{"id":9291,"date":"2025-12-15T16:32:18","date_gmt":"2025-12-15T15:32:18","guid":{"rendered":"https:\/\/www.itpspa.it\/informazioni-mancato-pagamento-pedaggio\/compila-modulo-online-a21\/"},"modified":"2026-02-17T18:00:49","modified_gmt":"2026-02-17T17:00:49","slug":"acceder-au-formulaire-en-ligne-a21","status":"publish","type":"page","link":"https:\/\/www.itpspa.it\/fr\/troncon-2-a21\/informations-relatives-au-non-paiement-du-peage\/acceder-au-formulaire-en-ligne-a21\/","title":{"rendered":"Acc\u00e9der au formulaire en ligne A21"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row css_animation=\u00a0\u00bb\u00a0\u00bb row_type=\u00a0\u00bbrow\u00a0\u00bb use_row_as_full_screen_section=\u00a0\u00bbno\u00a0\u00bb type=\u00a0\u00bbfull_width\u00a0\u00bb angled_section=\u00a0\u00bbno\u00a0\u00bb text_align=\u00a0\u00bbleft\u00a0\u00bb background_image_as_pattern=\u00a0\u00bbwithout_pattern\u00a0\u00bb z_index=\u00a0\u00bb\u00a0\u00bb el_class=\u00a0\u00bbriga-testo-padding\u00a0\u00bb][vc_column][vc_column_text css=\u00a0\u00bb\u00a0\u00bb]<style type=\"text\/css\">\n\t#ipt_fsqm_form_wrap_64 .ipt_fsqm_form_logo img,\n\t#ipt_fsqm_form_wrap_64 .ipt-eform-width-restrain,\n\t#ipt_fsqm_form_wrap_64 .ipt_fsqm_form_message_restore,\n\t#ipt_fsqm_form_wrap_64 .ipt_fsqm_form_message_success,\n\t#ipt_fsqm_form_wrap_64 .ipt_fsqm_form_message_error,\n\t#ipt_fsqm_form_wrap_64 .ipt_fsqm_form_message_process,\n\t#ipt_fsqm_form_wrap_64 .ipt_fsqm_form_validation_error,\n\t#ipt_fsqm_form_wrap_64 .eform-ui-estimator {\n\t\tmax-width: 100%;\n\t\tmin-width: 240px;\n\t}\n\n\t\/**\/\n<\/style>\n\t\t<!-- Form Created using eForm - Ultimate WordPress Form Builder https:\/\/eform.live -->\n<div\n\tid=\"ipt_fsqm_form_wrap_64\"\n\tclass=\"ipt_uif_front ipt_uif_common ipt_fsqm_form type_0 ui-front eform-ltr eform-override-element-boxy eform-override-alignment-inherit\"\n\tdata-fsqmsayt=\"{&quot;auto_save&quot;:false,&quot;show_restore&quot;:true,&quot;restore&quot;:false,&quot;admin_override&quot;:false,&quot;user_update&quot;:false,&quot;interval_save&quot;:false,&quot;interval&quot;:&quot;30&quot;}\"\n\tdata-ui-type=\"0\"\n\tdata-ui-theme=\"[&quot;https:\\\/\\\/www.itpspa.it\\\/wp-content\\\/uploads\\\/eform-custom-material\\\/form-theme-64.css?checksum=2298970529&amp;ver=4.19.1&quot;]\"\n\tdata-ui-theme-id=\"material-custom\"\n\tdata-eformanim=\"1\"\n\tdata-fsqmga=\"{&quot;enabled&quot;:false,&quot;manual_load&quot;:false,&quot;tracking_id&quot;:&quot;&quot;,&quot;cookie&quot;:&quot;auto&quot;,&quot;user_update&quot;:false,&quot;name&quot;:&quot;Mancato Pagamento A21 - FRA&quot;,&quot;form_id&quot;:&quot;64&quot;}\"\n\tdata-fsqmreset=\"{&quot;reset&quot;:false,&quot;delay&quot;:10}\"\n\tdata-eformreg=\"{&quot;enabled&quot;:false,&quot;username_id&quot;:&quot;ipt_fsqm_form_64_pinfo_&quot;,&quot;password_id&quot;:&quot;ipt_fsqm_form_64_pinfo_&quot;,&quot;hide_pinfo&quot;:false,&quot;hide_meta&quot;:false,&quot;meta&quot;:[]}\"\n\tdata-eformscroll=\"{&quot;progress&quot;:true,&quot;message&quot;:true,&quot;offset&quot;:&quot;0&quot;,&quot;scrollOnError&quot;:true}\"\n\tdata-eform-cookie=\"0\"\n\tdata-subscription-form=\"false\"\n\tdata-instant-subscription=\"{&quot;doable&quot;:true,&quot;config&quot;:{&quot;enabled&quot;:false,&quot;min_tab&quot;:&quot;&quot;,&quot;debounce&quot;:&quot;3000&quot;},&quot;nonce&quot;:&quot;35c9a2d9eb&quot;}\"\n>\n\t\t\t\t<noscript>\n\t<div class=\"ipt_fsqm_form_message_noscript ui-widget ui-widget-content ui-corner-all\">\n\t\t<div class=\"ui-helper-reset ui-helper-clearfix ui-widget-header ui-corner-all\">\n\t\t\t<div>Javascript is disabled<\/div>\n\t\t<\/div>\n\t\t<div class=\"ui-widget-content ui-corner-bottom\">\n\t\t\t<p>Javascript is disabled on your browser. Please enable it in order to use this form.<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/noscript>\n\t\t\t\t\t<style type=\"text\/css\">\n\t\t\t.ipt_uif_ajax_loader,\n\t\t\t.ipt_uif_ajax_loader *,\n\t\t\tipt_uif_ajax_loader *::before,\n\t\t\tipt_uif_ajax_loader *::after {\n\t\t\t\tbox-sizing: border-box;\n\t\t\t}\n\t\t<\/style>\n\t\t<div class=\"ipt_uif_init_loader ipt-eform-preloader-inline ipt_uif_ajax_loader\">\n\t\t\t<div class=\"ipt-eform-preloader-inner\">\n\t\t\t\t<div class=\"ipt-eform-preloader-circle\">\n\t\t\t\t\t<div class=\"preloader-wrapper active\">\n\t\t\t\t\t\t<div class=\"spinner-layer spinner-blue\">\n\t\t\t\t\t\t\t<div class=\"circle-clipper left\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div><div class=\"gap-patch\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div><div class=\"circle-clipper right\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<div class=\"spinner-layer spinner-red\">\n\t\t\t\t\t\t\t<div class=\"circle-clipper left\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div><div class=\"gap-patch\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div><div class=\"circle-clipper right\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<div class=\"spinner-layer spinner-yellow\">\n\t\t\t\t\t\t\t<div class=\"circle-clipper left\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div><div class=\"gap-patch\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div><div class=\"circle-clipper right\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<div class=\"spinner-layer spinner-green\">\n\t\t\t\t\t\t\t<div class=\"circle-clipper left\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div><div class=\"gap-patch\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div><div class=\"circle-clipper right\">\n\t\t\t\t\t\t\t\t<div class=\"circle\"><\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"ipt-eform-preloader-text\">\n\t\t\t\t\t<div class=\"ipt-eform-preloader-text-inner ipt_uif_ajax_loader_text\">Chargement<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear\"><\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<input type=\"hidden\" data-sayt-exclude class=\"ipt_uif_conditional_logic\" id=\"ipt_uif_conditional_logic_64\" value=\"{&quot;logics&quot;:{&quot;ipt_fsqm_form_64_design_40&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;3&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Demande de d\\u00e9bit&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;blank_container&quot;,&quot;m_type&quot;:&quot;design&quot;},&quot;ipt_fsqm_form_64_design_55&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;3&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Paiement d\\u00e9j\\u00e0 effectu\\u00e9&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;blank_container&quot;,&quot;m_type&quot;:&quot;design&quot;},&quot;ipt_fsqm_form_64_design_87&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;11&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Locataire&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;blank_container&quot;,&quot;m_type&quot;:&quot;design&quot;},&quot;ipt_fsqm_form_64_design_88&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;11&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Propri\\u00e9taire&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;blank_container&quot;,&quot;m_type&quot;:&quot;design&quot;},&quot;ipt_fsqm_form_64_design_51&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;3&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Changement de propri\\u00e9t\\u00e9\\\/Location&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;blank_container&quot;,&quot;m_type&quot;:&quot;design&quot;},&quot;ipt_fsqm_form_64_design_47&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;3&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Vol&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;blank_container&quot;,&quot;m_type&quot;:&quot;design&quot;},&quot;ipt_fsqm_form_64_design_43&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;3&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;D\\u00e9claration de la gare d&#039;entr\\u00e9e&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;blank_container&quot;,&quot;m_type&quot;:&quot;design&quot;},&quot;ipt_fsqm_form_64_freetype_6&quot;:{&quot;active&quot;:true,&quot;status&quot;:true,&quot;change&quot;:false,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;1&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Azienda&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;feedback_small&quot;,&quot;m_type&quot;:&quot;freetype&quot;},&quot;ipt_fsqm_form_64_freetype_37&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;1&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Entreprise&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;feedback_small&quot;,&quot;m_type&quot;:&quot;freetype&quot;},&quot;ipt_fsqm_form_64_freetype_5&quot;:{&quot;active&quot;:true,&quot;status&quot;:true,&quot;change&quot;:false,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;1&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Azienda&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;feedback_small&quot;,&quot;m_type&quot;:&quot;freetype&quot;},&quot;ipt_fsqm_form_64_freetype_39&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;15&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Vendita&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;upload&quot;,&quot;m_type&quot;:&quot;freetype&quot;},&quot;ipt_fsqm_form_64_freetype_41&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;15&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Perdita di possesso&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;upload&quot;,&quot;m_type&quot;:&quot;freetype&quot;},&quot;ipt_fsqm_form_64_freetype_24&quot;:{&quot;active&quot;:true,&quot;status&quot;:true,&quot;change&quot;:false,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;12&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Azienda&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;feedback_small&quot;,&quot;m_type&quot;:&quot;freetype&quot;},&quot;ipt_fsqm_form_64_freetype_25&quot;:{&quot;active&quot;:true,&quot;status&quot;:true,&quot;change&quot;:false,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;12&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Azienda&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;feedback_small&quot;,&quot;m_type&quot;:&quot;freetype&quot;},&quot;ipt_fsqm_form_64_freetype_38&quot;:{&quot;active&quot;:true,&quot;status&quot;:false,&quot;change&quot;:true,&quot;logic&quot;:{&quot;0&quot;:{&quot;m_type&quot;:&quot;mcq&quot;,&quot;key&quot;:&quot;12&quot;,&quot;check&quot;:&quot;val&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;value&quot;:&quot;Entreprise&quot;,&quot;rel&quot;:&quot;and&quot;}},&quot;type&quot;:&quot;feedback_small&quot;,&quot;m_type&quot;:&quot;freetype&quot;}},&quot;indexes&quot;:{&quot;ipt_fsqm_form_64_mcq_3&quot;:[&quot;ipt_fsqm_form_64_design_40&quot;,&quot;ipt_fsqm_form_64_design_55&quot;,&quot;ipt_fsqm_form_64_design_51&quot;,&quot;ipt_fsqm_form_64_design_47&quot;,&quot;ipt_fsqm_form_64_design_43&quot;],&quot;ipt_fsqm_form_64_mcq_11&quot;:[&quot;ipt_fsqm_form_64_design_87&quot;,&quot;ipt_fsqm_form_64_design_88&quot;],&quot;ipt_fsqm_form_64_mcq_1&quot;:[&quot;ipt_fsqm_form_64_freetype_6&quot;,&quot;ipt_fsqm_form_64_freetype_37&quot;,&quot;ipt_fsqm_form_64_freetype_5&quot;],&quot;ipt_fsqm_form_64_mcq_15&quot;:[&quot;ipt_fsqm_form_64_freetype_39&quot;,&quot;ipt_fsqm_form_64_freetype_41&quot;],&quot;ipt_fsqm_form_64_mcq_12&quot;:[&quot;ipt_fsqm_form_64_freetype_24&quot;,&quot;ipt_fsqm_form_64_freetype_25&quot;,&quot;ipt_fsqm_form_64_freetype_38&quot;]},&quot;base&quot;:&quot;64&quot;}\" \/>\n\t<input type=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_timer_data\" id=\"ipt_fsqm_timer_data_64\" value=\"{&quot;type&quot;:&quot;none&quot;}\" \/>\n\t<input type=\"hidden\" data-sayt-exclude class=\"ipt_fsqm_epoc_data\" id=\"ipt_fsqm_epoc_data_64\" value=\"{&quot;CURRENTYEAR&quot;:2026,&quot;CURRENTDATE&quot;:1775840429000,&quot;CURRENTDAY&quot;:10,&quot;CURRENTMONTH&quot;:4,&quot;CURRENTHOUR&quot;:17,&quot;CURRENTMINUTE&quot;:0,&quot;CURRENTSECOND&quot;:29,&quot;CURRENTWEEK&quot;:15,&quot;CURRENTEPOC&quot;:20553}\" \/>\n\n\t<div style=\"display: none;\" class=\"ipt_uif_hidden_init\">\n\t\t\t\t\n\t\t\t\t<form method=\"post\" action=\"\" class=\"ipt_uif_validate_form ipt_fsqm_main_form\" id=\"ipt_fsqm_form_64\" autocomplete=\"off\">\n\t\t\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"action\" id=\"action\" value=\"ipt_fsqm_save_form\" \/>\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_epoc\" class=\"eform-epoc-value\" value=\"1775840429\" \/>\n\t\t\t<input type=\"hidden\" class=\"ipt_fsqm_form_tab_pos\" name=\"fsqm_form64_tab_pos\" value=\"0\" id=\"fsqm_form64_tab_pos\" \/>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ipt_fsqm_form_data_save\" name=\"ipt_fsqm_form_data_save\" value=\"b079823866\" data-sayt-exclude \/>\t\t\t<input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/9291\" \/>\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"form_id\" value=\"64\" \/>\n\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t<div class=\"ipt-eform-width-restrain\">\n\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t<div class=\"ipt-eform-content ipt-eform-no-wrap\">\n\t\t\t\n\t\t\t\t\t\t\t<div id=\"ipt_fsqm_form_64_layout_0_inner\" class=\"ipt-eform-layout-wrapper\">\n\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_main_heading_column\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][11][m_type]\" id=\"ipt_fsqm_form_64_design_11_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][11][type]\" id=\"ipt_fsqm_form_64_design_11_type\" value=\"richtext\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional\" id=\"ipt_fsqm_form_64_design_11\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t\t\t\t\t\t\t<div class=\"ipt_uif_richtext\">\n\t\t\t\t<p>Cher utilisateur, veuillez remplir le formulaire en ligne ci-dessous en s\u00e9lectionnant l&rsquo;un des cas pr\u00e9vus et en saisissant toutes les donn\u00e9es indiqu\u00e9es par un ast\u00e9risque (*), car elles sont obligatoires pour le traitement de la demande soumise.<\/p>\n<p>Une fois le formulaire compl\u00e9t\u00e9, veuillez attendre le message de confirmation d&rsquo;enregistrement du syst\u00e8me, qui vous sera envoy\u00e9 par e-mail \u00e0 l&rsquo;adresse que vous avez indiqu\u00e9e dans le formulaire.<\/p>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][33][m_type]\" id=\"ipt_fsqm_form_64_design_33_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][33][type]\" id=\"ipt_fsqm_form_64_design_33_type\" value=\"heading\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_heading\" id=\"ipt_fsqm_form_64_design_33\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][0][m_type]\" id=\"ipt_fsqm_form_64_design_0_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][0][type]\" id=\"ipt_fsqm_form_64_design_0_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_0\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][0][m_type]\" id=\"ipt_fsqm_form_64_freetype_0_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][0][type]\" id=\"ipt_fsqm_form_64_freetype_0_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_0\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_0_value\">N\u00b0 de relance<\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[custom[onlyNumberSp]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][0][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_0_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][4][m_type]\" id=\"ipt_fsqm_form_64_design_4_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][4][type]\" id=\"ipt_fsqm_form_64_design_4_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_4\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][4][m_type]\" id=\"ipt_fsqm_form_64_freetype_4_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][4][type]\" id=\"ipt_fsqm_form_64_freetype_4_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_4\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_4_value\">N\u00b0 RMPP<\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[custom[onlyNumberSp]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][4][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_4_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][2][m_type]\" id=\"ipt_fsqm_form_64_design_2_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][2][type]\" id=\"ipt_fsqm_form_64_design_2_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][1][m_type]\" id=\"ipt_fsqm_form_64_design_1_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][1][type]\" id=\"ipt_fsqm_form_64_design_1_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_1\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][3][m_type]\" id=\"ipt_fsqm_form_64_freetype_3_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][3][type]\" id=\"ipt_fsqm_form_64_freetype_3_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_3\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_3_value\">Plaque d'immatriculation<\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_3_value\">Saisissez la plaque d'immatriculation<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[custom[onlyLetterNumber],minSize[7],maxSize[7]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][3][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_3_value\"\n\t\tmaxlength=\"7\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][8][m_type]\" id=\"ipt_fsqm_form_64_design_8_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][8][type]\" id=\"ipt_fsqm_form_64_design_8_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_8\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][0][m_type]\" id=\"ipt_fsqm_form_64_mcq_0_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][0][type]\" id=\"ipt_fsqm_form_64_mcq_0_type\" value=\"select\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_select\" id=\"ipt_fsqm_form_64_mcq_0\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_0\">Gare de sortie<\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_0\">S\u00e9lectionnez la gare de sortie<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<select class=\" check_me  ipt_uif_select\" name=\"ipt_fsqm_form_64[mcq][0][options][]\" id=\"ipt_fsqm_form_64_mcq_0_options_\" data-placeholder=\"---\" data-allow-clear=\"true\" data-theme=\"eform-material\"><option value=\"\">---<\/option>\n\t\t\t<option value=\"0\" data-num=\"445\">445 \u2013 VILLANOVA BARRIERA<\/option>\n\t\t\t<option value=\"1\" data-num=\"446\">446 \u2013 VILLANOVA SVINCOLO<\/option>\n\t\t\t<option value=\"2\" data-num=\"447\">447 \u2013 ASTI OVEST<\/option>\n\t\t\t<option value=\"3\" data-num=\"448\">448 \u2013 ASTI EST<\/option>\n\t\t\t<option value=\"4\" data-num=\"449\">449 \u2013 FELIZZANO<\/option>\n\t\t\t<option value=\"5\" data-num=\"451\">451 \u2013 ALESSANDRIA OVEST<\/option>\n\t\t\t<option value=\"6\" data-num=\"452\">452 \u2013 ALESSANDRIA EST<\/option>\n\t\t\t<option value=\"7\" data-num=\"455\">455 \u2013 VOGHERA<\/option>\n\t\t\t<option value=\"8\" data-num=\"456\">456 \u2013 CASTEGGIO CASATISMA<\/option>\n\t\t\t<option value=\"9\" data-num=\"457\">457 \u2013 BRONI STRADELLA<\/option>\n\t\t\t<option value=\"10\" data-num=\"458\">458 \u2013 CASTEL SAN GIOVANNI<\/option>\n\t\t\t<option value=\"11\" data-num=\"459\">459 \u2013 PIACENZA OVEST<\/option>\n\t\t\t<\/select><div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][5][m_type]\" id=\"ipt_fsqm_form_64_design_5_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][5][type]\" id=\"ipt_fsqm_form_64_design_5_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][6][m_type]\" id=\"ipt_fsqm_form_64_design_6_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][6][type]\" id=\"ipt_fsqm_form_64_design_6_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_6\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][0][m_type]\" id=\"ipt_fsqm_form_64_pinfo_0_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][0][type]\" id=\"ipt_fsqm_form_64_pinfo_0_type\" value=\"datetime\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_datetime\" id=\"ipt_fsqm_form_64_pinfo_0\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_0_value\">Date de transit<\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_0_value\">Saisissez la date de transit<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field eform-dp-input-field has-icon\">\n\t<input class=\"datepicker ipt_uif_datepicker  check_me  is-empty ipt_uif_text\"\n\t data-dateFormat=\"dd-mm-yy\" data-timeFormat=\"HH:mm:ss\" data-year_range=\"5\"\t\ttype=\"text\"\n\treadonly=\"readonly\"\n\tname=\"ipt_fsqm_form_64[pinfo][0][value]\"\n\tid=\"ipt_fsqm_form_64_pinfo_0_value\"\n\tmaxlength=\"524288\"\n\tvalue=\"\" \/>\n\t\t\t<i title=\"\" class=\" ipt-icomoon-calendar ipticm prefix\"><\/i>\n\t\t\t\t\t<a href=\"javascript:;\" class=\"eform-dp-clear\" title=\"Clear\">&times;<\/a>\n<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][7][m_type]\" id=\"ipt_fsqm_form_64_design_7_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][7][type]\" id=\"ipt_fsqm_form_64_design_7_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_7\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][1][m_type]\" id=\"ipt_fsqm_form_64_mcq_1_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][1][type]\" id=\"ipt_fsqm_form_64_mcq_1_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_64_mcq_1\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_1\">Particulier\/Entreprise<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_1\">S\u00e9lectionnez Particulier ou Entreprise<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"ipt_uif_label_column column_2\">\n\t<input checked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][1][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_1_options__0\"\n\t\tvalue=\"0\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_1_options__0\" data-labelcon=\"&#xe18e;\">\n\t\t Particulier\t<\/label>\n<\/div>\n\t\t\t<div class=\"ipt_uif_label_column column_2\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][1][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_1_options__1\"\n\t\tvalue=\"1\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_1_options__1\" data-labelcon=\"&#xe18e;\">\n\t\t Entreprise\t<\/label>\n<\/div>\n\t\t\t<div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][42][m_type]\" id=\"ipt_fsqm_form_64_design_42_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][42][type]\" id=\"ipt_fsqm_form_64_design_42_type\" value=\"divider\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_divider\" id=\"ipt_fsqm_form_64_design_42\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_divider ipt_uif_align_center ipt_uif_empty_divider ipt_uif_divider_no_icon ipt_uif_divider_no_text eform-just-divider\">\n\t<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][9][m_type]\" id=\"ipt_fsqm_form_64_design_9_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][9][type]\" id=\"ipt_fsqm_form_64_design_9_type\" value=\"heading\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_heading\" id=\"ipt_fsqm_form_64_design_9\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<h4 class=\"ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_has_scroll\">\n\t\t\t\t\t<a href=\"#\" class=\"ipt_uif_scroll_to_top\"><i class=\"ipticm ipt-icomoon-chevron-up suffix\"><\/i><\/a>\n\t\t\t\t\t\t<span class=\"ipt_uif_divider_text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_divider_text_inner\">\n\t\t\t\tDonn\u00e9es du d\u00e9clarant\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t<\/h4>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][82][m_type]\" id=\"ipt_fsqm_form_64_design_82_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][82][type]\" id=\"ipt_fsqm_form_64_design_82_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_82\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][6][m_type]\" id=\"ipt_fsqm_form_64_freetype_6_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][6][type]\" id=\"ipt_fsqm_form_64_freetype_6_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_6\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_6_value\">Pr\u00e9nom<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_6_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][6][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_6_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][37][m_type]\" id=\"ipt_fsqm_form_64_freetype_37_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][37][type]\" id=\"ipt_fsqm_form_64_freetype_37_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_37\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_37_value\">Raison sociale<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_37_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][37][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_37_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][81][m_type]\" id=\"ipt_fsqm_form_64_design_81_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][81][type]\" id=\"ipt_fsqm_form_64_design_81_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_81\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][5][m_type]\" id=\"ipt_fsqm_form_64_freetype_5_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][5][type]\" id=\"ipt_fsqm_form_64_freetype_5_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_5\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_5_value\">Nom<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_5_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][5][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_5_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][83][m_type]\" id=\"ipt_fsqm_form_64_design_83_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][83][type]\" id=\"ipt_fsqm_form_64_design_83_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][26][m_type]\" id=\"ipt_fsqm_form_64_design_26_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][26][type]\" id=\"ipt_fsqm_form_64_design_26_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_26\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][7][m_type]\" id=\"ipt_fsqm_form_64_freetype_7_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][7][type]\" id=\"ipt_fsqm_form_64_freetype_7_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_7\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_7_value\">Code fiscal \/ Num\u00e9ro de TVA<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_7_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,custom[onlyLetterNumber],maxSize[16]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][7][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_7_value\"\n\t\tmaxlength=\"16\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][25][m_type]\" id=\"ipt_fsqm_form_64_design_25_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][25][type]\" id=\"ipt_fsqm_form_64_design_25_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_25\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][8][m_type]\" id=\"ipt_fsqm_form_64_freetype_8_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][8][type]\" id=\"ipt_fsqm_form_64_freetype_8_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_8\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_8_value\">Adresse<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_8_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][8][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_8_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][28][m_type]\" id=\"ipt_fsqm_form_64_design_28_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][28][type]\" id=\"ipt_fsqm_form_64_design_28_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][24][m_type]\" id=\"ipt_fsqm_form_64_design_24_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][24][type]\" id=\"ipt_fsqm_form_64_design_24_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_24\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][9][m_type]\" id=\"ipt_fsqm_form_64_freetype_9_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][9][type]\" id=\"ipt_fsqm_form_64_freetype_9_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_9\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_9_value\">Commune<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_9_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][9][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_9_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][23][m_type]\" id=\"ipt_fsqm_form_64_design_23_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][23][type]\" id=\"ipt_fsqm_form_64_design_23_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_23\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][10][m_type]\" id=\"ipt_fsqm_form_64_freetype_10_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][10][type]\" id=\"ipt_fsqm_form_64_freetype_10_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_10\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_10_value\">Province<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_10_value\">Sigle de la province (exemple : TO)<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,custom[onlyLetterSp],maxSize[2]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][10][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_10_value\"\n\t\tmaxlength=\"2\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][30][m_type]\" id=\"ipt_fsqm_form_64_design_30_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][30][type]\" id=\"ipt_fsqm_form_64_design_30_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][21][m_type]\" id=\"ipt_fsqm_form_64_design_21_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][21][type]\" id=\"ipt_fsqm_form_64_design_21_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_21\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][11][m_type]\" id=\"ipt_fsqm_form_64_freetype_11_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][11][type]\" id=\"ipt_fsqm_form_64_freetype_11_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_11\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_11_value\">Code postal<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_11_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,maxSize[5]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][11][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_11_value\"\n\t\tmaxlength=\"5\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][20][m_type]\" id=\"ipt_fsqm_form_64_design_20_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][20][type]\" id=\"ipt_fsqm_form_64_design_20_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_20\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][1][m_type]\" id=\"ipt_fsqm_form_64_pinfo_1_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][1][type]\" id=\"ipt_fsqm_form_64_pinfo_1_type\" value=\"p_phone\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_p_phone\" id=\"ipt_fsqm_form_64_pinfo_1\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_1_value\">T\u00e9l\u00e9phone<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_1_value\">Saisissez un num\u00e9ro de mobile ou de fixe<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,custom[phone]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"tel\"\n\t\t\t\tname=\"ipt_fsqm_form_64[pinfo][1][value]\"\n\t\tid=\"ipt_fsqm_form_64_pinfo_1_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][27][m_type]\" id=\"ipt_fsqm_form_64_design_27_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][27][type]\" id=\"ipt_fsqm_form_64_design_27_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][19][m_type]\" id=\"ipt_fsqm_form_64_design_19_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][19][type]\" id=\"ipt_fsqm_form_64_design_19_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_19\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][9][m_type]\" id=\"ipt_fsqm_form_64_pinfo_9_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][9][type]\" id=\"ipt_fsqm_form_64_pinfo_9_type\" value=\"email\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_email\" id=\"ipt_fsqm_form_64_pinfo_9\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_9_value\">E-mail<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_9_value\">Saisissez votre adresse e-mail<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,custom[email],equals[ipt_fsqm_form_64_pinfo_4_value]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"email\"\n\t\t\t\tname=\"ipt_fsqm_form_64[pinfo][9][value]\"\n\t\tid=\"ipt_fsqm_form_64_pinfo_9_value\"\n\t\t\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][18][m_type]\" id=\"ipt_fsqm_form_64_design_18_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][18][type]\" id=\"ipt_fsqm_form_64_design_18_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_18\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][4][m_type]\" id=\"ipt_fsqm_form_64_pinfo_4_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][4][type]\" id=\"ipt_fsqm_form_64_pinfo_4_type\" value=\"p_email\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_p_email\" id=\"ipt_fsqm_form_64_pinfo_4\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_4_value\">V\u00e9rification de l'e-mail<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_4_value\">Confirmez votre adresse e-mail<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,custom[email],equals[ipt_fsqm_form_64_pinfo_9_value]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"email\"\n\t\t\t\tname=\"ipt_fsqm_form_64[pinfo][4][value]\"\n\t\tid=\"ipt_fsqm_form_64_pinfo_4_value\"\n\t\t\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][32][m_type]\" id=\"ipt_fsqm_form_64_design_32_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][32][type]\" id=\"ipt_fsqm_form_64_design_32_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][17][m_type]\" id=\"ipt_fsqm_form_64_design_17_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][17][type]\" id=\"ipt_fsqm_form_64_design_17_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_17\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][2][m_type]\" id=\"ipt_fsqm_form_64_mcq_2_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][2][type]\" id=\"ipt_fsqm_form_64_mcq_2_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_64_mcq_2\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_2\">Type de document<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_2\">S\u00e9lectionnez le type de document<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"ipt_uif_label_column column_3\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][2][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_2_options__0\"\n\t\tvalue=\"0\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_2_options__0\" data-labelcon=\"&#xe18e;\">\n\t\t Carte d'identit\u00e9\t<\/label>\n<\/div>\n\t\t\t<div class=\"ipt_uif_label_column column_3\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][2][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_2_options__1\"\n\t\tvalue=\"1\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_2_options__1\" data-labelcon=\"&#xe18e;\">\n\t\t Permis de conduire\t<\/label>\n<\/div>\n\t\t\t<div class=\"ipt_uif_label_column column_3\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][2][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_2_options__2\"\n\t\tvalue=\"2\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_2_options__2\" data-labelcon=\"&#xe18e;\">\n\t\t Passeport\t<\/label>\n<\/div>\n\t\t\t<div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][16][m_type]\" id=\"ipt_fsqm_form_64_design_16_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][16][type]\" id=\"ipt_fsqm_form_64_design_16_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_16\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][13][m_type]\" id=\"ipt_fsqm_form_64_freetype_13_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][13][type]\" id=\"ipt_fsqm_form_64_freetype_13_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_13\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_13_value\">N\u00b0 de document<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_13_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][13][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_13_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][15][m_type]\" id=\"ipt_fsqm_form_64_design_15_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][15][type]\" id=\"ipt_fsqm_form_64_design_15_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][14][m_type]\" id=\"ipt_fsqm_form_64_freetype_14_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][14][type]\" id=\"ipt_fsqm_form_64_freetype_14_type\" value=\"upload\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_uif_qtooltip ipt_fsqm_container_upload\" id=\"ipt_fsqm_form_64_freetype_14\" title=\"Taille maximale: &lt;strong&gt;3MB&lt;\/strong&gt;&lt;br \/&gt;\r\nFichiers accept\u00e9s: &lt;strong&gt;GIF,JPG,PNG,PDF&lt;\/strong&gt;\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_container\" data-opened=\"1\">\n\t\t<div class=\"ipt_uif_container_head\">\n\t\t\t\t<h3>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_container_label\">Copie de la pi\u00e8ce d'identit\u00e9<\/span>\t\t\t\t\t<\/h3>\n\t<\/div>\n\t\t<div class=\"ipt_uif_container_inner\">\n\t\t<div class=\"ipt_uif_uploader\" id=\"ipt_fsqm_file_upload_64_14__uploader_wrap\" data-settings=\"{&quot;accept_file_types&quot;:&quot;gif,jpeg,png,jpg,pdf&quot;,&quot;max_number_of_files&quot;:&quot;1&quot;,&quot;min_number_of_files&quot;:&quot;1&quot;,&quot;max_file_size&quot;:3145728,&quot;min_file_size&quot;:&quot;1&quot;,&quot;show_drop_zone&quot;:true,&quot;wp_media_integration&quot;:false,&quot;auto_upload&quot;:true,&quot;single_upload&quot;:true,&quot;drag_n_drop&quot;:false,&quot;progress_bar&quot;:true,&quot;preview_media&quot;:false,&quot;can_delete&quot;:true,&quot;required&quot;:true,&quot;minimal_ui&quot;:true,&quot;accept&quot;:&quot;all&quot;,&quot;capture&quot;:&quot;environment&quot;,&quot;icon&quot;:&quot;none&quot;,&quot;centered&quot;:false,&quot;dragdrop&quot;:&quot;Trascina e rilascia&quot;,&quot;upload_label&quot;:&quot;Seleziona&quot;,&quot;recaptcha&quot;:false,&quot;site_key&quot;:&quot;&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;type&quot;:&quot;image&quot;,&quot;size&quot;:&quot;normal&quot;,&quot;hl&quot;:&quot;en&quot;}\" data-configuration=\"{&quot;id&quot;:&quot;ipt_fsqm_file_upload_64_14_&quot;,&quot;upload_url&quot;:&quot;?action=ipt_fsqm_fu_upload&quot;,&quot;download_url&quot;:&quot;?action=ipt_fsqm_fu_download&quot;,&quot;do_download&quot;:false,&quot;show_ui&quot;:true,&quot;captcha_url&quot;:&quot;?action=ipt_fsqm_fu_captcha&quot;}\" data-formData=\"{&quot;data_id&quot;:null,&quot;form_id&quot;:&quot;64&quot;,&quot;nonce&quot;:&quot;70bcf62907&quot;,&quot;element_key&quot;:&quot;14&quot;,&quot;files_key&quot;:&quot;ipt_fsqm_file_upload_64_14&quot;}\">\n\t\t\n\t<div class=\"fileupload-meta\">\n\t\t<p>Max file size: 3.00 MB. | Types de fichier autoris\u00e9s : gif,jpeg,png,jpg,pdf | Nombre maximum de fichier : 1 | Nombre minimum de fichier : 1<\/p>\n\t<\/div>\n\n\n\t<!-- The table listing the files available for upload\/download -->\n\t<div class=\"ipt_fsqm_fileuploader_list_wrap\">\n\t\t<table role=\"presentation\" class=\"ipt_fsqm_fileuploader_list\">\n\t\t\t\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<td colspan=\"4\">\n\t\t\t\t\t\t<div class=\"fileupload-buttonbar\">\n\t\t\t\t\t\t\t<div class=\"fileupload-buttons\">\n\t\t\t\t\t\t\t\t<span role=\"button\" class=\"fileinput-button secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-plusthick\"><\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"select secondary-button\">Seleziona<\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<input class=\"ipt_uif_uploader_handle\" type=\"file\" name=\"ipt_fsqm_file_upload_64_14[]\" id=\"ipt_fsqm_file_upload_64_14_\" capture=\"environment\" \/>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"fileupload-process\"><\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<!-- The global progress state -->\n\t\t\t\t\t\t\t<div class=\"fileupload-progress fade wp-eform-fileupload-globalprogress\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t<!-- The global progress bar -->\n\t\t\t\t\t\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t\t\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<!-- The extended global progress state -->\n\t\t\t\t\t\t\t\t<div class=\"progress-extended\">&nbsp;<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/td>\n\n\t\t\t\t\t\t\t\t\t\t<td class=\"delete_button\">\n\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t\t\t\t<tbody class=\"files\"><\/tbody>\n\t\t<\/table>\n\t<\/div>\n\n\t<!-- The template to display files available for upload -->\n<script class=\"template-upload\" id=\"ipt_fsqm_file_upload_64_14__tmpl_upload\" type=\"text\/x-tmpl\">\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n\t<tr class=\"template-upload\">\n\t\t<td>\n\t\t\t<span class=\"preview\"><\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">{%=file.name%}<\/p>\n\t\t\t<strong class=\"error\"><\/strong>\n\t\t<\/td>\n\t\t<td class=\"fileupload_list_pb\">\n\t\t\t<p class=\"size\">En cours de traitement &hellip;<\/p>\n\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t<\/div>\n\t\t<\/td>\n\t\t<td colspan=\"1\">\n\t\t\t{% if (!i && !o.options.autoUpload) { %}\n\t\t\t\t<button class=\"start secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" disabled>\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-circle-arrow-e\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tCommencer\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t\t{% if (!i) { %}\n\t\t\t\t<button class=\"cancel secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-cancel\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tAnnuler\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t<\/td>\n\t<\/tr>\n{% } %}\n<\/script>\n<!-- The template to display files available for download -->\n<script class=\"template-download\" id=\"ipt_fsqm_file_upload_64_14__tmpl_download\" type=\"text\/x-tmpl\">\n{%\n\twindow.ipt_fsqm_upload_count_global;\n\tif ( window.ipt_fsqm_upload_count_global == undefined ) {\n\t\twindow.ipt_fsqm_upload_count_global = 0;\n\t}\n%}\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n{% var toggler_check_id = window.ipt_fsqm_upload_count_global++; %}\n\t<tr class=\"template-download\">\n\t\t<td class=\"preview_td\" colspan=\"2\">\n\t\t\t<span class=\"preview\">\n\t\t\t\t{% if (file.thumbnailUrl) { %}\n\t\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\"><img decoding=\"async\" src=\"{%=file.thumbnailUrl%}\" \/><\/a>\n\t\t\t\t{% } else if ( file.validAudio ) { %}\n\t\t\t\t\t\t\t\t\t{% } else if ( file.validVideo ) { %}\n\t\t\t\t\t\t\t\t\t{% } %}\n\t\t\t<\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">\n\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\" {%=file.thumbnailUrl?'':''%}>{%=file.name%}<\/a>\n\t\t\t<\/p>\n\t\t\t{% if (file.error) { %}\n\t\t\t\t<div><span class=\"error\">Erreur<\/span> {%=file.error%}<\/div>\n\t\t\t{% } %}\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][14][id][]\" value=\"{%=file.id%}\" \/>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<span class=\"size\">{%=o.formatFileSize(file.size)%}<\/span>\n\t\t<\/td>\n\t\t\t\t<td class=\"delete_button\">\n\t\t\t<button class=\"delete secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" data-type=\"{%=file.deleteType%}\" data-url=\"{%=file.deleteUrl%}\"{% if (file.deleteWithCredentials) { %} data-xhr-fields='{\"withCredentials\":true}'{% } %}>\n\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-trash\"><\/span>\n\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\tDelete\t\t\t\t<\/span>\n\t\t\t<\/button>\n\t\t<\/td>\n\t\t\t\t\t<\/tr>\n{% } %}\n<\/script>\n\n\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][35][m_type]\" id=\"ipt_fsqm_form_64_design_35_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][35][type]\" id=\"ipt_fsqm_form_64_design_35_type\" value=\"heading\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_heading\" id=\"ipt_fsqm_form_64_design_35\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<h4 class=\"ipt_uif_heading ipt_uif_divider ipt_uif_align_left ipt_uif_divider_no_icon ipt_uif_divider_has_scroll\">\n\t\t\t\t\t<a href=\"#\" class=\"ipt_uif_scroll_to_top\"><i class=\"ipticm ipt-icomoon-chevron-up suffix\"><\/i><\/a>\n\t\t\t\t\t\t<span class=\"ipt_uif_divider_text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_divider_text_inner\">\n\t\t\t\tDescription\t\t\t\t<\/span>\n\t\t\t\t\t<\/span>\n\t<\/h4>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][3][m_type]\" id=\"ipt_fsqm_form_64_mcq_3_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][3][type]\" id=\"ipt_fsqm_form_64_mcq_3_type\" value=\"select\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_select\" id=\"ipt_fsqm_form_64_mcq_3\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_3\">Sujet<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_3\">S\u00e9lectionnez une des options puis remplissez les champs suivants<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<select class=\" check_me validate[required] ipt_uif_select\" name=\"ipt_fsqm_form_64[mcq][3][options][]\" id=\"ipt_fsqm_form_64_mcq_3_options_\" data-placeholder=\"S\u00e9lectionnez l&#039;un des cas pr\u00e9vus\" data-allow-clear=\"true\" data-theme=\"eform-material\"><option value=\"\">S\u00e9lectionnez l'un des cas pr\u00e9vus<\/option>\n\t\t\t<option value=\"0\" data-num=\"\">Demande de d\u00e9bit<\/option>\n\t\t\t<option value=\"1\" data-num=\"\">Transit non effectu\u00e9<\/option>\n\t\t\t<option value=\"2\" data-num=\"\">Paiement d\u00e9j\u00e0 effectu\u00e9<\/option>\n\t\t\t<option value=\"3\" data-num=\"\">Changement de propri\u00e9t\u00e9\/Location<\/option>\n\t\t\t<option value=\"4\" data-num=\"\">Vol<\/option>\n\t\t\t<option value=\"5\" data-num=\"\">D\u00e9claration de la gare d'entr\u00e9e<\/option>\n\t\t\t<\/select><div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][41][m_type]\" id=\"ipt_fsqm_form_64_design_41_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][41][type]\" id=\"ipt_fsqm_form_64_design_41_type\" value=\"divider\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_divider\" id=\"ipt_fsqm_form_64_design_41\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_divider ipt_uif_align_center ipt_uif_empty_divider ipt_uif_divider_no_icon ipt_uif_divider_no_text eform-just-divider\">\n\t<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][40][m_type]\" id=\"ipt_fsqm_form_64_design_40_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][40][type]\" id=\"ipt_fsqm_form_64_design_40_type\" value=\"blank_container\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_blank_container\" id=\"ipt_fsqm_form_64_design_40\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_blank_container\">\n\t\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][37][m_type]\" id=\"ipt_fsqm_form_64_design_37_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][37][type]\" id=\"ipt_fsqm_form_64_design_37_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_37\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][4][m_type]\" id=\"ipt_fsqm_form_64_mcq_4_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][4][type]\" id=\"ipt_fsqm_form_64_mcq_4_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_64_mcq_4\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_4\">N\u00b0 Telepass\/Viacard<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_4\">S\u00e9lectionnez Telepass ou Viacard<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"ipt_uif_label_column column_random\">\n\t<input checked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][4][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_4_options__0\"\n\t\tvalue=\"0\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_4_options__0\" data-labelcon=\"&#xe18e;\">\n\t\t N\u00b0 Telepass\t<\/label>\n<\/div>\n\t\t\t<div class=\"ipt_uif_label_column column_random\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][4][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_4_options__1\"\n\t\tvalue=\"1\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_4_options__1\" data-labelcon=\"&#xe18e;\">\n\t\t N\u00b0 Viacard\t<\/label>\n<\/div>\n\t\t\t<div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][38][m_type]\" id=\"ipt_fsqm_form_64_design_38_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][38][type]\" id=\"ipt_fsqm_form_64_design_38_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_38\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][15][m_type]\" id=\"ipt_fsqm_form_64_freetype_15_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][15][type]\" id=\"ipt_fsqm_form_64_freetype_15_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_15\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_15_value\">N\u00b0 Telepass<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_15_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][15][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_15_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][39][m_type]\" id=\"ipt_fsqm_form_64_design_39_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][39][type]\" id=\"ipt_fsqm_form_64_design_39_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\n\t<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][55][m_type]\" id=\"ipt_fsqm_form_64_design_55_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][55][type]\" id=\"ipt_fsqm_form_64_design_55_type\" value=\"blank_container\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_blank_container\" id=\"ipt_fsqm_form_64_design_55\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_blank_container\">\n\t\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][56][m_type]\" id=\"ipt_fsqm_form_64_design_56_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][56][type]\" id=\"ipt_fsqm_form_64_design_56_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_56\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][10][m_type]\" id=\"ipt_fsqm_form_64_mcq_10_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][10][type]\" id=\"ipt_fsqm_form_64_mcq_10_type\" value=\"select\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_select\" id=\"ipt_fsqm_form_64_mcq_10\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_10\">Mode de paiement<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_10\">S\u00e9lectionnez le mode de paiement<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<select class=\" check_me validate[required] ipt_uif_select\" name=\"ipt_fsqm_form_64[mcq][10][options][]\" id=\"ipt_fsqm_form_64_mcq_10_options_\" data-placeholder=\"---\" data-allow-clear=\"true\" data-theme=\"eform-material\"><option value=\"\">---<\/option>\n\t\t\t<option value=\"0\" data-num=\"\">Paiement au Centre de Services<\/option>\n\t\t\t<option value=\"1\" data-num=\"\">Virement bancaire<\/option>\n\t\t\t<option value=\"2\" data-num=\"\">Paiement en ligne<\/option>\n\t\t\t<option value=\"3\" data-num=\"\">Bulletin postal<\/option>\n\t\t\t<option value=\"4\" data-num=\"\">Paiement en voie<\/option>\n\t\t\t<\/select><div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][57][m_type]\" id=\"ipt_fsqm_form_64_design_57_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][57][type]\" id=\"ipt_fsqm_form_64_design_57_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_57\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][23][m_type]\" id=\"ipt_fsqm_form_64_freetype_23_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][23][type]\" id=\"ipt_fsqm_form_64_freetype_23_type\" value=\"upload\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_upload\" id=\"ipt_fsqm_form_64_freetype_23\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_container\" data-opened=\"1\">\n\t\t<div class=\"ipt_uif_container_head\">\n\t\t\t\t<h3>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_container_label\">Re\u00e7u de paiement<\/span>\t\t\t\t\t<\/h3>\n\t<\/div>\n\t\t<div class=\"ipt_uif_container_inner\">\n\t\t<div class=\"ipt_uif_uploader\" id=\"ipt_fsqm_file_upload_64_23__uploader_wrap\" data-settings=\"{&quot;accept_file_types&quot;:&quot;gif,jpeg,png,jpg,pdf&quot;,&quot;max_number_of_files&quot;:&quot;1&quot;,&quot;min_number_of_files&quot;:&quot;1&quot;,&quot;max_file_size&quot;:3145728,&quot;min_file_size&quot;:&quot;1&quot;,&quot;show_drop_zone&quot;:true,&quot;wp_media_integration&quot;:false,&quot;auto_upload&quot;:true,&quot;single_upload&quot;:true,&quot;drag_n_drop&quot;:false,&quot;progress_bar&quot;:true,&quot;preview_media&quot;:false,&quot;can_delete&quot;:true,&quot;required&quot;:true,&quot;minimal_ui&quot;:true,&quot;accept&quot;:&quot;all&quot;,&quot;capture&quot;:&quot;none&quot;,&quot;icon&quot;:&quot;none&quot;,&quot;centered&quot;:false,&quot;dragdrop&quot;:&quot;Glissez et d\\u00e9posez&quot;,&quot;upload_label&quot;:&quot;S\\u00e9lectionnez&quot;,&quot;recaptcha&quot;:false,&quot;site_key&quot;:&quot;&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;type&quot;:&quot;image&quot;,&quot;size&quot;:&quot;normal&quot;,&quot;hl&quot;:&quot;en&quot;}\" data-configuration=\"{&quot;id&quot;:&quot;ipt_fsqm_file_upload_64_23_&quot;,&quot;upload_url&quot;:&quot;?action=ipt_fsqm_fu_upload&quot;,&quot;download_url&quot;:&quot;?action=ipt_fsqm_fu_download&quot;,&quot;do_download&quot;:false,&quot;show_ui&quot;:true,&quot;captcha_url&quot;:&quot;?action=ipt_fsqm_fu_captcha&quot;}\" data-formData=\"{&quot;data_id&quot;:null,&quot;form_id&quot;:&quot;64&quot;,&quot;nonce&quot;:&quot;5c663f9cdb&quot;,&quot;element_key&quot;:&quot;23&quot;,&quot;files_key&quot;:&quot;ipt_fsqm_file_upload_64_23&quot;}\">\n\t\t\n\t<div class=\"fileupload-meta\">\n\t\t<p>Max file size: 3.00 MB. | Types de fichier autoris\u00e9s : gif,jpeg,png,jpg,pdf | Nombre maximum de fichier : 1 | Nombre minimum de fichier : 1<\/p>\n\t<\/div>\n\n\n\t<!-- The table listing the files available for upload\/download -->\n\t<div class=\"ipt_fsqm_fileuploader_list_wrap\">\n\t\t<table role=\"presentation\" class=\"ipt_fsqm_fileuploader_list\">\n\t\t\t\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<td colspan=\"4\">\n\t\t\t\t\t\t<div class=\"fileupload-buttonbar\">\n\t\t\t\t\t\t\t<div class=\"fileupload-buttons\">\n\t\t\t\t\t\t\t\t<span role=\"button\" class=\"fileinput-button secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-plusthick\"><\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"select secondary-button\">S\u00e9lectionnez<\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<input class=\"ipt_uif_uploader_handle\" type=\"file\" name=\"ipt_fsqm_file_upload_64_23[]\" id=\"ipt_fsqm_file_upload_64_23_\" \/>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"fileupload-process\"><\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<!-- The global progress state -->\n\t\t\t\t\t\t\t<div class=\"fileupload-progress fade wp-eform-fileupload-globalprogress\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t<!-- The global progress bar -->\n\t\t\t\t\t\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t\t\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<!-- The extended global progress state -->\n\t\t\t\t\t\t\t\t<div class=\"progress-extended\">&nbsp;<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/td>\n\n\t\t\t\t\t\t\t\t\t\t<td class=\"delete_button\">\n\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t\t\t\t<tbody class=\"files\"><\/tbody>\n\t\t<\/table>\n\t<\/div>\n\n\t<!-- The template to display files available for upload -->\n<script class=\"template-upload\" id=\"ipt_fsqm_file_upload_64_23__tmpl_upload\" type=\"text\/x-tmpl\">\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n\t<tr class=\"template-upload\">\n\t\t<td>\n\t\t\t<span class=\"preview\"><\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">{%=file.name%}<\/p>\n\t\t\t<strong class=\"error\"><\/strong>\n\t\t<\/td>\n\t\t<td class=\"fileupload_list_pb\">\n\t\t\t<p class=\"size\">En cours de traitement &hellip;<\/p>\n\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t<\/div>\n\t\t<\/td>\n\t\t<td colspan=\"1\">\n\t\t\t{% if (!i && !o.options.autoUpload) { %}\n\t\t\t\t<button class=\"start secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" disabled>\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-circle-arrow-e\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tCommencer\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t\t{% if (!i) { %}\n\t\t\t\t<button class=\"cancel secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-cancel\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tAnnuler\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t<\/td>\n\t<\/tr>\n{% } %}\n<\/script>\n<!-- The template to display files available for download -->\n<script class=\"template-download\" id=\"ipt_fsqm_file_upload_64_23__tmpl_download\" type=\"text\/x-tmpl\">\n{%\n\twindow.ipt_fsqm_upload_count_global;\n\tif ( window.ipt_fsqm_upload_count_global == undefined ) {\n\t\twindow.ipt_fsqm_upload_count_global = 0;\n\t}\n%}\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n{% var toggler_check_id = window.ipt_fsqm_upload_count_global++; %}\n\t<tr class=\"template-download\">\n\t\t<td class=\"preview_td\" colspan=\"2\">\n\t\t\t<span class=\"preview\">\n\t\t\t\t{% if (file.thumbnailUrl) { %}\n\t\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\"><img decoding=\"async\" src=\"{%=file.thumbnailUrl%}\" \/><\/a>\n\t\t\t\t{% } else if ( file.validAudio ) { %}\n\t\t\t\t\t\t\t\t\t{% } else if ( file.validVideo ) { %}\n\t\t\t\t\t\t\t\t\t{% } %}\n\t\t\t<\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">\n\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\" {%=file.thumbnailUrl?'':''%}>{%=file.name%}<\/a>\n\t\t\t<\/p>\n\t\t\t{% if (file.error) { %}\n\t\t\t\t<div><span class=\"error\">Erreur<\/span> {%=file.error%}<\/div>\n\t\t\t{% } %}\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][23][id][]\" value=\"{%=file.id%}\" \/>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<span class=\"size\">{%=o.formatFileSize(file.size)%}<\/span>\n\t\t<\/td>\n\t\t\t\t<td class=\"delete_button\">\n\t\t\t<button class=\"delete secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" data-type=\"{%=file.deleteType%}\" data-url=\"{%=file.deleteUrl%}\"{% if (file.deleteWithCredentials) { %} data-xhr-fields='{\"withCredentials\":true}'{% } %}>\n\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-trash\"><\/span>\n\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\tDelete\t\t\t\t<\/span>\n\t\t\t<\/button>\n\t\t<\/td>\n\t\t\t\t\t<\/tr>\n{% } %}\n<\/script>\n\n\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][58][m_type]\" id=\"ipt_fsqm_form_64_design_58_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][58][type]\" id=\"ipt_fsqm_form_64_design_58_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\n\t<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][51][m_type]\" id=\"ipt_fsqm_form_64_design_51_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][51][type]\" id=\"ipt_fsqm_form_64_design_51_type\" value=\"blank_container\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_blank_container\" id=\"ipt_fsqm_form_64_design_51\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_blank_container\">\n\t\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][52][m_type]\" id=\"ipt_fsqm_form_64_design_52_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][52][type]\" id=\"ipt_fsqm_form_64_design_52_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_52\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][11][m_type]\" id=\"ipt_fsqm_form_64_mcq_11_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][11][type]\" id=\"ipt_fsqm_form_64_mcq_11_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_64_mcq_11\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_11\">Locataire\/Propri\u00e9taire<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_11\">S\u00e9lectionnez locataire ou propri\u00e9taire<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"ipt_uif_label_column column_random\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][11][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_11_options__0\"\n\t\tvalue=\"0\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_11_options__0\" data-labelcon=\"&#xe18e;\">\n\t\t Locataire\t<\/label>\n<\/div>\n\t\t\t<div class=\"ipt_uif_label_column column_random\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][11][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_11_options__1\"\n\t\tvalue=\"1\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_11_options__1\" data-labelcon=\"&#xe18e;\">\n\t\t Propri\u00e9taire\t<\/label>\n<\/div>\n\t\t\t<div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][75][m_type]\" id=\"ipt_fsqm_form_64_design_75_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][75][type]\" id=\"ipt_fsqm_form_64_design_75_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][87][m_type]\" id=\"ipt_fsqm_form_64_design_87_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][87][type]\" id=\"ipt_fsqm_form_64_design_87_type\" value=\"blank_container\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_blank_container\" id=\"ipt_fsqm_form_64_design_87\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_blank_container\">\n\t\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][40][m_type]\" id=\"ipt_fsqm_form_64_freetype_40_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][40][type]\" id=\"ipt_fsqm_form_64_freetype_40_type\" value=\"upload\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_upload\" id=\"ipt_fsqm_form_64_freetype_40\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_container\" data-opened=\"1\">\n\t\t<div class=\"ipt_uif_container_head\">\n\t\t\t\t<h3>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_container_label\">Copie du contrat de location<\/span>\t\t\t\t\t<\/h3>\n\t<\/div>\n\t\t<div class=\"ipt_uif_container_inner\">\n\t\t<div class=\"ipt_uif_uploader\" id=\"ipt_fsqm_file_upload_64_40__uploader_wrap\" data-settings=\"{&quot;accept_file_types&quot;:&quot;gif,jpeg,png,jpg,pdf&quot;,&quot;max_number_of_files&quot;:&quot;1&quot;,&quot;min_number_of_files&quot;:&quot;1&quot;,&quot;max_file_size&quot;:3145728,&quot;min_file_size&quot;:&quot;1&quot;,&quot;show_drop_zone&quot;:true,&quot;wp_media_integration&quot;:false,&quot;auto_upload&quot;:true,&quot;single_upload&quot;:true,&quot;drag_n_drop&quot;:false,&quot;progress_bar&quot;:true,&quot;preview_media&quot;:false,&quot;can_delete&quot;:true,&quot;required&quot;:true,&quot;minimal_ui&quot;:true,&quot;accept&quot;:&quot;all&quot;,&quot;capture&quot;:&quot;none&quot;,&quot;icon&quot;:&quot;none&quot;,&quot;centered&quot;:false,&quot;dragdrop&quot;:&quot;Glissez et d\\u00e9posez&quot;,&quot;upload_label&quot;:&quot;S\\u00e9lectionnez&quot;,&quot;recaptcha&quot;:false,&quot;site_key&quot;:&quot;&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;type&quot;:&quot;image&quot;,&quot;size&quot;:&quot;normal&quot;,&quot;hl&quot;:&quot;en&quot;}\" data-configuration=\"{&quot;id&quot;:&quot;ipt_fsqm_file_upload_64_40_&quot;,&quot;upload_url&quot;:&quot;?action=ipt_fsqm_fu_upload&quot;,&quot;download_url&quot;:&quot;?action=ipt_fsqm_fu_download&quot;,&quot;do_download&quot;:false,&quot;show_ui&quot;:true,&quot;captcha_url&quot;:&quot;?action=ipt_fsqm_fu_captcha&quot;}\" data-formData=\"{&quot;data_id&quot;:null,&quot;form_id&quot;:&quot;64&quot;,&quot;nonce&quot;:&quot;7cf7d143ae&quot;,&quot;element_key&quot;:&quot;40&quot;,&quot;files_key&quot;:&quot;ipt_fsqm_file_upload_64_40&quot;}\">\n\t\t\n\t<div class=\"fileupload-meta\">\n\t\t<p>Max file size: 3.00 MB. | Types de fichier autoris\u00e9s : gif,jpeg,png,jpg,pdf | Nombre maximum de fichier : 1 | Nombre minimum de fichier : 1<\/p>\n\t<\/div>\n\n\n\t<!-- The table listing the files available for upload\/download -->\n\t<div class=\"ipt_fsqm_fileuploader_list_wrap\">\n\t\t<table role=\"presentation\" class=\"ipt_fsqm_fileuploader_list\">\n\t\t\t\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<td colspan=\"4\">\n\t\t\t\t\t\t<div class=\"fileupload-buttonbar\">\n\t\t\t\t\t\t\t<div class=\"fileupload-buttons\">\n\t\t\t\t\t\t\t\t<span role=\"button\" class=\"fileinput-button secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-plusthick\"><\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"select secondary-button\">S\u00e9lectionnez<\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<input class=\"ipt_uif_uploader_handle\" type=\"file\" name=\"ipt_fsqm_file_upload_64_40[]\" id=\"ipt_fsqm_file_upload_64_40_\" \/>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"fileupload-process\"><\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<!-- The global progress state -->\n\t\t\t\t\t\t\t<div class=\"fileupload-progress fade wp-eform-fileupload-globalprogress\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t<!-- The global progress bar -->\n\t\t\t\t\t\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t\t\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<!-- The extended global progress state -->\n\t\t\t\t\t\t\t\t<div class=\"progress-extended\">&nbsp;<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/td>\n\n\t\t\t\t\t\t\t\t\t\t<td class=\"delete_button\">\n\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t\t\t\t<tbody class=\"files\"><\/tbody>\n\t\t<\/table>\n\t<\/div>\n\n\t<!-- The template to display files available for upload -->\n<script class=\"template-upload\" id=\"ipt_fsqm_file_upload_64_40__tmpl_upload\" type=\"text\/x-tmpl\">\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n\t<tr class=\"template-upload\">\n\t\t<td>\n\t\t\t<span class=\"preview\"><\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">{%=file.name%}<\/p>\n\t\t\t<strong class=\"error\"><\/strong>\n\t\t<\/td>\n\t\t<td class=\"fileupload_list_pb\">\n\t\t\t<p class=\"size\">En cours de traitement &hellip;<\/p>\n\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t<\/div>\n\t\t<\/td>\n\t\t<td colspan=\"1\">\n\t\t\t{% if (!i && !o.options.autoUpload) { %}\n\t\t\t\t<button class=\"start secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" disabled>\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-circle-arrow-e\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tCommencer\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t\t{% if (!i) { %}\n\t\t\t\t<button class=\"cancel secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-cancel\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tAnnuler\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t<\/td>\n\t<\/tr>\n{% } %}\n<\/script>\n<!-- The template to display files available for download -->\n<script class=\"template-download\" id=\"ipt_fsqm_file_upload_64_40__tmpl_download\" type=\"text\/x-tmpl\">\n{%\n\twindow.ipt_fsqm_upload_count_global;\n\tif ( window.ipt_fsqm_upload_count_global == undefined ) {\n\t\twindow.ipt_fsqm_upload_count_global = 0;\n\t}\n%}\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n{% var toggler_check_id = window.ipt_fsqm_upload_count_global++; %}\n\t<tr class=\"template-download\">\n\t\t<td class=\"preview_td\" colspan=\"2\">\n\t\t\t<span class=\"preview\">\n\t\t\t\t{% if (file.thumbnailUrl) { %}\n\t\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\"><img decoding=\"async\" src=\"{%=file.thumbnailUrl%}\" \/><\/a>\n\t\t\t\t{% } else if ( file.validAudio ) { %}\n\t\t\t\t\t\t\t\t\t{% } else if ( file.validVideo ) { %}\n\t\t\t\t\t\t\t\t\t{% } %}\n\t\t\t<\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">\n\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\" {%=file.thumbnailUrl?'':''%}>{%=file.name%}<\/a>\n\t\t\t<\/p>\n\t\t\t{% if (file.error) { %}\n\t\t\t\t<div><span class=\"error\">Erreur<\/span> {%=file.error%}<\/div>\n\t\t\t{% } %}\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][40][id][]\" value=\"{%=file.id%}\" \/>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<span class=\"size\">{%=o.formatFileSize(file.size)%}<\/span>\n\t\t<\/td>\n\t\t\t\t<td class=\"delete_button\">\n\t\t\t<button class=\"delete secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" data-type=\"{%=file.deleteType%}\" data-url=\"{%=file.deleteUrl%}\"{% if (file.deleteWithCredentials) { %} data-xhr-fields='{\"withCredentials\":true}'{% } %}>\n\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-trash\"><\/span>\n\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\tDelete\t\t\t\t<\/span>\n\t\t\t<\/button>\n\t\t<\/td>\n\t\t\t\t\t<\/tr>\n{% } %}\n<\/script>\n\n\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t\n\t<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][88][m_type]\" id=\"ipt_fsqm_form_64_design_88_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][88][type]\" id=\"ipt_fsqm_form_64_design_88_type\" value=\"blank_container\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_blank_container\" id=\"ipt_fsqm_form_64_design_88\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_blank_container\">\n\t\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][89][m_type]\" id=\"ipt_fsqm_form_64_design_89_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][89][type]\" id=\"ipt_fsqm_form_64_design_89_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_89\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][15][m_type]\" id=\"ipt_fsqm_form_64_mcq_15_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][15][type]\" id=\"ipt_fsqm_form_64_mcq_15_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_64_mcq_15\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_15\">Vente\/Perte de possession<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_15\">S\u00e9lectionnez vente ou perte de possession<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"ipt_uif_label_column column_random\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][15][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_15_options__0\"\n\t\tvalue=\"0\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_15_options__0\" data-labelcon=\"&#xe18e;\">\n\t\t Vente\t<\/label>\n<\/div>\n\t\t\t<div class=\"ipt_uif_label_column column_random\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][15][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_15_options__1\"\n\t\tvalue=\"1\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_15_options__1\" data-labelcon=\"&#xe18e;\">\n\t\t Perte de possession\t<\/label>\n<\/div>\n\t\t\t<div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][91][m_type]\" id=\"ipt_fsqm_form_64_design_91_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][91][type]\" id=\"ipt_fsqm_form_64_design_91_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][39][m_type]\" id=\"ipt_fsqm_form_64_freetype_39_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][39][type]\" id=\"ipt_fsqm_form_64_freetype_39_type\" value=\"upload\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_upload\" id=\"ipt_fsqm_form_64_freetype_39\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_container\" data-opened=\"1\">\n\t\t<div class=\"ipt_uif_container_head\">\n\t\t\t\t<h3>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_container_label\">Copie de l'acte de vente<\/span>\t\t\t\t\t<\/h3>\n\t<\/div>\n\t\t<div class=\"ipt_uif_container_inner\">\n\t\t<div class=\"ipt_uif_uploader\" id=\"ipt_fsqm_file_upload_64_39__uploader_wrap\" data-settings=\"{&quot;accept_file_types&quot;:&quot;gif,jpeg,png,jpg,pdf&quot;,&quot;max_number_of_files&quot;:&quot;1&quot;,&quot;min_number_of_files&quot;:&quot;1&quot;,&quot;max_file_size&quot;:3145728,&quot;min_file_size&quot;:&quot;1&quot;,&quot;show_drop_zone&quot;:true,&quot;wp_media_integration&quot;:false,&quot;auto_upload&quot;:true,&quot;single_upload&quot;:true,&quot;drag_n_drop&quot;:false,&quot;progress_bar&quot;:true,&quot;preview_media&quot;:false,&quot;can_delete&quot;:true,&quot;required&quot;:true,&quot;minimal_ui&quot;:true,&quot;accept&quot;:&quot;all&quot;,&quot;capture&quot;:&quot;none&quot;,&quot;icon&quot;:&quot;none&quot;,&quot;centered&quot;:false,&quot;dragdrop&quot;:&quot;Glissez et d\\u00e9posez&quot;,&quot;upload_label&quot;:&quot;S\\u00e9lectionnez&quot;,&quot;recaptcha&quot;:false,&quot;site_key&quot;:&quot;&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;type&quot;:&quot;image&quot;,&quot;size&quot;:&quot;normal&quot;,&quot;hl&quot;:&quot;en&quot;}\" data-configuration=\"{&quot;id&quot;:&quot;ipt_fsqm_file_upload_64_39_&quot;,&quot;upload_url&quot;:&quot;?action=ipt_fsqm_fu_upload&quot;,&quot;download_url&quot;:&quot;?action=ipt_fsqm_fu_download&quot;,&quot;do_download&quot;:false,&quot;show_ui&quot;:true,&quot;captcha_url&quot;:&quot;?action=ipt_fsqm_fu_captcha&quot;}\" data-formData=\"{&quot;data_id&quot;:null,&quot;form_id&quot;:&quot;64&quot;,&quot;nonce&quot;:&quot;13d860bbd6&quot;,&quot;element_key&quot;:&quot;39&quot;,&quot;files_key&quot;:&quot;ipt_fsqm_file_upload_64_39&quot;}\">\n\t\t\n\t<div class=\"fileupload-meta\">\n\t\t<p>Max file size: 3.00 MB. | Types de fichier autoris\u00e9s : gif,jpeg,png,jpg,pdf | Nombre maximum de fichier : 1 | Nombre minimum de fichier : 1<\/p>\n\t<\/div>\n\n\n\t<!-- The table listing the files available for upload\/download -->\n\t<div class=\"ipt_fsqm_fileuploader_list_wrap\">\n\t\t<table role=\"presentation\" class=\"ipt_fsqm_fileuploader_list\">\n\t\t\t\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<td colspan=\"4\">\n\t\t\t\t\t\t<div class=\"fileupload-buttonbar\">\n\t\t\t\t\t\t\t<div class=\"fileupload-buttons\">\n\t\t\t\t\t\t\t\t<span role=\"button\" class=\"fileinput-button secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-plusthick\"><\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"select secondary-button\">S\u00e9lectionnez<\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<input class=\"ipt_uif_uploader_handle\" type=\"file\" name=\"ipt_fsqm_file_upload_64_39[]\" id=\"ipt_fsqm_file_upload_64_39_\" \/>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"fileupload-process\"><\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<!-- The global progress state -->\n\t\t\t\t\t\t\t<div class=\"fileupload-progress fade wp-eform-fileupload-globalprogress\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t<!-- The global progress bar -->\n\t\t\t\t\t\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t\t\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<!-- The extended global progress state -->\n\t\t\t\t\t\t\t\t<div class=\"progress-extended\">&nbsp;<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/td>\n\n\t\t\t\t\t\t\t\t\t\t<td class=\"delete_button\">\n\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t\t\t\t<tbody class=\"files\"><\/tbody>\n\t\t<\/table>\n\t<\/div>\n\n\t<!-- The template to display files available for upload -->\n<script class=\"template-upload\" id=\"ipt_fsqm_file_upload_64_39__tmpl_upload\" type=\"text\/x-tmpl\">\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n\t<tr class=\"template-upload\">\n\t\t<td>\n\t\t\t<span class=\"preview\"><\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">{%=file.name%}<\/p>\n\t\t\t<strong class=\"error\"><\/strong>\n\t\t<\/td>\n\t\t<td class=\"fileupload_list_pb\">\n\t\t\t<p class=\"size\">En cours de traitement &hellip;<\/p>\n\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t<\/div>\n\t\t<\/td>\n\t\t<td colspan=\"1\">\n\t\t\t{% if (!i && !o.options.autoUpload) { %}\n\t\t\t\t<button class=\"start secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" disabled>\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-circle-arrow-e\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tCommencer\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t\t{% if (!i) { %}\n\t\t\t\t<button class=\"cancel secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-cancel\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tAnnuler\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t<\/td>\n\t<\/tr>\n{% } %}\n<\/script>\n<!-- The template to display files available for download -->\n<script class=\"template-download\" id=\"ipt_fsqm_file_upload_64_39__tmpl_download\" type=\"text\/x-tmpl\">\n{%\n\twindow.ipt_fsqm_upload_count_global;\n\tif ( window.ipt_fsqm_upload_count_global == undefined ) {\n\t\twindow.ipt_fsqm_upload_count_global = 0;\n\t}\n%}\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n{% var toggler_check_id = window.ipt_fsqm_upload_count_global++; %}\n\t<tr class=\"template-download\">\n\t\t<td class=\"preview_td\" colspan=\"2\">\n\t\t\t<span class=\"preview\">\n\t\t\t\t{% if (file.thumbnailUrl) { %}\n\t\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\"><img decoding=\"async\" src=\"{%=file.thumbnailUrl%}\" \/><\/a>\n\t\t\t\t{% } else if ( file.validAudio ) { %}\n\t\t\t\t\t\t\t\t\t{% } else if ( file.validVideo ) { %}\n\t\t\t\t\t\t\t\t\t{% } %}\n\t\t\t<\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">\n\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\" {%=file.thumbnailUrl?'':''%}>{%=file.name%}<\/a>\n\t\t\t<\/p>\n\t\t\t{% if (file.error) { %}\n\t\t\t\t<div><span class=\"error\">Erreur<\/span> {%=file.error%}<\/div>\n\t\t\t{% } %}\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][39][id][]\" value=\"{%=file.id%}\" \/>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<span class=\"size\">{%=o.formatFileSize(file.size)%}<\/span>\n\t\t<\/td>\n\t\t\t\t<td class=\"delete_button\">\n\t\t\t<button class=\"delete secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" data-type=\"{%=file.deleteType%}\" data-url=\"{%=file.deleteUrl%}\"{% if (file.deleteWithCredentials) { %} data-xhr-fields='{\"withCredentials\":true}'{% } %}>\n\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-trash\"><\/span>\n\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\tDelete\t\t\t\t<\/span>\n\t\t\t<\/button>\n\t\t<\/td>\n\t\t\t\t\t<\/tr>\n{% } %}\n<\/script>\n\n\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][41][m_type]\" id=\"ipt_fsqm_form_64_freetype_41_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][41][type]\" id=\"ipt_fsqm_form_64_freetype_41_type\" value=\"upload\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_upload\" id=\"ipt_fsqm_form_64_freetype_41\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_container\" data-opened=\"1\">\n\t\t<div class=\"ipt_uif_container_head\">\n\t\t\t\t<h3>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_container_label\">Attestation de perte de possession<\/span>\t\t\t\t\t<\/h3>\n\t<\/div>\n\t\t<div class=\"ipt_uif_container_inner\">\n\t\t<div class=\"ipt_uif_uploader\" id=\"ipt_fsqm_file_upload_64_41__uploader_wrap\" data-settings=\"{&quot;accept_file_types&quot;:&quot;gif,jpeg,png,jpg,pdf&quot;,&quot;max_number_of_files&quot;:&quot;1&quot;,&quot;min_number_of_files&quot;:&quot;1&quot;,&quot;max_file_size&quot;:3145728,&quot;min_file_size&quot;:&quot;1&quot;,&quot;show_drop_zone&quot;:true,&quot;wp_media_integration&quot;:false,&quot;auto_upload&quot;:true,&quot;single_upload&quot;:true,&quot;drag_n_drop&quot;:false,&quot;progress_bar&quot;:true,&quot;preview_media&quot;:false,&quot;can_delete&quot;:true,&quot;required&quot;:true,&quot;minimal_ui&quot;:true,&quot;accept&quot;:&quot;all&quot;,&quot;capture&quot;:&quot;none&quot;,&quot;icon&quot;:&quot;none&quot;,&quot;centered&quot;:false,&quot;dragdrop&quot;:&quot;Glissez et d\\u00e9posez&quot;,&quot;upload_label&quot;:&quot;S\\u00e9lectionnez&quot;,&quot;recaptcha&quot;:false,&quot;site_key&quot;:&quot;&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;type&quot;:&quot;image&quot;,&quot;size&quot;:&quot;normal&quot;,&quot;hl&quot;:&quot;en&quot;}\" data-configuration=\"{&quot;id&quot;:&quot;ipt_fsqm_file_upload_64_41_&quot;,&quot;upload_url&quot;:&quot;?action=ipt_fsqm_fu_upload&quot;,&quot;download_url&quot;:&quot;?action=ipt_fsqm_fu_download&quot;,&quot;do_download&quot;:false,&quot;show_ui&quot;:true,&quot;captcha_url&quot;:&quot;?action=ipt_fsqm_fu_captcha&quot;}\" data-formData=\"{&quot;data_id&quot;:null,&quot;form_id&quot;:&quot;64&quot;,&quot;nonce&quot;:&quot;7b6fd7a08d&quot;,&quot;element_key&quot;:&quot;41&quot;,&quot;files_key&quot;:&quot;ipt_fsqm_file_upload_64_41&quot;}\">\n\t\t\n\t<div class=\"fileupload-meta\">\n\t\t<p>Max file size: 3.00 MB. | Types de fichier autoris\u00e9s : gif,jpeg,png,jpg,pdf | Nombre maximum de fichier : 1 | Nombre minimum de fichier : 1<\/p>\n\t<\/div>\n\n\n\t<!-- The table listing the files available for upload\/download -->\n\t<div class=\"ipt_fsqm_fileuploader_list_wrap\">\n\t\t<table role=\"presentation\" class=\"ipt_fsqm_fileuploader_list\">\n\t\t\t\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<td colspan=\"4\">\n\t\t\t\t\t\t<div class=\"fileupload-buttonbar\">\n\t\t\t\t\t\t\t<div class=\"fileupload-buttons\">\n\t\t\t\t\t\t\t\t<span role=\"button\" class=\"fileinput-button secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-plusthick\"><\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"select secondary-button\">S\u00e9lectionnez<\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<input class=\"ipt_uif_uploader_handle\" type=\"file\" name=\"ipt_fsqm_file_upload_64_41[]\" id=\"ipt_fsqm_file_upload_64_41_\" \/>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"fileupload-process\"><\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<!-- The global progress state -->\n\t\t\t\t\t\t\t<div class=\"fileupload-progress fade wp-eform-fileupload-globalprogress\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t<!-- The global progress bar -->\n\t\t\t\t\t\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t\t\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<!-- The extended global progress state -->\n\t\t\t\t\t\t\t\t<div class=\"progress-extended\">&nbsp;<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/td>\n\n\t\t\t\t\t\t\t\t\t\t<td class=\"delete_button\">\n\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t\t\t\t<tbody class=\"files\"><\/tbody>\n\t\t<\/table>\n\t<\/div>\n\n\t<!-- The template to display files available for upload -->\n<script class=\"template-upload\" id=\"ipt_fsqm_file_upload_64_41__tmpl_upload\" type=\"text\/x-tmpl\">\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n\t<tr class=\"template-upload\">\n\t\t<td>\n\t\t\t<span class=\"preview\"><\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">{%=file.name%}<\/p>\n\t\t\t<strong class=\"error\"><\/strong>\n\t\t<\/td>\n\t\t<td class=\"fileupload_list_pb\">\n\t\t\t<p class=\"size\">En cours de traitement &hellip;<\/p>\n\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t<\/div>\n\t\t<\/td>\n\t\t<td colspan=\"1\">\n\t\t\t{% if (!i && !o.options.autoUpload) { %}\n\t\t\t\t<button class=\"start secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" disabled>\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-circle-arrow-e\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tCommencer\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t\t{% if (!i) { %}\n\t\t\t\t<button class=\"cancel secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-cancel\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tAnnuler\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t<\/td>\n\t<\/tr>\n{% } %}\n<\/script>\n<!-- The template to display files available for download -->\n<script class=\"template-download\" id=\"ipt_fsqm_file_upload_64_41__tmpl_download\" type=\"text\/x-tmpl\">\n{%\n\twindow.ipt_fsqm_upload_count_global;\n\tif ( window.ipt_fsqm_upload_count_global == undefined ) {\n\t\twindow.ipt_fsqm_upload_count_global = 0;\n\t}\n%}\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n{% var toggler_check_id = window.ipt_fsqm_upload_count_global++; %}\n\t<tr class=\"template-download\">\n\t\t<td class=\"preview_td\" colspan=\"2\">\n\t\t\t<span class=\"preview\">\n\t\t\t\t{% if (file.thumbnailUrl) { %}\n\t\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\"><img decoding=\"async\" src=\"{%=file.thumbnailUrl%}\" \/><\/a>\n\t\t\t\t{% } else if ( file.validAudio ) { %}\n\t\t\t\t\t\t\t\t\t{% } else if ( file.validVideo ) { %}\n\t\t\t\t\t\t\t\t\t{% } %}\n\t\t\t<\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">\n\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\" {%=file.thumbnailUrl?'':''%}>{%=file.name%}<\/a>\n\t\t\t<\/p>\n\t\t\t{% if (file.error) { %}\n\t\t\t\t<div><span class=\"error\">Erreur<\/span> {%=file.error%}<\/div>\n\t\t\t{% } %}\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][41][id][]\" value=\"{%=file.id%}\" \/>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<span class=\"size\">{%=o.formatFileSize(file.size)%}<\/span>\n\t\t<\/td>\n\t\t\t\t<td class=\"delete_button\">\n\t\t\t<button class=\"delete secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" data-type=\"{%=file.deleteType%}\" data-url=\"{%=file.deleteUrl%}\"{% if (file.deleteWithCredentials) { %} data-xhr-fields='{\"withCredentials\":true}'{% } %}>\n\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-trash\"><\/span>\n\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\tDelete\t\t\t\t<\/span>\n\t\t\t<\/button>\n\t\t<\/td>\n\t\t\t\t\t<\/tr>\n{% } %}\n<\/script>\n\n\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t\n\t<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][84][m_type]\" id=\"ipt_fsqm_form_64_design_84_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][84][type]\" id=\"ipt_fsqm_form_64_design_84_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][72][m_type]\" id=\"ipt_fsqm_form_64_design_72_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][72][type]\" id=\"ipt_fsqm_form_64_design_72_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_72\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][5][m_type]\" id=\"ipt_fsqm_form_64_pinfo_5_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][5][type]\" id=\"ipt_fsqm_form_64_pinfo_5_type\" value=\"datetime\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_datetime\" id=\"ipt_fsqm_form_64_pinfo_5\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_5_value\">Du<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_5_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field eform-dp-input-field has-icon\">\n\t<input class=\"datepicker ipt_uif_datepicker  check_me validate[required] is-empty ipt_uif_text\"\n\t data-dateFormat=\"dd-mm-yy\" data-timeFormat=\"HH:mm:ss\" data-year_range=\"50\"\t\ttype=\"text\"\n\treadonly=\"readonly\"\n\tname=\"ipt_fsqm_form_64[pinfo][5][value]\"\n\tid=\"ipt_fsqm_form_64_pinfo_5_value\"\n\tmaxlength=\"524288\"\n\tvalue=\"\" \/>\n\t\t\t<i title=\"\" class=\" ipt-icomoon-calendar ipticm prefix\"><\/i>\n\t\t\t\t\t<a href=\"javascript:;\" class=\"eform-dp-clear\" title=\"Clear\">&times;<\/a>\n<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][71][m_type]\" id=\"ipt_fsqm_form_64_design_71_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][71][type]\" id=\"ipt_fsqm_form_64_design_71_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_71\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][6][m_type]\" id=\"ipt_fsqm_form_64_pinfo_6_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][6][type]\" id=\"ipt_fsqm_form_64_pinfo_6_type\" value=\"datetime\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_datetime\" id=\"ipt_fsqm_form_64_pinfo_6\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_6_value\">Au<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_6_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field eform-dp-input-field has-icon\">\n\t<input class=\"datepicker ipt_uif_datepicker  check_me validate[required] is-empty ipt_uif_text\"\n\t data-dateFormat=\"dd-mm-yy\" data-timeFormat=\"HH:mm:ss\" data-year_range=\"50\"\t\ttype=\"text\"\n\treadonly=\"readonly\"\n\tname=\"ipt_fsqm_form_64[pinfo][6][value]\"\n\tid=\"ipt_fsqm_form_64_pinfo_6_value\"\n\tmaxlength=\"524288\"\n\tvalue=\"\" \/>\n\t\t\t<i title=\"\" class=\" ipt-icomoon-calendar ipticm prefix\"><\/i>\n\t\t\t\t\t<a href=\"javascript:;\" class=\"eform-dp-clear\" title=\"Clear\">&times;<\/a>\n<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][78][m_type]\" id=\"ipt_fsqm_form_64_design_78_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][78][type]\" id=\"ipt_fsqm_form_64_design_78_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][70][m_type]\" id=\"ipt_fsqm_form_64_design_70_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][70][type]\" id=\"ipt_fsqm_form_64_design_70_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_70\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][12][m_type]\" id=\"ipt_fsqm_form_64_mcq_12_m_type\" value=\"mcq\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[mcq][12][type]\" id=\"ipt_fsqm_form_64_mcq_12_type\" value=\"radio\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_radio\" id=\"ipt_fsqm_form_64_mcq_12\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_12\">Particulier\/Entreprise<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_mcq_12\">S\u00e9lectionnez particulier ou entreprise<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"ipt_uif_label_column column_2\">\n\t<input checked=\"checked\"\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][12][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_12_options__0\"\n\t\tvalue=\"0\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_12_options__0\" data-labelcon=\"&#xe18e;\">\n\t\t Particulier\t<\/label>\n<\/div>\n\t\t\t<div class=\"ipt_uif_label_column column_2\">\n\t<input\t\t data-num=\"\"\t\t\t\ttype=\"radio\"\n\t\tclass=\"check_me validate[required] ipt_uif_radio with-gap\"\n\t\tname=\"ipt_fsqm_form_64[mcq][12][options][]\"\n\t\tid=\"ipt_fsqm_form_64_mcq_12_options__1\"\n\t\tvalue=\"1\" \/>\n\t<label class=\"eform-label-with-tabindex\" tabindex=\"0\" for=\"ipt_fsqm_form_64_mcq_12_options__1\" data-labelcon=\"&#xe18e;\">\n\t\t Entreprise\t<\/label>\n<\/div>\n\t\t\t<div class=\"clear-both\"><\/div>\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][69][m_type]\" id=\"ipt_fsqm_form_64_design_69_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][69][type]\" id=\"ipt_fsqm_form_64_design_69_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_69\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][24][m_type]\" id=\"ipt_fsqm_form_64_freetype_24_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][24][type]\" id=\"ipt_fsqm_form_64_freetype_24_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_24\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_24_value\">Nom<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_24_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][24][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_24_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][76][m_type]\" id=\"ipt_fsqm_form_64_design_76_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][76][type]\" id=\"ipt_fsqm_form_64_design_76_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][68][m_type]\" id=\"ipt_fsqm_form_64_design_68_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][68][type]\" id=\"ipt_fsqm_form_64_design_68_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_68\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][25][m_type]\" id=\"ipt_fsqm_form_64_freetype_25_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][25][type]\" id=\"ipt_fsqm_form_64_freetype_25_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_25\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_25_value\">Pr\u00e9nom<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_25_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][25][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_25_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][38][m_type]\" id=\"ipt_fsqm_form_64_freetype_38_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][38][type]\" id=\"ipt_fsqm_form_64_freetype_38_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_38\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_38_value\">Raison sociale<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_38_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][38][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_38_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][67][m_type]\" id=\"ipt_fsqm_form_64_design_67_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][67][type]\" id=\"ipt_fsqm_form_64_design_67_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_67\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][26][m_type]\" id=\"ipt_fsqm_form_64_freetype_26_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][26][type]\" id=\"ipt_fsqm_form_64_freetype_26_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_26\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_26_value\">Code fiscal \/ Num\u00e9ro de TVA<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_26_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,maxSize[16]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][26][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_26_value\"\n\t\tmaxlength=\"16\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][54][m_type]\" id=\"ipt_fsqm_form_64_design_54_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][54][type]\" id=\"ipt_fsqm_form_64_design_54_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][64][m_type]\" id=\"ipt_fsqm_form_64_design_64_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][64][type]\" id=\"ipt_fsqm_form_64_design_64_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_64\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][27][m_type]\" id=\"ipt_fsqm_form_64_freetype_27_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][27][type]\" id=\"ipt_fsqm_form_64_freetype_27_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_27\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_27_value\">Adresse<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_27_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][27][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_27_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][63][m_type]\" id=\"ipt_fsqm_form_64_design_63_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][63][type]\" id=\"ipt_fsqm_form_64_design_63_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_63\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][28][m_type]\" id=\"ipt_fsqm_form_64_freetype_28_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][28][type]\" id=\"ipt_fsqm_form_64_freetype_28_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_28\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_28_value\">Commune<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_28_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][28][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_28_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][74][m_type]\" id=\"ipt_fsqm_form_64_design_74_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][74][type]\" id=\"ipt_fsqm_form_64_design_74_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][73][m_type]\" id=\"ipt_fsqm_form_64_design_73_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][73][type]\" id=\"ipt_fsqm_form_64_design_73_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_73\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][29][m_type]\" id=\"ipt_fsqm_form_64_freetype_29_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][29][type]\" id=\"ipt_fsqm_form_64_freetype_29_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_29\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_29_value\">Province<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_29_value\">Sigle de la province (exemple : TO)<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,maxSize[2]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][29][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_29_value\"\n\t\tmaxlength=\"2\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][53][m_type]\" id=\"ipt_fsqm_form_64_design_53_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][53][type]\" id=\"ipt_fsqm_form_64_design_53_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_53\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][30][m_type]\" id=\"ipt_fsqm_form_64_freetype_30_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][30][type]\" id=\"ipt_fsqm_form_64_freetype_30_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_30\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_30_value\">Code postal<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_30_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required,maxSize[5]] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][30][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_30_value\"\n\t\tmaxlength=\"5\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][79][m_type]\" id=\"ipt_fsqm_form_64_design_79_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][79][type]\" id=\"ipt_fsqm_form_64_design_79_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\n\t<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][47][m_type]\" id=\"ipt_fsqm_form_64_design_47_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][47][type]\" id=\"ipt_fsqm_form_64_design_47_type\" value=\"blank_container\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_blank_container\" id=\"ipt_fsqm_form_64_design_47\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_blank_container\">\n\t\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][48][m_type]\" id=\"ipt_fsqm_form_64_design_48_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][48][type]\" id=\"ipt_fsqm_form_64_design_48_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_48\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][7][m_type]\" id=\"ipt_fsqm_form_64_pinfo_7_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][7][type]\" id=\"ipt_fsqm_form_64_pinfo_7_type\" value=\"datetime\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_datetime\" id=\"ipt_fsqm_form_64_pinfo_7\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_7_value\">Du<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_7_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field eform-dp-input-field has-icon\">\n\t<input class=\"datepicker ipt_uif_datepicker  check_me validate[required] is-empty ipt_uif_text\"\n\t data-dateFormat=\"dd-mm-yy\" data-timeFormat=\"HH:mm:ss\" data-year_range=\"50\"\t\ttype=\"text\"\n\treadonly=\"readonly\"\n\tname=\"ipt_fsqm_form_64[pinfo][7][value]\"\n\tid=\"ipt_fsqm_form_64_pinfo_7_value\"\n\tmaxlength=\"524288\"\n\tvalue=\"\" \/>\n\t\t\t<i title=\"\" class=\" ipt-icomoon-calendar ipticm prefix\"><\/i>\n\t\t\t\t\t<a href=\"javascript:;\" class=\"eform-dp-clear\" title=\"Clear\">&times;<\/a>\n<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][49][m_type]\" id=\"ipt_fsqm_form_64_design_49_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][49][type]\" id=\"ipt_fsqm_form_64_design_49_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_49\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][8][m_type]\" id=\"ipt_fsqm_form_64_pinfo_8_m_type\" value=\"pinfo\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[pinfo][8][type]\" id=\"ipt_fsqm_form_64_pinfo_8_type\" value=\"datetime\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_datetime\" id=\"ipt_fsqm_form_64_pinfo_8\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_8_value\">Au<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_pinfo_8_value\">Remplissez le champ<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field eform-dp-input-field has-icon\">\n\t<input class=\"datepicker ipt_uif_datepicker  check_me validate[required] is-empty ipt_uif_text\"\n\t data-dateFormat=\"dd-mm-yy\" data-timeFormat=\"HH:mm:ss\" data-year_range=\"50\"\t\ttype=\"text\"\n\treadonly=\"readonly\"\n\tname=\"ipt_fsqm_form_64[pinfo][8][value]\"\n\tid=\"ipt_fsqm_form_64_pinfo_8_value\"\n\tmaxlength=\"524288\"\n\tvalue=\"\" \/>\n\t\t\t<i title=\"\" class=\" ipt-icomoon-calendar ipticm prefix\"><\/i>\n\t\t\t\t\t<a href=\"javascript:;\" class=\"eform-dp-clear\" title=\"Clear\">&times;<\/a>\n<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][50][m_type]\" id=\"ipt_fsqm_form_64_design_50_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][50][type]\" id=\"ipt_fsqm_form_64_design_50_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][31][m_type]\" id=\"ipt_fsqm_form_64_freetype_31_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][31][type]\" id=\"ipt_fsqm_form_64_freetype_31_type\" value=\"upload\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_upload\" id=\"ipt_fsqm_form_64_freetype_31\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_container\" data-opened=\"1\">\n\t\t<div class=\"ipt_uif_container_head\">\n\t\t\t\t<h3>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_container_label\">Plainte<\/span>\t\t\t\t\t<\/h3>\n\t<\/div>\n\t\t<div class=\"ipt_uif_container_inner\">\n\t\t<div class=\"ipt_uif_uploader\" id=\"ipt_fsqm_file_upload_64_31__uploader_wrap\" data-settings=\"{&quot;accept_file_types&quot;:&quot;gif,jpeg,png,jpg,pdf&quot;,&quot;max_number_of_files&quot;:&quot;1&quot;,&quot;min_number_of_files&quot;:&quot;1&quot;,&quot;max_file_size&quot;:3145728,&quot;min_file_size&quot;:&quot;1&quot;,&quot;show_drop_zone&quot;:true,&quot;wp_media_integration&quot;:false,&quot;auto_upload&quot;:true,&quot;single_upload&quot;:true,&quot;drag_n_drop&quot;:false,&quot;progress_bar&quot;:true,&quot;preview_media&quot;:false,&quot;can_delete&quot;:true,&quot;required&quot;:true,&quot;minimal_ui&quot;:true,&quot;accept&quot;:&quot;all&quot;,&quot;capture&quot;:&quot;none&quot;,&quot;icon&quot;:&quot;none&quot;,&quot;centered&quot;:false,&quot;dragdrop&quot;:&quot;Glissez et d\\u00e9posez&quot;,&quot;upload_label&quot;:&quot;S\\u00e9lectionnez&quot;,&quot;recaptcha&quot;:false,&quot;site_key&quot;:&quot;&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;type&quot;:&quot;image&quot;,&quot;size&quot;:&quot;normal&quot;,&quot;hl&quot;:&quot;en&quot;}\" data-configuration=\"{&quot;id&quot;:&quot;ipt_fsqm_file_upload_64_31_&quot;,&quot;upload_url&quot;:&quot;?action=ipt_fsqm_fu_upload&quot;,&quot;download_url&quot;:&quot;?action=ipt_fsqm_fu_download&quot;,&quot;do_download&quot;:false,&quot;show_ui&quot;:true,&quot;captcha_url&quot;:&quot;?action=ipt_fsqm_fu_captcha&quot;}\" data-formData=\"{&quot;data_id&quot;:null,&quot;form_id&quot;:&quot;64&quot;,&quot;nonce&quot;:&quot;aab2a6d299&quot;,&quot;element_key&quot;:&quot;31&quot;,&quot;files_key&quot;:&quot;ipt_fsqm_file_upload_64_31&quot;}\">\n\t\t\n\t<div class=\"fileupload-meta\">\n\t\t<p>Max file size: 3.00 MB. | Types de fichier autoris\u00e9s : gif,jpeg,png,jpg,pdf | Nombre maximum de fichier : 1 | Nombre minimum de fichier : 1<\/p>\n\t<\/div>\n\n\n\t<!-- The table listing the files available for upload\/download -->\n\t<div class=\"ipt_fsqm_fileuploader_list_wrap\">\n\t\t<table role=\"presentation\" class=\"ipt_fsqm_fileuploader_list\">\n\t\t\t\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<td colspan=\"4\">\n\t\t\t\t\t\t<div class=\"fileupload-buttonbar\">\n\t\t\t\t\t\t\t<div class=\"fileupload-buttons\">\n\t\t\t\t\t\t\t\t<span role=\"button\" class=\"fileinput-button secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-plusthick\"><\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"select secondary-button\">S\u00e9lectionnez<\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<input class=\"ipt_uif_uploader_handle\" type=\"file\" name=\"ipt_fsqm_file_upload_64_31[]\" id=\"ipt_fsqm_file_upload_64_31_\" \/>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"fileupload-process\"><\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<!-- The global progress state -->\n\t\t\t\t\t\t\t<div class=\"fileupload-progress fade wp-eform-fileupload-globalprogress\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t<!-- The global progress bar -->\n\t\t\t\t\t\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t\t\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<!-- The extended global progress state -->\n\t\t\t\t\t\t\t\t<div class=\"progress-extended\">&nbsp;<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/td>\n\n\t\t\t\t\t\t\t\t\t\t<td class=\"delete_button\">\n\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t\t\t\t<tbody class=\"files\"><\/tbody>\n\t\t<\/table>\n\t<\/div>\n\n\t<!-- The template to display files available for upload -->\n<script class=\"template-upload\" id=\"ipt_fsqm_file_upload_64_31__tmpl_upload\" type=\"text\/x-tmpl\">\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n\t<tr class=\"template-upload\">\n\t\t<td>\n\t\t\t<span class=\"preview\"><\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">{%=file.name%}<\/p>\n\t\t\t<strong class=\"error\"><\/strong>\n\t\t<\/td>\n\t\t<td class=\"fileupload_list_pb\">\n\t\t\t<p class=\"size\">En cours de traitement &hellip;<\/p>\n\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t<\/div>\n\t\t<\/td>\n\t\t<td colspan=\"1\">\n\t\t\t{% if (!i && !o.options.autoUpload) { %}\n\t\t\t\t<button class=\"start secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" disabled>\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-circle-arrow-e\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tCommencer\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t\t{% if (!i) { %}\n\t\t\t\t<button class=\"cancel secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-cancel\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tAnnuler\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t<\/td>\n\t<\/tr>\n{% } %}\n<\/script>\n<!-- The template to display files available for download -->\n<script class=\"template-download\" id=\"ipt_fsqm_file_upload_64_31__tmpl_download\" type=\"text\/x-tmpl\">\n{%\n\twindow.ipt_fsqm_upload_count_global;\n\tif ( window.ipt_fsqm_upload_count_global == undefined ) {\n\t\twindow.ipt_fsqm_upload_count_global = 0;\n\t}\n%}\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n{% var toggler_check_id = window.ipt_fsqm_upload_count_global++; %}\n\t<tr class=\"template-download\">\n\t\t<td class=\"preview_td\" colspan=\"2\">\n\t\t\t<span class=\"preview\">\n\t\t\t\t{% if (file.thumbnailUrl) { %}\n\t\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\"><img decoding=\"async\" src=\"{%=file.thumbnailUrl%}\" \/><\/a>\n\t\t\t\t{% } else if ( file.validAudio ) { %}\n\t\t\t\t\t\t\t\t\t{% } else if ( file.validVideo ) { %}\n\t\t\t\t\t\t\t\t\t{% } %}\n\t\t\t<\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">\n\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\" {%=file.thumbnailUrl?'':''%}>{%=file.name%}<\/a>\n\t\t\t<\/p>\n\t\t\t{% if (file.error) { %}\n\t\t\t\t<div><span class=\"error\">Erreur<\/span> {%=file.error%}<\/div>\n\t\t\t{% } %}\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][31][id][]\" value=\"{%=file.id%}\" \/>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<span class=\"size\">{%=o.formatFileSize(file.size)%}<\/span>\n\t\t<\/td>\n\t\t\t\t<td class=\"delete_button\">\n\t\t\t<button class=\"delete secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" data-type=\"{%=file.deleteType%}\" data-url=\"{%=file.deleteUrl%}\"{% if (file.deleteWithCredentials) { %} data-xhr-fields='{\"withCredentials\":true}'{% } %}>\n\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-trash\"><\/span>\n\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\tDelete\t\t\t\t<\/span>\n\t\t\t<\/button>\n\t\t<\/td>\n\t\t\t\t\t<\/tr>\n{% } %}\n<\/script>\n\n\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t\n\t<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][43][m_type]\" id=\"ipt_fsqm_form_64_design_43_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][43][type]\" id=\"ipt_fsqm_form_64_design_43_type\" value=\"blank_container\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_blank_container\" id=\"ipt_fsqm_form_64_design_43\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t<div class=\"ipt_uif_blank_container\">\n\t\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][44][m_type]\" id=\"ipt_fsqm_form_64_design_44_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][44][type]\" id=\"ipt_fsqm_form_64_design_44_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_44\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][32][m_type]\" id=\"ipt_fsqm_form_64_freetype_32_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][32][type]\" id=\"ipt_fsqm_form_64_freetype_32_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_32\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_32_value\">D\u00e9claration de la gare d'entr\u00e9e<span class=\"ipt_uif_question_required\">*<\/span><\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_32_value\">Saisissez la gare d'entr\u00e9e<\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me validate[required] ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][32][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_32_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][80][m_type]\" id=\"ipt_fsqm_form_64_design_80_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][80][type]\" id=\"ipt_fsqm_form_64_design_80_type\" value=\"col_half\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_half ipt_uif_conditional ipt_uif_column_custom ipt_fsqm_container_col_half\" id=\"ipt_fsqm_form_64_design_80\">\n\t<div class=\"ipt_uif_column_inner\">\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][34][m_type]\" id=\"ipt_fsqm_form_64_freetype_34_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][34][type]\" id=\"ipt_fsqm_form_64_freetype_34_type\" value=\"feedback_small\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_feedback_small\" id=\"ipt_fsqm_form_64_freetype_34\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_question ipt_uif_question_vertical\">\n\t\t\t<div class=\"ipt_uif_question_label\">\n\t\t\t<label class=\"ipt_uif_question_title ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_34_value\">N\u00b0 du ticket de la gare d'entr\u00e9e<\/label>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t\t\t\t<label class=\"ipt_uif_question_subtitle ipt_uif_label\" for=\"ipt_fsqm_form_64_freetype_34_value\"><a href=\"\/wp-content\/uploads\/modulo-online-be.png\" rel=\"prettyPhoto[iframes]\" title=\"\">O\u00f9 trouver le N\u00b0 du ticket ?<\/a><\/label>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t<div class=\"ipt_uif_question_content\">\n\t\t\t\t<div class=\"input-field\">\n\t<input class=\" check_me  ipt_uif_text\"\n\t\t\t\t\t\t\t\t\t\ttype=\"text\"\n\t\t\t\tname=\"ipt_fsqm_form_64[freetype][34][value]\"\n\t\tid=\"ipt_fsqm_form_64_freetype_34_value\"\n\t\tmaxlength=\"\"\t\tvalue=\"\" \/>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t\t<\/div>\n<\/div>\n\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t\t<div class=\"clear-both\"><\/div>\t<\/div>\n<\/div>\n\t\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][46][m_type]\" id=\"ipt_fsqm_form_64_design_46_m_type\" value=\"design\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[design][46][type]\" id=\"ipt_fsqm_form_64_design_46_type\" value=\"clear\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"clear-both\"><\/div>\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][35][m_type]\" id=\"ipt_fsqm_form_64_freetype_35_m_type\" value=\"freetype\" class=\"ipt_fsqm_hf_m_type\" \/>\n<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][35][type]\" id=\"ipt_fsqm_form_64_freetype_35_type\" value=\"upload\" class=\"ipt_fsqm_hf_type\" \/>\n\t\t\t\t<div class=\"ipt_uif_column ipt_uif_column_full ipt_uif_conditional ipt_fsqm_container_upload\" id=\"ipt_fsqm_form_64_freetype_35\">\n\t<div class=\"ipt_uif_column_inner side_margin\">\n\t\t<div class=\"ipt_uif_container\" data-opened=\"1\">\n\t\t<div class=\"ipt_uif_container_head\">\n\t\t\t\t<h3>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"ipt_uif_container_label\">Copie du ticket d'entr\u00e9e<\/span>\t\t\t\t\t<\/h3>\n\t<\/div>\n\t\t<div class=\"ipt_uif_container_inner\">\n\t\t<div class=\"ipt_uif_uploader\" id=\"ipt_fsqm_file_upload_64_35__uploader_wrap\" data-settings=\"{&quot;accept_file_types&quot;:&quot;gif,jpeg,png,jpg,pdf&quot;,&quot;max_number_of_files&quot;:&quot;1&quot;,&quot;min_number_of_files&quot;:&quot;1&quot;,&quot;max_file_size&quot;:3145728,&quot;min_file_size&quot;:&quot;1&quot;,&quot;show_drop_zone&quot;:true,&quot;wp_media_integration&quot;:false,&quot;auto_upload&quot;:true,&quot;single_upload&quot;:true,&quot;drag_n_drop&quot;:false,&quot;progress_bar&quot;:true,&quot;preview_media&quot;:false,&quot;can_delete&quot;:true,&quot;required&quot;:false,&quot;minimal_ui&quot;:true,&quot;accept&quot;:&quot;all&quot;,&quot;capture&quot;:&quot;none&quot;,&quot;icon&quot;:&quot;none&quot;,&quot;centered&quot;:false,&quot;dragdrop&quot;:&quot;Glissez et d\\u00e9posez&quot;,&quot;upload_label&quot;:&quot;S\\u00e9lectionnez&quot;,&quot;recaptcha&quot;:false,&quot;site_key&quot;:&quot;&quot;,&quot;theme&quot;:&quot;light&quot;,&quot;type&quot;:&quot;image&quot;,&quot;size&quot;:&quot;normal&quot;,&quot;hl&quot;:&quot;en&quot;}\" data-configuration=\"{&quot;id&quot;:&quot;ipt_fsqm_file_upload_64_35_&quot;,&quot;upload_url&quot;:&quot;?action=ipt_fsqm_fu_upload&quot;,&quot;download_url&quot;:&quot;?action=ipt_fsqm_fu_download&quot;,&quot;do_download&quot;:false,&quot;show_ui&quot;:true,&quot;captcha_url&quot;:&quot;?action=ipt_fsqm_fu_captcha&quot;}\" data-formData=\"{&quot;data_id&quot;:null,&quot;form_id&quot;:&quot;64&quot;,&quot;nonce&quot;:&quot;e2f63d9a2f&quot;,&quot;element_key&quot;:&quot;35&quot;,&quot;files_key&quot;:&quot;ipt_fsqm_file_upload_64_35&quot;}\">\n\t\t\n\t<div class=\"fileupload-meta\">\n\t\t<p>Max file size: 3.00 MB. | Types de fichier autoris\u00e9s : gif,jpeg,png,jpg,pdf | Nombre maximum de fichier : 1 | Nombre minimum de fichier : 1<\/p>\n\t<\/div>\n\n\n\t<!-- The table listing the files available for upload\/download -->\n\t<div class=\"ipt_fsqm_fileuploader_list_wrap\">\n\t\t<table role=\"presentation\" class=\"ipt_fsqm_fileuploader_list\">\n\t\t\t\t\t\t<thead>\n\t\t\t\t<tr>\n\t\t\t\t\t<td colspan=\"4\">\n\t\t\t\t\t\t<div class=\"fileupload-buttonbar\">\n\t\t\t\t\t\t\t<div class=\"fileupload-buttons\">\n\t\t\t\t\t\t\t\t<span role=\"button\" class=\"fileinput-button secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-plusthick\"><\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"select secondary-button\">S\u00e9lectionnez<\/span>\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<input class=\"ipt_uif_uploader_handle\" type=\"file\" name=\"ipt_fsqm_file_upload_64_35[]\" id=\"ipt_fsqm_file_upload_64_35_\" \/>\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"fileupload-process\"><\/span>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<!-- The global progress state -->\n\t\t\t\t\t\t\t<div class=\"fileupload-progress fade wp-eform-fileupload-globalprogress\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t<!-- The global progress bar -->\n\t\t\t\t\t\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t\t\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<!-- The extended global progress state -->\n\t\t\t\t\t\t\t\t<div class=\"progress-extended\">&nbsp;<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/td>\n\n\t\t\t\t\t\t\t\t\t\t<td class=\"delete_button\">\n\t\t\t\t\t\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/tr>\n\t\t\t<\/thead>\n\t\t\t\t\t\t<tbody class=\"files\"><\/tbody>\n\t\t<\/table>\n\t<\/div>\n\n\t<!-- The template to display files available for upload -->\n<script class=\"template-upload\" id=\"ipt_fsqm_file_upload_64_35__tmpl_upload\" type=\"text\/x-tmpl\">\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n\t<tr class=\"template-upload\">\n\t\t<td>\n\t\t\t<span class=\"preview\"><\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">{%=file.name%}<\/p>\n\t\t\t<strong class=\"error\"><\/strong>\n\t\t<\/td>\n\t\t<td class=\"fileupload_list_pb\">\n\t\t\t<p class=\"size\">En cours de traitement &hellip;<\/p>\n\t\t\t<div class=\"progress ui-progressbar ui-widget ui-widget-content ui-corner-all\" role=\"progressbar\" aria-valuemin=\"0\" aria-valuemax=\"100\">\n\t\t\t\t<div class=\"progress-bar ui-progressbar-value ui-widget-header ui-corner-left\" style=\"width: 0%;\"><\/div>\n\t\t\t<\/div>\n\t\t<\/td>\n\t\t<td colspan=\"1\">\n\t\t\t{% if (!i && !o.options.autoUpload) { %}\n\t\t\t\t<button class=\"start secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\" disabled>\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-circle-arrow-e\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tCommencer\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t\t{% if (!i) { %}\n\t\t\t\t<button class=\"cancel secondary-button small ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-primary\">\n\t\t\t\t\t<span class=\"ui-button-icon-primary ui-icon ui-icon-cancel\"><\/span>\n\t\t\t\t\t<span class=\"ui-button-text\">\n\t\t\t\t\t\tAnnuler\t\t\t\t\t<\/span>\n\t\t\t\t<\/button>\n\t\t\t{% } %}\n\t\t<\/td>\n\t<\/tr>\n{% } %}\n<\/script>\n<!-- The template to display files available for download -->\n<script class=\"template-download\" id=\"ipt_fsqm_file_upload_64_35__tmpl_download\" type=\"text\/x-tmpl\">\n{%\n\twindow.ipt_fsqm_upload_count_global;\n\tif ( window.ipt_fsqm_upload_count_global == undefined ) {\n\t\twindow.ipt_fsqm_upload_count_global = 0;\n\t}\n%}\n{% for (var i=0, file; file=o.files[i]; i++) { %}\n{% var toggler_check_id = window.ipt_fsqm_upload_count_global++; %}\n\t<tr class=\"template-download\">\n\t\t<td class=\"preview_td\" colspan=\"2\">\n\t\t\t<span class=\"preview\">\n\t\t\t\t{% if (file.thumbnailUrl) { %}\n\t\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\"><img decoding=\"async\" src=\"{%=file.thumbnailUrl%}\" \/><\/a>\n\t\t\t\t{% } else if ( file.validAudio ) { %}\n\t\t\t\t\t\t\t\t\t{% } else if ( file.validVideo ) { %}\n\t\t\t\t\t\t\t\t\t{% } %}\n\t\t\t<\/span>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p class=\"name\">\n\t\t\t\t<a href=\"{%=file.url%}\" title=\"{%=file.name%}\" download=\"{%=file.name%}\" {%=file.thumbnailUrl?'':''%}>{%=file.name%}<\/a>\n\t\t\t<\/p>\n\t\t\t{% if (file.error) { %}\n\t\t\t\t<div><span class=\"error\">Erreur<\/span> {%=file.error%}<\/div>\n\t\t\t{% } %}\n\t\t\t<input type=\"hidden\" data-sayt-exclude name=\"ipt_fsqm_form_64[freetype][35][id][]\" value=\"{%=file.id%}\" \/>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<span 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