisser ce champ vide :</label> <input type="text" name="nobotnobot" id="nobotnobot-6" value="" size="10" /></p> <fieldset> <legend>Code de vérification</legend> <p><span class="spip_form_label"> <label for="captcha2">Recopiez, SVP, le code ci-dessous </label> <span class="spip_form_label_obligatoire">[Obligatoire]</span> : </span> <br /><img id="imgCaptcha" src="http://www.mfa.fr/plugins/captcha2/create_image.php?uri=&format=jpg" alt="captcha" style='max-width: 520px; max-height: 100000px' /><br /> <input type="text" class="forml" name="captcha2" id="captcha2" value="" size="10" /> </fieldset> <div style='text-align:center' class='spip_bouton'><input type="submit" name='Valider' value="Valider" /></div> <script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/jtip.js" type="text/javascript"></script> <script type="text/javascript" src="http://www.mfa.fr/squelettes/javascript/jquery-calendar.js"></script> <script type="text/javascript" src="http://www.mfa.fr/squelettes/javascript/jquery-calendar-fr.js"></script> <!--<script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/jquery-dom.js" type="text/javascript"></script> <script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/datePicker.js" type="text/javascript"></script> --> <script type="text/javascript"><!-- //dateFormat: 'M-Y', customDate:popUpCal.noWeekends, speed:'fast' addLoadEvent(function() { popUpCal.setDefaults({autoPopUp: 'both', buttonImageOnly: true, buttonImage: 'squelettes/images/formulaires/ico_calendrier_16par16.gif', buttonText: 'Calendrier', speed:'', yearRange: (new Date().getFullYear()-100)+':'+(new Date().getFullYear()) }); $('input.date-picker').calendar(); }); //$.datePicker.setDateFormat('dmy','/'); // //$('input.date-picker').datePicker({startDate:'01/01/1900'}); //--></script> </div> </form> </div></div> http://www.mfa.fr/popTarif-Gauche-Description-Tarif.html http://www.mfa.fr/popTarif-Gauche-Description-Tarif.html 2009-03-26T18:25:35Z text/html fr admin Tarif donné à titre indicatif, basé sur les informations que vous avez fournies et sous réserve d&rsquo;acceptation du risque par l&rsquo;assureur. - <a href="http://www.mfa.fr/-popTarif-Gauche-Description-Tarif,148-.html" rel="directory">2. popTarif Gauche - Description Tarif</a> <div class='rss_texte'><font size="1">Tarif donné à titre indicatif, basé sur les informations que vous avez fournies et sous réserve d&rsquo;acceptation du risque par l&rsquo;assureur.</font></div> http://www.mfa.fr/popTarif-Gauche-Description.html http://www.mfa.fr/popTarif-Gauche-Description.html 2009-03-26T18:24:30Z text/html fr admin Notre contrat inclut sans supplément et pour toutes les formules, la protection corporelle du conducteur ainsi que l'assistance. - <a href="http://www.mfa.fr/-popTarif-Gauche-Description,147-.html" rel="directory">1. popTarif Gauche - Description Tableau</a> <div class='rss_texte'>Notre contrat inclut <u>sans supplément</u> et pour toutes les formules, la <u>protection corporelle du conducteur</u> ainsi que <u>l'assistance</u>.</div> http://www.mfa.fr/popTarif-Droite-Auto.html http://www.mfa.fr/popTarif-Droite-Auto.html 2009-03-26T18:22:42Z text/html fr admin Protection corporelle du conducteur : vous êtes indemnisé pour vos blessures même si vous êtes responsable. Les conducteurs à qui vous prêtez votre véhicule profitent de cette garantie. <br />Assistance : vous pouvez joindre l'assistance 24h/24 en cas de problèmes avec votre véhicule. Si vous êtes en déplacement, nous mettons tout en oeuvre pour vous venir en aide (poursuite du voyage ou retour au domicile, récupération du véhicule réparé). <br />Vous pouvez (...) - <a href="http://www.mfa.fr/-popTarif-Droite,150-.html" rel="directory">3. popTarif Droite</a> <div class='rss_texte'><p class="spip"><font size="1"><strong>Protection corporelle du conducteur :</strong> vous êtes indemnisé pour vos blessures <strong>même si vous êtes responsable</strong>. Les conducteurs à qui vous prêtez votre véhicule <strong>profitent de cette garantie</strong>.</p> <p class="spip"><strong>Assistance :</strong> vous pouvez joindre l'assistance 24h/24 en cas de problèmes avec votre véhicule. Si vous êtes en déplacement, nous mettons tout en oeuvre pour vous venir en aide (poursuite du voyage ou retour au domicile, récupération du véhicule réparé).</p> <p class="spip"><strong>Vous pouvez personnaliser votre assurance auto</strong> avec des options adaptées à vos besoins comme : <br /> &bull; La protection du <strong>contenu</strong> de votre voiture (bagages, courses laissées dans le coffre) <br /> &bull; Le remboursement de votre véhicule neuf à sa <strong>valeur d'achat</strong> pendant 24 mois.</font></p></div> http://www.mfa.fr/popTarif-Droite.html http://www.mfa.fr/popTarif-Droite.html 2009-03-26T16:45:00Z text/html fr admin Un service d&rsquo;assistance complet : vous pouvez joindre l&rsquo;assistance 24h/24 qui <br />intervient : <br />&bull; en votre absence (pose de serrure, gardiennage, prise en charge de votre <br />retour au plus vite&hellip;) <br />&bull; Suite au sinistre (hébergement à l&rsquo;hôtel,déménagement de vos biens &hellip;) <br />&bull; si vous avez perdu vos clés, pour vous permettre de rentrer chez vous (envoi d&rsquo;un serrurier) <br />Vous pouvez personnaliser votre assurance habitation avec des options (...) - <a href="http://www.mfa.fr/-popTarif-Droite-.html" rel="directory">3. popTarif Droite</a> <div class='rss_texte'><strong>Un service d&rsquo;assistance complet :</strong> vous pouvez joindre l&rsquo;assistance 24h/24 qui<br /> intervient : <br /> &bull; en votre absence (pose de serrure, gardiennage, prise en charge de votre <br /> retour au plus vite&hellip;) <br /> &bull; Suite au sinistre (hébergement à l&rsquo;hôtel,déménagement de vos biens &hellip;) <br /> &bull; si vous avez perdu vos clés, pour vous permettre de rentrer chez vous (envoi d&rsquo;un serrurier) <strong> <br /> <br /> Vous pouvez personnaliser votre assurance habitation avec des options</strong> adaptées à vos besoins comme : <br /> &bull; La protection de votre enfant et de ses lunettes, son cartable&hellip; lors de ses activités scolaires et extra scolaires <br /> &bull; Le remboursement de vos biens (meubles, vaisselle, ordinateur&hellip;) à leur valeur à neuf. jusqu&rsquo;à 4 ans après leur achat.</div> http://www.mfa.fr/popTarif-Gauche-Bas-Description.html http://www.mfa.fr/popTarif-Gauche-Bas-Description.html 2009-03-26T16:40:27Z text/html fr admin Tarif donné à titre indicatif, basé sur les informations que vous avez fournies et sous réserve d&rsquo;acceptation du risque par l&rsquo;assureur. - <a href="http://www.mfa.fr/-popTarif-Gauche-Description-Tarif-.html" rel="directory">2. popTarif Gauche - Description Tarif</a> <div class='rss_texte'>Tarif donné à titre indicatif, basé sur les informations que vous avez fournies et sous réserve d&rsquo;acceptation du risque par l&rsquo;assureur.</div> http://www.mfa.fr/popTarif-Gauche-Description,177.html http://www.mfa.fr/popTarif-Gauche-Description,177.html 2009-03-26T13:08:52Z text/html fr admin Notre contrat inclut sans supplément et pour toutes les formules l'assistance. - <a href="http://www.mfa.fr/-popTarif-Gauche-Description-.html" rel="directory">1. popTarif Gauche - Description Tableau</a> <div class='rss_texte'><font size="1">Notre contrat inclut <u>sans supplément</u> et pour toutes les formules <u>l'assistance</u>.</font></div> http://www.mfa.fr/Habitation.html http://www.mfa.fr/Habitation.html 2009-03-25T19:44:25Z text/html fr admin - <a href="http://www.mfa.fr/-Calculez-votre-tarif-en-ligne-.html" rel="directory">Calculez votre tarif en ligne :</a> <img src="IMG/arton102.png" alt="" align="right" width="166" height="53" onmouseover="this.src='IMG/artoff102.png'" onmouseout="this.src='http://www.mfa.fr/IMG/arton102.png'" class="spip_logos" /> <div class='rss_texte'><a name='form12'></a> <div class='spip_forms form_12'> <div class='spip_descriptif titre_noir_12'></div> <form method='post' action='spip.php?page=backend&id_rubrique=98#form12' enctype='multipart/form-data'> <div> <input name='page' value='backend' type='hidden' /> <input name='id_rubrique' value='98' type='hidden' /> <input type='hidden' name='ajout_reponse' value='12' /> <input type='hidden' name='id_donnee' value='0' /> <input type='hidden' name='retour_form' value='' /> </div> <div id="form" style="display:none;"> <fieldset class='separateur_1'><legend>Description du bien</legend> <div class='spip_form_champ code_postal_1'> <span class='spip_form_label'> <label for="input-12-code_postal_1">Code postal</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='postalAuto'><input type="text" name='code_postal_1' id='input-12-code_postal_1' value="" class=' code_postal forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_1'> <span class='spip_form_label'> <label for="input-12-ligne_1">Commune</label> : </span> <div id='communeAuto'><input type="text" name='ligne_1' id='input-12-ligne_1' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_1'> <span class='spip_form_label'> <span class='label'>Nombre de pièces</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='nbPieces'> <select name='select_1' id='input-12-select_1' class='fondl'> <option value=''></option> <option value='select_1_1' > 1 </option> <option value='select_1_2' > 2 </option> <option value='select_1_3' > 3 </option> <option value='select_1_4' > 4 </option> <option value='select_1_5' > 5 </option> <option value='select_1_6' > 6 </option> <option value='select_1_7' > 7 </option> <option value='select_1_8' > 8 </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_1'> <span class='spip_form_label'> <label for="input-12-num_1">Surface habitable (m²)</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=12&champ=num_1&width=200" class="jTip" id='aide-12-num_1'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='surface'><input type="text" name='num_1' id='input-12-num_1' value="" class=' num forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_2'> <span class='spip_form_label'> <label for="input-12-num_2">Nombre de pièces de plus de 35 m²</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='nbPieces35'><input type="text" name='num_2' id='input-12-num_2' value="" class=' num forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_13'> <span class='spip_form_label'> <label for="input-12-ligne_13">Type de logement</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='logement'><input type="text" name='ligne_13' id='input-12-ligne_13' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ monnaie_1'> <span class='spip_form_label'> <label for="input-12-monnaie_1">Capital mobilier (€)</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=12&champ=monnaie_1&width=200" class="jTip" id='aide-12-monnaie_1'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='capital'><input type="text" name='monnaie_1' id='input-12-monnaie_1' value="" class=' monnaie forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_3'> <span class='spip_form_label'> <span class='label'>Le logement est-il occupé par vous-même ?</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='occupe'> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_3' value='select_3_1' id='input-12-select_3_1' /> <label for='input-12-select_3_1'>Oui</label> </li> <li> <input type='radio' name='select_3' value='select_3_2' id='input-12-select_3_2' /> <label for='input-12-select_3_2'>Non</label> </li> </ul> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_8'> <span class='spip_form_label'> <label for="input-12-ligne_8">A quel titre occupez-vous ce logement ?</label> : </span> <div id='qualite'><input type="text" name='ligne_8' id='input-12-ligne_8' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_4'> <span class='spip_form_label'> <span class='label'>Existe-t-il des dépendances ?</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=12&champ=select_4&width=200" class="jTip" id='aide-12-select_4'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='dependances'> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_4' value='select_4_1' id='input-12-select_4_1' /> <label for='input-12-select_4_1'>Oui</label> </li> <li> <input type='radio' name='select_4' value='select_4_2' id='input-12-select_4_2' /> <label for='input-12-select_4_2'>Non</label> </li> </ul> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_3'> <span class='spip_form_label'> <label for="input-12-num_3">Surface des dépendances (m²)</label> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=12&champ=num_3&width=200" class="jTip" id='aide-12-num_3'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='surfaceDependances' class='hidden'><input type="text" name='num_3' id='input-12-num_3' value="" class=' num formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_9'> <span class='spip_form_label'> <label for="input-12-ligne_9">Usage</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='usage'><input type="text" name='ligne_9' id='input-12-ligne_9' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_1'> <span class='spip_form_label'> <label for="input-12-date_1">Date de naissance</label> : </span> <div id='dateNaissance'><input type="text" name='date_1' id='input-12-date_1' value="" class='date-picker date formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_10'> <span class='spip_form_label'> <label for="input-12-ligne_10">Calcul du tarif</label> : </span> <div id='flagCalcul' class='hidden'><input type="text" name='ligne_10' id='input-12-ligne_10' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_12'> <span class='spip_form_label'> <label for="input-12-ligne_12">Montant tarif</label> : </span> <div id='montantTarif' class='hidden'><input type="text" name='ligne_12' id='input-12-ligne_12' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_14'> <span class='spip_form_label'> <label for="input-12-ligne_14">Popup fermée</label> : </span> <div id='popupFermee' class='hidden'><input type="text" name='ligne_14' id='input-12-ligne_14' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_2'><legend>Informations complémentaires</legend> <div class='spip_form_champ select_10'> <span class='spip_form_label'> <span class='label'>Formule de garantie souhaitée</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='formule' class='hidden'> <select name='select_10' id='input-12-select_10' class='fondl'> <option value=''></option> <option value='select_10_1' > Confort </option> <option value='select_10_2' > Confort+ </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_6'> <span class='spip_form_label'> <span class='label'>Sociétaire MFA</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='societaire'> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_6' value='select_6_1' id='input-12-select_6_1' /> <label for='input-12-select_6_1'>Oui</label> </li> <li> <input type='radio' name='select_6' value='select_6_2' id='input-12-select_6_2' /> <label for='input-12-select_6_2'>Non</label> </li> </ul> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_4'> <span class='spip_form_label'> <label for="input-12-ligne_4">Numéro de sociétaire MFA</label> : </span> <div id='numSocietaire' class='hidden'><input type="text" name='ligne_4' id='input-12-ligne_4' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_7'> <span class='spip_form_label'> <span class='label'>Civilité</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='civilite'> <select name='select_7' id='input-12-select_7' class='fondl'> <option value=''></option> <option value='select_7_1' > M </option> <option value='select_7_2' > Melle </option> <option value='select_7_3' > Mme </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_2'> <span class='spip_form_label'> <label for="input-12-ligne_2">Nom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='nom'><input type="text" name='ligne_2' id='input-12-ligne_2' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_3'> <span class='spip_form_label'> <label for="input-12-ligne_3">Prénom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='prenom'><input type="text" name='ligne_3' id='input-12-ligne_3' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_9'> <span class='spip_form_label'> <span class='label'>Mode de réponse</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='modeReponse'> <select name='select_9' id='input-12-select_9' class='fondl'> <option value=''></option> <option value='select_9_1' > Courrier </option> <option value='select_9_2' > Mail </option> <option value='select_9_3' > Téléphone </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ email_1'> <span class='spip_form_label'> <label for="input-12-email_1">Adresse e-mail</label> : </span> <span class='spip_form_label_details'>Veuillez entrer une adresse e-mail valide (de type vous@fournisseur.com).</span> <div id='mail' class='hidden'><input type="text" name='email_1' id='input-12-email_1' value="" class=' email formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ telephone_1'> <span class='spip_form_label'> <label for="input-12-telephone_1">Numéro de téléphone</label> : </span> <div id='telephone' class='hidden'><input type="text" name='telephone_1' id='input-12-telephone_1' value="" class=' telephone formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_8'> <span class='spip_form_label'> <span class='label'>A quel moment souhaitez-vous être rappelé ?</span> : </span> <div id='horaire' class='hidden'> <select name='select_8' id='input-12-select_8' class='fondo'> <option value=''></option> <option value='select_8_1' > Matin </option> <option value='select_8_2' > Après-midi </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_5'> <span class='spip_form_label'> <label for="input-12-ligne_5">Adresse</label> : </span> <div id='adresse' class='hidden'><input type="text" name='ligne_5' id='input-12-ligne_5' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_6'> <span class='spip_form_label'> <label for="input-12-ligne_6">Complément</label> : </span> <div id='complement' class='hidden'><input type="text" name='ligne_6' id='input-12-ligne_6' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ code_postal_2'> <span class='spip_form_label'> <label for="input-12-code_postal_2">Code postal</label> : </span> <div id='postal' class='hidden'><input type="text" name='code_postal_2' id='input-12-code_postal_2' value="" class=' code_postal formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_7'> <span class='spip_form_label'> <label for="input-12-ligne_7">Commune</label> : </span> <div id='commune' class='hidden'><input type="text" name='ligne_7' id='input-12-ligne_7' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ email_2'> <span class='spip_form_label'> <label for="input-12-email_2">emailCommercial</label> : </span> <span class='spip_form_label_details'>Veuillez entrer une adresse e-mail valide (de type vous@fournisseur.com).</span> <div id='emailCommercial'><input type="text" name='email_2' id='input-12-email_2' value="" class=' email formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> </fieldset> <p style='display:none;'><label for="nobotnobot-12">Veuillez laisser ce champ vide :</label> <input type="text" name="nobotnobot" id="nobotnobot-12" value="" size="10" /></p> <fieldset> <legend>Code de vérification</legend> <p><span class="spip_form_label"> <label for="captcha2">Recopiez, SVP, le code ci-dessous </label> <span class="spip_form_label_obligatoire">[Obligatoire]</span> : </span> <br /><img id="imgCaptcha" src="http://www.mfa.fr/plugins/captcha2/create_image.php?uri=&format=jpg" alt="captcha" style='max-width: 520px; max-height: 100000px' /><br /> <input type="text" class="forml" name="captcha2" id="captcha2" value="" size="10" /> </fieldset> <div style='text-align:center' class='spip_bouton'><input type="submit" name='Valider' value="Valider" /></div> <script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/jtip.js" type="text/javascript"></script> <script type="text/javascript" src="http://www.mfa.fr/squelettes/javascript/jquery-calendar.js"></script> <script type="text/javascript" src="http://www.mfa.fr/squelettes/javascript/jquery-calendar-fr.js"></script> <!--<script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/jquery-dom.js" type="text/javascript"></script> <script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/datePicker.js" type="text/javascript"></script> --> <script type="text/javascript"><!-- //dateFormat: 'M-Y', customDate:popUpCal.noWeekends, speed:'fast' addLoadEvent(function() { popUpCal.setDefaults({autoPopUp: 'both', buttonImageOnly: true, buttonImage: 'squelettes/images/formulaires/ico_calendrier_16par16.gif', buttonText: 'Calendrier', speed:'', yearRange: (new Date().getFullYear()-100)+':'+(new Date().getFullYear()) }); $('input.date-picker').calendar(); }); //$.datePicker.setDateFormat('dmy','/'); // //$('input.date-picker').datePicker({startDate:'01/01/1900'}); //--></script> </div> </form> </div> <p class="spip"></form12></p></div> http://www.mfa.fr/Auto.html http://www.mfa.fr/Auto.html 2009-03-25T19:44:22Z text/html fr admin - <a href="http://www.mfa.fr/-Calculez-votre-tarif-en-ligne-.html" rel="directory">Calculez votre tarif en ligne :</a> <img src="IMG/arton109.png" alt="" align="right" width="166" height="53" onmouseover="this.src='IMG/artoff109.png'" onmouseout="this.src='http://www.mfa.fr/IMG/arton109.png'" class="spip_logos" /> <div class='rss_texte'><a name='form6'></a> <div class='spip_forms form_6'> <div class='spip_descriptif titre_noir_12'>Devis automobile MFA</div> <form method='post' action='spip.php?page=backend&id_rubrique=98#form6' enctype='multipart/form-data'> <div> <input name='page' value='backend' type='hidden' /> <input name='id_rubrique' value='98' type='hidden' /> <input type='hidden' name='ajout_reponse' value='6' /> <input type='hidden' name='id_donnee' value='0' /> <input type='hidden' name='retour_form' value='' /> </div> <div id="form" style="display:none;"> <fieldset class='separateur_1'><legend>Identification du véhicule 1/4</legend> <div class='spip_form_champ date_1'> <span class='spip_form_label'> <label for="input-6-date_1">Date de 1ère mise en circulation</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='dateMiseEnCirculation'><input type="text" name='date_1' id='input-6-date_1' value="" class='date-picker date forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_18'> <span class='spip_form_label'> <label for="input-6-ligne_18">Type de véhicule</label> : </span> <div id='typeVehicule'><input type="text" name='ligne_18' id='input-6-ligne_18' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_6'> <span class='spip_form_label'> <label for="input-6-ligne_6">Marque</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='marque'><input type="text" name='ligne_6' id='input-6-ligne_6' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_7'> <span class='spip_form_label'> <label for="input-6-ligne_7">Gamme</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='gamme'><input type="text" name='ligne_7' id='input-6-ligne_7' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_8'> <span class='spip_form_label'> <label for="input-6-ligne_8">Carrosserie</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='carrosserie'><input type="text" name='ligne_8' id='input-6-ligne_8' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_9'> <span class='spip_form_label'> <label for="input-6-ligne_9">Energie</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='energie'><input type="text" name='ligne_9' id='input-6-ligne_9' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_10'> <span class='spip_form_label'> <label for="input-6-ligne_10">Version</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='version'><input type="text" name='ligne_10' id='input-6-ligne_10' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ texte_1'> <span class='spip_form_label'> <label for="input-6-texte_1">Complétez votre saisie</label> : </span> <div id='autreVehicule' class='hidden'><textarea name='texte_1' rows='10' class='formo ' cols='80' id='input-6-texte_1'></textarea></div> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_4'><legend>Zone et nature d'assurance 2/4</legend> <div class='spip_form_champ code_postal_1'> <span class='spip_form_label'> <label for="input-6-code_postal_1">Code postal</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='postalAuto'><input type="text" name='code_postal_1' id='input-6-code_postal_1' value="" class=' code_postal forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_5'> <span class='spip_form_label'> <label for="input-6-ligne_5">Commune</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='communeAuto'><input type="text" name='ligne_5' id='input-6-ligne_5' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_19'> <span class='spip_form_label'> <label for="input-6-ligne_19">Usage</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='usage'><input type="text" name='ligne_19' id='input-6-ligne_19' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_2'><legend>Conducteur 3/4</legend> <div class='spip_form_champ select_15'> <span class='spip_form_label'> <span class='label'>Sexe</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='sexe'> <select name='select_15' id='input-6-select_15' class='fondl'> <option value=''></option> <option value='select_15_1' > Homme </option> <option value='select_15_2' > Femme </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_2'> <span class='spip_form_label'> <label for="input-6-date_2">Date de naissance</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='dateNaissance'><input type="text" name='date_2' id='input-6-date_2' value="" class='date-picker date forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_3'> <span class='spip_form_label'> <label for="input-6-date_3">Date d'obtention du permis de conduire</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='datePermis'><input type="text" name='date_3' id='input-6-date_3' value="" class='date-picker date forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_12'> <span class='spip_form_label'> <label for="input-6-ligne_12">Permis de moins d'un an</label> : </span> <div id='flagPermisUnAn' class='hidden'><input type="text" name='ligne_12' id='input-6-ligne_12' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_6'> <span class='spip_form_label'> <span class='label'>Votre ancienneté d'assurance</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='anciennete'> <select name='select_6' id='input-6-select_6' class='fondl'> <option value=''></option> <option value='select_6_1' > Moins d'un an </option> <option value='select_6_2' > De un à deux ans </option> <option value='select_6_3' > Plus de deux ans </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_3'> <span class='spip_form_label'> <label for="input-6-num_3">Réduction - Majoration</label> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=6&champ=num_3&width=200" class="jTip" id='aide-6-num_3'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='bonus'><input type="text" name='num_3' id='input-6-num_3' value="" class=' num formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_11'> <span class='spip_form_label'> <span class='label'>Depuis combien d'années</span> : </span> <div id='bonus50' class='hidden'> <select name='select_11' id='input-6-select_11' class='fondo'> <option value=''></option> <option value='select_11_1' > Depuis 1 an </option> <option value='select_11_2' > Depuis 2 ans </option> <option value='select_11_3' > Depuis 3 ans et plus </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_1'> <span class='spip_form_label'> <label for="input-6-num_1">Nombres de sinistres responsables</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=6&champ=num_1&width=200" class="jTip" id='aide-6-num_1'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='nbSinistresResp'><input type="text" name='num_1' id='input-6-num_1' value="" class=' num forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_4'> <span class='spip_form_label'> <label for="input-6-date_4">Date du dernier sinistre responsable</label> : </span> <div id='dateSinistreResp' class='hidden'><input type="text" name='date_4' id='input-6-date_4' value="" class='date-picker date formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ num_2'> <span class='spip_form_label'> <label for="input-6-num_2">Nombres de sinistres non responsables</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <span class="formInfo"><a href="http://www.mfa.fr/spip.php?page=forms_tip&id_form=6&champ=num_2&width=200" class="jTip" id='aide-6-num_2'><img src="http://www.mfa.fr/local/cache-vignettes/L16xH16/ico_aide-97bb9.gif"/ width='16' height='16' style='height:16px;width:16px;' class='' ></a></span> <div id='nbSinistresNonResp'><input type="text" name='num_2' id='input-6-num_2' value="" class=' num forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_13'> <span class='spip_form_label'> <span class='label'>Le véhicule est en leasing ou location avec option d'achat</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='leasing'> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_13' value='select_13_1' id='input-6-select_13_1' /> <label for='input-6-select_13_1'>Oui</label> </li> <li> <input type='radio' name='select_13' value='select_13_2' id='input-6-select_13_2' /> <label for='input-6-select_13_2'>Non</label> </li> </ul> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_20'> <span class='spip_form_label'> <label for="input-6-ligne_20">Calcul du tarif</label> : </span> <div id='flagCalcul' class='hidden'><input type="text" name='ligne_20' id='input-6-ligne_20' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_22'> <span class='spip_form_label'> <label for="input-6-ligne_22">Montant tarif</label> : </span> <div id='montantTarif' class='hidden'><input type="text" name='ligne_22' id='input-6-ligne_22' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_23'> <span class='spip_form_label'> <label for="input-6-ligne_23">Popup fermée</label> : </span> <div id='popupFermee' class='hidden'><input type="text" name='ligne_23' id='input-6-ligne_23' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_3'><legend>Informations complémentaires 4/4</legend> <div class='spip_form_champ select_16'> <span class='spip_form_label'> <span class='label'>Formule de garantie souhaitée</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='formule' class='hidden'> <select name='select_16' id='input-6-select_16' class='fondl'> <option value=''></option> <option value='select_16_1' > Auto Simple </option> <option value='select_16_2' > Auto Eco </option> <option value='select_16_3' > Auto Malin </option> <option value='select_16_4' > Auto Complet </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_7'> <span class='spip_form_label'> <span class='label'>Sociétaire MFA</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='societaire'> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_7' value='select_7_1' id='input-6-select_7_1' /> <label for='input-6-select_7_1'>Oui</label> </li> <li> <input type='radio' name='select_7' value='select_7_2' id='input-6-select_7_2' /> <label for='input-6-select_7_2'>Non</label> </li> </ul> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_11'> <span class='spip_form_label'> <label for="input-6-ligne_11">Numéro de sociétaire MFA</label> : </span> <div id='numSocietaire' class='hidden'><input type="text" name='ligne_11' id='input-6-ligne_11' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_10'> <span class='spip_form_label'> <span class='label'>Civilité</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='civilite'> <select name='select_10' id='input-6-select_10' class='fondl'> <option value=''></option> <option value='select_10_1' > M </option> <option value='select_10_2' > Mme </option> <option value='select_10_3' > Melle </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_2'> <span class='spip_form_label'> <label for="input-6-ligne_2">Nom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='nom'><input type="text" name='ligne_2' id='input-6-ligne_2' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_3'> <span class='spip_form_label'> <label for="input-6-ligne_3">Prénom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='prenom'><input type="text" name='ligne_3' id='input-6-ligne_3' value="" class=' ligne forml' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_14'> <span class='spip_form_label'> <span class='label'>Mode de réponse</span> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <div id='modeReponse'> <select name='select_14' id='input-6-select_14' class='fondl'> <option value=''></option> <option value='select_14_1' > Courrier </option> <option value='select_14_2' > Mail </option> <option value='select_14_3' > Téléphone </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ email_1'> <span class='spip_form_label'> <label for="input-6-email_1">Adresse e-mail</label> : </span> <span class='spip_form_label_details'>Veuillez entrer une adresse e-mail valide (de type vous@fournisseur.com).</span> <div id='mail' class='hidden'><input type="text" name='email_1' id='input-6-email_1' value="" class=' email formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ telephone_1'> <span class='spip_form_label'> <label for="input-6-telephone_1">Numéro de téléphone</label> : </span> <div id='telephone' class='hidden'><input type="text" name='telephone_1' id='input-6-telephone_1' value="" class=' telephone formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_12'> <span class='spip_form_label'> <span class='label'>A quel moment souhaitez-vous être rappelé ?</span> : </span> <div id='horaire' class='hidden'> <select name='select_12' id='input-6-select_12' class='fondo'> <option value=''></option> <option value='select_12_1' > Matin </option> <option value='select_12_2' > Après-midi </option> </select> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_15'> <span class='spip_form_label'> <label for="input-6-ligne_15">Adresse</label> : </span> <div id='adresse' class='hidden'><input type="text" name='ligne_15' id='input-6-ligne_15' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_16'> <span class='spip_form_label'> <label for="input-6-ligne_16">Complément</label> : </span> <div id='complement' class='hidden'><input type="text" name='ligne_16' id='input-6-ligne_16' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ code_postal_2'> <span class='spip_form_label'> <label for="input-6-code_postal_2">Code postal</label> : </span> <div id='postal'><input type="text" name='code_postal_2' id='input-6-code_postal_2' value="" class=' code_postal formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_17'> <span class='spip_form_label'> <label for="input-6-ligne_17">Commune</label> : </span> <div id='commune'><input type="text" name='ligne_17' id='input-6-ligne_17' value="" class=' ligne formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ email_2'> <span class='spip_form_label'> <label for="input-6-email_2">emailCommercial</label> : </span> <span class='spip_form_label_details'>Veuillez entrer une adresse e-mail valide (de type vous@fournisseur.com).</span> <div id='emailCommercial'><input type="text" name='email_2' id='input-6-email_2' value="" class=' email formo' size='40' /> </div> <span class='nettoyeur'> </span> </div> </fieldset> <p style='display:none;'><label for="nobotnobot-6">Veuillez laisser ce champ vide :</label> <input type="text" name="nobotnobot" id="nobotnobot-6" value="" size="10" /></p> <fieldset> <legend>Code de vérification</legend> <p><span class="spip_form_label"> <label for="captcha2">Recopiez, SVP, le code ci-dessous </label> <span class="spip_form_label_obligatoire">[Obligatoire]</span> : </span> <br /><img id="imgCaptcha" src="http://www.mfa.fr/plugins/captcha2/create_image.php?uri=&format=jpg" alt="captcha" style='max-width: 520px; max-height: 100000px' /><br /> <input type="text" class="forml" name="captcha2" id="captcha2" value="" size="10" /> </fieldset> <div style='text-align:center' class='spip_bouton'><input type="submit" name='Valider' value="Valider" /></div> <script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/jtip.js" type="text/javascript"></script> <script type="text/javascript" src="http://www.mfa.fr/squelettes/javascript/jquery-calendar.js"></script> <script type="text/javascript" src="http://www.mfa.fr/squelettes/javascript/jquery-calendar-fr.js"></script> <!--<script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/jquery-dom.js" type="text/javascript"></script> <script src="http://www.mfa.fr/plugins/forms_et_tables_1_9_1/javascript/datePicker.js" type="text/javascript"></script> --> <script type="text/javascript"><!-- //dateFormat: 'M-Y', customDate:popUpCal.noWeekends, speed:'fast' addLoadEvent(function() { popUpCal.setDefaults({autoPopUp: 'both', buttonImageOnly: true, buttonImage: 'squelettes/images/formulaires/ico_calendrier_16par16.gif', buttonText: 'Calendrier', speed:'', yearRange: (new Date().getFullYear()-100)+':'+(new Date().getFullYear()) }); $('input.date-picker').calendar(); }); //$.datePicker.setDateFormat('dmy','/'); // //$('input.date-picker').datePicker({startDate:'01/01/1900'}); //--></script> </div> </form> </div></div> http://www.mfa.fr/Article-1-Demande-de-devis-et.html http://www.mfa.fr/Article-1-Demande-de-devis-et.html 2009-03-11T19:30:34Z text/html fr admin (Le chapeau n'est pas pris en compte.) <br />Pour toute autre demande de devis, contactez votre conseiller. - <a href="http://www.mfa.fr/-Devis-et-tarifs-en-ligne-.html" rel="directory">1. Vos Tarifs en ligne</a> <div class='rss_chapo'>(Le chapeau n'est pas pris en compte.)</div> <div class='rss_texte'><font size="1">Pour toute autre demande de devis, <a class="lien_bleu_11" href="http://www.mfa.fr/spip.php?rubrique33">contactez votre conseiller</a>.</font></div>