Probleme dans demande de support

Code PHP :
<?php 

<HTML>

<HEAD>

<TITLE>Waterloo - Connexion à la demande de support</TITLE>

<link rel="icon" type="image/png" href="interface/dragarde.jpg" />

<body background="interface/fond.jpg">





<Center><img src="interface/banniereW.jpg"/></center>

<br>



<link rel="stylesheet" type="text/css" href="/css/stamm.css?1242999659" />

<script src="/js/script.js?1243596864" type="text/javascript"></script>

<script src="/js/mootools.js?1237202053" type="text/javascript"></script>

</head>





<table border="0" cellspacing="0" cellpadding="5" width="35%" align="center"><tr><td>

<table border="0" cellspacing="0" cellpadding="3" width="35%" align="left">

<tr><td background="interface/coin_1.jpg" width="6" height="6"></td><td background="interface/haut_cadre.jpg"></td><td background="interface/coin_2.jpg" width="6" height="6"></td></tr>

<tr><td background="interface/gauche_cadre.jpg" width="6"></td><td background="interface/fond.jpg">



<table cellspacing="1" cellpadding="5" align="center" class="tableau_simple" id="menu_haut" width="50%">



    <tr>

        <td><a HREF="aide.html?" onClick='AffMenu()'"><img src="interface/aide.gif" alt="aide"  border="0"</a></td>

                <td><a HREF="support.html"><img src="interface/support.gif" alt="Support" border="0"/></a></td>



        <td><a href="http://la-coalition.xooit.fr/index.php"><img src="interface/Forum.gif" alt="Forum" border="0"/></a></td>

        <td><A HREF="http://la-coalition.xooit.fr/t625-Liste-par-nation.htm"><img src="interface/stats.gif" alt="stats" border="0"/></a></td>

        <td><A HREF="equipe.html"><img src="interface/equipe.gif" alt="Equipe" border="0"/></a></td>

        <td><A HREF="index.html"><img src="interface/acceuil.gif" alt="Acceuil" border="0"/></a></td>



    </tr>

</table>



</td><td background="interface/droite_cadre.jpg" width="6"></td></tr>

<tr><td background="interface/coin_3.jpg" width="6" height="6"></td><td background="interface/bas_cadre.jpg"></TD><TD background="interface/coin_4.jpg" width="6" height="6"></td></tr>

</table>

</td></tr><tr><td>







<body id="ds_body" >

<table class="navi-border" width="800" style="margin:auto; margin-top: 25px; border-collapse: collapse;">

    <tr>



        <td>

            <table class="main" width="800" align="center">

                <tr>

                    <td>









<form id="form" action="/ticket.php?mode=new_ticket&amp;action=new_ticket&amp;personal=true" method="post">

<input type="hidden" name="server_id" value="fr1">

<input type="hidden" name="type" value="question">



    <h2>Poser une question</h2>



    <table class="vis">

    <tr>

        <td>Objet:</td>

        <td><input name="subject" type="text" size="48" value=""></td>

    </tr>

    <tr>

        <td>Question:</td>

        <td><textarea name="message" cols="50" rows="6"></textarea></td>



    </tr>

    <tr>

        <td colspan="2"><label><input type="checkbox" name="read">J'ai déjà regardé dans l'<a href="" target="_blank">aide</a> pour trouver une réponse.</label></td>

    </tr>



    </table>





<input type="submit" value="Envoyer une demande">

</form>

<br />

</td></tr></table>

</td></tr></table>

<script type="text/javascript">setImageTitles();</script>

<script src="http://www.google-analytics.com/urchin.js" type="text/javascript">

</script>

<script type="text/javascript">

_uacct = "UA-1897727-21";

urchinTracker();

</script>

</body>

</html>