Remplissez le formulaire pour demander un devis

Question

Accepted Answer

<div class="frm_forms  with_frm_style frm_style_style-formidable" id="frm_form_8_container" data-token="883cfaba128bd923daf574ec634cd902">
<form enctype="multipart/form-data" method="post" class="frm-show-form " id="form_formulaire-de-demande-de-devis-metrhom"  data-token="883cfaba128bd923daf574ec634cd902">
<div class="frm_form_fields ">
<fieldset>
<legend class="frm_screen_reader">formulaire de demande de devis METRHOM</legend>

<div class="frm_fields_container">
<input type="hidden" name="frm_action" value="create" />
<input type="hidden" name="form_id" value="8" />
<input type="hidden" name="frm_hide_fields_8" id="frm_hide_fields_8" value="" />
<input type="hidden" name="form_key" value="formulaire-de-demande-de-devis-metrhom" />
<input type="hidden" name="item_meta[0]" value="" />
<input type="hidden" id="frm_submit_entry_8" name="frm_submit_entry_8" value="3b90acf408" /><input type="hidden" name="_wp_http_referer" value="/produit/ti-touch-916/?page&#038;product=ti-touch-916&#038;post_type=product&#038;add_to_wishlist=1586" /><div id="frm_field_62_container" class="frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first">
    <label for="field_v9ogd6" id="field_v9ogd6_label" class="frm_primary_label">Nom
        <span class="frm_required" aria-hidden="true">*</span>
    </label>
    <input type="text" id="field_v9ogd6" name="item_meta[62]" value=""  data-reqmsg="Nom cannot be blank." aria-required="true" data-invmsg="Nom est non valide" aria-invalid="false"  />
    
    
</div>
<div id="frm_field_63_container" class="frm_form_field form-field  frm_required_field frm_top_container frm6">
    <label for="field_j3t5l6" id="field_j3t5l6_label" class="frm_primary_label">Prénom 
        <span class="frm_required" aria-hidden="true">*</span>
    </label>
    <input type="text" id="field_j3t5l6" name="item_meta[63]" value=""  data-reqmsg="Prénom  cannot be blank." aria-required="true" data-invmsg="Prénom  est non valide" aria-invalid="false"  /> 
    
    
</div>
<div id="frm_field_64_container" class="frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first">
    <label for="field_nb4ey6" id="field_nb4ey6_label" class="frm_primary_label">Entreprise / Organisation
        <span class="frm_required" aria-hidden="true">*</span>
    </label>
    <input type="text" id="field_nb4ey6" name="item_meta[64]" value=""  data-reqmsg="Entreprise / Organisation cannot be blank." aria-required="true" data-invmsg="Entreprise / Organisation est non valide" aria-invalid="false"  />
    
    
</div>
<div id="frm_field_65_container" class="frm_form_field form-field  frm_required_field frm_top_container frm6">
    <label for="field_oz2kk6" id="field_oz2kk6_label" class="frm_primary_label">La fonction
        <span class="frm_required" aria-hidden="true">*</span>
    </label>
    <input type="text" id="field_oz2kk6" name="item_meta[65]" value=""  data-reqmsg="La fonction cannot be blank." aria-required="true" data-invmsg="La fonction est non valide" aria-invalid="false"  />
    
    
</div>
<div id="frm_field_66_container" class="frm_form_field form-field  frm_top_container">
    <label for="field_32kgz6" id="field_32kgz6_label" class="frm_primary_label">Nom de produit 
        <span class="frm_required" aria-hidden="true"></span>
    </label>
    <input type="text" id="field_32kgz6" name="item_meta[66]" value=""  data-invmsg="Nom de produit  est non valide" class="nmpro" style="color: black;" aria-invalid="false"  />
    
    
</div>
<div id="frm_field_67_container" class="frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first">
    <label for="field_hj2bc6" id="field_hj2bc6_label" class="frm_primary_label">Téléphone
        <span class="frm_required" aria-hidden="true">*</span>
    </label>
    <input type="tel" id="field_hj2bc6" name="item_meta[67]" value=""  data-reqmsg="Téléphone cannot be blank." aria-required="true" data-invmsg="Téléphone est non valide" aria-invalid="false" pattern="((\+\d{1,3}(-|.| )?$?\d$?(-| |.)?\d{1,5})|($?\d{2,6}$?))(-|.| )?(\d{3,4})(-|.| )?(\d{4})(( x| ext)\d{1,5}){0,1}$"  />
    
    
</div>
<div id="frm_field_68_container" class="frm_form_field form-field  frm_required_field frm_top_container">
    <label for="field_tqzrs6" id="field_tqzrs6_label" class="frm_primary_label">Email
        <span class="frm_required" aria-hidden="true">*</span>
    </label>
    <input type="email" id="field_tqzrs6" name="item_meta[68]" value=""  data-reqmsg="Email cannot be blank." aria-required="true" data-invmsg="Email est non valide" aria-invalid="false"  />
    
    
</div>
<div id="frm_field_69_container" class="frm_form_field form-field  frm_top_container">
    <label for="field_ufqaf6" id="field_ufqaf6_label" class="frm_primary_label">Message 
        <span class="frm_required" aria-hidden="true"></span>
    </label>
    <textarea name="item_meta[69]" id="field_ufqaf6" rows="5"  data-invmsg="Message  est non valide" aria-invalid="false"  ></textarea>
    
    
</div>
<div id="frm_field_70_container" class="frm_form_field form-field  frm_none_container">
    <label for="g-recaptcha-response" id="field_89nru6_label" class="frm_primary_label">Captcha
        <span class="frm_required" aria-hidden="true"></span>
    </label>
    <div  id="field_89nru6" class="frm-g-recaptcha" data-sitekey="6LebJa0pAAAAABPD54PeMmIFwHk1D7SWY775x1hk" data-size="invisible" data-theme="light"></div>
    
    
</div>
	<input type="hidden" name="item_key" value="" />
				<div class="frm__660ca0987c12a">
				<label for="frm_email_8" >
					Si vous êtes un humain, ne remplissez pas ce champ.				</label>
				<input  id="frm_email_8" type="text" class="frm_verify" name="frm__660ca0987c12a" value="" autocomplete="false"  />
			</div>
		<div class="frm_submit frm_flex">
<button class="frm_button_submit" type="submit"  >Envoyer</button>



</div></div>
</fieldset>
</div>
</form>
</div>

Présentation

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Médical

TITRAGE Ti-Touch 916

Remplissez le formulaire pour demander un devis

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