{"id":12101,"date":"2024-07-29T17:27:07","date_gmt":"2024-07-29T17:27:07","guid":{"rendered":"https:\/\/www.psi-polymersystems.com\/?page_id=12101"},"modified":"2024-07-29T20:50:11","modified_gmt":"2024-07-29T20:50:11","slug":"service-questionnaire","status":"publish","type":"page","link":"https:\/\/www.psi-polymersystems.com\/fr\/service-questionnaire\/","title":{"rendered":"Questionnaire de service"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"12101\" class=\"elementor elementor-12101\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-16e9ce94 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"16e9ce94\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-2d263f5d\" data-id=\"2d263f5d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3e2825de elementor-widget elementor-widget-heading\" data-id=\"3e2825de\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Assistance au d\u00e9marrage<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-178a20c7 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"178a20c7\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Start-up Support\" action=\"\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"12101\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"178a20c7\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Service Questionnaire - PSI-Polymer Systems\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"12101\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom de l&#039;entreprise\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_142f4e9 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_142f4e9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom du contact\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_142f4e9]\" id=\"form-field-field_142f4e9\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ff74e4a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ff74e4a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tadresse 1\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ff74e4a]\" id=\"form-field-field_ff74e4a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_26a2870 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_26a2870\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse municipale 2\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_26a2870]\" id=\"form-field-field_26a2870\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_da092bd elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_da092bd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVille\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_da092bd]\" id=\"form-field-field_da092bd\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_ec53c58 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ec53c58\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u00c9tat\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_ec53c58]\" id=\"form-field-field_ec53c58\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Alabama\">Alabama<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Alaska\">Alaska<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Arizona\">Arizona<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Arkansas\">Arkansas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"California\">Californie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Colorado\">Colorado<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Connecticut\">Connecticut<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Delaware\">Delaware<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"District of Columbia\">District de Colombie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Florida\">Floride<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Georgia\">G\u00e9orgie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hawaii\">Hawaii<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Idaho\">Idaho<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Illinois\">Illinois<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Indiana\">Indiana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iowa\">Iowa<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kansas\">Kansas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kentucky\">Kentucky<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Louisiana\">Louisiane<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Maine\">Maine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Maryland\">Maryland<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Massachusetts\">Massachusetts<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Michigan\">Michigan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Minnesota\">Minnesota<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mississippi\">Mississippi<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Missouri\">Missouri<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Montana\">Montana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nebraska\">Nebraska<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nevada\">Nevada<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Hampshire\">New Hampshire<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Jersey\">New Jersey<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Mexico\">Nouveau Mexique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New York\">New York<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Carolina\">Caroline du Nord<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Dakota\">Dakota du nord<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ohio\">Ohio<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oklahoma\">Oklahoma<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oregon\">Oregon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Pennsylvania\">Pennsylvanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Rhode Island\">Rhode Island<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Carolina\">Caroline du Sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Dakota\">Dakota du Sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tennessee\">Tennessee<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Texas\">Texas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Utah\">Utah<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vermont\">Vermont<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Virginia\">Virginie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Washington\">Washington<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"West Virginia\">Virginie-Occidentale<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Wisconsin\">Wisconsin<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Wyoming\">Wyoming<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Alberta\">Alberta<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"British Columbia\">Colombie britannique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Manitoba\">Manitoba<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Brunswick\">Nouveau-Brunswick<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Newfoundland and Labrador\">Terre-Neuve-et-Labrador<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Northwest Territories\">Territoires du nord-ouest<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nova Scotia\">Nouvelle-\u00c9cosse<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nunavut\">Nunavut<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ontario\">Ontario<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Prince Edward Island\">\u00cele-du-Prince-\u00c9douard<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Quebec\">Qu\u00e9bec<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saskatchewan\">Saskatchewan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yukon\">Yukon<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_53e5f00 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_53e5f00\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZipper\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_53e5f00]\" id=\"form-field-field_53e5f00\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_f1f9dc9 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f1f9dc9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPays\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_f1f9dc9]\" id=\"form-field-field_f1f9dc9\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Afghanistan\">Afghanistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Albania\">Albanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Algeria\">Alg\u00e9rie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Andorra\">Andorre<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Angola\">Angola<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Antigua and Barbuda\">Antigua-et-Barbuda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Argentina\">Argentine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Armenia\">Arm\u00e9nie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Australia\">Australie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Austria\">L&#039;Autriche<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Austrian Empire\">Empire autrichien<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Azerbaijan\">Azerba\u00efdjan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Baden\">Bade<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bahamas, The\">Bahamas, Les<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bahrain\">Bahre\u00efn<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bangladesh\">Bengladesh<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Barbados\">Barbade<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bavaria\">Bavi\u00e8re<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belarus\">Bi\u00e9lorussie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belgium\">Belgique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belize\">B\u00e9lize<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Benin (Dahomey)\">B\u00e9nin (Dahomey)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bolivia\">Bolivie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bosnia and Herzegovina\">Bosnie Herz\u00e9govine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Botswana\">Bostwana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brazil\">Br\u00e9sil<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brunei\">Brun\u00e9i<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brunswick and L\u00fcneburg\">Brunswick et Lunebourg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bulgaria\">Bulgarie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burkina Faso \">Burkina Faso <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burma\">Birmanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burundi\">Burundi<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cabo Verde\">Cap-Vert<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cambodia\">Cambodge<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cameroon\">Cameroun<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Canada\">Canada<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cayman Islands\">\u00celes Ca\u00efmans<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chad\">Tchad<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chile\">Chili<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"China\">Chine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Colombia\">Colombie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Comoros\">Comores<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Congo Free State, The\">\u00c9tat ind\u00e9pendant du Congo, L&#039;<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Costa Rica\">Costa Rica<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cote d\u2019Ivoire (Ivory Coast)\">C\u00f4te d&#039;Ivoire (C\u00f4te d&#039;Ivoire)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Croatia\">Croatie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cuba\">Cuba<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cyprus\">Chypre<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Czechia\">Tch\u00e9quie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Czechoslovakia\">Tch\u00e9coslovaquie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Denmark\">Danemark<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Djibouti\">Djibouti<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dominica\">Dominique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dominican Republic\">R\u00e9publique Dominicaine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Duchy of Parma\">Duch\u00e9 de Parme<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ecuador\">Equateur<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Egypt\">Egypte<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"El Salvador\">Le Salvador<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Equatorial Guinea\">Guin\u00e9e \u00c9quatoriale<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Eritrea\">\u00c9rythr\u00e9e<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Estonia\">Estonie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Eswatini\">Eswatini<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ethiopia\">Ethiopie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Fiji\">Fidji<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Finland\">Finlande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"France\">France<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gabon\">Gabon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gambia, The\">Gambie, La<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Georgia\">G\u00e9orgie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Germany\">Allemagne<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ghana\">Ghana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Grand Duchy of Tuscany\">Grand-Duch\u00e9 de Toscane<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Greece\">Gr\u00e8ce<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Grenada\">Grenade<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guatemala\">Guatemala<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea\">Guin\u00e9e<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea-Bissau\">Guin\u00e9e-Bissau<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guyana\">Guyane<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"H\">H<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Haiti\">Ha\u00efti<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hanover\">Hanovre<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hanseatic Republics\">R\u00e9publiques hans\u00e9atiques<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hawaii\">Hawaii<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hesse\">Hesse<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Holy See\">Saint-Si\u00e8ge<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Honduras\">Honduras<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hungary\">Hongrie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iceland\">Islande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"India\">Inde<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Indonesia\">Indon\u00e9sie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iran\">L&#039;Iran<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iraq\">Irak<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ireland\">Irlande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Israel\">Isra\u00ebl<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Italy\">Italie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jamaica\">Jama\u00efque<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Japan\">Japon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jordan\">Jordan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kazakhstan\">Kazakhstan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kenya\">Kenya<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kingdom of Serbia\/Yugoslavia\">Royaume de Serbie\/Yougoslavie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kiribati\">Kiribati<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Korea\">Cor\u00e9e<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kosovo\">Kosovo<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kuwait\">Koweit<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kyrgyzstan\">Kirghizistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Laos\">Laos<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Latvia\">Lettonie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lebanon\">Liban<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lesotho\">Lesotho<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Liberia\">Lib\u00e9ria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Libya\">Libye<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Liechtenstein\">Liechtenstein<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lithuania\">Lituanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Luxembourg\">Luxembourg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Madagascar\">Madagascar<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malawi\">Malawi<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malaysia\">Malaisie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Maldives\">Maldives<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mali\">Mali<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malta\">Malte<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Marshall Islands\">Iles Marshall<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mauritania\">Mauritanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mauritius\">Maurice<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mecklenburg-Schwerin\">Mecklembourg-Schwerin<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mecklenburg-Strelitz\">Mecklembourg-Strelitz<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mexico\">Mexique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Micronesia\">Micron\u00e9sie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Moldova\">Moldavie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Monaco\">Monaco<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mongolia\">Mongolie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Montenegro\">Mont\u00e9n\u00e9gro<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Morocco\">Maroc<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mozambique\">Mozambique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Namibia\">Namibie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nassau\">Nassau<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nauru\">Nauru<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nepal\">N\u00e9pal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Netherlands, The\">Pays-Bas, Les<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Zealand\">Nouvelle-Z\u00e9lande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nicaragua\">Nicaragua<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Niger\">Niger<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nigeria\">Nigeria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Macedonia\">Mac\u00e9doine du Nord<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Norway\">Norv\u00e8ge<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oldenburg\">Oldenbourg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oman\">Oman<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Pakistan\">Pakistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Palau\">Palaos<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Panama\">Panama<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Papal States\">\u00c9tats pontificaux<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Papua New Guinea\">Papouasie Nouvelle Guin\u00e9e<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Paraguay\">Paraguay<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Peru\">P\u00e9rou<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Philippines\">Philippines<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Piedmont-Sardinia\">Pi\u00e9mont-Sardaigne<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Poland\">Pologne<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Portugal\">le Portugal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Qatar\">Qatar<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Republic of Genoa\">R\u00e9publique de G\u00eanes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Republic of the Congo\">R\u00e9publique du Congo<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Romania\">Roumanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Russia\">Russie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Rwanda\">Rwanda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Kitts and Nevis\">Saint-Christophe-et-Ni\u00e9v\u00e8s<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Lucia\">Sainte-Lucie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Vincent and the Grenadines\">Saint-Vincent-et-les-Grenadines<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Samoa\">Samoa<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"San Marino\">Saint Marin<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sao Tome and Principe\">Sao Tom\u00e9 et Principe<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saudi Arabia\">Arabie Saoudite<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Schaumburg-Lippe\">Schaumbourg-Lippe<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Senegal\">S\u00e9n\u00e9gal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Serbia\">Serbie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Seychelles\">les Seychelles<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sierra Leone\">Sierra Leone<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Singapore\">Singapour<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slovakia\">Slovaquie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slovenia\">Slov\u00e9nie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Solomon Islands\">\u00eeles Salomon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Somalia\">Somalie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Africa\">Afrique du Sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Korea\">Cor\u00e9e du Sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Sudan\">Soudan du sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Spain\">Espagne<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sri Lanka\">Sri Lanka<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sudan\">Soudan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Suriname\">Suriname<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sweden\">Su\u00e8de<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Switzerland\">Suisse<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Syria\">Syrie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tajikistan\">Tadjikistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tanzania\">Tanzanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Texas\">Texas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Thailand\">Tha\u00eflande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Timor-Leste\">Timor oriental<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Togo\">Aller<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tonga\">Tonga<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Trinidad and Tobago\">Trinit\u00e9-et-Tobago<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tunisia\">Tunisie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Turkey\">Turquie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Turkmenistan\">Turkm\u00e9nistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tuvalu\">Tuvalu<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Two Sicilies\">Deux Siciles<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uganda\">Ouganda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ukraine\">Ukraine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Union of Soviet Socialist Republics\">Union des R\u00e9publiques socialistes sovi\u00e9tiques<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United Arab Emirates\">Emirats Arabes Unis<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United Kingdom\">Royaume-Uni<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United States\">\u00c9tats-Unis<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uruguay\">Uruguay<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uzbekistan\">Ouzb\u00e9kistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vanuatu\">Vanuatu<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Venezuela\">Venezuela<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vietnam\">Vi\u00eat Nam<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"W\u00fcrttemberg\">Wurtemberg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yemen\">Y\u00e9men<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zambia\">Zambie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zimbabwe\">Zimbabwe<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d85b064 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d85b064\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNum\u00e9ro de t\u00e9l\u00e9phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d85b064]\" id=\"form-field-field_d85b064\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_27dc424 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_27dc424\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse e-mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_27dc424]\" id=\"form-field-field_27dc424\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ef5ff3a elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ef5ff3a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tType d&#039;\u00e9quipement\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ef5ff3a]\" id=\"form-field-field_ef5ff3a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_945c8b9 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_945c8b9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTous les \u00e9quipements sont-ils fournis par le PSI ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_945c8b9]\" id=\"form-field-field_945c8b9\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_cd5d8de elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cd5d8de\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tL&#039;\u00e9quipement a-t-il \u00e9t\u00e9 install\u00e9 et correctement serr\u00e9\u00a0?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_cd5d8de]\" id=\"form-field-field_cd5d8de\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_a493d64 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a493d64\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tToutes les connexions \u00e9lectriques entrantes ont-elles \u00e9t\u00e9 \u00e9tablies\u00a0?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_a493d64]\" id=\"form-field-field_a493d64\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_8b20c7a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8b20c7a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tToutes les connexions \u00e9lectriques ont-elles \u00e9t\u00e9 \u00e9tablies entre les contr\u00f4leurs et l&#039;\u00e9quipement\u00a0?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8b20c7a]\" id=\"form-field-field_8b20c7a\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_8c8e507 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8c8e507\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPour les syst\u00e8mes de pompe, la pompe a-t-elle \u00e9t\u00e9 install\u00e9e et l&#039;arbre de transmission est-il laiss\u00e9 d\u00e9connect\u00e9 du c\u00f4t\u00e9 de la bo\u00eete de vitesses\u00a0?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8c8e507]\" id=\"form-field-field_8c8e507\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c7a6853 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c7a6853\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPour les syst\u00e8mes de pompes dot\u00e9s de syst\u00e8mes de contr\u00f4le fournis par le client, des contr\u00f4les de s\u00e9curit\u00e9 sont-ils en place\u00a0? :\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Pump drive amperage\" id=\"form-field-field_c7a6853-0\" name=\"form_fields[field_c7a6853][]\"> <label for=\"form-field-field_c7a6853-0\">Intensit\u00e9 d&#039;entra\u00eenement de la pompe<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Inlet high suction pressure \" id=\"form-field-field_c7a6853-1\" name=\"form_fields[field_c7a6853][]\"> <label for=\"form-field-field_c7a6853-1\">Pression d&#039;aspiration \u00e9lev\u00e9e d&#039;entr\u00e9e <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Inlet Low suction pressure\" id=\"form-field-field_c7a6853-2\" name=\"form_fields[field_c7a6853][]\"> <label for=\"form-field-field_c7a6853-2\">Entr\u00e9e Faible pression d\u2019aspiration<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"High discharge pressure\" id=\"form-field-field_c7a6853-3\" name=\"form_fields[field_c7a6853][]\"> <label for=\"form-field-field_c7a6853-3\">Pression de refoulement \u00e9lev\u00e9e<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Cold start protection \" id=\"form-field-field_c7a6853-4\" name=\"form_fields[field_c7a6853][]\"> <label for=\"form-field-field_c7a6853-4\">Protection contre le d\u00e9marrage \u00e0 froid <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_2694992 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2694992\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPour les syst\u00e8mes de changeur de tamis, l&#039;unit\u00e9 de puissance hydraulique a-t-elle \u00e9t\u00e9 install\u00e9e et l&#039;alimentation \u00e9lectrique appropri\u00e9e est-elle connect\u00e9e\u00a0?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_2694992]\" id=\"form-field-field_2694992\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_246ed7e elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_246ed7e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tToutes les canalisations externes non fournies par PSI ont-elles \u00e9t\u00e9 connect\u00e9es\u00a0? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_246ed7e]\" id=\"form-field-field_246ed7e\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_7661143 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7661143\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLa taille, la quantit\u00e9 et le maillage appropri\u00e9s des \u00e9crans sont-ils disponibles\u00a0?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_7661143]\" id=\"form-field-field_7661143\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_ac89d7a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ac89d7a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tY aura-t-il des employ\u00e9s du client ou des entrepreneurs d\u00fbment agr\u00e9\u00e9s et assur\u00e9s sur place pour les probl\u00e8mes \u00e9lectriques qui pourraient survenir\u00a0? (Les techniciens de service PSI sont responsables uniquement de l&#039;\u00e9quipement fourni par PSI. Ils ne sont ni agr\u00e9\u00e9s, ni assur\u00e9s pour effectuer des connexions au c\u00e2blage fourni par le client.) \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_ac89d7a]\" id=\"form-field-field_ac89d7a\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_7f27875 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7f27875\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tUne fois les v\u00e9rifications initiales de l\u2019installation termin\u00e9es, le syst\u00e8me est-il pr\u00eat \u00e0 fonctionner\u00a0?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_7f27875]\" id=\"form-field-field_7f27875\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_1719346 elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_1719346\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LdKvNsZAAAAAGuenKLeAGZKrRhP7X7FS9Zb9Aay\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Envoyer<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4b3ec6a3\" data-id=\"4b3ec6a3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-be997bc elementor-widget elementor-widget-heading\" data-id=\"be997bc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">R\u00e9paration\/D\u00e9pannage<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-728cfac elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"728cfac\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Repair-Troubleshooting\" action=\"\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"12101\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"728cfac\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Service Questionnaire - PSI-Polymer Systems\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"12101\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom de l&#039;entreprise\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_142f4e9 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_142f4e9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom du contact\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_142f4e9]\" id=\"form-field-field_142f4e9\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ff74e4a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ff74e4a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tadresse 1\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ff74e4a]\" id=\"form-field-field_ff74e4a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_26a2870 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_26a2870\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse municipale 2\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_26a2870]\" id=\"form-field-field_26a2870\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_da092bd elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_da092bd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVille\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_da092bd]\" id=\"form-field-field_da092bd\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_ec53c58 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ec53c58\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u00c9tat\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_ec53c58]\" id=\"form-field-field_ec53c58\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Alabama\">Alabama<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Alaska\">Alaska<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Arizona\">Arizona<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Arkansas\">Arkansas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"California\">Californie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Colorado\">Colorado<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Connecticut\">Connecticut<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Delaware\">Delaware<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"District of Columbia\">District de Colombie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Florida\">Floride<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Georgia\">G\u00e9orgie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hawaii\">Hawaii<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Idaho\">Idaho<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Illinois\">Illinois<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Indiana\">Indiana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iowa\">Iowa<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kansas\">Kansas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kentucky\">Kentucky<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Louisiana\">Louisiane<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Maine\">Maine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Maryland\">Maryland<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Massachusetts\">Massachusetts<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Michigan\">Michigan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Minnesota\">Minnesota<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mississippi\">Mississippi<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Missouri\">Missouri<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Montana\">Montana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nebraska\">Nebraska<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nevada\">Nevada<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Hampshire\">New Hampshire<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Jersey\">New Jersey<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Mexico\">Nouveau Mexique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New York\">New York<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Carolina\">Caroline du Nord<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Dakota\">Dakota du nord<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ohio\">Ohio<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oklahoma\">Oklahoma<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oregon\">Oregon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Pennsylvania\">Pennsylvanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Rhode Island\">Rhode Island<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Carolina\">Caroline du Sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Dakota\">Dakota du Sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tennessee\">Tennessee<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Texas\">Texas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Utah\">Utah<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vermont\">Vermont<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Virginia\">Virginie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Washington\">Washington<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"West Virginia\">Virginie-Occidentale<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Wisconsin\">Wisconsin<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Wyoming\">Wyoming<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Alberta\">Alberta<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"British Columbia\">Colombie britannique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Manitoba\">Manitoba<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Brunswick\">Nouveau-Brunswick<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Newfoundland and Labrador\">Terre-Neuve-et-Labrador<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Northwest Territories\">Territoires du nord-ouest<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nova Scotia\">Nouvelle-\u00c9cosse<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nunavut\">Nunavut<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ontario\">Ontario<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Prince Edward Island\">\u00cele-du-Prince-\u00c9douard<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Quebec\">Qu\u00e9bec<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saskatchewan\">Saskatchewan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yukon\">Yukon<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_53e5f00 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_53e5f00\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZipper\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_53e5f00]\" id=\"form-field-field_53e5f00\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_f1f9dc9 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f1f9dc9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPays\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_f1f9dc9]\" id=\"form-field-field_f1f9dc9\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Afghanistan\">Afghanistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Albania\">Albanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Algeria\">Alg\u00e9rie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Andorra\">Andorre<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Angola\">Angola<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Antigua and Barbuda\">Antigua-et-Barbuda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Argentina\">Argentine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Armenia\">Arm\u00e9nie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Australia\">Australie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Austria\">L&#039;Autriche<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Austrian Empire\">Empire autrichien<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Azerbaijan\">Azerba\u00efdjan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Baden\">Bade<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bahamas, The\">Bahamas, Les<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bahrain\">Bahre\u00efn<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bangladesh\">Bengladesh<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Barbados\">Barbade<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bavaria\">Bavi\u00e8re<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belarus\">Bi\u00e9lorussie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belgium\">Belgique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belize\">B\u00e9lize<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Benin (Dahomey)\">B\u00e9nin (Dahomey)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bolivia\">Bolivie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bosnia and Herzegovina\">Bosnie Herz\u00e9govine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Botswana\">Bostwana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brazil\">Br\u00e9sil<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brunei\">Brun\u00e9i<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brunswick and L\u00fcneburg\">Brunswick et Lunebourg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bulgaria\">Bulgarie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burkina Faso \">Burkina Faso <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burma\">Birmanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burundi\">Burundi<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cabo Verde\">Cap-Vert<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cambodia\">Cambodge<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cameroon\">Cameroun<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Canada\">Canada<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cayman Islands\">\u00celes Ca\u00efmans<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chad\">Tchad<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chile\">Chili<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"China\">Chine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Colombia\">Colombie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Comoros\">Comores<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Congo Free State, The\">\u00c9tat ind\u00e9pendant du Congo, L&#039;<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Costa Rica\">Costa Rica<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cote d\u2019Ivoire (Ivory Coast)\">C\u00f4te d&#039;Ivoire (C\u00f4te d&#039;Ivoire)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Croatia\">Croatie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cuba\">Cuba<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cyprus\">Chypre<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Czechia\">Tch\u00e9quie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Czechoslovakia\">Tch\u00e9coslovaquie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Denmark\">Danemark<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Djibouti\">Djibouti<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dominica\">Dominique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dominican Republic\">R\u00e9publique Dominicaine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Duchy of Parma\">Duch\u00e9 de Parme<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ecuador\">Equateur<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Egypt\">Egypte<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"El Salvador\">Le Salvador<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Equatorial Guinea\">Guin\u00e9e \u00c9quatoriale<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Eritrea\">\u00c9rythr\u00e9e<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Estonia\">Estonie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Eswatini\">Eswatini<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ethiopia\">Ethiopie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Fiji\">Fidji<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Finland\">Finlande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"France\">France<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gabon\">Gabon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gambia, The\">Gambie, La<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Georgia\">G\u00e9orgie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Germany\">Allemagne<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ghana\">Ghana<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Grand Duchy of Tuscany\">Grand-Duch\u00e9 de Toscane<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Greece\">Gr\u00e8ce<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Grenada\">Grenade<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guatemala\">Guatemala<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea\">Guin\u00e9e<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea-Bissau\">Guin\u00e9e-Bissau<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guyana\">Guyane<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"H\">H<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Haiti\">Ha\u00efti<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hanover\">Hanovre<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hanseatic Republics\">R\u00e9publiques hans\u00e9atiques<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hawaii\">Hawaii<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hesse\">Hesse<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Holy See\">Saint-Si\u00e8ge<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Honduras\">Honduras<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hungary\">Hongrie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iceland\">Islande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"India\">Inde<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Indonesia\">Indon\u00e9sie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iran\">L&#039;Iran<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iraq\">Irak<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ireland\">Irlande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Israel\">Isra\u00ebl<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Italy\">Italie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jamaica\">Jama\u00efque<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Japan\">Japon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jordan\">Jordan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kazakhstan\">Kazakhstan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kenya\">Kenya<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kingdom of Serbia\/Yugoslavia\">Royaume de Serbie\/Yougoslavie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kiribati\">Kiribati<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Korea\">Cor\u00e9e<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kosovo\">Kosovo<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kuwait\">Koweit<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kyrgyzstan\">Kirghizistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Laos\">Laos<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Latvia\">Lettonie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lebanon\">Liban<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lesotho\">Lesotho<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Liberia\">Lib\u00e9ria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Libya\">Libye<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Liechtenstein\">Liechtenstein<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lithuania\">Lituanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Luxembourg\">Luxembourg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Madagascar\">Madagascar<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malawi\">Malawi<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malaysia\">Malaisie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Maldives\">Maldives<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mali\">Mali<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malta\">Malte<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Marshall Islands\">Iles Marshall<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mauritania\">Mauritanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mauritius\">Maurice<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mecklenburg-Schwerin\">Mecklembourg-Schwerin<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mecklenburg-Strelitz\">Mecklembourg-Strelitz<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mexico\">Mexique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Micronesia\">Micron\u00e9sie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Moldova\">Moldavie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Monaco\">Monaco<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mongolia\">Mongolie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Montenegro\">Mont\u00e9n\u00e9gro<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Morocco\">Maroc<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mozambique\">Mozambique<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Namibia\">Namibie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nassau\">Nassau<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nauru\">Nauru<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nepal\">N\u00e9pal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Netherlands, The\">Pays-Bas, Les<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Zealand\">Nouvelle-Z\u00e9lande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nicaragua\">Nicaragua<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Niger\">Niger<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nigeria\">Nigeria<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Macedonia\">Mac\u00e9doine du Nord<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Norway\">Norv\u00e8ge<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oldenburg\">Oldenbourg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oman\">Oman<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Pakistan\">Pakistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Palau\">Palaos<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Panama\">Panama<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Papal States\">\u00c9tats pontificaux<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Papua New Guinea\">Papouasie Nouvelle Guin\u00e9e<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Paraguay\">Paraguay<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Peru\">P\u00e9rou<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Philippines\">Philippines<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Piedmont-Sardinia\">Pi\u00e9mont-Sardaigne<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Poland\">Pologne<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Portugal\">le Portugal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Qatar\">Qatar<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Republic of Genoa\">R\u00e9publique de G\u00eanes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Republic of the Congo\">R\u00e9publique du Congo<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Romania\">Roumanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Russia\">Russie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Rwanda\">Rwanda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Kitts and Nevis\">Saint-Christophe-et-Ni\u00e9v\u00e8s<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Lucia\">Sainte-Lucie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Vincent and the Grenadines\">Saint-Vincent-et-les-Grenadines<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Samoa\">Samoa<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"San Marino\">Saint Marin<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sao Tome and Principe\">Sao Tom\u00e9 et Principe<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saudi Arabia\">Arabie Saoudite<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Schaumburg-Lippe\">Schaumbourg-Lippe<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Senegal\">S\u00e9n\u00e9gal<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Serbia\">Serbie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Seychelles\">les Seychelles<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sierra Leone\">Sierra Leone<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Singapore\">Singapour<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slovakia\">Slovaquie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slovenia\">Slov\u00e9nie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Solomon Islands\">\u00eeles Salomon<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Somalia\">Somalie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Africa\">Afrique du Sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Korea\">Cor\u00e9e du Sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Sudan\">Soudan du sud<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Spain\">Espagne<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sri Lanka\">Sri Lanka<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sudan\">Soudan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Suriname\">Suriname<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sweden\">Su\u00e8de<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Switzerland\">Suisse<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Syria\">Syrie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tajikistan\">Tadjikistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tanzania\">Tanzanie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Texas\">Texas<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Thailand\">Tha\u00eflande<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Timor-Leste\">Timor oriental<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Togo\">Aller<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tonga\">Tonga<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Trinidad and Tobago\">Trinit\u00e9-et-Tobago<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tunisia\">Tunisie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Turkey\">Turquie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Turkmenistan\">Turkm\u00e9nistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tuvalu\">Tuvalu<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Two Sicilies\">Deux Siciles<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uganda\">Ouganda<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ukraine\">Ukraine<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Union of Soviet Socialist Republics\">Union des R\u00e9publiques socialistes sovi\u00e9tiques<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United Arab Emirates\">Emirats Arabes Unis<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United Kingdom\">Royaume-Uni<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United States\">\u00c9tats-Unis<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uruguay\">Uruguay<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uzbekistan\">Ouzb\u00e9kistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vanuatu\">Vanuatu<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Venezuela\">Venezuela<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vietnam\">Vi\u00eat Nam<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"W\u00fcrttemberg\">Wurtemberg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yemen\">Y\u00e9men<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zambia\">Zambie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zimbabwe\">Zimbabwe<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d85b064 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d85b064\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNum\u00e9ro de t\u00e9l\u00e9phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d85b064]\" id=\"form-field-field_d85b064\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_27dc424 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_27dc424\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse e-mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_27dc424]\" id=\"form-field-field_27dc424\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ef5ff3a elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ef5ff3a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tType d&#039;\u00e9quipement\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ef5ff3a]\" id=\"form-field-field_ef5ff3a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_945c8b9 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_945c8b9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTous les \u00e9quipements sont-ils fournis par le PSI ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before\">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_945c8b9]\" id=\"form-field-field_945c8b9\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yes\">Oui<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"No\">Non<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_d12adb0 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d12adb0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tType de probl\u00e8me\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mechanical\" id=\"form-field-field_d12adb0-0\" name=\"form_fields[field_d12adb0][]\"> <label for=\"form-field-field_d12adb0-0\">M\u00e9canique<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Controls \" id=\"form-field-field_d12adb0-1\" name=\"form_fields[field_d12adb0][]\"> <label for=\"form-field-field_d12adb0-1\">Les contr\u00f4les <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_730cc88 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_730cc88\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVeuillez d\u00e9crire bri\u00e8vement le probl\u00e8me \u00e0 r\u00e9soudre\u00a0:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_730cc88]\" id=\"form-field-field_730cc88\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ca1cd8b elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ca1cd8b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tQuel est le produit final produit par cette ligne\u00a0? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ca1cd8b]\" id=\"form-field-field_ca1cd8b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ba4960f elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ba4960f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tQuel est le polym\u00e8re trait\u00e9 ? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ba4960f]\" id=\"form-field-field_ba4960f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_871005d elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_871005d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u00c0 quelle temp\u00e9rature la ligne fonctionne-t-elle ?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_871005d]\" id=\"form-field-field_871005d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_1719346 elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_1719346\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LdKvNsZAAAAAGuenKLeAGZKrRhP7X7FS9Zb9Aay\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Envoyer<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-10173698 elementor-widget elementor-widget-html\" data-id=\"10173698\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<!-- Event snippet for Website conversion page In your html page, add the snippet and call gtag_report_conversion when someone clicks on the chosen link or button. --> <script> function gtag_report_conversion(url) { var callback = function () { if (typeof(url) != 'undefined') { window.location = url; } }; gtag('event', 'conversion', { 'send_to': 'AW-1040211517\/B7zICJKU04ABEL28gfAD', 'event_callback': callback }); return false; } <\/script> \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Assistance au d\u00e9marrage 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