Admin - Plateforme Administration Editions Préference

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

Contenu

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			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><strong>&nbsp;</strong></span>{% select_tag name=&quot;866691fd&quot; data_label=&quot;Civilit&eacute;&quot; data_map_field=&quot;civilite&quot; data_help=&quot;Choisissez la civilit&eacute;&quot; data_choices=&quot;Civilit&eacute;|; Monsieur / Mr|monsieur; Madame / Ms|madame;&quot; data_required_field=&quot;true&quot; data_bold_text=&quot;false&quot; %}&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nom <span style="font-weight:600;">Last name&nbsp;</span>:</span></td>
			<td style="vertical-align: bottom; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Pr&eacute;nom <span style="font-weight:600;">First name&nbsp;</span>:</span></td>
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			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;ef701867&quot; data_label=&quot;Nom &quot; data_map_field=&quot;nom&quot; data_help=&quot;Nom du signataire &quot; maxlength=&quot;50&quot; data_required_field=&quot;true&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;1f8ce236&quot; data_label=&quot;Pr&eacute;nom &quot; data_map_field=&quot;prenom&quot; data_help=&quot;Pr&eacute;nom du signataire&quot; maxlength=&quot;50&quot; data_required_field=&quot;true&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: middle; width: 70%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">E-mail <span style="font-weight:600;">E-mail</span> :&nbsp;</span></td>
			<td style="vertical-align: middle; width: 30%;">&nbsp;<span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">T&eacute;l <span style="font-weight:600;">Phone&nbsp;number</span> :&nbsp;&nbsp;</span></td>
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			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;80c95790&quot; data_label=&quot;Email du signataire&quot; data_map_field=&quot;email&quot; data_help=&quot;Email du signataire&quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% textinput_tag name=&quot;dfef57d2&quot; data_label=&quot;T&eacute;l du signataire&quot; data_map_field=&quot;tel&quot; data_help=&quot;T&eacute;l du signataire&quot; maxlength=&quot;25&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="vertical-align: bottom; width: 70%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Lieu de naissance <span style="font-weight:600;">Place of birth</span> :</span></td>
			<td style="vertical-align: middle; width: 30%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Date de naissance <span style="font-weight:600;">Date of birth</span> :</span></td>
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			<td style="vertical-align: middle; width: 70%;">{% textinput_tag name=&quot;46dde5c5&quot; data_label=&quot;Lieu de naissance :&quot; data_map_field=&quot;lieu_naissance&quot; data_help=&quot;Lieu de naissance :&quot; maxlength=&quot;80&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
			<td style="vertical-align: middle; width: 30%;">{% dateinput_tag name=&quot;b0773fa7&quot; placeholder=&quot;jj/mm/aaaa&quot; data_label=&quot;Date de naissance&quot; data_map_field=&quot;date_naissance&quot; data_help=&quot;Date de naissance&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;true&quot; %}</td>
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			<td style="vertical-align: middle; width: 50%;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">Nationalit&eacute;<span style="font-weight:600;"> Nationality</span> :</span></td>
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			<td style="vertical-align: middle; width: 50%;">{% textinput_tag name=&quot;9b260a78&quot; data_label=&quot;Nationalit&eacute; &quot; data_map_field=&quot;nationality&quot; data_help=&quot;Nationalit&eacute; &quot; maxlength=&quot;50&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="width: 35%; vertical-align: middle;"><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;"><font face="ITCAvantGardePro">Situation matrimoniale <span style="font-weight:600;">Marital status</span> :</font></span></td>
			<td><span style="font-family:ITCAvantGardePro;font-size:12px;font-weight:200;">{% select_tag name=&quot;ba402199&quot; data_label=&quot;Situation matrimoniale&quot; data_map_field=&quot;matrimonial_regime&quot; data_help=&quot;Situation matrimoniale&quot; data_choices=&quot;choix de la situation matrimoniale|choix de la situation matrimoniale; C&eacute;libataire / Single|Celibataire; Mari&eacute;(e) / Married|Marie; Pacs&eacute;(e)/ civil partnership|pacse; Divorc&eacute;(e) / Divorced|divorce(e);Veuf(ve) / Widow(er)|Veuf(ve);&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</span></td>
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			<td><span style="font-size:8px;"><span style="font-family: ITCAvantGardePro; font-weight: 200;"><em>Vous avez la possibilit&eacute; de vous inscrire sur www.bloctel.gouv.fr pour vous opposer &agrave; tout d&eacute;marchage t&eacute;l&eacute;phonique conform&eacute;ment &agrave; l&#39;article L223-1 du Code de la consommation /&nbsp;You have the possibility of registering on www.bloctel.gouv.fr to oppose any telephone canvassing in accordance with article L223-1 of the Consumer Code</em></span></span></td>
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