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			<td style="background-color: rgb(238, 238, 238); padding:5px; padding-top:10px; text-align: center;"><span class="titre_p" style="font-family:ITCAvantGardePro;font-size:18px;font-weight:900;">RENSEIGNEMENTS RELATIFS &Agrave; L&rsquo;AGENCE IMMOBILI&Egrave;RE</span></td>
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			<td colspan="5" style="width: 15%; vertical-align: middle; text-align:center; background-color: rgb(255, 255, 255);">&nbsp;</td>
			<td colspan="5" style="width: 15%; vertical-align: middle; padding:5px; padding-top:10px; text-align: center; background-color: rgb(1, 60, 166); white-space: nowrap;"><span style="color:#ffffff;"><span class="titre_p" style="font-family:ITCAvantGardePro;font-size:18px;font-weight:900;">&nbsp; Informations relatives &agrave; l&rsquo;entreprise&nbsp;(joindre un extrait k-bis)&nbsp;&nbsp;</span></span></td>
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			<td style="vertical-align: middle; width: 30%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">R&eacute;gion d&rsquo;exercice de votre activit&eacute; :&nbsp;</span>{% textinput_tag name=&quot;3cecb409&quot; data_label=&quot;R&eacute;gion d&rsquo;exercice de votre activit&eacute;&quot; data_map_field=&quot;nomap&quot; data_help=&quot;R&eacute;gion d&rsquo;exercice de votre activit&eacute;&quot; maxlength=&quot;60&quot; style=&quot;max-width:480px;min-width:480px;width:480px;&quot; fixedwidth=&quot;480&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%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">D&eacute;partement d&rsquo;exercice de votre activit&eacute; :&nbsp;</span>{% textinput_tag name=&quot;324942fd&quot; data_label=&quot;D&eacute;partement d&rsquo;exercice de votre activit&eacute; &quot; data_map_field=&quot;nomap&quot; data_help=&quot;D&eacute;partement d&rsquo;exercice de votre activit&eacute; &quot; maxlength=&quot;6&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;true&quot; %}</td>
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			<td colspan="2"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Profession :</span></td>
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			<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% checkbox_tag name=&quot;321f6f55&quot; data_label=&quot;Activit&eacute; transaction immobili&egrave;re&quot; data_map_field=&quot;nomap&quot; %}&nbsp;&nbsp;Activit&eacute; transaction immobili&egrave;re&nbsp; &nbsp; &nbsp;{% checkbox_tag name=&quot;6b8389d8&quot; data_label=&quot;Activit&eacute; gestion immobili&egrave;re&quot; data_map_field=&quot;nomap&quot; %}&nbsp;&nbsp;Activit&eacute; gestion immobili&egrave;re</span></p>

<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% checkbox_tag name=&quot;618498df&quot; data_label=&quot;Syndic de copropri&eacute;t&eacute;&quot; data_map_field=&quot;nomap&quot; %}&nbsp;&nbsp;Syndic de copropri&eacute;t&eacute;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;{% checkbox_tag name=&quot;bef819a3&quot; data_label=&quot;Agent commercial&quot; data_map_field=&quot;nomap&quot; %}&nbsp;&nbsp;Agent commercial</span></p>
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			<td style="width: 30%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nombre de salari&eacute;s :&nbsp;&nbsp;</span>{% textinput_tag name=&quot;4f953569&quot; data_label=&quot;Nombre de salari&eacute;s&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Nombre de salari&eacute;s&quot; maxlength=&quot;6&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;true&quot; %}&nbsp; &nbsp; &nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nombre d&rsquo;agents commerciaux :&nbsp;&nbsp;</span>{% textinput_tag name=&quot;7255da43&quot; data_label=&quot;Nombre d&rsquo;agents commerciaux&quot; data_map_field=&quot;nomap&quot; data_help=&quot;Nombre d&rsquo;agents commerciaux&quot; maxlength=&quot;6&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;true&quot; %}</td>
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