{"id":2777,"date":"2025-03-09T00:41:25","date_gmt":"2025-03-09T05:41:25","guid":{"rendered":"https:\/\/www.aristoassurance.ca\/index.php\/jet-popup\/rappelle-arisro\/"},"modified":"2025-04-02T15:49:08","modified_gmt":"2025-04-02T20:49:08","slug":"rappelle-arisro","status":"publish","type":"jet-popup","link":"https:\/\/www.aristoassurance.ca\/index.php\/jet-popup\/rappelle-arisro\/","title":{"rendered":"Evaluateur"},"content":{"rendered":"\t\t<div data-elementor-type=\"jet-popup\" data-elementor-id=\"2777\" class=\"elementor elementor-2777\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-af57686 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"af57686\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-93fa962\" data-id=\"93fa962\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0a3e5fd elementor-widget elementor-widget-spacer\" data-id=\"0a3e5fd\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.16.0 - 14-09-2023 *\/\n.elementor-column .elementor-spacer-inner{height:var(--spacer-size)}.e-con{--container-widget-width:100%}.e-con-inner>.elementor-widget-spacer,.e-con>.elementor-widget-spacer{width:var(--container-widget-width,var(--spacer-size));--align-self:var(--container-widget-align-self,initial);--flex-shrink:0}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container,.e-con>.elementor-widget-spacer>.elementor-widget-container{height:100%;width:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer{height:100%}.e-con-inner>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner,.e-con>.elementor-widget-spacer>.elementor-widget-container>.elementor-spacer>.elementor-spacer-inner{height:var(--container-widget-height,var(--spacer-size))}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty,.e-con>.elementor-widget-spacer.elementor-widget-empty{position:relative;min-height:22px;min-width:22px}.e-con-inner>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon,.e-con>.elementor-widget-spacer.elementor-widget-empty .elementor-widget-empty-icon{position:absolute;top:0;bottom:0;left:0;right:0;margin:auto;padding:0;width:22px;height:22px}<\/style>\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9706e95 elementor-widget elementor-widget-heading\" data-id=\"9706e95\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.16.0 - 14-09-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Comparateur de primes<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3f5c6ce elementor-widget elementor-widget-heading\" data-id=\"3f5c6ce\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-small\">Note : les primes affich\u00e9es ne sont pas garanties et peuvent <br>varier selon l'\u00e9tat de sant\u00e9 de la personne.<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8057273 elementor-widget elementor-widget-spacer\" data-id=\"8057273\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3bab6e4 elementor-widget elementor-widget-html\" data-id=\"3bab6e4\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<script\n    src=\"https:\/\/code.jquery.com\/jquery-3.6.4.min.js\"\n    integrity=\"sha256-oP6HI9z1XaZNBrJURtCoUT5SUnxFr8s3BzRl+cbzUq8=\"\n    crossorigin=\"anonymous\">\n<\/script>\n<style>\n    #winquote, #results {\n        color: #56595c;\n    }\n    #winquote .field {\n        display: inline-block;\n        min-width: 40%;\n        width: auto;\n    }\n    #winquote input,\n    #winquote select {\n        background-color: #fff;\n        border: solid #000 1px;\n        border-radius: 20px;\n        color: #56595c;\n        padding: 7px;\n        margin-bottom: 20px;\n        appearance: none;\n        -moz-appearance: none;\n        -webkit-appearance: none;\n    }\n    #winquote input {\n        font-size: 18px;\n        padding: 10px;\n        width: 60px;\n    }\n    #winquote select {\n        padding-right: 30px\n    }\n    #winquote select::-ms-expand {\n      display: none; \/* For Internet Explorer *\/\n    }\n    #winquote .select::after {\n      content: '\\25BC';\n      font-size: 12px;\n      color: #56595c;\n      margin-left: -30px;\n      pointer-events: none;\n    }\n    #winquote button {\n        background-color: #FFD300;\n        border: none;\n        border-radius: 30px;\n        color: #fff;\n        cursor: pointer;\n        font-size: 20px;\n        font-weight: bold;\n        padding: 20px;\n        width: 200px;\n    }\n    #results h5 {\n        color: #1183A4;\n        font-size: 24px;\n    }\n    #results h6 {\n        font-size: 22px;\n    }\n    #results h6 b {\n        color: #000;\n    }\n    @media only screen and (max-width: 600px) {\n        #winquote {\n            text-align: center;\n        }\n        #winquote label {\n            display: block;\n        }\n        #winquote input {\n            margin-left: 7px;\n        }\n        #winquote input,\n        #winquote select {\n            width: 100%;\n        }\n        #winquote .field {\n            display: block;\n        }\n    }\n<\/style>\n<form id=\"winquote\">\n    <div class=\"field select\">\n        <label>Sexe :<\/label>\n            <select name=\"sex\" data-param=\"g\">\n                <option value=\"1\">Homme<\/option>\n                <option value=\"2\">Femme<\/option>\n            <\/select>\n    <\/div>\n    <div class=\"field\">\n        <label>\u00c2ge :<\/label>\n            <input type=\"number\" name=\"age\" data-param=\"alan\" value=\"35\" required min=\"1\" max=\"99\" \/>\n    <\/div>\n    <div class=\"select\">\n        <label>Fumeur (cigarette) :<\/label>\n        <select name=\"smoker\" data-param=\"tucgt\">\n            <option value=\"100\">Non<\/option>\n            <option value=\"0\">Oui, dans les 12 derniers mois<\/option>\n        <\/select>\n    <\/div>\n    <div class=\"select\">\n        <label>Montant :<\/label>\n        <select name=\"amount\" data-param=\"fa\">\n            <option value=\"5000\">5 000 $<\/option>\n            <option value=\"10000\">10 000 $<\/option>\n            <option value=\"15000\">15 000 $<\/option>\n            <option value=\"20000\">20 000 $<\/option>\n            <option value=\"25000\">25 000 $<\/option>\n            <option value=\"30000\">30 000 $<\/option>\n            <option value=\"40000\">40 000 $<\/option>\n            <option value=\"45000\">45 000 $<\/option>\n            <option value=\"50000\" selected>50 000 $<\/option>\n            <option value=\"75000\">75 000 $<\/option>\n            <option value=\"100000\">100 000 $<\/option>\n            <option value=\"200000\">200 000 $<\/option>\n            <option value=\"300000\">300 000 $<\/option>\n        <\/select>\n    <\/div>\n    <div class=\"select\">\n        <label>Province :<\/label>\n        <select name=\"province\" data-param=\"lc\">\n            <option value=\"1\">Alberta<\/option>\n            <option value=\"0\">Colombie-Britannique<\/option>\n            <option value=\"11\">\u00cele-du-Prince-\u00c9douard<\/option>\n            <option value=\"6\">Manitoba<\/option>\n            <option value=\"10\">Nouveau-Brunswick<\/option>\n            <option value=\"9\">Nouvelle-\u00c9cosse<\/option>\n            <option value=\"5\">Nunavut<\/option>\n            <option value=\"7\">Ontario<\/option>\n            <option value=\"8\" selected>Qu\u00e9bec<\/option>\n            <option value=\"2\">Saskatchewan<\/option>\n            <option value=\"12\">Terre-Neuve-et-Labrador<\/option>\n            <option value=\"3\">Territoires-du-Nord-Ouest<\/option>\n            <option value=\"4\">Yukon<\/option>\n        <\/select>\n    <\/div>\n    <b>Type de couverture : Vie enti\u00e8re<\/b> <!-- (code -pg3 -pi0) -->\n    <br \/>\n    <br \/>\n    <div style=\"text-align:center\">  \n        <button>Calculer<\/button>\n    <\/div>\n<\/form>\n<br \/>\n<div id=\"results\"><\/div>\n\n<script>\n    $('form#winquote').submit(() => {\n        var message = '<br\/>';\n        var url = 'https:\/\/www.winquote.net\/cgi-bin\/compete.pl?dc=-pcca1736535731 -qt0 -rt0 -ofjson -pm3 -rc0 -pg3 -pi0 -fnASSUMPTI:BENEVA:BMOINSUR:CANADALI:CPPUNDER:EMPIRELI:EQUITABL:FORESTER:HUMANIAA:IAFINANC:IVARI:MANULIFE:RBCINSUR:SUNLIFE:UVASSURA';\n\n        message += 'Sexe : ' + $('select[name=sex] option:selected').text() + '<br\/>';\n        url += ' -' + $('select[name=sex').data('param') + $('select[name=sex').val();\n        \n        message += '\u00c2ge : ' + $('input[name=age]').val() + '<br\/>';\n        url += ' -' + $('input[name=age').data('param') + $('input[name=age').val();\n        \n        message += 'Fumeur (cigarette) : ' + $('select[name=smoker] option:selected').text() + '<br\/>';\n        url += ' -' + $('select[name=smoker').data('param') + $('select[name=smoker').val();\n\n        message += 'Montant : ' + $('select[name=amount] option:selected').text() + '<br\/>';\n        url += ' -' + $('select[name=amount').data('param') + $('select[name=amount').val();\n\n        message += 'Province : ' + $('select[name=province] option:selected').text() + '<br\/><br\/>';\n        url += ' -' + $('select[name=province').data('param') + $('select[name=province').val();\n\n        console.log(url);\n        message += '=== R\u00e9sultats ===<br\/>'\n\n        $.get(url, (data) => {\n            var html = '';\n            console.log(data)\n            if (parseFloat(data.results.record.recordSet[0].premium) > 9000000) {\n                html += '<h5>Aucune offre ne correspond \u00e0 vos crit\u00e8res de recherche.<\/h5>';\n                message += 'Aucune offre ne correspond \u00e0 vos crit\u00e8res de recherche.';\n            } else {\n                html += '<h5>Voici les primes mensuelles propos\u00e9es<\/h5>';\n                    for (var i = 0; i < data.results.record.recordSet.length; i++) {\n                    if ((i === 8) || (parseFloat(data.results.record.recordSet[i].premium) > 9000000)) {\n                        break;\n                    }\n                    html += 'Compagnie '+String.fromCharCode(65 + i);\n                    message += 'Compagnie '+String.fromCharCode(65 + i) + '<br\/>';\n                    message += data.results.record.recordSet[i].company + '<br\/>';\n                    message += data.results.record.recordSet[i].premium.replace('.', ',')+' $'\n                    \n                    message += '<br\/><br\/>'\n                    if (i === 0) {\n                        html += '<h6>Meilleur prix <b>'+data.results.record.recordSet[i].premium.replace('.', ',')+' $<\/b><\/h6>';\n                    }\n                    else {\n                        html += ' : '+data.results.record.recordSet[i].premium.replace('.', ',')+' $ <br\/>';\n                    }\n                }\n                html += '<\/table><br \/>';\n                html += '<h5>Aristo magasine pour vous !<\/h5>';\n            }\n            \n            $(\"#results\").html(html);\n            $(\"#contact-form [type=hidden]\").last().val(message);\n            $(\"#contact-form\").show();\n            $(\"#results\").get(0).scrollIntoView({behavior: 'smooth'});\n        });\n        return false;\n    });\n<\/script>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-81fc4d4 elementor-widget elementor-widget-spacer\" data-id=\"81fc4d4\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e4ef0da elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e4ef0da\" data-element_type=\"section\" id=\"contact-form\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[],&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-cbf793c\" data-id=\"cbf793c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e026d34 elementor-widget elementor-widget-spacer\" data-id=\"e026d34\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6dcaf58 elementor-widget elementor-widget-heading\" data-id=\"6dcaf58\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<p class=\"elementor-heading-title elementor-size-small\">Nous vous contacterons dans un d\u00e9lai de 48h, jours ouvrables.<\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-dd24c21 raven-form-button-align-center elementor-widget elementor-widget-raven-form\" data-id=\"dd24c21\" data-element_type=\"widget\" data-settings=\"{&quot;fields&quot;:[{&quot;_id&quot;:&quot;5092743&quot;,&quot;label&quot;:&quot;Nom&quot;,&quot;placeholder&quot;:&quot;Joe&quot;,&quot;acceptance_text&quot;:null,&quot;required&quot;:&quot;true&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;field_custom_id&quot;:&quot;field_5092743&quot;,&quot;type&quot;:&quot;text&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;bfff29c&quot;,&quot;type&quot;:&quot;tel&quot;,&quot;label&quot;:&quot;T\\u00e9l\\u00e9phone&quot;,&quot;placeholder&quot;:&quot;000-000-0000&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;width&quot;:&quot;50&quot;,&quot;field_custom_id&quot;:&quot;field_bfff29c&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;37ec340&quot;,&quot;type&quot;:&quot;email&quot;,&quot;label&quot;:&quot;Courriel&quot;,&quot;acceptance_text&quot;:null,&quot;required&quot;:&quot;true&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;width&quot;:&quot;50&quot;,&quot;field_custom_id&quot;:&quot;field_37ec340&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;f403cfa&quot;,&quot;type&quot;:&quot;hidden&quot;,&quot;label&quot;:&quot;Message&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;field_custom_id&quot;:&quot;message&quot;,&quot;__dynamic__&quot;:[],&quot;placeholder&quot;:null,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:null,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:null,&quot;field_value&quot;:&quot;&quot;}],&quot;steps_type&quot;:&quot;none&quot;}\" data-widget_type=\"raven-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<form class=\"raven-form raven-flex raven-flex-wrap raven-flex-bottom\" method=\"post\" name=\"Demande de soumission\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"2777\" \/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"dd24c21\" \/>\n\t\t\t\t\t<div id=\"raven-field-group-5092743\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100 raven-field-required\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-5092743\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tNom\t\t\t\t\t\t\t<span class=\"required-mark-label\"><\/span>\n\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[5092743]\" id=\"form-field-5092743\" class=\"raven-field\" placeholder=\"Joe\" data-type=\"text\" 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