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<table border="0" cellpadding="1" cellspacing="5" style="width:100%;">
	<tbody>
		<tr>
			<td colspan="3" style="vertical-align: middle; width: 3%;">SOMME &Agrave; FINANCER&nbsp;</td>
		</tr>
		<tr>
			<td style="text-align: right; vertical-align: middle; width: 3%;">&bull;&nbsp;</td>
			<td style="text-align: left; vertical-align: middle; width: 35%; white-space: nowrap;">Prix principal de la vente :</td>
			<td style="width: 18%; text-align: right;">{% textinput_tag name=&quot;fa66d619&quot; data_label=&quot;Prix principal de la vente&quot; data_map_field=&quot;sell_price&quot; data_help=&quot;Prix principal de la vente&quot; maxlength=&quot;20&quot; data_ancien_ids=&quot;2611&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
		<tr>
			<td style="text-align: right; vertical-align: middle; width: 3%;">&bull;&nbsp;</td>
			<td style="text-align: left; vertical-align: middle; width: 35%; white-space: nowrap;">Provision pour frais d&#39;acte (estimation) :</td>
			<td style="width: 18%; text-align: right;">{% textinput_tag name=&quot;5ea682a7&quot; data_label=&quot;Provision pour frais d&#39;acte&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Provision pour frais d&#39;acte&quot; maxlength=&quot;20&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="text-align: right; vertical-align: middle; width: 3px;">&bull;&nbsp;</td>
			<td style="text-align: left; vertical-align: middle; width: 3px; white-space: nowrap;">Provision pour frais d&#39;emprunt :</td>
			<td style="width: 18%; text-align: right;">{% textinput_tag name=&quot;0752e9fd&quot; data_label=&quot;Provision pour frais d&#39;emprunt&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Provision pour frais d&#39;emprunt&quot; maxlength=&quot;20&quot; data_ancien_ids=&quot;2658&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
		<tr>
			<td style="text-align: right; vertical-align: middle; width: 3%;">&bull;&nbsp;</td>
			<td style="text-align: left; vertical-align: middle; width: 3%; white-space: nowrap;">Honoraires agence charge ACQU&Eacute;REUR :</td>
			<td style="width: 18%; text-align: right;">{% textinput_tag name=&quot;16b235c3&quot; data_label=&quot;Honoraires agence charge ACQU&Eacute;REUR&quot; data_map_field=&quot;fees_buyer&quot; data_help=&quot;Honoraires agence charge ACQU&Eacute;REUR&quot; maxlength=&quot;20&quot; data_ancien_ids=&quot;2680&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
		<tr>
			<td style="text-align: right; vertical-align: middle; width: 3%;">&bull;&nbsp;</td>
			<td style="text-align: left; vertical-align: middle; width: 75%;">{% textinput_tag name=&quot;dabc9f26&quot; data_label=&quot;Autre somme &agrave; financer 1&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Autre somme &agrave; financer 1&quot; maxlength=&quot;85&quot; data_ancien_ids=&quot;2869&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 18%; text-align: right;">{% textinput_tag name=&quot;2457fe84&quot; data_label=&quot;Montant autre somme &agrave; financer 1&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Montant autre somme &agrave; financer 1&quot; data_ancien_ids=&quot;2702&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
		<tr>
			<td style="text-align: right; vertical-align: middle; width: 3%;">&bull;&nbsp;</td>
			<td style="text-align: left; vertical-align: middle; width: 75%;">{% textinput_tag name=&quot;a166f1c0&quot; data_label=&quot;Autre somme &agrave; financer 2&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Autre somme &agrave; financer 2&quot; maxlength=&quot;85&quot; data_ancien_ids=&quot;21559&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 18%; text-align: right;">{% textinput_tag name=&quot;61840489&quot; data_label=&quot;Montant autre somme &agrave; financer 2&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Montant autre somme &agrave; financer 2&quot; maxlength=&quot;20&quot; data_ancien_ids=&quot;21535&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
		<tr>
			<td style="text-align: right; vertical-align: middle; width: 3%;">&bull;&nbsp;</td>
			<td style="text-align: left; vertical-align: middle; width: 75%;">{% textinput_tag name=&quot;89845788&quot; data_label=&quot;Autre somme &agrave; financer 3&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Autre somme &agrave; financer 3&quot; maxlength=&quot;85&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 18%; text-align: right;">{% textinput_tag name=&quot;44abd6ec&quot; data_label=&quot;Montant autre somme &agrave; financer 3&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Montant autre somme &agrave; financer 3&quot; maxlength=&quot;20&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td style="text-align: right; vertical-align: middle;">TOTAL :&nbsp;</td>
			<td style="width: 18%; text-align: right;">{% textinput_tag name=&quot;88098eca&quot; data_label=&quot;Total somme &agrave; financer&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Total somme &agrave; financer&quot; maxlength=&quot;20&quot; data_ancien_ids=&quot;2724&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
	</tbody>
</table>

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