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<p><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">En partenariat avec l&rsquo;agence :</span></p>

<table border="0" cellpadding="2" cellspacing="2" style="width:100%;">
	<tbody>
		<tr>
			<td>{% textinput_tag name=&quot;e6d38bd1&quot; value=&quot;INFO_CLIENT_company&quot; data_label=&quot;Nom de l&#39;agence&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td>{% textinput_tag name=&quot;8b254931&quot; value=&quot;INFO_CLIENT_enseigne&quot; data_label=&quot;Enseigne&quot; data_help=&quot;Enseigne&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
		<tr>
			<td>{% textinput_tag name=&quot;c1626b88&quot; value=&quot;INFO_CLIENT_adresse&quot; data_label=&quot;Adresse agence partenaire&quot; data_help=&quot;Adresse agence partenaire&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<table border="0" cellpadding="1" cellspacing="1" style="width:100%;">
	<tbody>
		<tr>
			<td style="vertical-align: middle; width: 6%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail :</span></td>
			<td style="width: 64%;">{% textinput_tag name=&quot;b30941cc&quot; value=&quot;INFO_CLIENT_email&quot; data_label=&quot;Email agence partenaire&quot; data_help=&quot;Email agence partenaire&quot; maxlength=&quot;60&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 5%;">&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Tel :</span></td>
			<td style="width: 25%;">{% textinput_tag name=&quot;79ccc413&quot; value=&quot;INFO_CLIENT_telephone&quot; data_label=&quot;T&eacute;l agence partenaire&quot; maxlength=&quot;22&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
		</tr>
	</tbody>
</table>

<p style="text-align: justify;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">IL A ETE FAIT ET CONVENU CE QUI SUIT : Le mandant conf&egrave;re par les pr&eacute;sentes au mandataire, qui l&#39;accepte, mandat d&#39;administrer le(s) bien(s) suivant(s) tant activement que passivement.</span></p>

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