Admin - Plateforme Administration Editions Préference

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<table border="0" cellpadding="1" cellspacing="5" style="width:100%;">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;nomination sociale :</span></td>
		</tr>
		<tr>
			<td>{% textinput_tag name=&quot;ab03824b&quot; data_label=&quot;D&eacute;nomination sociale&quot; data_help=&quot;D&eacute;nomination sociale&quot; maxlength=&quot;100&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="5" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Immatricum&eacute;e au RCS de :</span></td>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Sous le num&eacute;ro :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;66cded07&quot; data_label=&quot;Lieu RCS&quot; data_help=&quot;Lieu RCS&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;79bc8f8a&quot; data_label=&quot;num&eacute;ro RCS&quot; data_help=&quot;num&eacute;ro RCS&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="5" style="width:100%;">
	<caption>
	<p style="text-align: left;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Repr&eacute;sent&eacute;e par :</span></p>
	</caption>
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;bf3d137b&quot; data_label=&quot;Nom et pr&eacute;nom du g&eacute;rant&quot; data_help=&quot;Nom et pr&eacute;nom du g&eacute;rant&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">en sa qualit&eacute; de G&eacute;rant,</span></td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="5" style="width:100%;">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">dont le si&egrave;ge social est domicili&eacute; :&nbsp;</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;39f7953a&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse si&egrave;ge social&quot; data_help=&quot;Adresse si&egrave;ge social&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="1" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 7%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail :&nbsp;</span></td>
			<td style="width: 65%;">{% textinput_tag name=&quot;5a87576a&quot; data_label=&quot;E mail bailleur&quot; data_help=&quot;E mail bailleur&quot; maxlength=&quot;65&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 5%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Tel :</span></td>
			<td style="vertical-align: middle; width: 20%;">{% textinput_tag name=&quot;b8a4c0b8&quot; data_label=&quot;T&eacute;l&eacute;phone bailleur&quot; data_help=&quot;T&eacute;l&eacute;phone bailleur&quot; maxlength=&quot;22&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<p style="text-align: justify;"><span style="font-size:8px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><em>Vous avez la possibilit&eacute; de vous inscrire sur www.bloctel.gouv.fr pour vous opposer &agrave; tout d&eacute;marchage t&eacute;l&eacute;phonique conform&eacute;ment &agrave; l&#39;article L223-1 du Code de la consommation.</em>&nbsp;</span></span></p>

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