{"id":97,"date":"2017-07-18T15:36:30","date_gmt":"2017-07-18T14:36:30","guid":{"rendered":"https:\/\/mes-formulaires.cpamcentre.fr\/?page_id=97"},"modified":"2021-10-21T09:24:54","modified_gmt":"2021-10-21T08:24:54","slug":"installation-fournisseurs","status":"publish","type":"page","link":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/installation-fournisseurs\/","title":{"rendered":"Fournisseurs : S&rsquo;installer en loir-et-Cher"},"content":{"rendered":"<p style=\"text-align: justify;\">Afin de faciliter nos \u00e9changes, nous vous proposons de compl\u00e9ter le formulaire ci-dessous en indiquant les informations relatives \u00e0 votre projet d&rsquo;installation en Loir-et-Cher.<\/p>\n<p style=\"text-align: justify;\">A r\u00e9ception de votre formulaire, le service Relations Professions de Sant\u00e9 de la CPAM de Loir-et-Cher s&rsquo;engage \u00e0 vous contacter sous 3 jours ouvr\u00e9s.<\/p>\n<hr>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f96-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"96\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/97#wpcf7-f96-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"96\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f96-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0>\n\t<tr>\n\t\t<td>\n\t\t\t<h4 style=\"padding-top:0;margin-top:0;\">Vos coordonn\u00e9es\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Cat\u00e9gorie professionnelle*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CategoriePro\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"CategoriePro\"><option value=\"Opticien\">Opticien<\/option><option value=\"Prestataire des titres I et IV de la LPP\">Prestataire des titres I et IV de la LPP<\/option><option value=\"Oculariste \/ Epith\u00e9siste \/ Podo-orth\u00e9siste\">Oculariste \/ Epith\u00e9siste \/ Podo-orth\u00e9siste<\/option><option value=\"Audioproth\u00e9siste\">Audioproth\u00e9siste<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Prenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>T\u00e9l\u00e9phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Telephone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Adresse mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"Mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Vos disponibilit\u00e9s pour \u00eatre contact\u00e9*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Dispo\"><textarea cols=\"42\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Dispo\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Votre projet\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Date pr\u00e9vue d'installation (jj\/mm\/aaaa)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"DateInstall\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"DateInstall\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Lieu d'installation*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"LieuInstall\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"LieuInstall\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom de votre soci\u00e9t\u00e9*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NomSociete\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NomSociete\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Adresse du si\u00e8ge social*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"AdresseSS\"><textarea cols=\"42\" rows=\"2\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"AdresseSS\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Type de projet*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"TypeProjet\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"TypeProjet\"><option value=\"Ouverture d&#039;un \u00e9tablissement principal\">Ouverture d&#039;un \u00e9tablissement principal<\/option><option value=\"Ouverture d&#039;un \u00e9tablissement secondaire\">Ouverture d&#039;un \u00e9tablissement secondaire<\/option><option value=\"D\u00e9m\u00e9nagement d&#039;un \u00e9tablissement\">D\u00e9m\u00e9nagement d&#039;un \u00e9tablissement<\/option><option value=\"Autre\">Autre<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Si autre, pr\u00e9cisez<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"AutreType\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"AutreType\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"3783065832\" \/><img decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/3783065832.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"142\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Afin de faciliter nos \u00e9changes, nous vous proposons de compl\u00e9ter le formulaire ci-dessous en indiquant les informations relatives \u00e0 votre projet d&rsquo;installation en Loir-et-Cher. A r\u00e9ception de votre formulaire, le service Relations Professions de Sant\u00e9 de la CPAM de Loir-et-Cher s&rsquo;engage \u00e0 vous contacter sous 3 jours ouvr\u00e9s.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-97","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/97"}],"collection":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/comments?post=97"}],"version-history":[{"count":3,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/97\/revisions"}],"predecessor-version":[{"id":333,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/97\/revisions\/333"}],"wp:attachment":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/media?parent=97"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}