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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

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			<p style="text-align: justify;"><span style="font-family: ITCAvantGardePro; font-size: 12px;"><span style="font-weight:600;">INFORMATIONS D&Eacute;BITEUR</span></span><span style="font-size: 10px;"><span style="font-family: ITCAvantGardePro;">&nbsp;</span></span><span style="font-size: 8px;"><span style="font-family: ITCAvantGardePro;"><em>Veuillez compl&eacute;ter les champs marqu&eacute;s *</em></span></span></p>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
				<tbody>
					<tr>
						<td style="width: 15%;"><span style="font-size:10px;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro;">Votre nom</span></span></span></td>
						<td style="width: 3%; text-align: right;">*</td>
						<td colspan="5" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;defbdd37&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Nom et pr&eacute;nom du d&eacute;biteur&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Nom et pr&eacute;nom du d&eacute;biteur&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
					</tr>
					<tr>
						<td style="width: 15%;">&nbsp;</td>
						<td style="width: 3%;">&nbsp;</td>
						<td colspan="5" rowspan="1" style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Nom / Pr&eacute;nom du d&eacute;biteur</span></span></em></td>
					</tr>
					<tr>
						<td style="width: 15%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Votre adresse</span></span></td>
						<td style="width: 3%; text-align: right;">*</td>
						<td colspan="5" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;cf2d47f2&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse du d&eacute;biteur&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Adresse du d&eacute;biteur&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
					</tr>
					<tr>
						<td style="width: 15%;">&nbsp;</td>
						<td style="width: 3%;">&nbsp;</td>
						<td colspan="5" rowspan="1" style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Num&eacute;ro et nom de la rue</span></span></em></td>
					</tr>
					<tr>
						<td style="width: 15%;">&nbsp;</td>
						<td style="width: 3%; text-align: right;">*</td>
						<td colspan="3" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;f9e61f53&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Code postal et ville du d&eacute;biteur&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Code postal et ville du d&eacute;biteur&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
						<td style="width: 3%; text-align: right;">*</td>
						<td style="width: 25%;">{% textarea_tag name=&quot;ec952aa5&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Pays du d&eacute;biteur&quot; data_map_field=&quot;nomap&quot; placeholder=&quot;France&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
					</tr>
					<tr>
						<td style="width: 15%;">&nbsp;</td>
						<td style="width: 3%;">&nbsp;</td>
						<td colspan="3" rowspan="1" style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Code Postal / Ville</span></span></em></td>
						<td style="width: 3%;">&nbsp;</td>
						<td style="width: 25%;"><span style="font-size:9px;"><em><span style="font-family: ITCAvantGardePro; font-weight: 200;">Pays</span></em></span></td>
					</tr>
					<tr>
						<td colspan="1" rowspan="2" style="width: 15%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Coordonn&eacute;es de<br />
						votre compte</span></span></td>
						<td style="width: 3%; text-align: right;">*</td>
						<td colspan="5" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;7d336534&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Num&eacute;ro d&rsquo;identification international du compte bancaire - IBAN (International Bank Account Number)&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Num&eacute;ro d&rsquo;identification international du compte bancaire - IBAN (International Bank Account Number)&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
					</tr>
					<tr>
						<td style="width: 3%;">&nbsp;</td>
						<td colspan="5" rowspan="1" style="width: 25%;"><span style="line-height:1;"><span style="font-size:9px;"><em><span style="font-family: ITCAvantGardePro; font-weight: 200;">Num&eacute;ro d&rsquo;identification international du compte bancaire - IBAN (International Bank Account Number)</span></em></span></span></td>
					</tr>
					<tr>
						<td style="width: 15%;">&nbsp;</td>
						<td style="width: 3%; text-align: right;">*</td>
						<td colspan="5" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;98088b40&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Code international d&rsquo;identification de votre banque - BIC (Bank Identifier Code)&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Code international d&rsquo;identification de votre banque - BIC (Bank Identifier Code)&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
					</tr>
					<tr>
						<td style="width: 15%;">&nbsp;</td>
						<td style="width: 3%;">&nbsp;</td>
						<td colspan="5" rowspan="1" style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Code international d&rsquo;identification de votre banque - BIC (Bank Identifier Code)</span></span></em></td>
					</tr>
					<tr>
						<td style="width: 15%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Sign&eacute; &agrave;</span></span></td>
						<td style="width: 3%; text-align: right;">*</td>
						<td style="width: 25%;">{% dateinput_tag name=&quot;238ff354&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de signature&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Date de signature&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
						<td style="width: 3%; text-align: right;">*</td>
						<td colspan="3" rowspan="1" style="width: 26px;">{% textarea_tag name=&quot;0fb0e7a9&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Lieu de signature&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Lieu de signature&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
					</tr>
					<tr>
						<td style="width: 15%;">&nbsp;</td>
						<td style="width: 3%;">&nbsp;</td>
						<td style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Date</span></span></em></td>
						<td style="width: 3%;">&nbsp;</td>
						<td colspan="3" rowspan="1" style="width: 26px;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Lieu</span></span></em></td>
					</tr>
					<tr>
						<td style="width: 15%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Signature(s)</span></span></td>
						<td style="width: 3%;">&nbsp;</td>
						<td colspan="5" rowspan="1" style="width: 25%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Veuillez signer ici</span></span></td>
					</tr>
					<tr height="100px">
						<td style="width: 15%;">&nbsp;</td>
						<td style="width: 3%;">&nbsp;</td>
						<td colspan="5" rowspan="1" style="border: 1px solid black;">&nbsp;</td>
					</tr>
				</tbody>
			</table>

<p><span style="font-size:9px;"><em><span style="font-family: ITCAvantGardePro; font-weight: 200;">Note : Vos droits concernant le pr&eacute;sent mandat sont expliqu&eacute;s dans un document que vous pouvez obtenir aupr&egrave;s de votre banque.</span></em></span></p>

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Reprise de donn&eacute;es date :&nbsp;{% dateinput_tag name=&quot;e4848d4d&quot; placeholder=&quot;jj/mm/aaaa&quot; data_help=&quot;Reprise de donns&quot; replaced_id=&quot;Reprise de donnes&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}&nbsp; en champ imput :&nbsp;{% textinput_tag name=&quot;e4848d4d&quot; data_label=&quot;input&quot; maxlength=&quot;10&quot; style=&quot;max-width:80px;min-width:80px;width:80px;&quot; fixedwidth=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp;</span></p>

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% textarea_tag name=&quot;e4848d4d&quot; data_width=&quot;30&quot; rows=&quot;1&quot; data_label=&quot;texte area&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</span></p>

<div style="page-break-inside: avoid;">
			<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
				<tbody>
					<tr>
						<td>{% select_tag name=&quot;dc65f323&quot; data_label=&quot;test correspondance select&quot; data_choices=&quot;select 1 choix A |A; select 1 choix B |B; select 1 choix C |C;&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>{% select_tag name=&quot;dc65f323&quot; data_label=&quot;test correspondance select&quot; data_choices=&quot;A = A |A; B = B |B; C = C |C;&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>
						<h2><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span class="titre_p" style="font-size: 18px; font-weight: 900;">TEST Chek :&nbsp;</span></span>{% radio_tag name=&quot;0051fd81&quot; data_label=&quot;oui non&quot; data_choices=&quot;oui|oui; non|non;&quot; checked=&quot;non&quot; %}</h2>
						</td>
					</tr>
					<tr>
						<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Immeuble sis &agrave;</span></td>
					</tr>
					<tr>
						<td>{% textarea_tag name=&quot;258bb751&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse du bien&quot; data_map_field=&quot;full_address&quot; data_help=&quot;Adresse du bien&quot; data_value=&quot;test texte d&eacute;j&agrave; pr&eacute;sent dans blocarea&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
					</tr>
				</tbody>
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			</div>

<div style="page-break-inside: avoid;">
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						<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;signation&nbsp;</span></td>
					</tr>
					<tr>
						<td>{% textarea_tag name=&quot;455019e6&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;D&eacute;signation du bien&quot; relation_ids_list=&quot;826da781&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
					</tr>
				</tbody>
			</table>
			</div>

<p style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span style="font-weight:600;">INFORMATIONS D&Eacute;BITEUR</span></span><span style="font-size:10px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">&nbsp;</span></span><span style="font-size:8px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><em>Veuillez compl&eacute;ter les champs marqu&eacute;s *</em></span></span></p>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
				<tbody>
					<tr>
						<td>
						<h2><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span class="titre_p" style="font-size: 18px; font-weight: 900;">TEST Chek :&nbsp;</span></span>{% radio_tag name=&quot;0051fd81&quot; data_label=&quot;oui non&quot; data_choices=&quot;oui|oui; non|non;&quot; checked=&quot;oui&quot; %}</h2>
						</td>
					</tr>
					<tr>
						<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Immeuble sis &agrave;</span></td>
					</tr>
					<tr>
						<td>{% textarea_tag name=&quot;258bb751&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse du bien&quot; data_map_field=&quot;full_address&quot; data_help=&quot;Adresse du bien&quot; data_value=&quot;test texte d&eacute;j&agrave; pr&eacute;sent dans blocarea&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
					</tr>
				</tbody>
			</table>
			</div>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td style="width: 15%;"><span style="font-size:10px;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro;">Votre nom</span></span></span></td>
			<td style="width: 3%; text-align: right;">*</td>
			<td colspan="5" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;defbdd37&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Nom et pr&eacute;nom du d&eacute;biteur&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Nom et pr&eacute;nom du d&eacute;biteur&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 3%;">&nbsp;</td>
			<td colspan="5" rowspan="1" style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Nom / Pr&eacute;nom du d&eacute;biteur</span></span></em></td>
		</tr>
		<tr>
			<td style="width: 15%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Votre adresse</span></span></td>
			<td style="width: 3%; text-align: right;">*</td>
			<td colspan="5" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;cf2d47f2&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse du d&eacute;biteur&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Adresse du d&eacute;biteur&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 3%;">&nbsp;</td>
			<td colspan="5" rowspan="1" style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Num&eacute;ro et nom de la rue</span></span></em></td>
		</tr>
		<tr>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 3%; text-align: right;">*</td>
			<td colspan="3" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;f9e61f53&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Code postal et ville du d&eacute;biteur&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Code postal et ville du d&eacute;biteur&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 3%; text-align: right;">*</td>
			<td style="width: 25%;">{% textarea_tag name=&quot;ec952aa5&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Pays du d&eacute;biteur&quot; data_map_field=&quot;nomap&quot; placeholder=&quot;France&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 3%;">&nbsp;</td>
			<td colspan="3" rowspan="1" style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Code Postal / Ville</span></span></em></td>
			<td style="width: 3%;">&nbsp;</td>
			<td style="width: 25%;"><span style="font-size:9px;"><em><span style="font-family: ITCAvantGardePro; font-weight: 200;">Pays</span></em></span></td>
		</tr>
		<tr>
			<td colspan="1" rowspan="2" style="width: 15%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Coordonn&eacute;es de<br />
			votre compte</span></span></td>
			<td style="width: 3%; text-align: right;">*</td>
			<td colspan="5" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;7d336534&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Num&eacute;ro d&rsquo;identification international du compte bancaire - IBAN (International Bank Account Number)&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Num&eacute;ro d&rsquo;identification international du compte bancaire - IBAN (International Bank Account Number)&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="width: 3%;">&nbsp;</td>
			<td colspan="5" rowspan="1" style="width: 25%;"><span style="line-height:1;"><span style="font-size:9px;"><em><span style="font-family: ITCAvantGardePro; font-weight: 200;">Num&eacute;ro d&rsquo;identification international du compte bancaire - IBAN (International Bank Account Number)</span></em></span></span></td>
		</tr>
		<tr>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 3%; text-align: right;">*</td>
			<td colspan="5" rowspan="1" style="width: 25%;">{% textarea_tag name=&quot;98088b40&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Code international d&rsquo;identification de votre banque - BIC (Bank Identifier Code)&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Code international d&rsquo;identification de votre banque - BIC (Bank Identifier Code)&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 3%;">&nbsp;</td>
			<td colspan="5" rowspan="1" style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Code international d&rsquo;identification de votre banque - BIC (Bank Identifier Code)</span></span></em></td>
		</tr>
		<tr>
			<td style="width: 15%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Sign&eacute; &agrave;</span></span></td>
			<td style="width: 3%; text-align: right;">*</td>
			<td style="width: 25%;">{% dateinput_tag name=&quot;238ff354&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de signature&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Date de signature&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
			<td style="width: 3%; text-align: right;">*</td>
			<td colspan="3" rowspan="1" style="width: 26px;">{% textarea_tag name=&quot;0fb0e7a9&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Lieu de signature&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Lieu de signature&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 3%;">&nbsp;</td>
			<td style="width: 25%;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Date</span></span></em></td>
			<td style="width: 3%;">&nbsp;</td>
			<td colspan="3" rowspan="1" style="width: 26px;"><em><span style="font-size:9px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;">Lieu</span></span></em></td>
		</tr>
		<tr>
			<td style="width: 15%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Signature(s)</span></span></td>
			<td style="width: 3%;">&nbsp;</td>
			<td colspan="5" rowspan="1" style="width: 25%;"><span style="font-weight:600;"><span style="font-family: ITCAvantGardePro; font-size: 10px;">Veuillez signer ici</span></span></td>
		</tr>
		<tr height="100px">
			<td style="width: 15%;">&nbsp;</td>
			<td style="width: 3%;">&nbsp;</td>
			<td colspan="5" rowspan="1" style="border: 1px solid black;">&nbsp;</td>
		</tr>
	</tbody>
</table>

<div style="page-break-inside: avoid;">
<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td>{% select_tag name=&quot;dc65f323&quot; data_label=&quot;test correspondance select&quot; data_choices=&quot;select 1 choix A |A; select 1 choix B |B; select 1 choix C |C;&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>{% select_tag name=&quot;dc65f323&quot; data_label=&quot;test correspondance select&quot; data_choices=&quot;A = A |A; B = B |B; C = C |C;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

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			<td>
			<h2><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><span class="titre_p" style="font-size: 18px; font-weight: 900;">TEST Chek :&nbsp;</span></span>{% radio_tag name=&quot;0051fd81&quot; data_label=&quot;oui non&quot; data_choices=&quot;oui|oui; non|non;&quot; checked=&quot;oui&quot; %}</h2>
			</td>
		</tr>
		<tr>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Immeuble sis &agrave;</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;258bb751&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;Adresse du bien&quot; data_map_field=&quot;full_address&quot; data_help=&quot;Adresse du bien&quot; data_value=&quot;test texte d&eacute;j&agrave; pr&eacute;sent dans blocarea&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
		</tr>
	</tbody>
</table>
</div>

<div style="page-break-inside: avoid;">
<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;signation&nbsp;</span></td>
		</tr>
		<tr>
			<td>{% textarea_tag name=&quot;455019e6&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;D&eacute;signation du bien&quot; relation_ids_list=&quot;826da781&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>
</div>

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