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<p><strong><em><span style="font-family:Garamond;">Ci-apr&egrave;s d&eacute;nomm&eacute;e &quot;le Mandataire&quot;</span></em></strong><br />
<span style="color:#a5644b;font-family:ITCAvantGardePro;font-size:12px;font-style:italic;font-weight:300;"><em>Hereinafter referred to as the &ldquo;Agent&rdquo;</em></span></p>

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			<td style="white-space: nowrap; width: 26%; vertical-align: middle;"><span style="font-size:16px;"><span class="titre_p" style="font-family: ITCAvantGardePro; font-weight: 900;">ET LE(S) SOUSSIGN&Eacute;(S) :</span></span></td>
			<td style="vertical-align: middle;">&nbsp;{% select_tag name=&quot;127a7778&quot; data_label=&quot;Type de mandant&quot; data_map_field=&quot;type&quot; data_help=&quot;Indiqu&eacute; le type de mandant&quot; data_choices=&quot;Personne physique / Natural person|Personne physique;Personne morale / Legal entity|Personne morale;Couple mari&eacute; / Married couple|Couple mari&eacute;;Couple non mari&eacute; / unmarried couple|Couple non mari&eacute;;&quot; data_required_field=&quot;false&quot; data_bold_text=&quot;false&quot; %}</td>
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			<td style="white-space: nowrap; width: 26%; vertical-align: middle;"><span style="color:#a5644b;font-family:ITCAvantGardePro;font-size:12px;font-style:italic;font-weight:300;">AND THE UNDERSIGNED:</span></td>
			<td style="vertical-align: middle;">&nbsp;</td>
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