{"id":13,"date":"2024-02-09T19:01:53","date_gmt":"2024-02-09T19:01:53","guid":{"rendered":"https:\/\/integratedfn.com\/emailing\/?page_id=13"},"modified":"2024-02-09T19:01:53","modified_gmt":"2024-02-09T19:01:53","slug":"form-fr","status":"publish","type":"page","link":"https:\/\/integratedfn.com\/emailing\/index.php\/form-fr\/","title":{"rendered":"Form Fr"},"content":{"rendered":"\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f11-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"11\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/emailing\/index.php\/wp-json\/wp\/v2\/pages\/13#wpcf7-f11-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"11\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f11-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"container form-horizontal\">\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-12\">\n\t\t\t<h1>Demande de soumission\n\t\t\t<\/h1>\n\t\t\t<h2>Coordonn\u00e9es client\n\t\t\t<\/h2>\n\t\t\t<p class=\"required-info\">* Champs requis\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"name\" class=\"control-label\">Nom*<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"email\" class=\"control-label\">Courriel*<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email-292\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-292\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"companyName\" class=\"control-label\">Compagnie*<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"company-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"company-name\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"title\" class=\"control-label\">Titre<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"Title\" id=\"title\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"city\" class=\"control-label\">Ville<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"City\" id=\"city\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"country\" class=\"control-label\">Pays<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Country\" id=\"country\" class=\"form-control\"\n                        data-placeholder=\"Choisir un pays...\">\n <option value=\"\"><\/option>\n <option value=\"canada\">Canada<\/option>\n <option value=\"usa\">\u00c9tas-Unis<\/option>\n <option value=\"mexico\">Mexique<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"province\" class=\"control-label\">Province\/\u00c9tat<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Province\" id=\"province\" class=\"form-control\"\n                        data-placeholder=\"Choisir une province...\">\n <option value=\"\"><\/option>\n <option class=\"usa\" value=\"AL\">Alabama<\/option>\n <option class=\"usa\" value=\"AK\">Alaska<\/option>\n <option class=\"usa\" value=\"AZ\">Arizona<\/option>\n <option class=\"usa\" value=\"AR\">Arkansas<\/option>\n <option class=\"usa\" value=\"CA\">California<\/option>\n <option class=\"usa\" value=\"CO\">Colorado<\/option>\n <option class=\"usa\" value=\"CT\">Connecticut<\/option>\n <option class=\"usa\" value=\"DE\">Delaware<\/option>\n <option class=\"usa\" value=\"DC\">District of Columbia<\/option>\n <option class=\"usa\" value=\"FL\">Florida<\/option>\n <option class=\"usa\" value=\"GA\">Georgia<\/option>\n <option class=\"usa\" value=\"HI\">Hawaii<\/option>\n <option class=\"usa\" value=\"ID\">Idaho<\/option>\n <option class=\"usa\" value=\"IL\">Illinois<\/option>\n <option class=\"usa\" value=\"IN\">Indiana<\/option>\n <option class=\"usa\" value=\"IO\">Iowa<\/option>\n <option class=\"usa\" value=\"KS\">Kansas<\/option>\n <option class=\"usa\" value=\"KY\">Kentucky<\/option>\n <option class=\"usa\" value=\"LA\">Louisiana<\/option>\n <option class=\"usa\" value=\"ME\">Maine<\/option>\n <option class=\"usa\" value=\"MD\">Maryland<\/option>\n <option class=\"usa\" value=\"MA\">Massachusetts<\/option>\n <option class=\"usa\" value=\"MI\">Michigan<\/option>\n <option class=\"usa\" value=\"MN\">Minnesota<\/option>\n <option class=\"usa\" value=\"MS\">Mississippi<\/option>\n <option class=\"usa\" value=\"MO\">Missouri<\/option>\n <option class=\"usa\" value=\"MT\">Montana<\/option>\n <option class=\"usa\" value=\"NE\">Nebraska<\/option>\n <option class=\"usa\" value=\"NV\">Nevada<\/option>\n <option class=\"usa\" value=\"NH\">New Hampshire<\/option>\n <option class=\"usa\" value=\"NJ\">New Jersey<\/option>\n <option class=\"usa\" value=\"NM\">New Mexico<\/option>\n <option class=\"usa\" value=\"NY\">New York<\/option>\n <option class=\"usa\" value=\"NC\">North Carolina<\/option>\n <option class=\"usa\" value=\"ND\">North Dakota<\/option>\n <option class=\"usa\" value=\"OH\">Ohio<\/option>\n <option class=\"usa\" value=\"OK\">Oklahoma<\/option>\n <option class=\"usa\" value=\"OR\">Oregon<\/option>\n <option class=\"usa\" value=\"PA\">Pennsylvania<\/option>\n <option class=\"usa\" value=\"RI\">Rhode Island<\/option>\n <option class=\"usa\" value=\"SC\">South Carolina<\/option>\n <option class=\"usa\" value=\"SD\">South Dakota<\/option>\n <option class=\"usa\" value=\"TN\">Tennessee<\/option>\n <option class=\"usa\" value=\"TX\">Texas<\/option>\n <option class=\"usa\" value=\"UT\">Utah<\/option>\n <option class=\"usa\" value=\"VT\">Vermont<\/option>\n <option class=\"usa\" value=\"VA\">Virginia<\/option>\n <option class=\"usa\" value=\"WA\">Washington<\/option>\n <option class=\"usa\" value=\"WV\">West Virginia<\/option>\n <option class=\"usa\" value=\"WI\">Wisconsin<\/option>\n <option class=\"usa\" value=\"WY\">Wyoming<\/option>\n <option class=\"usa\" value=\"none\">- - - <\/option>\n <option class=\"canada\" value=\"AB\">Alberta<\/option>\n <option class=\"canada\" value=\"BC\">British Columbia<\/option>\n <option class=\"canada\" value=\"MB\">Manitoba<\/option>\n <option class=\"canada\" value=\"NB\">New Brunswick<\/option>\n <option class=\"canada\" value=\"NF\">Newfoundland<\/option>\n <option class=\"canada\" value=\"NS\">Nova Scotia<\/option>\n <option class=\"canada\" value=\"NT\">Northwest Territories<\/option>\n <option class=\"canada\" value=\"NU\">Nunavut<\/option>\n <option class=\"canada\" value=\"ON\">Ontario<\/option>\n <option class=\"canada\" value=\"PE\">Prince Edward Is.<\/option>\n <option class=\"canada\" value=\"QC\">Quebec<\/option>\n <option class=\"canada\" value=\"SK\">Saskatchewan<\/option>\n <option class=\"canada\" value=\"YT\">Yukon Territory<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"postal\" class=\"control-label\">Code postal \/ Zip<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"Postal_Code_ZIP\" id=\"postal\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 col-xs-2 text-right\">\n\t\t\t\t\t<p><label for=\"phone\" class=\"control-label\">T\u00e9l\u00e9phone*<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-3 col-xs-6\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"Telephone\" id=\"phone\"\n                        required \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5 col-xs-4\">\n\t\t\t\t\t<p><label for=\"ext\" class=\"control-label display-inline\">Ext.<\/label><br \/>\n<input type=\"text\" class=\"form-control display-inline\" name=\"ext\" id=\"ext\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"fax\" class=\"control-label\">T\u00e9l\u00e9copieur<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"Fax\" id=\"fax\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-12\">\n\t\t\t<h2>D\u00e9tails de l'exp\u00e9dition\n\t\t\t<\/h2>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"commodity\" class=\"control-label twoLines\">Description du<br \/>\nproduit<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"Commodity\" id=\"commodity\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"province\" class=\"control-label\">Format<br \/>\nd'exp\u00e9dition<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Packaging\" id=\"packaging\" class=\"form-control\"\n                        data-placeholder=\"Format...\">\n <option value=\"\"><\/option>\n <option value=\"Palletized\">Palettes<\/option>\n <option value=\"Crates\">Caisses<\/option>\n <option value=\"Boxes\">Bo\u00eetes<\/option>\n <option value=\"Loose\">Vrac<\/option>\n <option value=\"Various\">Vari\u00e9s<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"quantity\" class=\"control-label\">Quantit\u00e9<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"quantity\" id=\"quantity\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group dimensions\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Dimensions<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5 col-xs-12 table\">\n\t\t\t\t\t<div class=\"col-sm-3 nopadding\">\n\t\t\t\t\t\t<p><label for=\"length\" class=\"control-label mute\">Longueur<\/label><br \/>\n<input type=\"text\" class=\"form-control\" name=\"Length\" id=\"length\" \/>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-sm-1 nopadding text-center\">\n\t\t\t\t\t\t<p><strong>x<\/strong>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-sm-3 nopadding\">\n\t\t\t\t\t\t<p><label for=\"width\" class=\"control-label mute\">Largeur<\/label><br \/>\n<input type=\"text\" class=\"form-control\" name=\"Width\" id=\"width\" \/>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-sm-1 nopadding text-center\">\n\t\t\t\t\t\t<p><strong>x<\/strong>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"col-sm-3 nopadding\">\n\t\t\t\t\t\t<p><label for=\"height\" class=\"control-label mute\">Hauteur<\/label><br \/>\n<input type=\"text\" class=\"form-control\" name=\"Height\" id=\"height\" \/>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"type\" class=\"control-label mute\">Type<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Type\" id=\"type\" class=\"form-control\" data-placeholder=\"Choisir...\">\n <option value=\"\"><\/option>\n <option value=\"Feet\">Pieds<\/option>\n <option value=\"Inches\">Pouces<\/option>\n <option value=\"Cm\">Cm<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"totalLinearFeet\" class=\"control-label mute twoLines\">Ou<br \/>\npied lin\u00e9aire total de la remorque <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"trailer\" id=\"totalLinearFeet\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label twoLines\">Livraison en provenance des<br \/>\n\u00c9tats-Unis<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"nmfc\" class=\"control-label mute\">NMFC#<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"NMFCt\" id=\"nmfc\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"class\" class=\"control-label mute\">Class<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"Class-f\" id=\"class\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"totalWeight\" class=\"control-label\">Poids total<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"totalWeight\" id=\"totalWeight\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Weight\" id=\"weight\" class=\"form-control\"\n                        data-placeholder=\"Poids...\">\n <option value=\"\"><\/option>\n <option value=\"Lbs\">Lbs<\/option>\n <option value=\"Kg\">Kg<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group single\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Marchandise empilable<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Stackable_Merchandise\"\n                            id=\"stackableMerchandise1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label\n                        class=\"radio-inline\"> <input name=\"Stackable_Merchandise\" id=\"stackableMerchandise2\" value=\"No\"\n                            type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group single\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Marchandise dangereuse<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Hazerdous_Materials\"\n                            id=\"hazerdousMaterials1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Hazerdous_Materials\" id=\"hazerdousMaterials2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Service de temp\u00e9rature contr\u00f4l\u00e9<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Temperature_Control\"\n                            id=\"hazerdousMaterials1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Temperature_Control\" id=\"hazerdousMaterials2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Temperature\" id=\"temp\" class=\"form-control\"\n                        data-placeholder=\"Choisir la temp\u00e9rature...\">\n <option value=\"\"><\/option>\n <option value=\"Heated\">Chauffage<\/option>\n <option value=\"Refrigerated\">R\u00e9frig\u00e9ration<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-12\">\n\t\t\t<h2>D\u00e9tails de la cueillette\n\t\t\t<\/h2>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"shipmentDate\" class=\"control-label\">Date de<br \/>\nl'envoi<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"date\" class=\"form-control\" name=\"shipmentDate\" id=\"shipmentDate\"\n                        placeholder=\"DD\/MM\/YY\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Heure du rdv<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Appointment_Time\" id=\"appointmentTime1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input\n                            name=\"Appointment_Time\" id=\"appointmentTime2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"appointmentTimeValue\" class=\"control-label mute\">Si<br \/>\noui<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"time\" class=\"form-control\" name=\"Si_oui\" id=\"appointmentTimeValue\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Origine de l'envoi<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"shipmentCity\" class=\"control-label mute\">Ville<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"shipmentCity\" id=\"shipmentCity\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"provinceState\"\n                        class=\"control-label mute\">Province\/\u00c9tat<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Province_State\" id=\"provinceState\" class=\"form-control\"\n                        data-placeholder=\"Choisir...\">\n <option value=\"\"><\/option>\n <option class=\"usa\" value=\"AL\">Alabama<\/option>\n <option class=\"usa\" value=\"AK\">Alaska<\/option>\n <option class=\"usa\" value=\"AZ\">Arizona<\/option>\n <option class=\"usa\" value=\"AR\">Arkansas<\/option>\n <option class=\"usa\" value=\"CA\">California<\/option>\n <option class=\"usa\" value=\"CO\">Colorado<\/option>\n <option class=\"usa\" value=\"CT\">Connecticut<\/option>\n <option class=\"usa\" value=\"DE\">Delaware<\/option>\n <option class=\"usa\" value=\"DC\">District of Columbia<\/option>\n <option class=\"usa\" value=\"FL\">Florida<\/option>\n <option class=\"usa\" value=\"GA\">Georgia<\/option>\n <option class=\"usa\" value=\"HI\">Hawaii<\/option>\n <option class=\"usa\" value=\"ID\">Idaho<\/option>\n <option class=\"usa\" value=\"IL\">Illinois<\/option>\n <option class=\"usa\" value=\"IN\">Indiana<\/option>\n <option class=\"usa\" value=\"IO\">Iowa<\/option>\n <option class=\"usa\" value=\"KS\">Kansas<\/option>\n <option class=\"usa\" value=\"KY\">Kentucky<\/option>\n <option class=\"usa\" value=\"LA\">Louisiana<\/option>\n <option class=\"usa\" value=\"ME\">Maine<\/option>\n <option class=\"usa\" value=\"MD\">Maryland<\/option>\n <option class=\"usa\" value=\"MA\">Massachusetts<\/option>\n <option class=\"usa\" value=\"MI\">Michigan<\/option>\n <option class=\"usa\" value=\"MN\">Minnesota<\/option>\n <option class=\"usa\" value=\"MS\">Mississippi<\/option>\n <option class=\"usa\" value=\"MO\">Missouri<\/option>\n <option class=\"usa\" value=\"MT\">Montana<\/option>\n <option class=\"usa\" value=\"NE\">Nebraska<\/option>\n <option class=\"usa\" value=\"NV\">Nevada<\/option>\n <option class=\"usa\" value=\"NH\">New Hampshire<\/option>\n <option class=\"usa\" value=\"NJ\">New Jersey<\/option>\n <option class=\"usa\" value=\"NM\">New Mexico<\/option>\n <option class=\"usa\" value=\"NY\">New York<\/option>\n <option class=\"usa\" value=\"NC\">North Carolina<\/option>\n <option class=\"usa\" value=\"ND\">North Dakota<\/option>\n <option class=\"usa\" value=\"OH\">Ohio<\/option>\n <option class=\"usa\" value=\"OK\">Oklahoma<\/option>\n <option class=\"usa\" value=\"OR\">Oregon<\/option>\n <option class=\"usa\" value=\"PA\">Pennsylvania<\/option>\n <option class=\"usa\" value=\"RI\">Rhode Island<\/option>\n <option class=\"usa\" value=\"SC\">South Carolina<\/option>\n <option class=\"usa\" value=\"SD\">South Dakota<\/option>\n <option class=\"usa\" value=\"TN\">Tennessee<\/option>\n <option class=\"usa\" value=\"TX\">Texas<\/option>\n <option class=\"usa\" value=\"UT\">Utah<\/option>\n <option class=\"usa\" value=\"VT\">Vermont<\/option>\n <option class=\"usa\" value=\"VA\">Virginia<\/option>\n <option class=\"usa\" value=\"WA\">Washington<\/option>\n <option class=\"usa\" value=\"WV\">West Virginia<\/option>\n <option class=\"usa\" value=\"WI\">Wisconsin<\/option>\n <option class=\"usa\" value=\"WY\">Wyoming<\/option>\n <option class=\"usa\" value=\"none\">- - - <\/option>\n <option class=\"canada\" value=\"AB\">Alberta<\/option>\n <option class=\"canada\" value=\"BC\">British Columbia<\/option>\n <option class=\"canada\" value=\"MB\">Manitoba<\/option>\n <option class=\"canada\" value=\"NB\">New Brunswick<\/option>\n <option class=\"canada\" value=\"NF\">Newfoundland<\/option>\n <option class=\"canada\" value=\"NS\">Nova Scotia<\/option>\n <option class=\"canada\" value=\"NT\">Northwest Territories<\/option>\n <option class=\"canada\" value=\"NU\">Nunavut<\/option>\n <option class=\"canada\" value=\"ON\">Ontario<\/option>\n <option class=\"canada\" value=\"PE\">Prince Edward Is.<\/option>\n <option class=\"canada\" value=\"QC\">Quebec<\/option>\n <option class=\"canada\" value=\"SK\">Saskatchewan<\/option>\n <option class=\"canada\" value=\"YT\">Yukon Territory<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"shipmentZip\" class=\"control-label mute\">Code postal \/<br \/>\nZip<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"Postal_Code_ZIP\" id=\"shipmentZip\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Conditions sp\u00e9ciales<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Centre commercial<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Shopping_Centre_Mail\"\n                            id=\"shoppingCentre1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Shopping_Centre_Mail\" id=\"shoppingCentre2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Site en construction<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Jobsite_Construction_Site\"\n                            id=\"jobSite1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input\n                            name=\"Jobsite_Construction_Site\" id=\"jobSite2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Hayon \u00e9l\u00e9vateur<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Tallgate\" id=\"tallgate1\" value=\"Yes\"\n                            type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input name=\"Tallgate\"\n                            id=\"tallgate2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Main d'oeuvre suppl\u00e9mentaire<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Additional_Labourer\" id=\"addLabourers1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Additional_Labourer\" id=\"addLabourers2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"loadingRequirements\" class=\"control-label\">Conditions du<br \/>\nchargement<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Loading_Requirements\" id=\"loadingRequirements\" class=\"form-control\"\n                        data-placeholder=\"S\u00e9lectionnez...\">\n <option value=\"\"><\/option>\n <option value=\"Drop Trailer\">Remorque immobilis\u00e9e<\/option>\n <option value=\"Live Loading\">Chargement direct<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"addSpecialReq\" class=\"control-label\">Besoins sp\u00e9ciaux<br \/>\nadditionnels<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><textarea name=\"Additionnal_Special_Requirements\" id=\"addSpecialReq\"\n                        class=\"form-control\"><\/textarea>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-12\">\n\t\t\t<h2>D\u00e9tails de la livraison\n\t\t\t<\/h2>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"del-shipmentDate\" class=\"control-label\">Date de<br \/>\nlivraison<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"date\" class=\"form-control\" name=\"Delivery_Date\"\n                        id=\"del-shipmentDate\" placeholder=\"DD\/MM\/YY\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Rendez-vous<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Delivery_Appointment_Time\"\n                            id=\"del-appointmentTime1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label\n                        class=\"radio-inline\"> <input name=\"Delivery_Appointment_Time\" id=\"del-appointmentTime2\"\n                            value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"del-appointmentTimeValue\" class=\"control-label mute\">Si<br \/>\noui<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"time\" class=\"form-control\" name=\"IF_Oui\"\n                        id=\"del-appointmentTimeValue\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Destination<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"del-shipmentCity\" class=\"control-label mute\">Ville<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"del-shipmentCity\"\n                        id=\"del-shipmentCity\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"del-provinceState\"\n                        class=\"control-label mute\">Province\/\u00c9tat<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Province_State\" id=\"del-provinceState\" class=\"form-control\"\n                        data-placeholder=\"Choisir...\">\n <option value=\"\"><\/option>\n <option class=\"usa\" value=\"AL\">Alabama<\/option>\n <option class=\"usa\" value=\"AK\">Alaska<\/option>\n <option class=\"usa\" value=\"AZ\">Arizona<\/option>\n <option class=\"usa\" value=\"AR\">Arkansas<\/option>\n <option class=\"usa\" value=\"CA\">California<\/option>\n <option class=\"usa\" value=\"CO\">Colorado<\/option>\n <option class=\"usa\" value=\"CT\">Connecticut<\/option>\n <option class=\"usa\" value=\"DE\">Delaware<\/option>\n <option class=\"usa\" value=\"DC\">District of Columbia<\/option>\n <option class=\"usa\" value=\"FL\">Florida<\/option>\n <option class=\"usa\" value=\"GA\">Georgia<\/option>\n <option class=\"usa\" value=\"HI\">Hawaii<\/option>\n <option class=\"usa\" value=\"ID\">Idaho<\/option>\n <option class=\"usa\" value=\"IL\">Illinois<\/option>\n <option class=\"usa\" value=\"IN\">Indiana<\/option>\n <option class=\"usa\" value=\"IO\">Iowa<\/option>\n <option class=\"usa\" value=\"KS\">Kansas<\/option>\n <option class=\"usa\" value=\"KY\">Kentucky<\/option>\n <option class=\"usa\" value=\"LA\">Louisiana<\/option>\n <option class=\"usa\" value=\"ME\">Maine<\/option>\n <option class=\"usa\" value=\"MD\">Maryland<\/option>\n <option class=\"usa\" value=\"MA\">Massachusetts<\/option>\n <option class=\"usa\" value=\"MI\">Michigan<\/option>\n <option class=\"usa\" value=\"MN\">Minnesota<\/option>\n <option class=\"usa\" value=\"MS\">Mississippi<\/option>\n <option class=\"usa\" value=\"MO\">Missouri<\/option>\n <option class=\"usa\" value=\"MT\">Montana<\/option>\n <option class=\"usa\" value=\"NE\">Nebraska<\/option>\n <option class=\"usa\" value=\"NV\">Nevada<\/option>\n <option class=\"usa\" value=\"NH\">New Hampshire<\/option>\n <option class=\"usa\" value=\"NJ\">New Jersey<\/option>\n <option class=\"usa\" value=\"NM\">New Mexico<\/option>\n <option class=\"usa\" value=\"NY\">New York<\/option>\n <option class=\"usa\" value=\"NC\">North Carolina<\/option>\n <option class=\"usa\" value=\"ND\">North Dakota<\/option>\n <option class=\"usa\" value=\"OH\">Ohio<\/option>\n <option class=\"usa\" value=\"OK\">Oklahoma<\/option>\n <option class=\"usa\" value=\"OR\">Oregon<\/option>\n <option class=\"usa\" value=\"PA\">Pennsylvania<\/option>\n <option class=\"usa\" value=\"RI\">Rhode Island<\/option>\n <option class=\"usa\" value=\"SC\">South Carolina<\/option>\n <option class=\"usa\" value=\"SD\">South Dakota<\/option>\n <option class=\"usa\" value=\"TN\">Tennessee<\/option>\n <option class=\"usa\" value=\"TX\">Texas<\/option>\n <option class=\"usa\" value=\"UT\">Utah<\/option>\n <option class=\"usa\" value=\"VT\">Vermont<\/option>\n <option class=\"usa\" value=\"VA\">Virginia<\/option>\n <option class=\"usa\" value=\"WA\">Washington<\/option>\n <option class=\"usa\" value=\"WV\">West Virginia<\/option>\n <option class=\"usa\" value=\"WI\">Wisconsin<\/option>\n <option class=\"usa\" value=\"WY\">Wyoming<\/option>\n <option class=\"usa\" value=\"none\">- - - <\/option>\n <option class=\"canada\" value=\"AB\">Alberta<\/option>\n <option class=\"canada\" value=\"BC\">British Columbia<\/option>\n <option class=\"canada\" value=\"MB\">Manitoba<\/option>\n <option class=\"canada\" value=\"NB\">New Brunswick<\/option>\n <option class=\"canada\" value=\"NF\">Newfoundland<\/option>\n <option class=\"canada\" value=\"NS\">Nova Scotia<\/option>\n <option class=\"canada\" value=\"NT\">Northwest Territories<\/option>\n <option class=\"canada\" value=\"NU\">Nunavut<\/option>\n <option class=\"canada\" value=\"ON\">Ontario<\/option>\n <option class=\"canada\" value=\"PE\">Prince Edward Is.<\/option>\n <option class=\"canada\" value=\"QC\">Quebec<\/option>\n <option class=\"canada\" value=\"SK\">Saskatchewan<\/option>\n <option class=\"canada\" value=\"YT\">Yukon Territory<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"del-shipmentZip\" class=\"control-label mute\">Code Postal \/<br \/>\nZip<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><input type=\"text\" class=\"form-control\" name=\"Postal_Code_ZIP\"\n                        id=\"del-shipmentZip\" \/>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Conditions sp\u00e9ciales<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Centre commercial<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Delivery_Mail\" id=\"del-shoppingCentre1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Delivery_Mail\" id=\"del-shoppingCentre2\" value=\"No\" type=\"radio\" \/><br \/>\nNon <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Site en construction<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Delivery_Construction_Site\"\n                            id=\"del-jobSite1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input\n                            name=\"Delivery_Construction_Site\" id=\"del-jobSite2\" value=\"No\" type=\"radio\" \/> Non<br \/>\n<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Hayon \u00e9l\u00e9vateur<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Delivery_Tallgate\" id=\"del-tallgate1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input\n                            name=\"Delivery_Tallgate\" id=\"del-tallgate2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Main d'oeuvre suppl\u00e9mentaire<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Delivery_Additional_Labourer\"\n                            id=\"del-addLabourers1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Delivery_Additional_Labourer\" id=\"del-addLabourers2\" value=\"No\" type=\"radio\" \/><br \/>\nNon <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"del-loadingRequirements\" class=\"control-label\">Conditions<br \/>\nde la livraison<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Loading_Requirements\" id=\"del-loadingRequirements\"\n                        class=\"form-control\" data-placeholder=\"S\u00e9lectionnez...\">\n <option value=\"\"><\/option>\n <option value=\"Drop Trailer\">Remorque immobilis\u00e9e<\/option>\n <option value=\"Live Loading\">D\u00e9chargement imm\u00e9diat<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"addSpecialReq\" class=\"control-label\">Besoins sp\u00e9ciaux<br \/>\nadditionnels<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><textarea name=\"Additionnal_Special_Requirements\" id=\"addSpecialReq\"\n                        class=\"form-control\"><\/textarea>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-12\">\n\t\t\t<h2>Service \u00e0 valeur ajout\u00e9\n\t\t\t<\/h2>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label for=\"retailSpecificEvent\"\n                        class=\"control-label\">\u00c9v\u00e9nement<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><select name=\"Retail_Specific_Event\" id=\"retailSpecificEvent\"\n                        class=\"form-control\" data-placeholder=\"S\u00e9lectionnez...\">\n <option value=\"\"><\/option>\n <option value=\"Store Opening\">Ouverture de boutique<\/option>\n <option value=\"Store Closing\">Fermeture de boutique<\/option>\n <option value=\"Jobsite\/Construction material\">Mat\u00e9riel de construction \/ chantier<\/option>\n <option value=\"Renovation\">R\u00e9novation<\/option>\n <option value=\"Relocation\">Relocalisation<\/option>\n <option value=\"New Product Testing\">Analyse de nouveau produit<\/option>\n <option value=\"Display Roll Out\">Exposition<\/option>\n <\/select>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">D\u00e9tails des heures de livraison \/<br \/>\ncueillette<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">\u00c0 l'int\u00e9rieur des heures d'ouverture<br \/>\ndu centre commercial<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Within_Regular\" id=\"withingRegHours1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Within_Regular\" id=\"withingRegHours2\" value=\"No\" type=\"radio\" \/> Non<br \/>\n<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Avant l'ouverture du centre<br \/>\ncommercial<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Before_Mall\" id=\"beforeMallOpens1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Before_Mall\" id=\"beforeMallOpens2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Apr\u00e8s la fermeture du centre<br \/>\ncommercial<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"After_Closes\" id=\"afterMallCloses1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"After_Closes\" id=\"afterMallCloses2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-sm-6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">\u00c9quipements sp\u00e9ciaux requis<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Camion remorque (cube)<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Straight_Body\" id=\"straightBodyTruck1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Straight_Body\" id=\"straightBodyTruck2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Chariot \/ chariot \u00e0 fourche<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Dollies_Jack\" id=\"dolliesPalletJack1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Dollies_Jack\" id=\"dolliesPalletJack2\" value=\"No\" type=\"radio\" \/> Non<br \/>\n<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Mat\u00e9riaux d\u2019emballage<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Packaging_Materials\"\n                            id=\"packagingMaterials1\" value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"><br \/>\n<input name=\"Packaging_Materials\" id=\"packagingMaterials2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<hr class=\"col-sm-9\" \/>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label\">Services \u00e0 valeur ajout\u00e9s<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">D\u00e9ballage en magasin<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"In_Store_Unpack\" id=\"inStoreUnpack1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input\n                            name=\"In_Store_Unpack\" id=\"inStoreUnpack2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">R\u00e9emballage en magasin<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"In_Store_Repack\" id=\"inStoreRepack1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input\n                            name=\"In_Store_Repack\" id=\"inStoreRepack2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Montage en magasin<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Installations\" id=\"installations1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input\n                            name=\"Installations\" id=\"installations2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<div class=\"col-sm-4 text-right\">\n\t\t\t\t\t<p><label class=\"control-label mute\">Disposition des d\u00e9bris et<br \/>\nemballages<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-sm-5\">\n\t\t\t\t\t<p><label class=\"radio-inline\"> <input name=\"Debris_Removal\" id=\"debrisRemoval1\"\n                            value=\"Yes\" type=\"radio\" \/> Oui <\/label><label class=\"radio-inline\"> <input\n                            name=\"Debris_Removal\" id=\"debrisRemoval2\" value=\"No\" type=\"radio\" \/> Non <\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<hr \/>\n\t<div class=\"row\">\n\t\t<div class=\"col-sm-12 text-right\">\n\t\t\t<p><button type=\"submit\" class=\"btn btn-primary\">Envoyer<\/button>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-13","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/integratedfn.com\/emailing\/index.php\/wp-json\/wp\/v2\/pages\/13","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/integratedfn.com\/emailing\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/integratedfn.com\/emailing\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/integratedfn.com\/emailing\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/integratedfn.com\/emailing\/index.php\/wp-json\/wp\/v2\/comments?post=13"}],"version-history":[{"count":1,"href":"https:\/\/integratedfn.com\/emailing\/index.php\/wp-json\/wp\/v2\/pages\/13\/revisions"}],"predecessor-version":[{"id":14,"href":"https:\/\/integratedfn.com\/emailing\/index.php\/wp-json\/wp\/v2\/pages\/13\/revisions\/14"}],"wp:attachment":[{"href":"https:\/\/integratedfn.com\/emailing\/index.php\/wp-json\/wp\/v2\/media?parent=13"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}