function CheckMap (form) {
  if (form.city.value == "") {
    alert ("Le champ Ville ou CP doit être renseigné")
    return (false);
  }
  document.mapForm.action = "http://www.1bis.com/1bis/geo/geocode.asp";
  return (true);
}
document.write('<FORM NAME="mapForm" onSubmit="return CheckMap(this);" METHOD="POST" TARGET="_blank">')
document.write('<TABLE BORDER="1" CELLSPACING="0" CELLPADDING="0" BORDERCOLOR="#000000" BGCOLOR="#FFFFFF">')
document.write('<TR BORDERCOLOR="#000000" ALIGN="CENTER">')
document.write('<TD NOWRAP BGCOLOR="#006699"><FONT COLOR="#FFFFFF" FACE="Arial, Helvetica, sans-serif" SIZE="2"><B>') 
document.write('&nbsp;Un plan, une adresse avec</B></FONT><A HREF="HTTP://www.1bis.com" TARGET="_blank"><IMG SRC="http://www.1bis.com/1bis/affiliate/1bis_logo.gif" WIDTH="46" HEIGHT="28" ALIGN="ABSMIDDLE" BORDER="0"></A></TD></TR>')
document.write('<TR><TD><TABLE BORDER="0" CELLSPACING="0" CELLPADDING="3" BGCOLOR="#FFFFFF" WIDTH="185" HEIGHT="100" ALIGN="CENTER">')
document.write('<TR><TD ALIGN="RIGHT" NOWRAP><FONT FACE="Arial, Helvetica, sans-serif" SIZE="1" COLOR="#000000">N&deg; de rue</FONT></TD>')
document.write('<TD COLSPAN="2"><INPUT TYPE="text" NAME="number" SIZE="3"></TD></TR>')
document.write('<TR><TD ALIGN="RIGHT"><FONT FACE="Arial, Helvetica, sans-serif" SIZE="1" COLOR="#000000">Rue</FONT></TD>')
document.write('<TD COLSPAN="2"><INPUT TYPE="text" NAME="street" SIZE="15"></TD></TR>')
document.write('<TR><TD ALIGN="RIGHT" NOWRAP><FONT FACE="Arial, Helvetica, sans-serif" SIZE="1" COLOR="#000000">Ville (ou CP)</FONT></TD>')
document.write('<TD COLSPAN="2"><INPUT TYPE="text" NAME="city" SIZE="15"></TD>')
document.write('</TR><TR><TD ALIGN="RIGHT"><FONT FACE="Arial, Helvetica, sans-serif" SIZE="1" COLOR="#000000">Dpt</FONT></TD>')
document.write('<TD COLSPAN="2"><INPUT TYPE="text" NAME="deptId" MAXLENGTH="4" SIZE="3"></TD></TR>')
document.write('<TR><TD ALIGN="RIGHT"><FONT FACE="Arial, Helvetica, sans-serif" SIZE="1" COLOR="#000000">Pays</FONT></TD>')
document.write('<TD><SELECT NAME="Country"><OPTION VALUE="33" selected>France</OPTION></SELECT></TD>')
document.write('<TD ALIGN="RIGHT"><INPUT TYPE="submit" NAME="Submit" VALUE="OK"></TD></TR></TABLE></TD></TR></TABLE></FORM>')