{"id":514,"date":"2018-11-15T14:18:39","date_gmt":"2018-11-15T14:18:39","guid":{"rendered":"https:\/\/nagworld.mydev.ca\/outils-formulaires\/demande-de-credit.html"},"modified":"2025-08-21T14:55:43","modified_gmt":"2025-08-21T14:55:43","slug":"demande-de-credit","status":"publish","type":"page","link":"https:\/\/nagworld.ca\/fr-ca\/outils-formulaires\/demande-de-credit.html","title":{"rendered":"DEMANDE DE CR\u00c9DIT"},"content":{"rendered":"<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-16\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-16\" value=\"1777314828\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"16\" id=\"\"><div class=\"vfb-form-group\"><div><h1 class=\"\">NAGWorld - DEMANDE DE CR\u00c9DIT<\/h1><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField748\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField749\"><div class=\"vfb-form-group\"><label for=\"vfb-field-749\" class=\"vfb-control-label\">Cette demande de cr\u00e9dit demeure confidentielle et sera utilis\u00e9e  exclusivement par NAGWorld Inc.<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField750\"><div class=\"vfb-form-group\"><label for=\"vfb-field-750\" class=\"vfb-control-label\"> INFORMATION  SUR L'ENTREPRISE<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-7 vfb-fieldType-text\" id=\"vfbField751\"><div class=\"vfb-form-group\"><label for=\"vfb-field-751\" class=\"vfb-control-label\">Nom du propri\u00e9taire <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-751\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-751\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-address\" id=\"vfbField752\"><div class=\"vfb-form-group\"><label for=\"vfb-field-752\" class=\"vfb-control-label\">Adresse<\/label><div class=\"vfb-address-block\" id=\"vfb-field-752\"><div class=\"vfb-form-group\" style=\"\"><input id=\"vfb-field-752-address-1\" class=\"vfb-form-control vfb-addresspart-address-1\" placeholder=\"\" type=\"text\" name=\"vfb-field-752[address-1]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-752-address-2\" class=\"vfb-address-label\">Apt, suite, etc.<\/label><input id=\"vfb-field-752-address-2\" class=\"vfb-form-control vfb-addresspart-address-2\" placeholder=\"\" type=\"text\" name=\"vfb-field-752[address-2]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-752-country\" class=\"vfb-address-label\">Country<\/label><select id=\"vfb-field-752-country\" class=\"vfb-form-control vfb-addresspart-country\" placeholder=\"\" name=\"vfb-field-752[country]\"><option value=\"US\">United States (US)<\/option><option value=\"GB\">United Kingdom (UK)<\/option><option value=\"CA\" selected='selected'>Canada<\/option><option value=\"AU\">Australia<\/option><option value=\"\">---<\/option><option value=\"AF\">Afghanistan<\/option><option value=\"AX\">&#197;land Islands<\/option><option value=\"AL\">Albania<\/option><option value=\"DZ\">Algeria<\/option><option value=\"AD\">Andorra<\/option><option value=\"AO\">Angola<\/option><option value=\"AI\">Anguilla<\/option><option value=\"AQ\">Antarctica<\/option><option value=\"AG\">Antigua and Barbuda<\/option><option value=\"AR\">Argentina<\/option><option value=\"AM\">Armenia<\/option><option value=\"AW\">Aruba<\/option><option value=\"AS\">American Samoa<\/option><option value=\"AT\">Austria<\/option><option value=\"AZ\">Azerbaijan<\/option><option value=\"BS\">Bahamas<\/option><option value=\"BH\">Bahrain<\/option><option value=\"BD\">Bangladesh<\/option><option value=\"BB\">Barbados<\/option><option value=\"BY\">Belarus<\/option><option value=\"BE\">Belgium<\/option><option value=\"PW\">Belau<\/option><option value=\"BZ\">Belize<\/option><option value=\"BJ\">Benin<\/option><option value=\"BM\">Bermuda<\/option><option value=\"BT\">Bhutan<\/option><option value=\"BO\">Bolivia<\/option><option value=\"BQ\">Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\">Bosnia and Herzegovina<\/option><option value=\"BW\">Botswana<\/option><option value=\"BV\">Bouvet Island<\/option><option value=\"BR\">Brazil<\/option><option value=\"IO\">British Indian Ocean Territory<\/option><option value=\"VG\">British Virgin Islands<\/option><option value=\"BN\">Brunei<\/option><option value=\"BG\">Bulgaria<\/option><option value=\"BF\">Burkina Faso<\/option><option value=\"BI\">Burundi<\/option><option value=\"KH\">Cambodia<\/option><option value=\"CM\">Cameroon<\/option><option value=\"CV\">Cape Verde<\/option><option value=\"KY\">Cayman Islands<\/option><option value=\"CF\">Central African Republic<\/option><option value=\"TD\">Chad<\/option><option value=\"CL\">Chile<\/option><option value=\"CN\">China<\/option><option value=\"CX\">Christmas Island<\/option><option value=\"CC\">Cocos (Keeling) Islands<\/option><option value=\"CO\">Colombia<\/option><option value=\"KM\">Comoros<\/option><option value=\"CG\">Congo (Brazzaville)<\/option><option value=\"CD\">Congo (Kinshasa)<\/option><option value=\"CK\">Cook Islands<\/option><option value=\"CR\">Costa Rica<\/option><option value=\"HR\">Croatia<\/option><option value=\"CU\">Cuba<\/option><option value=\"CW\">Cura&Ccedil;ao<\/option><option value=\"CY\">Cyprus<\/option><option value=\"CZ\">Czech Republic<\/option><option value=\"DK\">Denmark<\/option><option value=\"DJ\">Djibouti<\/option><option value=\"DM\">Dominica<\/option><option value=\"DO\">Dominican Republic<\/option><option value=\"EC\">Ecuador<\/option><option value=\"EG\">Egypt<\/option><option value=\"SV\">El Salvador<\/option><option value=\"GQ\">Equatorial Guinea<\/option><option value=\"ER\">Eritrea<\/option><option value=\"EE\">Estonia<\/option><option value=\"ET\">Ethiopia<\/option><option value=\"FK\">Falkland Islands<\/option><option value=\"FO\">Faroe Islands<\/option><option value=\"FJ\">Fiji<\/option><option value=\"FI\">Finland<\/option><option value=\"FR\">France<\/option><option value=\"GF\">French Guiana<\/option><option value=\"PF\">French Polynesia<\/option><option value=\"TF\">French Southern Territories<\/option><option value=\"GA\">Gabon<\/option><option value=\"GM\">Gambia<\/option><option value=\"GE\">Georgia<\/option><option value=\"DE\">Germany<\/option><option value=\"GH\">Ghana<\/option><option value=\"GI\">Gibraltar<\/option><option value=\"GR\">Greece<\/option><option value=\"GL\">Greenland<\/option><option value=\"GD\">Grenada<\/option><option value=\"GP\">Guadeloupe<\/option><option value=\"GT\">Guatemala<\/option><option value=\"GG\">Guernsey<\/option><option value=\"GN\">Guinea<\/option><option value=\"GW\">Guinea-Bissau<\/option><option value=\"GY\">Guyana<\/option><option value=\"HT\">Haiti<\/option><option value=\"HM\">Heard Island and McDonald Islands<\/option><option value=\"HN\">Honduras<\/option><option value=\"HK\">Hong Kong<\/option><option value=\"HU\">Hungary<\/option><option value=\"IS\">Iceland<\/option><option value=\"IN\">India<\/option><option value=\"ID\">Indonesia<\/option><option value=\"IR\">Iran<\/option><option value=\"IQ\">Iraq<\/option><option value=\"IE\">Republic of Ireland<\/option><option value=\"IM\">Isle of Man<\/option><option value=\"IL\">Israel<\/option><option value=\"IT\">Italy<\/option><option value=\"CI\">Ivory Coast<\/option><option value=\"JM\">Jamaica<\/option><option value=\"JP\">Japan<\/option><option value=\"JE\">Jersey<\/option><option value=\"JO\">Jordan<\/option><option value=\"KZ\">Kazakhstan<\/option><option value=\"KE\">Kenya<\/option><option value=\"KI\">Kiribati<\/option><option value=\"KW\">Kuwait<\/option><option value=\"KG\">Kyrgyzstan<\/option><option value=\"LA\">Laos<\/option><option value=\"LV\">Latvia<\/option><option value=\"LB\">Lebanon<\/option><option value=\"LS\">Lesotho<\/option><option value=\"LR\">Liberia<\/option><option value=\"LY\">Libya<\/option><option value=\"LI\">Liechtenstein<\/option><option value=\"LT\">Lithuania<\/option><option value=\"LU\">Luxembourg<\/option><option value=\"MO\">Macao S.A.R., China<\/option><option value=\"MK\">Macedonia<\/option><option value=\"MG\">Madagascar<\/option><option value=\"MW\">Malawi<\/option><option value=\"MY\">Malaysia<\/option><option value=\"MV\">Maldives<\/option><option value=\"ML\">Mali<\/option><option value=\"MT\">Malta<\/option><option value=\"MH\">Marshall Islands<\/option><option value=\"MQ\">Martinique<\/option><option value=\"MR\">Mauritania<\/option><option value=\"MU\">Mauritius<\/option><option value=\"YT\">Mayotte<\/option><option value=\"MX\">Mexico<\/option><option value=\"FM\">Micronesia<\/option><option value=\"MD\">Moldova<\/option><option value=\"MC\">Monaco<\/option><option value=\"MN\">Mongolia<\/option><option value=\"ME\">Montenegro<\/option><option value=\"MS\">Montserrat<\/option><option value=\"MA\">Morocco<\/option><option value=\"MZ\">Mozambique<\/option><option value=\"MM\">Myanmar<\/option><option value=\"NA\">Namibia<\/option><option value=\"NR\">Nauru<\/option><option value=\"NP\">Nepal<\/option><option value=\"NL\">Netherlands<\/option><option value=\"AN\">Netherlands Antilles<\/option><option value=\"NC\">New Caledonia<\/option><option value=\"NZ\">New Zealand<\/option><option value=\"NI\">Nicaragua<\/option><option value=\"NE\">Niger<\/option><option value=\"NG\">Nigeria<\/option><option value=\"NU\">Niue<\/option><option value=\"NF\">Norfolk Island<\/option><option value=\"KP\">North Korea<\/option><option value=\"NO\">Norway<\/option><option value=\"OM\">Oman<\/option><option value=\"PK\">Pakistan<\/option><option value=\"PS\">Palestinian Territory<\/option><option value=\"PA\">Panama<\/option><option value=\"PG\">Papua New Guinea<\/option><option value=\"PY\">Paraguay<\/option><option value=\"PE\">Peru<\/option><option value=\"PH\">Philippines<\/option><option value=\"PN\">Pitcairn<\/option><option value=\"PL\">Poland<\/option><option value=\"PT\">Portugal<\/option><option value=\"QA\">Qatar<\/option><option value=\"RE\">Reunion<\/option><option value=\"RO\">Romania<\/option><option value=\"RU\">Russia<\/option><option value=\"RW\">Rwanda<\/option><option value=\"BL\">Saint Barth&eacute;lemy<\/option><option value=\"SH\">Saint Helena<\/option><option value=\"KN\">Saint Kitts and Nevis<\/option><option value=\"LC\">Saint Lucia<\/option><option value=\"MF\">Saint Martin (French part)<\/option><option value=\"SX\">Saint Martin (Dutch part)<\/option><option value=\"PM\">Saint Pierre and Miquelon<\/option><option value=\"VC\">Saint Vincent and the Grenadines<\/option><option value=\"SM\">San Marino<\/option><option value=\"ST\">S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value=\"SA\">Saudi Arabia<\/option><option value=\"SN\">Senegal<\/option><option value=\"RS\">Serbia<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra Leone<\/option><option value=\"SG\">Singapore<\/option><option value=\"SK\">Slovakia<\/option><option value=\"SI\">Slovenia<\/option><option value=\"SB\">Solomon Islands<\/option><option value=\"SO\">Somalia<\/option><option value=\"ZA\">South Africa<\/option><option value=\"GS\">South Georgia\/Sandwich Islands<\/option><option value=\"KR\">South Korea<\/option><option value=\"SS\">South Sudan<\/option><option value=\"ES\">Spain<\/option><option value=\"LK\">Sri Lanka<\/option><option value=\"SD\">Sudan<\/option><option value=\"SR\">Suriname<\/option><option value=\"SJ\">Svalbard and Jan Mayen<\/option><option value=\"SZ\">Swaziland<\/option><option value=\"SE\">Sweden<\/option><option value=\"CH\">Switzerland<\/option><option value=\"SY\">Syria<\/option><option value=\"TW\">Taiwan<\/option><option value=\"TJ\">Tajikistan<\/option><option value=\"TZ\">Tanzania<\/option><option value=\"TH\">Thailand<\/option><option value=\"TL\">Timor-Leste<\/option><option value=\"TG\">Togo<\/option><option value=\"TK\">Tokelau<\/option><option value=\"TO\">Tonga<\/option><option value=\"TT\">Trinidad and Tobago<\/option><option value=\"TN\">Tunisia<\/option><option value=\"TR\">Turkey<\/option><option value=\"TM\">Turkmenistan<\/option><option value=\"TC\">Turks and Caicos Islands<\/option><option value=\"TV\">Tuvalu<\/option><option value=\"UG\">Uganda<\/option><option value=\"UA\">Ukraine<\/option><option value=\"AE\">United Arab Emirates<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UZ\">Uzbekistan<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VA\">Vatican<\/option><option value=\"VE\">Venezuela<\/option><option value=\"VN\">Vietnam<\/option><option value=\"WF\">Wallis and Futuna<\/option><option value=\"EH\">Western Sahara<\/option><option value=\"WS\">Western Samoa<\/option><option value=\"YE\">Yemen<\/option><option value=\"ZM\">Zambia<\/option><option value=\"ZW\">Zimbabwe<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-752-city\" class=\"vfb-address-label\">City<\/label><input id=\"vfb-field-752-city\" class=\"vfb-form-control vfb-addresspart-city\" placeholder=\"\" type=\"text\" name=\"vfb-field-752[city]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-752-province\" class=\"vfb-address-label\">State<\/label><select id=\"vfb-field-752-province\" class=\"vfb-form-control vfb-addresspart-province\" placeholder=\"\" name=\"vfb-field-752[province]\"><option value=\"\"><\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District Of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\">Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option><option value=\"AA\">Armed Forces (AA)<\/option><option value=\"AE\">Armed Forces (AE)<\/option><option value=\"AP\">Armed Forces (AP)<\/option><option value=\"AS\">American Samoa<\/option><option value=\"GU\">Guam<\/option><option value=\"MP\">Northern Mariana Islands<\/option><option value=\"PR\">Puerto Rico<\/option><option value=\"UM\">US Minor Outlying Islands<\/option><option value=\"VI\">US Virgin Islands<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-752-zip\" class=\"vfb-address-label\">Zip code<\/label><input id=\"vfb-field-752-zip\" class=\"vfb-form-control vfb-addresspart-zip\" placeholder=\"\" type=\"text\" name=\"vfb-field-752[zip]\"><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField753\"><div class=\"vfb-form-group\"><label for=\"vfb-field-753\" class=\"vfb-control-label\">T\u00e9l *<\/label><div><input id=\"vfb-field-753\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-753\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField754\"><div class=\"vfb-form-group\"><label for=\"vfb-field-754\" class=\"vfb-control-label\">T\u00e9l\u00e9copieur <\/label><div><input id=\"vfb-field-754\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-754\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField755\"><div class=\"vfb-form-group\"><label for=\"vfb-field-755\" class=\"vfb-control-label\">INFORMATION SUR LES COMPTES PAYABLES<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField756\"><div class=\"vfb-form-group\"><label for=\"vfb-field-756\" class=\"vfb-control-label\">Personne \u00e0 contacter aux Comptes Payable<\/label><div><input id=\"vfb-field-756\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-756\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-select\" id=\"vfbField757\"><label for=\"vfb-field-757\" class=\"vfb-control-label\">Modalit\u00e9s de paiement effectives (transport). Veuillez identifier vos modalit\u00e9s :<\/label><div><div class=\"vfb-form-group\"><select id=\"vfb-field-757\" class=\"vfb-form-control\" placeholder=\"\" name=\"vfb-field-757\"><option value=\"7 Days\">7 Days<\/option><option value=\"15 Days\">15 Days<\/option><option value=\"21 Days\">21 Days<\/option><option value=\"30 Days\">30 Days<\/option><\/select><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField758\"><div class=\"vfb-form-group\"><label for=\"vfb-field-758\" class=\"vfb-control-label\">DONN\u00c9ES BANCAIRES<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField759\"><div class=\"vfb-form-group\"><label for=\"vfb-field-759\" class=\"vfb-control-label\">Banque<\/label><div><input id=\"vfb-field-759\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-759\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField760\"><div class=\"vfb-form-group\"><label for=\"vfb-field-760\" class=\"vfb-control-label\">Depuis<\/label><div><input id=\"vfb-field-760\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-760\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField761\"><div class=\"vfb-form-group\"><label for=\"vfb-field-761\" class=\"vfb-control-label\">No, de compte<\/label><div><input id=\"vfb-field-761\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-761\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField762\"><div class=\"vfb-form-group\"><label for=\"vfb-field-762\" class=\"vfb-control-label\">Succursale<\/label><div><input id=\"vfb-field-762\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-762\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-phone\" id=\"vfbField763\"><div class=\"vfb-form-group\"><label for=\"vfb-field-763\" class=\"vfb-control-label\">T\u00e9l\u00e9phone<\/label><div><input id=\"vfb-field-763\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-763\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-number\" id=\"vfbField764\"><div class=\"vfb-form-group\"><label for=\"vfb-field-764\" class=\"vfb-control-label\">Montant de cr\u00e9dit d\u00e9sir\u00e9 $<\/label><div><input id=\"vfb-field-764\" class=\"vfb-form-control\" placeholder=\"\" type=\"number\" name=\"vfb-field-764\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField765\"><div class=\"vfb-form-group\"><label for=\"vfb-field-765\" class=\"vfb-control-label\">R\u00c9F\u00c9RENCES DU FOURNISSEUR (Minimum 3)<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField767\"><div class=\"vfb-form-group\"><label for=\"vfb-field-767\" class=\"vfb-control-label\">FOURNISSEUR #1<\/label><div><input id=\"vfb-field-767\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-767\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-address\" id=\"vfbField768\"><div class=\"vfb-form-group\"><label for=\"vfb-field-768\" class=\"vfb-control-label\">Adresse<\/label><div class=\"vfb-address-block\" id=\"vfb-field-768\"><div class=\"vfb-form-group\" style=\"\"><input id=\"vfb-field-768-address-1\" class=\"vfb-form-control vfb-addresspart-address-1\" placeholder=\"\" type=\"text\" name=\"vfb-field-768[address-1]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-768-address-2\" class=\"vfb-address-label\">Apt, suite, etc.<\/label><input id=\"vfb-field-768-address-2\" class=\"vfb-form-control vfb-addresspart-address-2\" placeholder=\"\" type=\"text\" name=\"vfb-field-768[address-2]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-768-country\" class=\"vfb-address-label\">Country<\/label><select id=\"vfb-field-768-country\" class=\"vfb-form-control vfb-addresspart-country\" placeholder=\"\" name=\"vfb-field-768[country]\"><option value=\"US\">United States (US)<\/option><option value=\"GB\">United Kingdom (UK)<\/option><option value=\"CA\" selected='selected'>Canada<\/option><option value=\"AU\">Australia<\/option><option value=\"\">---<\/option><option value=\"AF\">Afghanistan<\/option><option value=\"AX\">&#197;land Islands<\/option><option value=\"AL\">Albania<\/option><option value=\"DZ\">Algeria<\/option><option value=\"AD\">Andorra<\/option><option value=\"AO\">Angola<\/option><option value=\"AI\">Anguilla<\/option><option value=\"AQ\">Antarctica<\/option><option value=\"AG\">Antigua and Barbuda<\/option><option value=\"AR\">Argentina<\/option><option value=\"AM\">Armenia<\/option><option value=\"AW\">Aruba<\/option><option value=\"AS\">American Samoa<\/option><option value=\"AT\">Austria<\/option><option value=\"AZ\">Azerbaijan<\/option><option value=\"BS\">Bahamas<\/option><option value=\"BH\">Bahrain<\/option><option value=\"BD\">Bangladesh<\/option><option value=\"BB\">Barbados<\/option><option value=\"BY\">Belarus<\/option><option value=\"BE\">Belgium<\/option><option value=\"PW\">Belau<\/option><option value=\"BZ\">Belize<\/option><option value=\"BJ\">Benin<\/option><option value=\"BM\">Bermuda<\/option><option value=\"BT\">Bhutan<\/option><option value=\"BO\">Bolivia<\/option><option value=\"BQ\">Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\">Bosnia and Herzegovina<\/option><option value=\"BW\">Botswana<\/option><option value=\"BV\">Bouvet Island<\/option><option value=\"BR\">Brazil<\/option><option value=\"IO\">British Indian Ocean Territory<\/option><option value=\"VG\">British Virgin Islands<\/option><option value=\"BN\">Brunei<\/option><option value=\"BG\">Bulgaria<\/option><option value=\"BF\">Burkina Faso<\/option><option value=\"BI\">Burundi<\/option><option value=\"KH\">Cambodia<\/option><option value=\"CM\">Cameroon<\/option><option value=\"CV\">Cape Verde<\/option><option value=\"KY\">Cayman Islands<\/option><option value=\"CF\">Central African Republic<\/option><option value=\"TD\">Chad<\/option><option value=\"CL\">Chile<\/option><option value=\"CN\">China<\/option><option value=\"CX\">Christmas Island<\/option><option value=\"CC\">Cocos (Keeling) Islands<\/option><option value=\"CO\">Colombia<\/option><option value=\"KM\">Comoros<\/option><option value=\"CG\">Congo (Brazzaville)<\/option><option value=\"CD\">Congo (Kinshasa)<\/option><option value=\"CK\">Cook Islands<\/option><option value=\"CR\">Costa Rica<\/option><option value=\"HR\">Croatia<\/option><option value=\"CU\">Cuba<\/option><option value=\"CW\">Cura&Ccedil;ao<\/option><option value=\"CY\">Cyprus<\/option><option value=\"CZ\">Czech Republic<\/option><option value=\"DK\">Denmark<\/option><option value=\"DJ\">Djibouti<\/option><option value=\"DM\">Dominica<\/option><option value=\"DO\">Dominican Republic<\/option><option value=\"EC\">Ecuador<\/option><option value=\"EG\">Egypt<\/option><option value=\"SV\">El Salvador<\/option><option value=\"GQ\">Equatorial Guinea<\/option><option value=\"ER\">Eritrea<\/option><option value=\"EE\">Estonia<\/option><option value=\"ET\">Ethiopia<\/option><option value=\"FK\">Falkland Islands<\/option><option value=\"FO\">Faroe Islands<\/option><option value=\"FJ\">Fiji<\/option><option value=\"FI\">Finland<\/option><option value=\"FR\">France<\/option><option value=\"GF\">French Guiana<\/option><option value=\"PF\">French Polynesia<\/option><option value=\"TF\">French Southern Territories<\/option><option value=\"GA\">Gabon<\/option><option value=\"GM\">Gambia<\/option><option value=\"GE\">Georgia<\/option><option value=\"DE\">Germany<\/option><option value=\"GH\">Ghana<\/option><option value=\"GI\">Gibraltar<\/option><option value=\"GR\">Greece<\/option><option value=\"GL\">Greenland<\/option><option value=\"GD\">Grenada<\/option><option value=\"GP\">Guadeloupe<\/option><option value=\"GT\">Guatemala<\/option><option value=\"GG\">Guernsey<\/option><option value=\"GN\">Guinea<\/option><option value=\"GW\">Guinea-Bissau<\/option><option value=\"GY\">Guyana<\/option><option value=\"HT\">Haiti<\/option><option value=\"HM\">Heard Island and McDonald Islands<\/option><option value=\"HN\">Honduras<\/option><option value=\"HK\">Hong Kong<\/option><option value=\"HU\">Hungary<\/option><option value=\"IS\">Iceland<\/option><option value=\"IN\">India<\/option><option value=\"ID\">Indonesia<\/option><option value=\"IR\">Iran<\/option><option value=\"IQ\">Iraq<\/option><option value=\"IE\">Republic of Ireland<\/option><option value=\"IM\">Isle of Man<\/option><option value=\"IL\">Israel<\/option><option value=\"IT\">Italy<\/option><option value=\"CI\">Ivory Coast<\/option><option value=\"JM\">Jamaica<\/option><option value=\"JP\">Japan<\/option><option value=\"JE\">Jersey<\/option><option value=\"JO\">Jordan<\/option><option value=\"KZ\">Kazakhstan<\/option><option value=\"KE\">Kenya<\/option><option value=\"KI\">Kiribati<\/option><option value=\"KW\">Kuwait<\/option><option value=\"KG\">Kyrgyzstan<\/option><option value=\"LA\">Laos<\/option><option value=\"LV\">Latvia<\/option><option value=\"LB\">Lebanon<\/option><option value=\"LS\">Lesotho<\/option><option value=\"LR\">Liberia<\/option><option value=\"LY\">Libya<\/option><option value=\"LI\">Liechtenstein<\/option><option value=\"LT\">Lithuania<\/option><option value=\"LU\">Luxembourg<\/option><option value=\"MO\">Macao S.A.R., China<\/option><option value=\"MK\">Macedonia<\/option><option value=\"MG\">Madagascar<\/option><option value=\"MW\">Malawi<\/option><option value=\"MY\">Malaysia<\/option><option value=\"MV\">Maldives<\/option><option value=\"ML\">Mali<\/option><option value=\"MT\">Malta<\/option><option value=\"MH\">Marshall Islands<\/option><option value=\"MQ\">Martinique<\/option><option value=\"MR\">Mauritania<\/option><option value=\"MU\">Mauritius<\/option><option value=\"YT\">Mayotte<\/option><option value=\"MX\">Mexico<\/option><option value=\"FM\">Micronesia<\/option><option value=\"MD\">Moldova<\/option><option value=\"MC\">Monaco<\/option><option value=\"MN\">Mongolia<\/option><option value=\"ME\">Montenegro<\/option><option value=\"MS\">Montserrat<\/option><option value=\"MA\">Morocco<\/option><option value=\"MZ\">Mozambique<\/option><option value=\"MM\">Myanmar<\/option><option value=\"NA\">Namibia<\/option><option value=\"NR\">Nauru<\/option><option value=\"NP\">Nepal<\/option><option value=\"NL\">Netherlands<\/option><option value=\"AN\">Netherlands Antilles<\/option><option value=\"NC\">New Caledonia<\/option><option value=\"NZ\">New Zealand<\/option><option value=\"NI\">Nicaragua<\/option><option value=\"NE\">Niger<\/option><option value=\"NG\">Nigeria<\/option><option value=\"NU\">Niue<\/option><option value=\"NF\">Norfolk Island<\/option><option value=\"KP\">North Korea<\/option><option value=\"NO\">Norway<\/option><option value=\"OM\">Oman<\/option><option value=\"PK\">Pakistan<\/option><option value=\"PS\">Palestinian Territory<\/option><option value=\"PA\">Panama<\/option><option value=\"PG\">Papua New Guinea<\/option><option value=\"PY\">Paraguay<\/option><option value=\"PE\">Peru<\/option><option value=\"PH\">Philippines<\/option><option value=\"PN\">Pitcairn<\/option><option value=\"PL\">Poland<\/option><option value=\"PT\">Portugal<\/option><option value=\"QA\">Qatar<\/option><option value=\"RE\">Reunion<\/option><option value=\"RO\">Romania<\/option><option value=\"RU\">Russia<\/option><option value=\"RW\">Rwanda<\/option><option value=\"BL\">Saint Barth&eacute;lemy<\/option><option value=\"SH\">Saint Helena<\/option><option value=\"KN\">Saint Kitts and Nevis<\/option><option value=\"LC\">Saint Lucia<\/option><option value=\"MF\">Saint Martin (French part)<\/option><option value=\"SX\">Saint Martin (Dutch part)<\/option><option value=\"PM\">Saint Pierre and Miquelon<\/option><option value=\"VC\">Saint Vincent and the Grenadines<\/option><option value=\"SM\">San Marino<\/option><option value=\"ST\">S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value=\"SA\">Saudi Arabia<\/option><option value=\"SN\">Senegal<\/option><option value=\"RS\">Serbia<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra Leone<\/option><option value=\"SG\">Singapore<\/option><option value=\"SK\">Slovakia<\/option><option value=\"SI\">Slovenia<\/option><option value=\"SB\">Solomon Islands<\/option><option value=\"SO\">Somalia<\/option><option value=\"ZA\">South Africa<\/option><option value=\"GS\">South Georgia\/Sandwich Islands<\/option><option value=\"KR\">South Korea<\/option><option value=\"SS\">South Sudan<\/option><option value=\"ES\">Spain<\/option><option value=\"LK\">Sri Lanka<\/option><option value=\"SD\">Sudan<\/option><option value=\"SR\">Suriname<\/option><option value=\"SJ\">Svalbard and Jan Mayen<\/option><option value=\"SZ\">Swaziland<\/option><option value=\"SE\">Sweden<\/option><option value=\"CH\">Switzerland<\/option><option value=\"SY\">Syria<\/option><option value=\"TW\">Taiwan<\/option><option value=\"TJ\">Tajikistan<\/option><option value=\"TZ\">Tanzania<\/option><option value=\"TH\">Thailand<\/option><option value=\"TL\">Timor-Leste<\/option><option value=\"TG\">Togo<\/option><option value=\"TK\">Tokelau<\/option><option value=\"TO\">Tonga<\/option><option value=\"TT\">Trinidad and Tobago<\/option><option value=\"TN\">Tunisia<\/option><option value=\"TR\">Turkey<\/option><option value=\"TM\">Turkmenistan<\/option><option value=\"TC\">Turks and Caicos Islands<\/option><option value=\"TV\">Tuvalu<\/option><option value=\"UG\">Uganda<\/option><option value=\"UA\">Ukraine<\/option><option value=\"AE\">United Arab Emirates<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UZ\">Uzbekistan<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VA\">Vatican<\/option><option value=\"VE\">Venezuela<\/option><option value=\"VN\">Vietnam<\/option><option value=\"WF\">Wallis and Futuna<\/option><option value=\"EH\">Western Sahara<\/option><option value=\"WS\">Western Samoa<\/option><option value=\"YE\">Yemen<\/option><option value=\"ZM\">Zambia<\/option><option value=\"ZW\">Zimbabwe<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-768-city\" class=\"vfb-address-label\">City<\/label><input id=\"vfb-field-768-city\" class=\"vfb-form-control vfb-addresspart-city\" placeholder=\"\" type=\"text\" name=\"vfb-field-768[city]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-768-province\" class=\"vfb-address-label\">State<\/label><select id=\"vfb-field-768-province\" class=\"vfb-form-control vfb-addresspart-province\" placeholder=\"\" name=\"vfb-field-768[province]\"><option value=\"\"><\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District Of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\">Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option><option value=\"AA\">Armed Forces (AA)<\/option><option value=\"AE\">Armed Forces (AE)<\/option><option value=\"AP\">Armed Forces (AP)<\/option><option value=\"AS\">American Samoa<\/option><option value=\"GU\">Guam<\/option><option value=\"MP\">Northern Mariana Islands<\/option><option value=\"PR\">Puerto Rico<\/option><option value=\"UM\">US Minor Outlying Islands<\/option><option value=\"VI\">US Virgin Islands<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-768-zip\" class=\"vfb-address-label\">Zip code<\/label><input id=\"vfb-field-768-zip\" class=\"vfb-form-control vfb-addresspart-zip\" placeholder=\"\" type=\"text\" name=\"vfb-field-768[zip]\"><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField769\"><div class=\"vfb-form-group\"><label for=\"vfb-field-769\" class=\"vfb-control-label\">T\u00e9l\u00e9phone<\/label><div><input id=\"vfb-field-769\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-769\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField770\"><div class=\"vfb-form-group\"><label for=\"vfb-field-770\" class=\"vfb-control-label\">T\u00e9l\u00e9copieur<\/label><div><input id=\"vfb-field-770\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-770\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField771\"><div class=\"vfb-form-group\"><label for=\"vfb-field-771\" class=\"vfb-control-label\">FOURNISSEUR #2<\/label><div><input id=\"vfb-field-771\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-771\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-address\" id=\"vfbField772\"><div class=\"vfb-form-group\"><label for=\"vfb-field-772\" class=\"vfb-control-label\">Adresse<\/label><div class=\"vfb-address-block\" id=\"vfb-field-772\"><div class=\"vfb-form-group\" style=\"\"><input id=\"vfb-field-772-address-1\" class=\"vfb-form-control vfb-addresspart-address-1\" placeholder=\"\" type=\"text\" name=\"vfb-field-772[address-1]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-772-address-2\" class=\"vfb-address-label\">Apt, suite, etc.<\/label><input id=\"vfb-field-772-address-2\" class=\"vfb-form-control vfb-addresspart-address-2\" placeholder=\"\" type=\"text\" name=\"vfb-field-772[address-2]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-772-country\" class=\"vfb-address-label\">Country<\/label><select id=\"vfb-field-772-country\" class=\"vfb-form-control vfb-addresspart-country\" placeholder=\"\" name=\"vfb-field-772[country]\"><option value=\"US\">United States (US)<\/option><option value=\"GB\">United Kingdom (UK)<\/option><option value=\"CA\" selected='selected'>Canada<\/option><option value=\"AU\">Australia<\/option><option value=\"\">---<\/option><option value=\"AF\">Afghanistan<\/option><option value=\"AX\">&#197;land Islands<\/option><option value=\"AL\">Albania<\/option><option value=\"DZ\">Algeria<\/option><option value=\"AD\">Andorra<\/option><option value=\"AO\">Angola<\/option><option value=\"AI\">Anguilla<\/option><option value=\"AQ\">Antarctica<\/option><option value=\"AG\">Antigua and Barbuda<\/option><option value=\"AR\">Argentina<\/option><option value=\"AM\">Armenia<\/option><option value=\"AW\">Aruba<\/option><option value=\"AS\">American Samoa<\/option><option value=\"AT\">Austria<\/option><option value=\"AZ\">Azerbaijan<\/option><option value=\"BS\">Bahamas<\/option><option value=\"BH\">Bahrain<\/option><option value=\"BD\">Bangladesh<\/option><option value=\"BB\">Barbados<\/option><option value=\"BY\">Belarus<\/option><option value=\"BE\">Belgium<\/option><option value=\"PW\">Belau<\/option><option value=\"BZ\">Belize<\/option><option value=\"BJ\">Benin<\/option><option value=\"BM\">Bermuda<\/option><option value=\"BT\">Bhutan<\/option><option value=\"BO\">Bolivia<\/option><option value=\"BQ\">Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\">Bosnia and Herzegovina<\/option><option value=\"BW\">Botswana<\/option><option value=\"BV\">Bouvet Island<\/option><option value=\"BR\">Brazil<\/option><option value=\"IO\">British Indian Ocean Territory<\/option><option value=\"VG\">British Virgin Islands<\/option><option value=\"BN\">Brunei<\/option><option value=\"BG\">Bulgaria<\/option><option value=\"BF\">Burkina Faso<\/option><option value=\"BI\">Burundi<\/option><option value=\"KH\">Cambodia<\/option><option value=\"CM\">Cameroon<\/option><option value=\"CV\">Cape Verde<\/option><option value=\"KY\">Cayman Islands<\/option><option value=\"CF\">Central African Republic<\/option><option value=\"TD\">Chad<\/option><option value=\"CL\">Chile<\/option><option value=\"CN\">China<\/option><option value=\"CX\">Christmas Island<\/option><option value=\"CC\">Cocos (Keeling) Islands<\/option><option value=\"CO\">Colombia<\/option><option value=\"KM\">Comoros<\/option><option value=\"CG\">Congo (Brazzaville)<\/option><option value=\"CD\">Congo (Kinshasa)<\/option><option value=\"CK\">Cook Islands<\/option><option value=\"CR\">Costa Rica<\/option><option value=\"HR\">Croatia<\/option><option value=\"CU\">Cuba<\/option><option value=\"CW\">Cura&Ccedil;ao<\/option><option value=\"CY\">Cyprus<\/option><option value=\"CZ\">Czech Republic<\/option><option value=\"DK\">Denmark<\/option><option value=\"DJ\">Djibouti<\/option><option value=\"DM\">Dominica<\/option><option value=\"DO\">Dominican Republic<\/option><option value=\"EC\">Ecuador<\/option><option value=\"EG\">Egypt<\/option><option value=\"SV\">El Salvador<\/option><option value=\"GQ\">Equatorial Guinea<\/option><option value=\"ER\">Eritrea<\/option><option value=\"EE\">Estonia<\/option><option value=\"ET\">Ethiopia<\/option><option value=\"FK\">Falkland Islands<\/option><option value=\"FO\">Faroe Islands<\/option><option value=\"FJ\">Fiji<\/option><option value=\"FI\">Finland<\/option><option value=\"FR\">France<\/option><option value=\"GF\">French Guiana<\/option><option value=\"PF\">French Polynesia<\/option><option value=\"TF\">French Southern Territories<\/option><option value=\"GA\">Gabon<\/option><option value=\"GM\">Gambia<\/option><option value=\"GE\">Georgia<\/option><option value=\"DE\">Germany<\/option><option value=\"GH\">Ghana<\/option><option value=\"GI\">Gibraltar<\/option><option value=\"GR\">Greece<\/option><option value=\"GL\">Greenland<\/option><option value=\"GD\">Grenada<\/option><option value=\"GP\">Guadeloupe<\/option><option value=\"GT\">Guatemala<\/option><option value=\"GG\">Guernsey<\/option><option value=\"GN\">Guinea<\/option><option value=\"GW\">Guinea-Bissau<\/option><option value=\"GY\">Guyana<\/option><option value=\"HT\">Haiti<\/option><option value=\"HM\">Heard Island and McDonald Islands<\/option><option value=\"HN\">Honduras<\/option><option value=\"HK\">Hong Kong<\/option><option value=\"HU\">Hungary<\/option><option value=\"IS\">Iceland<\/option><option value=\"IN\">India<\/option><option value=\"ID\">Indonesia<\/option><option value=\"IR\">Iran<\/option><option value=\"IQ\">Iraq<\/option><option value=\"IE\">Republic of Ireland<\/option><option value=\"IM\">Isle of Man<\/option><option value=\"IL\">Israel<\/option><option value=\"IT\">Italy<\/option><option value=\"CI\">Ivory Coast<\/option><option value=\"JM\">Jamaica<\/option><option value=\"JP\">Japan<\/option><option value=\"JE\">Jersey<\/option><option value=\"JO\">Jordan<\/option><option value=\"KZ\">Kazakhstan<\/option><option value=\"KE\">Kenya<\/option><option value=\"KI\">Kiribati<\/option><option value=\"KW\">Kuwait<\/option><option value=\"KG\">Kyrgyzstan<\/option><option value=\"LA\">Laos<\/option><option value=\"LV\">Latvia<\/option><option value=\"LB\">Lebanon<\/option><option value=\"LS\">Lesotho<\/option><option value=\"LR\">Liberia<\/option><option value=\"LY\">Libya<\/option><option value=\"LI\">Liechtenstein<\/option><option value=\"LT\">Lithuania<\/option><option value=\"LU\">Luxembourg<\/option><option value=\"MO\">Macao S.A.R., China<\/option><option value=\"MK\">Macedonia<\/option><option value=\"MG\">Madagascar<\/option><option value=\"MW\">Malawi<\/option><option value=\"MY\">Malaysia<\/option><option value=\"MV\">Maldives<\/option><option value=\"ML\">Mali<\/option><option value=\"MT\">Malta<\/option><option value=\"MH\">Marshall Islands<\/option><option value=\"MQ\">Martinique<\/option><option value=\"MR\">Mauritania<\/option><option value=\"MU\">Mauritius<\/option><option value=\"YT\">Mayotte<\/option><option value=\"MX\">Mexico<\/option><option value=\"FM\">Micronesia<\/option><option value=\"MD\">Moldova<\/option><option value=\"MC\">Monaco<\/option><option value=\"MN\">Mongolia<\/option><option value=\"ME\">Montenegro<\/option><option value=\"MS\">Montserrat<\/option><option value=\"MA\">Morocco<\/option><option value=\"MZ\">Mozambique<\/option><option value=\"MM\">Myanmar<\/option><option value=\"NA\">Namibia<\/option><option value=\"NR\">Nauru<\/option><option value=\"NP\">Nepal<\/option><option value=\"NL\">Netherlands<\/option><option value=\"AN\">Netherlands Antilles<\/option><option value=\"NC\">New Caledonia<\/option><option value=\"NZ\">New Zealand<\/option><option value=\"NI\">Nicaragua<\/option><option value=\"NE\">Niger<\/option><option value=\"NG\">Nigeria<\/option><option value=\"NU\">Niue<\/option><option value=\"NF\">Norfolk Island<\/option><option value=\"KP\">North Korea<\/option><option value=\"NO\">Norway<\/option><option value=\"OM\">Oman<\/option><option value=\"PK\">Pakistan<\/option><option value=\"PS\">Palestinian Territory<\/option><option value=\"PA\">Panama<\/option><option value=\"PG\">Papua New Guinea<\/option><option value=\"PY\">Paraguay<\/option><option value=\"PE\">Peru<\/option><option value=\"PH\">Philippines<\/option><option value=\"PN\">Pitcairn<\/option><option value=\"PL\">Poland<\/option><option value=\"PT\">Portugal<\/option><option value=\"QA\">Qatar<\/option><option value=\"RE\">Reunion<\/option><option value=\"RO\">Romania<\/option><option value=\"RU\">Russia<\/option><option value=\"RW\">Rwanda<\/option><option value=\"BL\">Saint Barth&eacute;lemy<\/option><option value=\"SH\">Saint Helena<\/option><option value=\"KN\">Saint Kitts and Nevis<\/option><option value=\"LC\">Saint Lucia<\/option><option value=\"MF\">Saint Martin (French part)<\/option><option value=\"SX\">Saint Martin (Dutch part)<\/option><option value=\"PM\">Saint Pierre and Miquelon<\/option><option value=\"VC\">Saint Vincent and the Grenadines<\/option><option value=\"SM\">San Marino<\/option><option value=\"ST\">S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value=\"SA\">Saudi Arabia<\/option><option value=\"SN\">Senegal<\/option><option value=\"RS\">Serbia<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra Leone<\/option><option value=\"SG\">Singapore<\/option><option value=\"SK\">Slovakia<\/option><option value=\"SI\">Slovenia<\/option><option value=\"SB\">Solomon Islands<\/option><option value=\"SO\">Somalia<\/option><option value=\"ZA\">South Africa<\/option><option value=\"GS\">South Georgia\/Sandwich Islands<\/option><option value=\"KR\">South Korea<\/option><option value=\"SS\">South Sudan<\/option><option value=\"ES\">Spain<\/option><option value=\"LK\">Sri Lanka<\/option><option value=\"SD\">Sudan<\/option><option value=\"SR\">Suriname<\/option><option value=\"SJ\">Svalbard and Jan Mayen<\/option><option value=\"SZ\">Swaziland<\/option><option value=\"SE\">Sweden<\/option><option value=\"CH\">Switzerland<\/option><option value=\"SY\">Syria<\/option><option value=\"TW\">Taiwan<\/option><option value=\"TJ\">Tajikistan<\/option><option value=\"TZ\">Tanzania<\/option><option value=\"TH\">Thailand<\/option><option value=\"TL\">Timor-Leste<\/option><option value=\"TG\">Togo<\/option><option value=\"TK\">Tokelau<\/option><option value=\"TO\">Tonga<\/option><option value=\"TT\">Trinidad and Tobago<\/option><option value=\"TN\">Tunisia<\/option><option value=\"TR\">Turkey<\/option><option value=\"TM\">Turkmenistan<\/option><option value=\"TC\">Turks and Caicos Islands<\/option><option value=\"TV\">Tuvalu<\/option><option value=\"UG\">Uganda<\/option><option value=\"UA\">Ukraine<\/option><option value=\"AE\">United Arab Emirates<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UZ\">Uzbekistan<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VA\">Vatican<\/option><option value=\"VE\">Venezuela<\/option><option value=\"VN\">Vietnam<\/option><option value=\"WF\">Wallis and Futuna<\/option><option value=\"EH\">Western Sahara<\/option><option value=\"WS\">Western Samoa<\/option><option value=\"YE\">Yemen<\/option><option value=\"ZM\">Zambia<\/option><option value=\"ZW\">Zimbabwe<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-772-city\" class=\"vfb-address-label\">City<\/label><input id=\"vfb-field-772-city\" class=\"vfb-form-control vfb-addresspart-city\" placeholder=\"\" type=\"text\" name=\"vfb-field-772[city]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-772-province\" class=\"vfb-address-label\">State<\/label><select id=\"vfb-field-772-province\" class=\"vfb-form-control vfb-addresspart-province\" placeholder=\"\" name=\"vfb-field-772[province]\"><option value=\"\"><\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District Of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\">Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option><option value=\"AA\">Armed Forces (AA)<\/option><option value=\"AE\">Armed Forces (AE)<\/option><option value=\"AP\">Armed Forces (AP)<\/option><option value=\"AS\">American Samoa<\/option><option value=\"GU\">Guam<\/option><option value=\"MP\">Northern Mariana Islands<\/option><option value=\"PR\">Puerto Rico<\/option><option value=\"UM\">US Minor Outlying Islands<\/option><option value=\"VI\">US Virgin Islands<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-772-zip\" class=\"vfb-address-label\">Zip code<\/label><input id=\"vfb-field-772-zip\" class=\"vfb-form-control vfb-addresspart-zip\" placeholder=\"\" type=\"text\" name=\"vfb-field-772[zip]\"><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField773\"><div class=\"vfb-form-group\"><label for=\"vfb-field-773\" class=\"vfb-control-label\">T\u00e9l\u00e9phone<\/label><div><input id=\"vfb-field-773\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-773\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField774\"><div class=\"vfb-form-group\"><label for=\"vfb-field-774\" class=\"vfb-control-label\">T\u00e9l\u00e9copieur<\/label><div><input id=\"vfb-field-774\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-774\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField775\"><div class=\"vfb-form-group\"><label for=\"vfb-field-775\" class=\"vfb-control-label\">FOURNISSEUR #3<\/label><div><input id=\"vfb-field-775\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-775\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-address\" id=\"vfbField776\"><div class=\"vfb-form-group\"><label for=\"vfb-field-776\" class=\"vfb-control-label\">Adresse<\/label><div class=\"vfb-address-block\" id=\"vfb-field-776\"><div class=\"vfb-form-group\" style=\"\"><input id=\"vfb-field-776-address-1\" class=\"vfb-form-control vfb-addresspart-address-1\" placeholder=\"\" type=\"text\" name=\"vfb-field-776[address-1]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-776-address-2\" class=\"vfb-address-label\">Apt, suite, etc.<\/label><input id=\"vfb-field-776-address-2\" class=\"vfb-form-control vfb-addresspart-address-2\" placeholder=\"\" type=\"text\" name=\"vfb-field-776[address-2]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-776-country\" class=\"vfb-address-label\">Country<\/label><select id=\"vfb-field-776-country\" class=\"vfb-form-control vfb-addresspart-country\" placeholder=\"\" name=\"vfb-field-776[country]\"><option value=\"US\">United States (US)<\/option><option value=\"GB\">United Kingdom (UK)<\/option><option value=\"CA\" selected='selected'>Canada<\/option><option value=\"AU\">Australia<\/option><option value=\"\">---<\/option><option value=\"AF\">Afghanistan<\/option><option value=\"AX\">&#197;land Islands<\/option><option value=\"AL\">Albania<\/option><option value=\"DZ\">Algeria<\/option><option value=\"AD\">Andorra<\/option><option value=\"AO\">Angola<\/option><option value=\"AI\">Anguilla<\/option><option value=\"AQ\">Antarctica<\/option><option value=\"AG\">Antigua and Barbuda<\/option><option value=\"AR\">Argentina<\/option><option value=\"AM\">Armenia<\/option><option value=\"AW\">Aruba<\/option><option value=\"AS\">American Samoa<\/option><option value=\"AT\">Austria<\/option><option value=\"AZ\">Azerbaijan<\/option><option value=\"BS\">Bahamas<\/option><option value=\"BH\">Bahrain<\/option><option value=\"BD\">Bangladesh<\/option><option value=\"BB\">Barbados<\/option><option value=\"BY\">Belarus<\/option><option value=\"BE\">Belgium<\/option><option value=\"PW\">Belau<\/option><option value=\"BZ\">Belize<\/option><option value=\"BJ\">Benin<\/option><option value=\"BM\">Bermuda<\/option><option value=\"BT\">Bhutan<\/option><option value=\"BO\">Bolivia<\/option><option value=\"BQ\">Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\">Bosnia and Herzegovina<\/option><option value=\"BW\">Botswana<\/option><option value=\"BV\">Bouvet Island<\/option><option value=\"BR\">Brazil<\/option><option value=\"IO\">British Indian Ocean Territory<\/option><option value=\"VG\">British Virgin Islands<\/option><option value=\"BN\">Brunei<\/option><option value=\"BG\">Bulgaria<\/option><option value=\"BF\">Burkina Faso<\/option><option value=\"BI\">Burundi<\/option><option value=\"KH\">Cambodia<\/option><option value=\"CM\">Cameroon<\/option><option value=\"CV\">Cape Verde<\/option><option value=\"KY\">Cayman Islands<\/option><option value=\"CF\">Central African Republic<\/option><option value=\"TD\">Chad<\/option><option value=\"CL\">Chile<\/option><option value=\"CN\">China<\/option><option value=\"CX\">Christmas Island<\/option><option value=\"CC\">Cocos (Keeling) Islands<\/option><option value=\"CO\">Colombia<\/option><option value=\"KM\">Comoros<\/option><option value=\"CG\">Congo (Brazzaville)<\/option><option value=\"CD\">Congo (Kinshasa)<\/option><option value=\"CK\">Cook Islands<\/option><option value=\"CR\">Costa Rica<\/option><option value=\"HR\">Croatia<\/option><option value=\"CU\">Cuba<\/option><option value=\"CW\">Cura&Ccedil;ao<\/option><option value=\"CY\">Cyprus<\/option><option value=\"CZ\">Czech Republic<\/option><option value=\"DK\">Denmark<\/option><option value=\"DJ\">Djibouti<\/option><option value=\"DM\">Dominica<\/option><option value=\"DO\">Dominican Republic<\/option><option value=\"EC\">Ecuador<\/option><option value=\"EG\">Egypt<\/option><option value=\"SV\">El Salvador<\/option><option value=\"GQ\">Equatorial Guinea<\/option><option value=\"ER\">Eritrea<\/option><option value=\"EE\">Estonia<\/option><option value=\"ET\">Ethiopia<\/option><option value=\"FK\">Falkland Islands<\/option><option value=\"FO\">Faroe Islands<\/option><option value=\"FJ\">Fiji<\/option><option value=\"FI\">Finland<\/option><option value=\"FR\">France<\/option><option value=\"GF\">French Guiana<\/option><option value=\"PF\">French Polynesia<\/option><option value=\"TF\">French Southern Territories<\/option><option value=\"GA\">Gabon<\/option><option value=\"GM\">Gambia<\/option><option value=\"GE\">Georgia<\/option><option value=\"DE\">Germany<\/option><option value=\"GH\">Ghana<\/option><option value=\"GI\">Gibraltar<\/option><option value=\"GR\">Greece<\/option><option value=\"GL\">Greenland<\/option><option value=\"GD\">Grenada<\/option><option value=\"GP\">Guadeloupe<\/option><option value=\"GT\">Guatemala<\/option><option value=\"GG\">Guernsey<\/option><option value=\"GN\">Guinea<\/option><option value=\"GW\">Guinea-Bissau<\/option><option value=\"GY\">Guyana<\/option><option value=\"HT\">Haiti<\/option><option value=\"HM\">Heard Island and McDonald Islands<\/option><option value=\"HN\">Honduras<\/option><option value=\"HK\">Hong Kong<\/option><option value=\"HU\">Hungary<\/option><option value=\"IS\">Iceland<\/option><option value=\"IN\">India<\/option><option value=\"ID\">Indonesia<\/option><option value=\"IR\">Iran<\/option><option value=\"IQ\">Iraq<\/option><option value=\"IE\">Republic of Ireland<\/option><option value=\"IM\">Isle of Man<\/option><option value=\"IL\">Israel<\/option><option value=\"IT\">Italy<\/option><option value=\"CI\">Ivory Coast<\/option><option value=\"JM\">Jamaica<\/option><option value=\"JP\">Japan<\/option><option value=\"JE\">Jersey<\/option><option value=\"JO\">Jordan<\/option><option value=\"KZ\">Kazakhstan<\/option><option value=\"KE\">Kenya<\/option><option value=\"KI\">Kiribati<\/option><option value=\"KW\">Kuwait<\/option><option value=\"KG\">Kyrgyzstan<\/option><option value=\"LA\">Laos<\/option><option value=\"LV\">Latvia<\/option><option value=\"LB\">Lebanon<\/option><option value=\"LS\">Lesotho<\/option><option value=\"LR\">Liberia<\/option><option value=\"LY\">Libya<\/option><option value=\"LI\">Liechtenstein<\/option><option value=\"LT\">Lithuania<\/option><option value=\"LU\">Luxembourg<\/option><option value=\"MO\">Macao S.A.R., China<\/option><option value=\"MK\">Macedonia<\/option><option value=\"MG\">Madagascar<\/option><option value=\"MW\">Malawi<\/option><option value=\"MY\">Malaysia<\/option><option value=\"MV\">Maldives<\/option><option value=\"ML\">Mali<\/option><option value=\"MT\">Malta<\/option><option value=\"MH\">Marshall Islands<\/option><option value=\"MQ\">Martinique<\/option><option value=\"MR\">Mauritania<\/option><option value=\"MU\">Mauritius<\/option><option value=\"YT\">Mayotte<\/option><option value=\"MX\">Mexico<\/option><option value=\"FM\">Micronesia<\/option><option value=\"MD\">Moldova<\/option><option value=\"MC\">Monaco<\/option><option value=\"MN\">Mongolia<\/option><option value=\"ME\">Montenegro<\/option><option value=\"MS\">Montserrat<\/option><option value=\"MA\">Morocco<\/option><option value=\"MZ\">Mozambique<\/option><option value=\"MM\">Myanmar<\/option><option value=\"NA\">Namibia<\/option><option value=\"NR\">Nauru<\/option><option value=\"NP\">Nepal<\/option><option value=\"NL\">Netherlands<\/option><option value=\"AN\">Netherlands Antilles<\/option><option value=\"NC\">New Caledonia<\/option><option value=\"NZ\">New Zealand<\/option><option value=\"NI\">Nicaragua<\/option><option value=\"NE\">Niger<\/option><option value=\"NG\">Nigeria<\/option><option value=\"NU\">Niue<\/option><option value=\"NF\">Norfolk Island<\/option><option value=\"KP\">North Korea<\/option><option value=\"NO\">Norway<\/option><option value=\"OM\">Oman<\/option><option value=\"PK\">Pakistan<\/option><option value=\"PS\">Palestinian Territory<\/option><option value=\"PA\">Panama<\/option><option value=\"PG\">Papua New Guinea<\/option><option value=\"PY\">Paraguay<\/option><option value=\"PE\">Peru<\/option><option value=\"PH\">Philippines<\/option><option value=\"PN\">Pitcairn<\/option><option value=\"PL\">Poland<\/option><option value=\"PT\">Portugal<\/option><option value=\"QA\">Qatar<\/option><option value=\"RE\">Reunion<\/option><option value=\"RO\">Romania<\/option><option value=\"RU\">Russia<\/option><option value=\"RW\">Rwanda<\/option><option value=\"BL\">Saint Barth&eacute;lemy<\/option><option value=\"SH\">Saint Helena<\/option><option value=\"KN\">Saint Kitts and Nevis<\/option><option value=\"LC\">Saint Lucia<\/option><option value=\"MF\">Saint Martin (French part)<\/option><option value=\"SX\">Saint Martin (Dutch part)<\/option><option value=\"PM\">Saint Pierre and Miquelon<\/option><option value=\"VC\">Saint Vincent and the Grenadines<\/option><option value=\"SM\">San Marino<\/option><option value=\"ST\">S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value=\"SA\">Saudi Arabia<\/option><option value=\"SN\">Senegal<\/option><option value=\"RS\">Serbia<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra Leone<\/option><option value=\"SG\">Singapore<\/option><option value=\"SK\">Slovakia<\/option><option value=\"SI\">Slovenia<\/option><option value=\"SB\">Solomon Islands<\/option><option value=\"SO\">Somalia<\/option><option value=\"ZA\">South Africa<\/option><option value=\"GS\">South Georgia\/Sandwich Islands<\/option><option value=\"KR\">South Korea<\/option><option value=\"SS\">South Sudan<\/option><option value=\"ES\">Spain<\/option><option value=\"LK\">Sri Lanka<\/option><option value=\"SD\">Sudan<\/option><option value=\"SR\">Suriname<\/option><option value=\"SJ\">Svalbard and Jan Mayen<\/option><option value=\"SZ\">Swaziland<\/option><option value=\"SE\">Sweden<\/option><option value=\"CH\">Switzerland<\/option><option value=\"SY\">Syria<\/option><option value=\"TW\">Taiwan<\/option><option value=\"TJ\">Tajikistan<\/option><option value=\"TZ\">Tanzania<\/option><option value=\"TH\">Thailand<\/option><option value=\"TL\">Timor-Leste<\/option><option value=\"TG\">Togo<\/option><option value=\"TK\">Tokelau<\/option><option value=\"TO\">Tonga<\/option><option value=\"TT\">Trinidad and Tobago<\/option><option value=\"TN\">Tunisia<\/option><option value=\"TR\">Turkey<\/option><option value=\"TM\">Turkmenistan<\/option><option value=\"TC\">Turks and Caicos Islands<\/option><option value=\"TV\">Tuvalu<\/option><option value=\"UG\">Uganda<\/option><option value=\"UA\">Ukraine<\/option><option value=\"AE\">United Arab Emirates<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UZ\">Uzbekistan<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VA\">Vatican<\/option><option value=\"VE\">Venezuela<\/option><option value=\"VN\">Vietnam<\/option><option value=\"WF\">Wallis and Futuna<\/option><option value=\"EH\">Western Sahara<\/option><option value=\"WS\">Western Samoa<\/option><option value=\"YE\">Yemen<\/option><option value=\"ZM\">Zambia<\/option><option value=\"ZW\">Zimbabwe<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-776-city\" class=\"vfb-address-label\">City<\/label><input id=\"vfb-field-776-city\" class=\"vfb-form-control vfb-addresspart-city\" placeholder=\"\" type=\"text\" name=\"vfb-field-776[city]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-776-province\" class=\"vfb-address-label\">State<\/label><select id=\"vfb-field-776-province\" class=\"vfb-form-control vfb-addresspart-province\" placeholder=\"\" name=\"vfb-field-776[province]\"><option value=\"\"><\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District Of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\">Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option><option value=\"AA\">Armed Forces (AA)<\/option><option value=\"AE\">Armed Forces (AE)<\/option><option value=\"AP\">Armed Forces (AP)<\/option><option value=\"AS\">American Samoa<\/option><option value=\"GU\">Guam<\/option><option value=\"MP\">Northern Mariana Islands<\/option><option value=\"PR\">Puerto Rico<\/option><option value=\"UM\">US Minor Outlying Islands<\/option><option value=\"VI\">US Virgin Islands<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-776-zip\" class=\"vfb-address-label\">Zip code<\/label><input id=\"vfb-field-776-zip\" class=\"vfb-form-control vfb-addresspart-zip\" placeholder=\"\" type=\"text\" name=\"vfb-field-776[zip]\"><\/div><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField777\"><div class=\"vfb-form-group\"><label for=\"vfb-field-777\" class=\"vfb-control-label\">T\u00e9l\u00e9phone<\/label><div><input id=\"vfb-field-777\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-777\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField778\"><div class=\"vfb-form-group\"><label for=\"vfb-field-778\" class=\"vfb-control-label\">T\u00e9l\u00e9copieur<\/label><div><input id=\"vfb-field-778\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-778\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField779\"><div class=\"vfb-form-group\"><label for=\"vfb-field-779\" class=\"vfb-control-label\">FOURNISSEUR #4<\/label><div><input id=\"vfb-field-779\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-779\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-address\" id=\"vfbField780\"><div class=\"vfb-form-group\"><label for=\"vfb-field-780\" class=\"vfb-control-label\">Adresse<\/label><div class=\"vfb-address-block\" id=\"vfb-field-780\"><div class=\"vfb-form-group\" style=\"\"><input id=\"vfb-field-780-address-1\" class=\"vfb-form-control vfb-addresspart-address-1\" placeholder=\"\" type=\"text\" name=\"vfb-field-780[address-1]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-780-address-2\" class=\"vfb-address-label\">Apt, suite, etc.<\/label><input id=\"vfb-field-780-address-2\" class=\"vfb-form-control vfb-addresspart-address-2\" placeholder=\"\" type=\"text\" name=\"vfb-field-780[address-2]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-780-country\" class=\"vfb-address-label\">Country<\/label><select id=\"vfb-field-780-country\" class=\"vfb-form-control vfb-addresspart-country\" placeholder=\"\" name=\"vfb-field-780[country]\"><option value=\"US\">United States (US)<\/option><option value=\"GB\">United Kingdom (UK)<\/option><option value=\"CA\" selected='selected'>Canada<\/option><option value=\"AU\">Australia<\/option><option value=\"\">---<\/option><option value=\"AF\">Afghanistan<\/option><option value=\"AX\">&#197;land Islands<\/option><option value=\"AL\">Albania<\/option><option value=\"DZ\">Algeria<\/option><option value=\"AD\">Andorra<\/option><option value=\"AO\">Angola<\/option><option value=\"AI\">Anguilla<\/option><option value=\"AQ\">Antarctica<\/option><option value=\"AG\">Antigua and Barbuda<\/option><option value=\"AR\">Argentina<\/option><option value=\"AM\">Armenia<\/option><option value=\"AW\">Aruba<\/option><option value=\"AS\">American Samoa<\/option><option value=\"AT\">Austria<\/option><option value=\"AZ\">Azerbaijan<\/option><option value=\"BS\">Bahamas<\/option><option value=\"BH\">Bahrain<\/option><option value=\"BD\">Bangladesh<\/option><option value=\"BB\">Barbados<\/option><option value=\"BY\">Belarus<\/option><option value=\"BE\">Belgium<\/option><option value=\"PW\">Belau<\/option><option value=\"BZ\">Belize<\/option><option value=\"BJ\">Benin<\/option><option value=\"BM\">Bermuda<\/option><option value=\"BT\">Bhutan<\/option><option value=\"BO\">Bolivia<\/option><option value=\"BQ\">Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\">Bosnia and Herzegovina<\/option><option value=\"BW\">Botswana<\/option><option value=\"BV\">Bouvet Island<\/option><option value=\"BR\">Brazil<\/option><option value=\"IO\">British Indian Ocean Territory<\/option><option value=\"VG\">British Virgin Islands<\/option><option value=\"BN\">Brunei<\/option><option value=\"BG\">Bulgaria<\/option><option value=\"BF\">Burkina Faso<\/option><option value=\"BI\">Burundi<\/option><option value=\"KH\">Cambodia<\/option><option value=\"CM\">Cameroon<\/option><option value=\"CV\">Cape Verde<\/option><option value=\"KY\">Cayman Islands<\/option><option value=\"CF\">Central African Republic<\/option><option value=\"TD\">Chad<\/option><option value=\"CL\">Chile<\/option><option value=\"CN\">China<\/option><option value=\"CX\">Christmas Island<\/option><option value=\"CC\">Cocos (Keeling) Islands<\/option><option value=\"CO\">Colombia<\/option><option value=\"KM\">Comoros<\/option><option value=\"CG\">Congo (Brazzaville)<\/option><option value=\"CD\">Congo (Kinshasa)<\/option><option value=\"CK\">Cook Islands<\/option><option value=\"CR\">Costa Rica<\/option><option value=\"HR\">Croatia<\/option><option value=\"CU\">Cuba<\/option><option value=\"CW\">Cura&Ccedil;ao<\/option><option value=\"CY\">Cyprus<\/option><option value=\"CZ\">Czech Republic<\/option><option value=\"DK\">Denmark<\/option><option value=\"DJ\">Djibouti<\/option><option value=\"DM\">Dominica<\/option><option value=\"DO\">Dominican Republic<\/option><option value=\"EC\">Ecuador<\/option><option value=\"EG\">Egypt<\/option><option value=\"SV\">El Salvador<\/option><option value=\"GQ\">Equatorial Guinea<\/option><option value=\"ER\">Eritrea<\/option><option value=\"EE\">Estonia<\/option><option value=\"ET\">Ethiopia<\/option><option value=\"FK\">Falkland Islands<\/option><option value=\"FO\">Faroe Islands<\/option><option value=\"FJ\">Fiji<\/option><option value=\"FI\">Finland<\/option><option value=\"FR\">France<\/option><option value=\"GF\">French Guiana<\/option><option value=\"PF\">French Polynesia<\/option><option value=\"TF\">French Southern Territories<\/option><option value=\"GA\">Gabon<\/option><option value=\"GM\">Gambia<\/option><option value=\"GE\">Georgia<\/option><option value=\"DE\">Germany<\/option><option value=\"GH\">Ghana<\/option><option value=\"GI\">Gibraltar<\/option><option value=\"GR\">Greece<\/option><option value=\"GL\">Greenland<\/option><option value=\"GD\">Grenada<\/option><option value=\"GP\">Guadeloupe<\/option><option value=\"GT\">Guatemala<\/option><option value=\"GG\">Guernsey<\/option><option value=\"GN\">Guinea<\/option><option value=\"GW\">Guinea-Bissau<\/option><option value=\"GY\">Guyana<\/option><option value=\"HT\">Haiti<\/option><option value=\"HM\">Heard Island and McDonald Islands<\/option><option value=\"HN\">Honduras<\/option><option value=\"HK\">Hong Kong<\/option><option value=\"HU\">Hungary<\/option><option value=\"IS\">Iceland<\/option><option value=\"IN\">India<\/option><option value=\"ID\">Indonesia<\/option><option value=\"IR\">Iran<\/option><option value=\"IQ\">Iraq<\/option><option value=\"IE\">Republic of Ireland<\/option><option value=\"IM\">Isle of Man<\/option><option value=\"IL\">Israel<\/option><option value=\"IT\">Italy<\/option><option value=\"CI\">Ivory Coast<\/option><option value=\"JM\">Jamaica<\/option><option value=\"JP\">Japan<\/option><option value=\"JE\">Jersey<\/option><option value=\"JO\">Jordan<\/option><option value=\"KZ\">Kazakhstan<\/option><option value=\"KE\">Kenya<\/option><option value=\"KI\">Kiribati<\/option><option value=\"KW\">Kuwait<\/option><option value=\"KG\">Kyrgyzstan<\/option><option value=\"LA\">Laos<\/option><option value=\"LV\">Latvia<\/option><option value=\"LB\">Lebanon<\/option><option value=\"LS\">Lesotho<\/option><option value=\"LR\">Liberia<\/option><option value=\"LY\">Libya<\/option><option value=\"LI\">Liechtenstein<\/option><option value=\"LT\">Lithuania<\/option><option value=\"LU\">Luxembourg<\/option><option value=\"MO\">Macao S.A.R., China<\/option><option value=\"MK\">Macedonia<\/option><option value=\"MG\">Madagascar<\/option><option value=\"MW\">Malawi<\/option><option value=\"MY\">Malaysia<\/option><option value=\"MV\">Maldives<\/option><option value=\"ML\">Mali<\/option><option value=\"MT\">Malta<\/option><option value=\"MH\">Marshall Islands<\/option><option value=\"MQ\">Martinique<\/option><option value=\"MR\">Mauritania<\/option><option value=\"MU\">Mauritius<\/option><option value=\"YT\">Mayotte<\/option><option value=\"MX\">Mexico<\/option><option value=\"FM\">Micronesia<\/option><option value=\"MD\">Moldova<\/option><option value=\"MC\">Monaco<\/option><option value=\"MN\">Mongolia<\/option><option value=\"ME\">Montenegro<\/option><option value=\"MS\">Montserrat<\/option><option value=\"MA\">Morocco<\/option><option value=\"MZ\">Mozambique<\/option><option value=\"MM\">Myanmar<\/option><option value=\"NA\">Namibia<\/option><option value=\"NR\">Nauru<\/option><option value=\"NP\">Nepal<\/option><option value=\"NL\">Netherlands<\/option><option value=\"AN\">Netherlands Antilles<\/option><option value=\"NC\">New Caledonia<\/option><option value=\"NZ\">New Zealand<\/option><option value=\"NI\">Nicaragua<\/option><option value=\"NE\">Niger<\/option><option value=\"NG\">Nigeria<\/option><option value=\"NU\">Niue<\/option><option value=\"NF\">Norfolk Island<\/option><option value=\"KP\">North Korea<\/option><option value=\"NO\">Norway<\/option><option value=\"OM\">Oman<\/option><option value=\"PK\">Pakistan<\/option><option value=\"PS\">Palestinian Territory<\/option><option value=\"PA\">Panama<\/option><option value=\"PG\">Papua New Guinea<\/option><option value=\"PY\">Paraguay<\/option><option value=\"PE\">Peru<\/option><option value=\"PH\">Philippines<\/option><option value=\"PN\">Pitcairn<\/option><option value=\"PL\">Poland<\/option><option value=\"PT\">Portugal<\/option><option value=\"QA\">Qatar<\/option><option value=\"RE\">Reunion<\/option><option value=\"RO\">Romania<\/option><option value=\"RU\">Russia<\/option><option value=\"RW\">Rwanda<\/option><option value=\"BL\">Saint Barth&eacute;lemy<\/option><option value=\"SH\">Saint Helena<\/option><option value=\"KN\">Saint Kitts and Nevis<\/option><option value=\"LC\">Saint Lucia<\/option><option value=\"MF\">Saint Martin (French part)<\/option><option value=\"SX\">Saint Martin (Dutch part)<\/option><option value=\"PM\">Saint Pierre and Miquelon<\/option><option value=\"VC\">Saint Vincent and the Grenadines<\/option><option value=\"SM\">San Marino<\/option><option value=\"ST\">S&atilde;o Tom&eacute; and Pr&iacute;ncipe<\/option><option value=\"SA\">Saudi Arabia<\/option><option value=\"SN\">Senegal<\/option><option value=\"RS\">Serbia<\/option><option value=\"SC\">Seychelles<\/option><option value=\"SL\">Sierra Leone<\/option><option value=\"SG\">Singapore<\/option><option value=\"SK\">Slovakia<\/option><option value=\"SI\">Slovenia<\/option><option value=\"SB\">Solomon Islands<\/option><option value=\"SO\">Somalia<\/option><option value=\"ZA\">South Africa<\/option><option value=\"GS\">South Georgia\/Sandwich Islands<\/option><option value=\"KR\">South Korea<\/option><option value=\"SS\">South Sudan<\/option><option value=\"ES\">Spain<\/option><option value=\"LK\">Sri Lanka<\/option><option value=\"SD\">Sudan<\/option><option value=\"SR\">Suriname<\/option><option value=\"SJ\">Svalbard and Jan Mayen<\/option><option value=\"SZ\">Swaziland<\/option><option value=\"SE\">Sweden<\/option><option value=\"CH\">Switzerland<\/option><option value=\"SY\">Syria<\/option><option value=\"TW\">Taiwan<\/option><option value=\"TJ\">Tajikistan<\/option><option value=\"TZ\">Tanzania<\/option><option value=\"TH\">Thailand<\/option><option value=\"TL\">Timor-Leste<\/option><option value=\"TG\">Togo<\/option><option value=\"TK\">Tokelau<\/option><option value=\"TO\">Tonga<\/option><option value=\"TT\">Trinidad and Tobago<\/option><option value=\"TN\">Tunisia<\/option><option value=\"TR\">Turkey<\/option><option value=\"TM\">Turkmenistan<\/option><option value=\"TC\">Turks and Caicos Islands<\/option><option value=\"TV\">Tuvalu<\/option><option value=\"UG\">Uganda<\/option><option value=\"UA\">Ukraine<\/option><option value=\"AE\">United Arab Emirates<\/option><option value=\"UY\">Uruguay<\/option><option value=\"UZ\">Uzbekistan<\/option><option value=\"VU\">Vanuatu<\/option><option value=\"VA\">Vatican<\/option><option value=\"VE\">Venezuela<\/option><option value=\"VN\">Vietnam<\/option><option value=\"WF\">Wallis and Futuna<\/option><option value=\"EH\">Western Sahara<\/option><option value=\"WS\">Western Samoa<\/option><option value=\"YE\">Yemen<\/option><option value=\"ZM\">Zambia<\/option><option value=\"ZW\">Zimbabwe<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-780-city\" class=\"vfb-address-label\">City<\/label><input id=\"vfb-field-780-city\" class=\"vfb-form-control vfb-addresspart-city\" placeholder=\"\" type=\"text\" name=\"vfb-field-780[city]\"><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-780-province\" class=\"vfb-address-label\">State<\/label><select id=\"vfb-field-780-province\" class=\"vfb-form-control vfb-addresspart-province\" placeholder=\"\" name=\"vfb-field-780[province]\"><option value=\"\"><\/option><option value=\"AL\">Alabama<\/option><option value=\"AK\">Alaska<\/option><option value=\"AZ\">Arizona<\/option><option value=\"AR\">Arkansas<\/option><option value=\"CA\">California<\/option><option value=\"CO\">Colorado<\/option><option value=\"CT\">Connecticut<\/option><option value=\"DE\">Delaware<\/option><option value=\"DC\">District Of Columbia<\/option><option value=\"FL\">Florida<\/option><option value=\"GA\">Georgia<\/option><option value=\"HI\">Hawaii<\/option><option value=\"ID\">Idaho<\/option><option value=\"IL\">Illinois<\/option><option value=\"IN\">Indiana<\/option><option value=\"IA\">Iowa<\/option><option value=\"KS\">Kansas<\/option><option value=\"KY\">Kentucky<\/option><option value=\"LA\">Louisiana<\/option><option value=\"ME\">Maine<\/option><option value=\"MD\">Maryland<\/option><option value=\"MA\">Massachusetts<\/option><option value=\"MI\">Michigan<\/option><option value=\"MN\">Minnesota<\/option><option value=\"MS\">Mississippi<\/option><option value=\"MO\">Missouri<\/option><option value=\"MT\">Montana<\/option><option value=\"NE\">Nebraska<\/option><option value=\"NV\">Nevada<\/option><option value=\"NH\">New Hampshire<\/option><option value=\"NJ\">New Jersey<\/option><option value=\"NM\">New Mexico<\/option><option value=\"NY\">New York<\/option><option value=\"NC\">North Carolina<\/option><option value=\"ND\">North Dakota<\/option><option value=\"OH\">Ohio<\/option><option value=\"OK\">Oklahoma<\/option><option value=\"OR\">Oregon<\/option><option value=\"PA\">Pennsylvania<\/option><option value=\"RI\">Rhode Island<\/option><option value=\"SC\">South Carolina<\/option><option value=\"SD\">South Dakota<\/option><option value=\"TN\">Tennessee<\/option><option value=\"TX\">Texas<\/option><option value=\"UT\">Utah<\/option><option value=\"VT\">Vermont<\/option><option value=\"VA\">Virginia<\/option><option value=\"WA\">Washington<\/option><option value=\"WV\">West Virginia<\/option><option value=\"WI\">Wisconsin<\/option><option value=\"WY\">Wyoming<\/option><option value=\"AA\">Armed Forces (AA)<\/option><option value=\"AE\">Armed Forces (AE)<\/option><option value=\"AP\">Armed Forces (AP)<\/option><option value=\"AS\">American Samoa<\/option><option value=\"GU\">Guam<\/option><option value=\"MP\">Northern Mariana Islands<\/option><option value=\"PR\">Puerto Rico<\/option><option value=\"UM\">US Minor Outlying Islands<\/option><option value=\"VI\">US Virgin Islands<\/option><\/select><\/div><div class=\"vfb-form-group\" style=\"\"><label for=\"vfb-field-780-zip\" class=\"vfb-address-label\">Zip code<\/label><input id=\"vfb-field-780-zip\" class=\"vfb-form-control vfb-addresspart-zip\" placeholder=\"\" type=\"text\" name=\"vfb-field-780[zip]\"><\/div><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField781\"><div class=\"vfb-form-group\"><label for=\"vfb-field-781\" class=\"vfb-control-label\">T\u00e9l\u00e9phone<\/label><div><input id=\"vfb-field-781\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-781\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-phone\" id=\"vfbField782\"><div class=\"vfb-form-group\"><label for=\"vfb-field-782\" class=\"vfb-control-label\">T\u00e9l\u00e9copieur<\/label><div><input id=\"vfb-field-782\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" type=\"tel\" name=\"vfb-field-782\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField783\"><div class=\"vfb-form-group\"><label for=\"vfb-field-783\" class=\"vfb-control-label\">R\u00c9F\u00c9RENCES<\/label><div class=\"\"><p><span class=\"vfb-help-block\"><strong>Nous autorisons NAGWorld Inc. \u00e0 obtenir des r\u00e9f\u00e9rences de cr\u00e9dit provenant de notre banque et de nos fournisseurs. Nous comprenons et nous acceptons les modalit\u00e9s de paiement que vous avez pr\u00e9cis\u00e9 dans la section Comptes Payables ci-dessus.<\/strong><\/span><\/p>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField784\"><div class=\"vfb-form-group\"><label for=\"vfb-field-784\" class=\"vfb-control-label\">Nom, Adresse, Courriel, Num\u00e9ro de t\u00e9l\u00e9phone<\/label><div><textarea id=\"vfb-field-784\" class=\"vfb-form-control\" placeholder=\"\" rows=\"10\" name=\"vfb-field-784\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField785\"><div class=\"vfb-form-group\"><label for=\"vfb-field-785\" class=\"vfb-control-label\">Nom de la personne autoris\u00e9<\/label><div><input id=\"vfb-field-785\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-785\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-text\" id=\"vfbField786\"><div class=\"vfb-form-group\"><label for=\"vfb-field-786\" class=\"vfb-control-label\">Titre de la personne autoris\u00e9<\/label><div><input id=\"vfb-field-786\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-786\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-4 vfb-fieldType-date\" id=\"vfbField787\"><div class=\"vfb-form-group\"><label for=\"vfb-field-787\" class=\"vfb-control-label\">Date<\/label><div><input id=\"vfb-field-787\" class=\"vfb-form-control\" placeholder=\"\" data-provide=\"datepicker\" type=\"text\" name=\"vfb-field-787\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-captcha\" id=\"vfbField788\"><div class=\"vfb-form-group\"><label for=\"vfb-field-788\" class=\"vfb-control-label\">V\u00e9rification <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"g-recaptcha\" data-sitekey=\"6Lcm6nIUAAAAAAyb1kSMgvtFuA98Y1AhYcITTk4d\"><\/div><input type=\"hidden\" name=\"_vfb_recaptcha_enabled\" value=\"1\" id=\"\"><div class=\"vfb-has-error\" id=\"vfb-recaptcha-error\"><span class=\"vfb-help-block\">reCAPTCHA is required.<\/span><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField789\"><button id=\"vfb-field-789\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Envoyer<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":510,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"page-full.php","meta":{"footnotes":""},"class_list":["post-514","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/pages\/514\/"}],"collection":[{"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/pages\/"}],"about":[{"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/types\/page\/"}],"author":[{"embeddable":true,"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/users\/2\/"}],"replies":[{"embeddable":true,"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/comments\/?post=514"}],"version-history":[{"count":1,"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/pages\/514\/revisions\/"}],"predecessor-version":[{"id":852,"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/pages\/514\/revisions\/852\/"}],"up":[{"embeddable":true,"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/pages\/510\/"}],"wp:attachment":[{"href":"https:\/\/nagworld.ca\/fr-ca\/wp-json\/wp\/v2\/media\/?parent=514"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}