Admin - Plateforme Administration Editions Préference

Contient un/plusieurs signataires

Reprise des signataires

Peut etre dupliqué

Nombre maximum de block

Texte du bouton 'ajouter'

Texte du bouton 'supprimer'

Ce block contient un

Contenu

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: bottom; width: 50%;">{% select_tag name=&quot;871cxx9a&quot; data_label=&quot;Civilit&eacute;&quot; data_map_field=&quot;civilite&quot; data_help=&quot;Civilit&eacute;&quot; data_choices=&quot;Civilit&eacute;|civilite; Madame / Ms|madame; Monsieur / Mr|monsieur;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nom <span style="font-weight:600;">Last name</span> :</span></td>
			<td style="vertical-align: bottom; width: 50%; text-align: left;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Pr&eacute;nom<span style="font-weight:600;"> First name</span> :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;c3f8ff9f&quot; data_label=&quot;Nom du signataire&quot; data_map_field=&quot;nom&quot; data_help=&quot;Nom du signataire&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;67af634a&quot; data_label=&quot;Pr&eacute;nom du signataire&quot; data_map_field=&quot;prenom&quot; data_help=&quot;Pr&eacute;nom du signataire&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="2" cellspacing="2" style="width:100%;">
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			<td style="vertical-align: middle; width: 70%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail<span style="font-weight:600;"> E-mail</span> :&nbsp;</span></td>
			<td style="vertical-align: middle; width: 30%;">&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">T&eacute;l&nbsp;<span style="font-weight:600;">Phone number</span> :&nbsp;&nbsp;</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;0b645c7c&quot; data_label=&quot;Email du signataire&quot; data_map_field=&quot;email&quot; data_help=&quot;Email du signataire&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% textinput_tag name=&quot;28f36895&quot; data_label=&quot;T&eacute;l du signataire&quot; data_map_field=&quot;tel&quot; data_help=&quot;T&eacute;l du signataire&quot; maxlength=&quot;25&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="break-inside:avoid;width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de naissance <span style="font-weight:600;">Date of birth</span> :</span></td>
			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Lieu de naissance <span style="font-weight:600;">Place of birth</span> :</span></td>
		</tr>
		<tr>
			<td style="width: 30%;">{% dateinput_tag name=&quot;28fdeb1b&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de naissance&quot; data_map_field=&quot;date_naissance&quot; data_help=&quot;Date de naissance&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="width: 70%;">{% textinput_tag name=&quot;01cb48dd&quot; data_label=&quot;Lieu de naissance&quot; data_map_field=&quot;lieu_naissance&quot; data_help=&quot;Lieu de naissance&quot; maxlength=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Autres informations utiles <span style="font-weight:600;">Other useful information</span> :</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;51d7740f&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Autres informations utiles&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Autres informations utiles&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 68%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Adresse <span style="font-weight:600;">Address</span> :</span></td>
		</tr>
		<tr>
			<td style="width: 68%;">{% textinput_tag name=&quot;acdfc6e4&quot; data_label=&quot;Adresse postale du signataire&quot; data_map_field=&quot;adresse&quot; data_help=&quot;Adresse postale du signataire&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="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Code postal&nbsp;<span style="font-weight:600;">Zip code</span> :</span></td>
			<td style="width: 55%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Ville <span style="font-weight:600;">City</span> :</span></td>
			<td style="width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Pays&nbsp;<span style="font-weight:600;">Country</span> :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% textinput_tag name=&quot;64baad57&quot; data_label=&quot;Code Postal du signataire&quot; data_map_field=&quot;zipcode&quot; data_help=&quot;Code Postal du signataire&quot; maxlength=&quot;10&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 55%;">{% textinput_tag name=&quot;8d0dbcc6&quot; data_label=&quot;Ville du signataire&quot; data_map_field=&quot;ville&quot; data_help=&quot;Ville du signataire&quot; maxlength=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 25%;">{% textinput_tag name=&quot;75e7cacb&quot; placeholder=&quot;France&quot; data_label=&quot;Pays du signataire&quot; data_map_field=&quot;pays&quot; data_help=&quot;Pays du signataire&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="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: bottom; width: 50%;">{% select_tag name=&quot;871xsa9b&quot; data_label=&quot;Civilit&eacute; signataire&quot; data_map_field=&quot;civilite&quot; data_help=&quot;Civilit&eacute;&quot; data_choices=&quot;Civilit&eacute;|civilite; Madame / Ms|madame; Monsieur / Mr|monsieur;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nom <span style="font-weight:600;">Last name</span> :</span></td>
			<td style="vertical-align: bottom; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;Pr&eacute;nom<span style="font-weight:600;"> First name</span> :</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;aa8ce05b&quot; data_label=&quot;Nom du signataire&quot; data_map_field=&quot;nom&quot; data_help=&quot;Nom du signataire&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;611c25f9&quot; data_label=&quot;Pr&eacute;nom du signataire&quot; data_map_field=&quot;prenom&quot; data_help=&quot;Pr&eacute;nom du signataire&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="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 70%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail <span style="font-weight:600;">E-mail</span> :&nbsp;</span></td>
			<td style="vertical-align: middle; width: 30%;">&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">T&eacute;l <span style="font-weight:600;">Phone number</span> :&nbsp;&nbsp;</span></td>
		</tr>
		<tr>
			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;579ad53d&quot; data_label=&quot;Email du signataire&quot; data_map_field=&quot;email&quot; data_help=&quot;Email du signataire&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% textinput_tag name=&quot;89df3922&quot; data_label=&quot;T&eacute;l du signataire&quot; data_map_field=&quot;tel&quot; data_help=&quot;T&eacute;l du signataire&quot; maxlength=&quot;25&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="break-inside:avoid;width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de naissance&nbsp;<span style="font-weight:600;">Date of birth</span> :</span></td>
			<td style="width: 80%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Lieu de naissance <span style="font-weight:600;">Place of birth</span> :</span></td>
		</tr>
		<tr>
			<td style="width: 30%;">{% dateinput_tag name=&quot;641bd7e8&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de naissance&quot; data_map_field=&quot;date_naissance&quot; data_help=&quot;Date de naissance&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="width: 70%;">{% textinput_tag name=&quot;9bd33ab4&quot; data_label=&quot;Lieu de naissance&quot; data_map_field=&quot;lieu_naissance&quot; data_help=&quot;Lieu de naissance&quot; maxlength=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 20%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Code postal <span style="font-weight:600;">Zip code</span> :</span></td>
			<td style="width: 55%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Ville <span style="font-weight:600;">City</span> :</span></td>
			<td style="width: 25%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Pays&nbsp;<span style="font-weight:600;">Country</span> :</span></td>
		</tr>
		<tr>
			<td style="width: 20%;">{% textinput_tag name=&quot;64baad57&quot; data_label=&quot;Code Postal du signataire&quot; data_map_field=&quot;zipcode&quot; data_help=&quot;Code Postal du signataire&quot; maxlength=&quot;10&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 55%;">{% textinput_tag name=&quot;8d0dbcc6&quot; data_label=&quot;Ville du signataire&quot; data_map_field=&quot;ville&quot; data_help=&quot;Ville du signataire&quot; maxlength=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 25%;">{% textinput_tag name=&quot;75e7cacb&quot; placeholder=&quot;France&quot; data_label=&quot;Pays du signataire&quot; data_map_field=&quot;pays&quot; data_help=&quot;Pays du signataire&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="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Autres informations utiles <span style="font-weight:600;">Other useful information</span> :</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;af9f60fa&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Autres informations utiles&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Autres informations utiles&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

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			<td><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 /&nbsp;You have the possibility of registering on www.bloctel.gouv.fr to oppose any telephone canvassing in accordance with article L223-1 of the Consumer Code</em></span></span></td>
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</table>

Mode Simplifié

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>{{871cxx9a}}&nbsp;{{c3f8ff9f</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;{{67af634a</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}} </strong>demeurant/Resident<strong>&nbsp;{{5acdfc6e4</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;{{64baad57</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;{{8d0dbcc6</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}</strong>, <strong>{{75e7cacb</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}},</strong><br />
&bull; E-mail&nbsp;: <strong>{{0b645c7c</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}</strong>, &bull; T&eacute;l&eacute;phone/Phone&nbsp;number :&nbsp;<strong>{{28f36895</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;</strong><br />
&bull; Lieu de naissance/Place of birth&nbsp;:&nbsp;<strong>{{01cb48dd</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}</strong>, le/The&nbsp;<strong>{{28fdeb1b</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}</strong></span><br />
&nbsp;</p>

<p><span style="font-family: ITCAvantGardePro; font-size: 12px;">Autres informations utiles/Other useful information :&nbsp;</span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>{{51d7740f</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;</strong></span></p>

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>{{871xsa9b</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;{{aa8ce05b</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;{{611c25f9</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}} </strong>demeurant/Resident&nbsp;<strong>{{5acdfc6e4}}&nbsp;{{64baad57}}&nbsp;{{8d0dbcc6}}</strong>, <strong>{{75e7cacb}},</strong><br />
&bull; E-mail&nbsp;: <strong>{{579ad53d</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}</strong>, &bull; T&eacute;l&eacute;phone/Phone&nbsp;number :&nbsp;<strong>{{89df3922</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;</strong><br />
&bull; Lieu de naissance/Place of birth&nbsp;:&nbsp;<strong>{{9bd33ab4</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}</strong>, le/The&nbsp;<strong>{{641bd7e8</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}</strong></span><br />
<br />
<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Autres informations utiles/Other useful information :&nbsp;<strong>{{af9f60fa</strong></span><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>}}&nbsp;</strong></span></p>

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