[wpforms id="7597" title="false"]
<div class="wpforms-container wpforms-container-full wpforms-form-abandonment wpf-center" id="wpforms-7597"><form id="wpforms-form-7597" class="wpforms-validate wpforms-form wpforms-ajax-form" data-formid="7597" method="post" enctype="multipart/form-data" action="/modeles/laser-blanc/" data-token="f2b1f41579d3919c0e0e7e9f562637ec"><noscript class="wpforms-error-noscript">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.</noscript><div class="wpforms-field-container"><div id="wpforms-7597-field_50-container" class="wpforms-field wpforms-field-select wpforms-field-select-style-modern" data-field-id="50"><label class="wpforms-field-label" for="wpforms-7597-field_50">Je souhaite prendre un rendez-vous <span class="wpforms-required-label">*</span></label><select id="wpforms-7597-field_50" class="wpforms-field-large wpforms-field-required choicesjs-select" data-size-class="wpforms-field-row wpforms-field-large" data-search-enabled="" name="wpforms[fields][50]" required="required"><option value="" class="placeholder" disabled selected='selected'>Á distance</option><option value="Á distance" >Á distance</option><option value="En Magasin" >En Magasin</option></select></div><div id="wpforms-7597-field_41-container" class="wpforms-field wpforms-field-name" data-field-id="41"><label class="wpforms-field-label wpforms-label-hide" for="wpforms-7597-field_41">Prénom Nom <span class="wpforms-required-label">*</span></label><div class="wpforms-field-row wpforms-field-large"><div class="wpforms-field-row-block wpforms-first wpforms-one-half"><input type="text" id="wpforms-7597-field_41" class="wpforms-field-name-first wpforms-field-required" name="wpforms[fields][41][first]" placeholder="Nom " required><label for="wpforms-7597-field_41" class="wpforms-field-sublabel after wpforms-sublabel-hide">Prénom</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-7597-field_41-last" class="wpforms-field-name-last wpforms-field-required" name="wpforms[fields][41][last]" placeholder="Prénom" required><label for="wpforms-7597-field_41-last" class="wpforms-field-sublabel after wpforms-sublabel-hide">Nom</label></div></div></div><div id="wpforms-7597-field_42-container" class="wpforms-field wpforms-field-email" data-field-id="42"><label class="wpforms-field-label" for="wpforms-7597-field_42">E-mail <span class="wpforms-required-label">*</span></label><input type="email" id="wpforms-7597-field_42" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][42]" required></div><div id="wpforms-7597-field_43-container" class="wpforms-field wpforms-field-phone" data-field-id="43"><label class="wpforms-field-label" for="wpforms-7597-field_43">Télephone <span class="wpforms-required-label">*</span></label><input type="tel" id="wpforms-7597-field_43" class="wpforms-field-large wpforms-field-required" data-rule-int-phone-field="true" name="wpforms[fields][43]" placeholder="06.." required></div><div id="wpforms-7597-field_45-container" class="wpforms-field wpforms-field-number" data-field-id="45"><label class="wpforms-field-label" for="wpforms-7597-field_45">Code Postal <span class="wpforms-required-label">*</span></label><input type="number" pattern="\d*" id="wpforms-7597-field_45" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][45]" required></div><div id="wpforms-7597-field_48-container" class="wpforms-field wpforms-field-payment-select wpforms-field-select-style-modern" data-field-id="48"><label class="wpforms-field-label" for="wpforms-7597-field_48">Choisissez votre magasin <span class="wpforms-required-label">*</span></label><select id="wpforms-7597-field_48" class="wpforms-payment-price wpforms-field-large wpforms-field-required choicesjs-select" data-size-class="wpforms-field-row wpforms-field-large" data-search-enabled="1" name="wpforms[fields][48]" required="required"><option value="" class="placeholder" disabled selected='selected'>Paris 75012</option><option value="1" data-amount="0,00" data-custom-properties="0,00" >Paris 75012</option><option value="2" data-amount="0,00" data-custom-properties="0,00" >Paris 75007</option><option value="3" data-amount="0,00" data-custom-properties="0,00" > Asnières-sur-Seine</option><option value="4" data-amount="0,00" data-custom-properties="0,00" >Boulogne-Billancourt</option><option value="5" data-amount="0,00" data-custom-properties="0,00" >Athis-Mons</option><option value="6" data-amount="0,00" data-custom-properties="0,00" >Sevran</option><option value="7" data-amount="0,00" data-custom-properties="0,00" >Chelles</option><option value="8" data-amount="0,00" data-custom-properties="0,00" >Limeil-Brévannes</option><option value="9" data-amount="0,00" data-custom-properties="0,00" >Montfermeil</option><option value="10" data-amount="0,00" data-custom-properties="0,00" >Meaux</option><option value="11" data-amount="0,00" data-custom-properties="0,00" >Angers</option><option value="12" data-amount="0,00" data-custom-properties="0,00" >Lyon</option><option value="13" data-amount="0,00" data-custom-properties="0,00" >Strasbourg</option><option value="14" data-amount="0,00" data-custom-properties="0,00" >Pontault-Combault</option><option value="15" data-amount="0,00" data-custom-properties="0,00" > Coignieres</option><option value="16" data-amount="0,00" data-custom-properties="0,00" >Saint-Maximin</option><option value="17" data-amount="0,00" data-custom-properties="0,00" > Mulhouse</option></select></div><div id="wpforms-7597-field_49-container" class="wpforms-field wpforms-field-payment-select wpforms-field-select-style-classic" data-field-id="49"><label class="wpforms-field-label" for="wpforms-7597-field_49">Budget <span class="wpforms-required-label">*</span></label><select id="wpforms-7597-field_49" class="wpforms-payment-price wpforms-field-medium wpforms-field-required" name="wpforms[fields][49]" required="required"><option value="1" data-amount="10,00" >4000€ - 6000€</option><option value="2" data-amount="25,00" >6000€ - 8000€</option><option value="3" data-amount="50,00" >8000€ - 10000€</option><option value="4" data-amount="0,00" >10000€ - 12000€</option><option value="5" data-amount="0,00" >12000€ - 15000€</option><option value="6" data-amount="0,00" >15000€ - 20000€</option><option value="7" data-amount="0,00" >Supérieure à 20000€</option></select></div><div id="wpforms-7597-field_51-container" class="wpforms-field wpforms-field-select wpforms-field-select-style-modern" data-field-id="51"><label class="wpforms-field-label" for="wpforms-7597-field_51">Quand envisagez-vous de concrétiser votre projet ? <span class="wpforms-required-label">*</span></label><select id="wpforms-7597-field_51" class="wpforms-field-large wpforms-field-required choicesjs-select" data-size-class="wpforms-field-row wpforms-field-large" data-search-enabled="" name="wpforms[fields][51]" required="required"><option value="" class="placeholder" disabled selected='selected'>Immédiatement</option><option value="Immédiatement" >Immédiatement</option><option value="Dans les 3 mois" >Dans les 3 mois</option><option value="Dans les 6 mois" >Dans les 6 mois</option><option value="Autre" >Autre</option></select></div><div id="wpforms-7597-field_40-container" class="wpforms-field wpforms-field-date-time wpf-rdv-date" data-field-id="40"><label class="wpforms-field-label" for="wpforms-7597-field_40">Je souhaite un rdv pour le :</label><div class="wpforms-field-row wpforms-field-large"><div class="wpforms-field-row-block wpforms-one-half wpforms-first"><div class="wpforms-datepicker-wrap"><input type="text" id="wpforms-7597-field_40" class="wpforms-field-date-time-date wpforms-datepicker" data-date-format="d/m/Y" data-disable-past-dates="1" data-input="true" name="wpforms[fields][40][date]" ><a title="Effacer la date" data-clear class="wpforms-datepicker-clear" style="display:none;"></a></div><label for="wpforms-7597-field_40" class="wpforms-field-sublabel after ">Date</label></div><div class="wpforms-field-row-block wpforms-one-half"><input type="text" id="wpforms-7597-field_40-time" class="wpforms-field-date-time-time wpforms-timepicker" data-rule-time24h="true" data-time-format="H:i" data-step="60" data-min-time="10:00" data-max-time="18:00" name="wpforms[fields][40][time]" placeholder="Créneau" ><label for="wpforms-7597-field_40-time" class="wpforms-field-sublabel after ">Heure</label></div></div><div class="wpforms-field-description">Je serai contacté(e) par téléphone sous 24H maximum (jours et heures ouvrés)</div></div></div><div class="wpforms-submit-container" ><input type="hidden" name="wpforms[id]" value="7597"><input type="hidden" name="wpforms[author]" value="1"><input type="hidden" name="wpforms[post_id]" value="3717"><button type="submit" name="wpforms[submit]" class="wpforms-submit " id="wpforms-submit-7597" value="wpforms-submit" aria-live="assertive" data-alt-text="Envoi..." data-submit-text="Soumettre">Soumettre</button><img src="https://www.cuisineselite.com/wp-content/plugins/wpforms/assets/images/submit-spin.svg" class="wpforms-submit-spinner" style="display: none;" width="26" height="26" alt=""></div></form></div> <!-- .wpforms-container -->
