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<table border="1" cellpadding="0" cellspacing="0" style="width: 100%; border-color: rgb(165, 100, 75);">
	<tbody>
		<tr>
			<td>
			<table border="0" cellpadding="2" cellspacing="2" style="width:100%; padding:10px ; padding-bottom:3px">
				<tbody>
					<tr>
						<td colspan="7" style="width:15%">INFORMATIONS CR&Eacute;ANCIER</td>
					</tr>
					<tr>
						<td style="width:15%">Votre adresse</td>
						<td style="width:3%; text-align:right">*</td>
						<td style="width:25%">{% textinput_tag name=&quot;e610e873&quot; value=&quot;FR59ZZZ85AD4D&quot; data_label=&quot;Identifiant du cr&eacute;ancier&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;50&quot; style=&quot;max-width:200px;min-width:200px;width:150px;&quot; fixedwidth=&quot;150&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
						<td style="width:3%; text-align:right">*</td>
						<td colspan="3" rowspan="1" style="width:26%">{% textinput_tag name=&quot;d0ffcca0&quot; value=&quot;SAS JUNOT CARIOCA&quot; data_label=&quot;NOM du cr&eacute;ancier&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;50&quot; style=&quot;max-width:180px;min-width:180px;width:180px;&quot; fixedwidth=&quot;180&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%">Identifiant du cr&eacute;ancier</td>
						<td style="width:3%">&nbsp;</td>
						<td colspan="3" rowspan="1" style="width:26%">Nom du cr&eacute;ancier</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%">{% textinput_tag name=&quot;y666e875&quot; value=&quot;23 bis, avenue Junot&quot; data_label=&quot;Num&eacute;ro et nom de rue&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;50&quot; style=&quot;max-width:200px;min-width:200px;width:200px;&quot; fixedwidth=&quot;200&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%">Num&eacute;ro et nom de la rue</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%">{% textinput_tag name=&quot;e610e995&quot; value=&quot;75018&quot; data_label=&quot;Code postal&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Code Postal&quot; maxlength=&quot;50&quot; style=&quot;max-width:50px;min-width:50px;width:50px;&quot; fixedwidth=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp; *{% textinput_tag name=&quot;e610e775&quot;&nbsp; value=&quot;Paris&quot;&nbsp; data_label=&quot;Ville&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;100&quot; style=&quot;max-width:100px;min-width:100px;width:100px;&quot; fixedwidth=&quot;100&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}&nbsp; *{% textinput_tag name=&quot;e610x495&quot;&nbsp; value=&quot;France&quot;&nbsp; data_label=&quot;Pays&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;180&quot; style=&quot;max-width:180px;min-width:150px;width:150px;&quot; fixedwidth=&quot;50&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%">Code postal&nbsp; &nbsp;&nbsp;Ville&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;Pays</td>
					</tr>
					<tr>
						<td style="width:15%">Cr&eacute;ancier</td>
						<td style="width:3%; text-align:right">*</td>
						<td colspan="5" rowspan="1" style="width:25%">{% textinput_tag name=&quot;e610e875&quot; value=&quot;Paiement r&eacute;current / r&eacute;p&eacute;titif&quot; data_label=&quot;Type de paiement&quot; data_map_field=&quot;nomap&quot; maxlength=&quot;50&quot; style=&quot;max-width:400px;min-width:200px;width:200px;&quot; fixedwidth=&quot;200&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%">Type de paiement</td>
					</tr>
				</tbody>
			</table>
			</td>
		</tr>
	</tbody>
</table>

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