{"id":76,"date":"2017-07-03T08:51:12","date_gmt":"2017-07-03T06:51:12","guid":{"rendered":"http:\/\/mesaides.info\/?page_id=76"},"modified":"2017-11-07T21:41:00","modified_gmt":"2017-11-07T20:41:00","slug":"formulaire","status":"publish","type":"page","link":"http:\/\/mesaides.info\/index.php\/formulaire\/","title":{"rendered":"Suis je \u00e9ligible ?"},"content":{"rendered":"<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f96-o1\" lang=\"fr-FR\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/76#wpcf7-f96-o1\" method=\"post\" class=\"wpcf7-form\" novalidate=\"novalidate\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"96\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"4.9.1\" \/>\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<\/div>\n<div >\n<!-- specify the url path for the image --><br \/>\n<img src=\"http:\/\/mesaides.info\/wp-content\/uploads\/2017\/11\/vous1.jpg\"><br \/>\n<br\/>\n<\/div>\n<p><label> Votre nom<br \/>\n    <span class=\"wpcf7-form-control-wrap your-name\"><input type=\"text\" name=\"your-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Votre pr\u00e9nom<br \/>\n    <span class=\"wpcf7-form-control-wrap your-prenom\"><input type=\"text\" name=\"your-prenom\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Votre t\u00e9l\u00e9phone<br \/>\n    <span class=\"wpcf7-form-control-wrap your-tel\"><input type=\"text\" name=\"your-tel\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Votre e-mail<br \/>\n    <span class=\"wpcf7-form-control-wrap your-email\"><input type=\"email\" name=\"your-email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<div >\n<!-- specify the url path for the image --><br \/>\n<img src=\"http:\/\/mesaides.info\/wp-content\/uploads\/2017\/11\/logement1.jpg\"><br \/>\n<br\/>\n<\/div>\n<p><label> Votre logement<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap checkbox-410\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-410[]\" value=\"Maison individuelle\" \/><span class=\"wpcf7-list-item-label\">Maison individuelle<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-410[]\" value=\"Appartement\" \/><span class=\"wpcf7-list-item-label\">Appartement<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-410[]\" value=\"Autre\" \/><span class=\"wpcf7-list-item-label\">Autre<\/span><\/span><\/span><\/span><\/p>\n<p><label> Ann\u00e9e du logement<br \/>\n    <span class=\"wpcf7-form-control-wrap your-annee\"><input type=\"text\" name=\"your-annee\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Surface habitable<br \/>\n    <span class=\"wpcf7-form-control-wrap your-surface\"><input type=\"text\" name=\"your-surface\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Adresse du logement<br \/>\n    <span class=\"wpcf7-form-control-wrap adress\"><input type=\"text\" name=\"adress\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Code postal<br \/>\n    <span class=\"wpcf7-form-control-wrap cp\"><input type=\"text\" name=\"cp\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Ville<br \/>\n    <span class=\"wpcf7-form-control-wrap ville\"><input type=\"text\" name=\"ville\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<div >\n<!-- specify the url path for the image --><br \/>\n<img src=\"http:\/\/mesaides.info\/wp-content\/uploads\/2017\/11\/situation.jpg\"><br \/>\n<br\/>\n<\/div>\n<p><label> Vous \u00eates<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap checkbox-409\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-409[]\" value=\"Propri\u00e9taire\" \/><span class=\"wpcf7-list-item-label\">Propri\u00e9taire<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-409[]\" value=\"Locataire\" \/><span class=\"wpcf7-list-item-label\">Locataire<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-409[]\" value=\"Autre\" \/><span class=\"wpcf7-list-item-label\">Autre<\/span><\/span><\/span><\/span><\/p>\n<p><label> Avez vous d\u00e9j\u00e0 b\u00e9n\u00e9fici\u00e9 des aides de l'ANAH ?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap checkbox-411\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-411[]\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-411[]\" value=\"Oui moins de 5 ans\" \/><span class=\"wpcf7-list-item-label\">Oui moins de 5 ans<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-411[]\" value=\"Oui plus de 5 ans\" \/><span class=\"wpcf7-list-item-label\">Oui plus de 5 ans<\/span><\/span><\/span><\/span><\/p>\n<p><label> Avez vous d\u00e9j\u00e0 b\u00e9n\u00e9fici\u00e9 de l'\u00e9co-ch\u00e8que de la r\u00e9gion ?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap checkbox-412\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-412[]\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-412[]\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span><\/p>\n<p><label> Dernier revenu fiscal de r\u00e9f\u00e9rence (RFR)<br \/>\n    <span class=\"wpcf7-form-control-wrap your-rfr\"><input type=\"text\" name=\"your-rfr\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<p><label> Nombre de personnes vivant dans le logement<br \/>\n    <span class=\"wpcf7-form-control-wrap your-foyer\"><input type=\"text\" name=\"your-foyer\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span> <\/label><\/p>\n<div >\n<!-- specify the url path for the image --><br \/>\n<img src=\"http:\/\/mesaides.info\/wp-content\/uploads\/2017\/11\/reno.jpg\"><br \/>\n<br\/>\n<\/div>\n<p><label> Travaux envisag\u00e9s<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap checkbox-413\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-413[]\" value=\"Isolation\" \/><span class=\"wpcf7-list-item-label\">Isolation<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-413[]\" value=\"Chauffage\" \/><span class=\"wpcf7-list-item-label\">Chauffage<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-413[]\" value=\"Menuiseries\" \/><span class=\"wpcf7-list-item-label\">Menuiseries<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-413[]\" value=\"Ventilation\" \/><span class=\"wpcf7-list-item-label\">Ventilation<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-413[]\" value=\"Adaptation\" \/><span class=\"wpcf7-list-item-label\">Adaptation<\/span><\/span><\/span><\/span><\/p>\n<p><label> Avez vous d\u00e9j\u00e0 d\u00e9but\u00e9 vos travaux ou sign\u00e9 un devis ?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap checkbox-415\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-415[]\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-415[]\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><\/span><\/span><\/p>\n<div >\n<!-- specify the url path for the image --><br \/>\n<img src=\"http:\/\/mesaides.info\/wp-content\/uploads\/2017\/11\/commentaire.jpg\"><br \/>\n<br\/>\n<\/div>\n<p><span class=\"wpcf7-form-control-wrap your-message\"><textarea name=\"your-message\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\"><\/textarea><\/span><\/p>\n<p><label>En cliquant sur envoyer, j'accepte d'\u00eatre recontact\u00e9 par un professionnel pour \u00eatre renseign\u00e9 gratuitement sur les diff\u00e9rents dispositifs d'aides dont je suis \u00e9ligible.<\/label><\/p>\n<p><input type=\"submit\" value=\"Envoyer ma demande d&#039;aides !\" class=\"wpcf7-form-control wpcf7-submit\" \/><\/p>\n<div class=\"wpcf7-response-output wpcf7-display-none\"><\/div><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"fullwidth.php","meta":[],"_links":{"self":[{"href":"http:\/\/mesaides.info\/index.php\/wp-json\/wp\/v2\/pages\/76"}],"collection":[{"href":"http:\/\/mesaides.info\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/mesaides.info\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/mesaides.info\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/mesaides.info\/index.php\/wp-json\/wp\/v2\/comments?post=76"}],"version-history":[{"count":19,"href":"http:\/\/mesaides.info\/index.php\/wp-json\/wp\/v2\/pages\/76\/revisions"}],"predecessor-version":[{"id":91,"href":"http:\/\/mesaides.info\/index.php\/wp-json\/wp\/v2\/pages\/76\/revisions\/91"}],"wp:attachment":[{"href":"http:\/\/mesaides.info\/index.php\/wp-json\/wp\/v2\/media?parent=76"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}