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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Reconnaissons qu&#39;en r&eacute;mun&eacute;ration de ses services de n&eacute;gociation du bien suivant :</span></td>
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			<td>{% textarea_tag name=&quot;26e52648&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;D&eacute;signation du bien &quot; data_map_field=&quot;realty_name&quot; data_help=&quot;bien&quot; data_ancien_ids=&quot;1267&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Pour lequel l&#39;acte authentique ou d&eacute;finitif a eu lieu le :&nbsp;</span>{% dateinput_tag name=&quot;b0281ba5&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de l&#39;acte&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Date de l&#39;acte&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</p>

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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Chez Ma&icirc;tre :&nbsp;</span></td>
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			<td>{% textarea_tag name=&quot;42c85b45&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Notaire&quot; data_map_field=&quot;notary&quot; data_help=&quot;Notaire&quot; data_ancien_ids=&quot;6576&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">L&#39;agence ci-dessus d&eacute;sign&eacute;e, a&nbsp;droit &agrave; une r&eacute;mun&eacute;ration, &agrave; notre charge, d&#39;un montant de :</span></td>
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			<td>{% textinput_tag name=&quot;bc4fbc29&quot; data_label=&quot;R&eacute;mun&eacute;ration agence&quot; data_map_field=&quot;fees&quot; data_help=&quot;R&eacute;mun&eacute;ration agence&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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