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Reprise des signataires

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<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
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			<td style="width: 20%; vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Forme juridique :</span></td>
			<td style="width: 15%;">{% select_tag name=&quot;d2b280ff&quot; data_label=&quot;Forme juridique&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Forme juridique&quot; data_choices=&quot;SARL ou EURL|SARL ou EURL; SAS ou SASU|SAS ou SASU; SCI|SCI; Autre|Autre;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 15%; vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">si autre :</span></td>
			<td style="width: 55%;">{% textinput_tag name=&quot;d902bea7&quot; data_label=&quot;autre forme juridique&quot; data_map_field=&quot;nomap&quot; data_help=&quot;autre forme juridique&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 20%; vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Num&eacute;ro de SIREN :</span></td>
			<td>{% numberinput_tag name=&quot;21eeb648&quot; data_label=&quot;Num&eacute;ro de SIREN&quot; data_map_field=&quot;rcs_num&quot; data_help=&quot;9 chiffres du num&eacute;ro SIREN&quot; maxlength=&quot;9&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Ville d&#39;immatriculation :</span></td>
			<td>{% textinput_tag name=&quot;16295b49&quot; data_label=&quot;Ville d&#39;immatriculation de la soci&eacute;t&eacute;&quot; data_map_field=&quot;rcs_place&quot; data_help=&quot;Ville d&#39;immatriculation de la soci&eacute;t&eacute;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de d&eacute;but d&#39;activit&eacute; :</span></td>
			<td>{% dateinput_tag name=&quot;281021e9&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de d&eacute;but d&#39;activit&eacute;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Date de d&eacute;but d&#39;activit&eacute;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Chiffre d&#39;affaires du dernier exercice social :</span></td>
			<td>{% textinput_tag name=&quot;8dbc3a33&quot; data_label=&quot;Chiffre d&#39;affaires du dernier exercice social&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Chiffre d&#39;affaires du dernier exercice social&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle; width: 35%;">
			<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">R&eacute;sultats constat&eacute;s au dernier exercice social :</span></p>
			</td>
			<td>{% textarea_tag name=&quot;fc2f3856&quot; data_width=&quot;100&quot; rows=&quot;1&quot; data_label=&quot;R&eacute;sultats constat&eacute;s au dernier exercice social&quot; data_map_field=&quot;nomap&quot; data_help=&quot;R&eacute;sultats constat&eacute;s au dernier exercice social&quot; data_ancien_ids=&quot;22124&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 27%; vertical-align: middle;">
			<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Repr&eacute;sentant de la soci&eacute;t&eacute; (nom et pr&eacute;nom) :</span></p>
			</td>
			<td style="width: 15px;">{% textinput_tag name=&quot;580633a9&quot; data_label=&quot;Nom et pr&eacute;nom du repr&eacute;sentant de la soci&eacute;t&eacute;&quot; data_map_field=&quot;nom&quot; data_help=&quot;Nom et pr&eacute;nom du repr&eacute;sentant de la soci&eacute;t&eacute;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="width: 15%; vertical-align: middle;">
			<p><font face="ITCAvantGardePro"><span style="font-size: 12px;">qualit&eacute; :</span></font></p>
			</td>
			<td style="width: 30%;">{% textinput_tag name=&quot;3885f2e7&quot; data_label=&quot;Qualit&eacute; du repr&eacute;sentant&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Qualit&eacute; du repr&eacute;sentant&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;">Le signataire du pr&eacute;sent engagement d&eacute;clare avoir tous les pouvoirs &agrave; cette fin.</span></p>

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			<td colspan="2" style="width: 40%; vertical-align: middle;"><span style="font-size:18px;"><span style="font-family:ITCAvantGardePro;"><span style="font-weight:200;">Informations financi&egrave;res</span></span></span></td>
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			<td style="width: 40%; vertical-align: middle;">
			<ul>
				<li><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">chiffre d&#39;affaires du dernier exercice social :</span></li>
			</ul>
			</td>
			<td style="width: 60%;">{% textinput_tag name=&quot;ca51cca3&quot; data_label=&quot;Chiffre d&#39;affaires du dernier exercice social&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Chiffre d&#39;affaires du dernier exercice social&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 40%; vertical-align: middle;">
			<ul>
				<li><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">r&eacute;sultats constat&eacute;s au dernier exercice social :</span></li>
			</ul>
			</td>
			<td style="width: 60%;">{% textinput_tag name=&quot;f341e4ec&quot; data_label=&quot;R&eacute;sultats constat&eacute;s au dernier exercice social&quot; data_map_field=&quot;nomap&quot; data_help=&quot;R&eacute;sultats constat&eacute;s au dernier exercice social&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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<table border="0" cellpadding="1" cellspacing="4" style="break-inside:avoid;width:100%;">
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	<p style="text-align: left;">&nbsp;</p>
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			<td colspan="3" style="width: 33%;"><span style="font-size:18px;"><span style="font-weight:200;"><span style="font-family:ITCAvantGardePro;"><span class="titre_p">Pi&egrave;ces &agrave; fournir</span></span></span></span></td>
		</tr>
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			<td style="width: 33%;">{% checkbox_tag name=&quot;4b11d6d3&quot; data_label=&quot;Pi&egrave;ce d&rsquo;identit&eacute;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Pi&egrave;ce d&rsquo;identit&eacute;&quot; data_ancien_ids=&quot;6376&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; pi&egrave;ce d&rsquo;identit&eacute;</span></td>
			<td style="width: 33%;">{% checkbox_tag name=&quot;8e001fcd&quot; data_label=&quot;Copie de la carte professionnelle pour les lib&eacute;raux&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Copie de la carte professionnelle pour les lib&eacute;raux&quot; data_ancien_ids=&quot;6353&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; copie de la carte professionnelle pour les professionnels lib&eacute;raux</span></td>
			<td style="width: 33%;">{% checkbox_tag name=&quot;ba7f1e57&quot; data_label=&quot;Derniers statuts &agrave; jour de la soci&eacute;t&eacute;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Derniers statuts &agrave; jour de la soci&eacute;t&eacute;&quot; data_ancien_ids=&quot;6420&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; derniers statuts &agrave; jour de la soci&eacute;t&eacute;</span></td>
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			<td style="width: 33%;">{% checkbox_tag name=&quot;d8c0e492&quot; data_label=&quot;Extrait Kbis du RCS de moins de 3 mois&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Extrait Kbis du RCS de moins de 3 mois&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp;extrait Kbis du RCS de moins de 3 mois</span></td>
			<td colspan="2" rowspan="1" style="width: 33%;">{% checkbox_tag name=&quot;7e879b26&quot; data_label=&quot;Les 2 derniers bilans de l&#39;entreprise ou le bilan pr&eacute;visionnel de l&#39;exercice &agrave; venir &eacute;tabli par un comptable si la soci&eacute;t&eacute; n&#39;a pas encore de bilan&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Les 2 derniers bilans de l&#39;entreprise ou le bilan pr&eacute;visionnel de l&#39;exercice &agrave; venir &eacute;tabli par un comptable si la soci&eacute;t&eacute; n&#39;a pas encore de bilan&quot; data_ancien_ids=&quot;6331&quot; %}<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">&nbsp; les 2 derniers bilans de l&#39;entreprise ou le bilan pr&eacute;visionnel de l&#39;exercice &agrave; venir &eacute;tabli par un comptable si la soci&eacute;t&eacute; n&#39;a pas encore de bilan</span></td>
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