﻿{"html":"<div class=\"lightbox_content richContent\"><form id=\"formCreationAcces\" action=\"\" method=\"post\" enctype=\"multipart\/form-data\" onsubmit=\"return verifFormCreation(this);\" class=\"formu\">\n\t<h2>Cr\u00e9ation d'un compte membre<\/h2>\n\t\n\t<div class=\"form_group\">\n\n\t\t<div class=\"form_group\">\n\t\t\t\n\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t<p class=\"form_grid form_grid2\">\n\t\t\t\t<label>Raison sociale<\/label>\n\t\t\t\t<input type=\"text\" name=\"RAISONSOCIALE\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Nom<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"NOM\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Pr\u00e9nom<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"PRENOM\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid2\">\n\t\t\t\t<label>Adresse<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"ADRESSE\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Code postal<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"CODEPOSTAL\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Ville<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"VILLE\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Email<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"EMAIL\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Confirmer l'email<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"CONFIRMEMAIL\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>T\u00e9l\u00e9phone<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"TEL\" value=\"\" \/>\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>T\u00e9l\u00e9phone portable (livraison)<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"TELLIVRAISON\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\n\t\t\n\t\t<div class=\"form_group\">\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Num\u00e9ro de SIRET<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"SIRET\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>&nbsp;<\/label>\n\t\t\t\t<span class=\"listCheck\">\n\t\t\t\t\t<label style=\"width:100%;\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"SIRETENCOURS\" value=\"1\"  \/> en cours\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t\n\t\t\n\t\t<div class=\"form_group\">\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Num\u00e9ro de certificat phytosanitaire<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"PHYTOSAN\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>&nbsp;<\/label>\n\t\t\t\t<span class=\"listCheck\">\n\t\t\t\t\t<label style=\"width:100%;\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"PHYTOSANENCOURS\" value=\"1\"  \/> en cours\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t\n\t\t\n\t\t<div class=\"form_group\">\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Num\u00e9ro de certificat Biocide<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"BIOCIDE\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>&nbsp;<\/label>\n\t\t\t\t<span class=\"listCheck\">\n\t\t\t\t\t<label style=\"width:100%;\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"BIOCIDEENCOURS\" value=\"1\"  \/> en cours\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1 breakLine\">\n\t\t\t\t<label>Date de validit\u00e9 du certificat Biocide<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" class=\"date\" name=\"BIOCIDEDATE\" value=\"\" placeholder=\"jj\/mm\/aaaa\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1 breakLine\">\n\t\t\t\t<label>Num\u00e9ro TVA<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"NUMTVA\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Code NAF<span class=\"requit\">*<\/span><\/label>\n\t\t\t\t<input type=\"text\" name=\"CODENAF\" value=\"\" \/>\n\t\t\t<\/p>\n\n\t\t<\/div>\n\t\t\n\n\t\t\n\t\t\n\t\t<\/div>\n\t\t<div class=\"form_group\">\n\t\t\t<h3>Lettre d'information<\/h3>\n\t\t\t<p class=\"form_grid form_grid2\">\n\t\t\t\t<span class=\"listCheck\">\n\t\t\t\t\t<label style=\"width: auto; line-height: 1.5rem; height: auto; white-space: normal; padding-top : 0.25rem; padding-bottom: 0.25rem\">\n\t\t\t\t\t\t<input type=\"checkbox\" name=\"NEWS\" value=\"1\"  \/>\n\t\t\t\t\t\tJe souhaite \u00eatre inform\u00e9 de l'actualit\u00e9 de <b>ARMOSA<\/b>\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t<\/p>\n\t\t\n\n\t\t\n\n\t\t\n\t\t\n\n\t\t\n\t\t<p class=\"form_grid form_grid1\">\n\t\t\t<label>Mot de passe<span class=\"requit\">*<\/span> <span class=\"etiq\">(6 caract\u00e8res minimum)<\/span><\/label>\n\t\t\t<input type=\"password\" name=\"PASS\" value=\"\" maxlength=\"150\" \/>\n\t\t<\/p>\n\t\t<p class=\"form_grid form_grid1\">\n\t\t\t<label>Confirmation<span class=\"requit\">*<\/span><\/label>\n\t\t\t<input type=\"password\" name=\"CONFIRMPASS\" value=\"\" maxlength=\"150\" \/>\n\t\t<\/p>\n\t\t\n\t<\/div>\n\n\t\n\t<div class=\"form_group\">\n\t\t<h3>Pi\u00e8ces \u00e0 joindre (PDF ou images)<\/h3>\n\t\t\n\t\t<p class=\"form_grid form_grid2\">\n\t\t\t<div class=\"mother-of-fileinput\">\r\n\t<span class=\"bouton fileinput-button\">\r\n\t\t<span>Fichier KBIS...<\/span>\r\n\t\t<!-- The file input field used as target for the file upload widget -->\r\n\t\t<input class=\"fileupload\" type=\"file\" name=\"files[]\" data-furole=\"KBIS\" >\r\n\t<\/span>\r\n\t<br>\r\n\t<br>\r\n\t<!-- The global progress bar -->\r\n\t<div class=\"progress\">\r\n\t\t<div class=\"progress-bar progress-bar-striped progress-bar-success\"><\/div>\r\n\t<\/div>\r\n\t<!-- The container for the uploaded files -->\r\n\t<div class=\"files\"><\/div>\r\n<\/div>\r\n\n\t\t<\/p>\n\t\t\n\t\t<p class=\"form_grid form_grid2\">\n\t\t\t<div class=\"mother-of-fileinput\">\r\n\t<span class=\"bouton fileinput-button\">\r\n\t\t<span>Fichier Certificat biocide...<\/span>\r\n\t\t<!-- The file input field used as target for the file upload widget -->\r\n\t\t<input class=\"fileupload\" type=\"file\" name=\"files[]\" data-furole=\"BIOCIDE\" >\r\n\t<\/span>\r\n\t<br>\r\n\t<br>\r\n\t<!-- The global progress bar -->\r\n\t<div class=\"progress\">\r\n\t\t<div class=\"progress-bar progress-bar-striped progress-bar-success\"><\/div>\r\n\t<\/div>\r\n\t<!-- The container for the uploaded files -->\r\n\t<div class=\"files\"><\/div>\r\n<\/div>\r\n\n\t\t<\/p>\n\t\t\n\t\t<p class=\"form_grid form_grid2\">\n\t\t\t<div class=\"mother-of-fileinput\">\r\n\t<span class=\"bouton fileinput-button\">\r\n\t\t<span>Fichier Certificat phytosanitaire...<\/span>\r\n\t\t<!-- The file input field used as target for the file upload widget -->\r\n\t\t<input class=\"fileupload\" type=\"file\" name=\"files[]\" data-furole=\"PHYTOSAN\" >\r\n\t<\/span>\r\n\t<br>\r\n\t<br>\r\n\t<!-- The global progress bar -->\r\n\t<div class=\"progress\">\r\n\t\t<div class=\"progress-bar progress-bar-striped progress-bar-success\"><\/div>\r\n\t<\/div>\r\n\t<!-- The container for the uploaded files -->\r\n\t<div class=\"files\"><\/div>\r\n<\/div>\r\n\n\t\t<\/p>\n\t\t\n\t\t<p class=\"form_grid form_grid2\">\n\t\t\t<div class=\"mother-of-fileinput\">\r\n\t<span class=\"bouton fileinput-button\">\r\n\t\t<span>Fichier RIB...<\/span>\r\n\t\t<!-- The file input field used as target for the file upload widget -->\r\n\t\t<input class=\"fileupload\" type=\"file\" name=\"files[]\" data-furole=\"RIB\" >\r\n\t<\/span>\r\n\t<br>\r\n\t<br>\r\n\t<!-- The global progress bar -->\r\n\t<div class=\"progress\">\r\n\t\t<div class=\"progress-bar progress-bar-striped progress-bar-success\"><\/div>\r\n\t<\/div>\r\n\t<!-- The container for the uploaded files -->\r\n\t<div class=\"files\"><\/div>\r\n<\/div>\r\n\n\t\t<\/p>\n\t\t\n\t<\/div>\n\t\n\n\t<div class=\"form_group\">\n\t\t<h3>Informations compl\u00e9mentaires<\/h3>\n\t\t<div class=\"form_group\">\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>Comment nous avez-vous connus?<\/label>\n\t\t\t\t<select name=\"CONNUCOMMENT\">\n\t\t\t\t\t<option value=\"\">-<\/option>\n\t\t\t\t\t<option value=\"rs\"  >R\u00e9seaux sociaux<\/option><option value=\"google\"  >Google<\/option><option value=\"par\"  >Recommandation par ?<\/option><option value=\"autres\"  >Autres ?<\/option>\n\t\t\t\t<\/select>\n\t\t\t<\/p>\n\t\t\t<p class=\"form_grid form_grid1\">\n\t\t\t\t<label>&nbsp;<\/label>\n\t\t\t\t<input type=\"text\" name=\"CONNUCOMMENTSUPPL\" value=\"\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\n\t<p class=\"form_grid form_grid1\">\n\t\t<label>&nbsp<\/label>\n\t\t<span class=\"requit legend\" style=\"float:left;\">* champs obligatoires<\/span>\n\t<\/p>\n\t<p class=\"form_grid form_grid1\">\n\t\t<label>&nbsp<\/label>\n\t\t<!--<button type=\"button\" onclick=\"resetForm(this.form)\" title=\"Annuler\">Annuler<\/button>-->\n\t\t<input type=\"submit\" value=\"Valider\"\/>\n\t<\/p>\n\t<input type=\"hidden\" name=\"IDMEMBRE\" value=\"\" \/>\n\t<input type=\"hidden\" name=\"TYPEMODIF\" value=\"\" \/>\n\t<br style=\"clear: both\"\/>\n<\/form>\n<\/div>","succesCrea":false,"logged":false}