{"id":3137,"date":"2024-05-17T16:10:24","date_gmt":"2024-05-17T16:10:24","guid":{"rendered":"https:\/\/brojacwine.com\/?page_id=3137"},"modified":"2024-05-22T14:57:25","modified_gmt":"2024-05-22T14:57:25","slug":"order-form","status":"publish","type":"page","link":"https:\/\/brojacwine.com\/fr\/direct-shipping\/order-form\/","title":{"rendered":"Winery Direct Shipping Order Form"},"content":{"rendered":"<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer uag-hide-desktop\"><\/div>\n\n\n<div class=\"wpforms-container wpforms-block\" id=\"wpforms-3129\"><form id=\"wpforms-form-3129\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3129\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/3137\" data-token=\"047069d7e534db8f426acdeaa337bdc7\" data-token-time=\"1776390035\" data-trp-original-action=\"\/fr\/wp-json\/wp\/v2\/pages\/3137\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Direct Shipping &#8211; Wine Order Form<\/div><div class=\"wpforms-description\">Veuillez remplir les informations suivantes pour passer votre commande. Quantit\u00e9 minimale de commande : 10 caisses par vignoble. \nPlusieurs vins peuvent \u00eatre s\u00e9lectionn\u00e9s dans chaque \u00e9tablissement et exp\u00e9di\u00e9s ensemble. Les vins provenant de diff\u00e9rentes vignobles seront exp\u00e9di\u00e9s s\u00e9par\u00e9ment.<\/div><\/div><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-3129-field_4-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"4\"><label class=\"wpforms-field-label\">Nom <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3129-field_4\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][4][first]\" placeholder=\"John\" required><label for=\"wpforms-3129-field_4\" class=\"wpforms-field-sublabel after\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3129-field_4-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][4][last]\" placeholder=\"Doe\" required><label for=\"wpforms-3129-field_4-last\" class=\"wpforms-field-sublabel after\">Nom<\/label><\/div><\/div><\/div><div id=\"wpforms-3129-field_11-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_11\">Adresse e-mail <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3129-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-3129-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_2\">Nom de l'entreprise <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3129-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" placeholder=\"Brojac Wine Alliance\" required><\/div><div id=\"wpforms-3129-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_7\">Pays <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3129-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" placeholder=\"France\" required><div class=\"wpforms-field-description\">Lieu d'Entreprise<\/div><\/div><div id=\"wpforms-3129-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_9\">Num\u00e9ro d'Accise <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3129-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" placeholder=\"FR12345678910\" required><\/div><div id=\"wpforms-3129-field_30-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_30\">Num\u00e9ro de T\u00e9l\u00e9phone<\/label><input type=\"text\" id=\"wpforms-3129-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" ><\/div><div id=\"wpforms-3129-field_15-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"15\"><label class=\"wpforms-field-label\">Ch\u00e2teau Alta Ga\u00efa<\/label><ul id=\"wpforms-3129-field_15\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_15_1\" name=\"wpforms[fields][15][]\" value=\"Ch\u00e2teau Alta Ga\u00efa N\u00b01\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_15_1\">Ch\u00e2teau Alta Ga\u00efa N\u00b01<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_15_2\" name=\"wpforms[fields][15][]\" value=\"Ch\u00e2teau Alta Ga\u00efa N\u00b02\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_15_2\">Ch\u00e2teau Alta Ga\u00efa N\u00b02<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_15_3\" name=\"wpforms[fields][15][]\" value=\"Ch\u00e2teau Alta Ga\u00efa White\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_15_3\">Ch\u00e2teau Alta Ga\u00efa Blanc<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_15_4\" name=\"wpforms[fields][15][]\" value=\"Kingly Ros\u00e9\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_15_4\">Kingly Ros\u00e9<\/label><\/li><\/ul><\/div><div id=\"wpforms-3129-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_26\">Quantit\u00e9 (caisses de 6) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3129-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" placeholder=\"ex. 10 N\u00b01; 20 N*2\" required><div class=\"wpforms-field-description\">Min. 10 caisses. \nSi vous commandez plusieurs r\u00e9f\u00e9rences, veuillez pr\u00e9ciser le nombre de caisses de chaque r\u00e9f\u00e9rence.<\/div><\/div><div id=\"wpforms-3129-field_20-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"20\"><label class=\"wpforms-field-label\">Ch\u00e2teau La Grang\u00e8re<\/label><ul id=\"wpforms-3129-field_20\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Ch\u00e2teau La Grang\u00e8re\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_20_1\">Ch\u00e2teau La Grang\u00e8re<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_20_2\" name=\"wpforms[fields][20][]\" value=\"Ch\u00e2teau Moulin de la Grang\u00e8re\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_20_2\">Ch\u00e2teau Moulin de la Grang\u00e8re<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_20_3\" name=\"wpforms[fields][20][]\" value=\"Ch\u00e2teau Saint Julian\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_20_3\">Ch\u00e2teau Saint Julian<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_20_4\" name=\"wpforms[fields][20][]\" value=\"Ch\u00e2teau Virecourt Cont\u00e9\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_20_4\">Ch\u00e2teau Virecourt Cont\u00e9<\/label><\/li><\/ul><\/div><div id=\"wpforms-3129-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_27\">Quantit\u00e9 (caisses de 6) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3129-field_27\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][27]\" placeholder=\"ex. 15 La Grang\u00e8re; 15 Virecourt Cont\u00e9\" required><div class=\"wpforms-field-description\">Min. 10 caisses. \nSi vous commandez plusieurs r\u00e9f\u00e9rences, veuillez pr\u00e9ciser le nombre de caisses de chaque r\u00e9f\u00e9rence.<\/div><\/div><div id=\"wpforms-3129-field_22-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"22\"><label class=\"wpforms-field-label\">Ch\u00e2teau La Rose Mayat<\/label><ul id=\"wpforms-3129-field_22\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_22_1\" name=\"wpforms[fields][22][]\" value=\"Ch\u00e2teau La Rose Mayat\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_22_1\">Ch\u00e2teau La Rose Mayat<\/label><\/li><\/ul><\/div><div id=\"wpforms-3129-field_28-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_28\">Quantit\u00e9 (caisses de 6) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3129-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" placeholder=\"ex. 20\" required><div class=\"wpforms-field-description\">Min. 10 caisses. <\/div><\/div><div id=\"wpforms-3129-field_25-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"25\"><label class=\"wpforms-field-label\">Ch\u00e2teau Moulin de Peyronin<\/label><ul id=\"wpforms-3129-field_25\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_25_1\" name=\"wpforms[fields][25][]\" value=\"Ch\u00e2teau Moulin de Peyronin red\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_25_1\">Ch\u00e2teau Moulin de Peyronin rouge<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_25_5\" name=\"wpforms[fields][25][]\" value=\"P\u00e9tillante Emma (ros\u00e9)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_25_5\">P\u00e9tillante Emma (ros\u00e9)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_25_2\" name=\"wpforms[fields][25][]\" value=\"Ch\u00e2teau Moulin de Peyronin white\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_25_2\">Ch\u00e2teau Moulin de Peyronin blanc<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_25_4\" name=\"wpforms[fields][25][]\" value=\"P\u00e9tillante Aline (white)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_25_4\">P\u00e9tillante Aline (blanc)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3129-field_25_3\" name=\"wpforms[fields][25][]\" value=\"Ch\u00e2teau Moulin de Peyronin clairet\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3129-field_25_3\">Ch\u00e2teau Moulin de Peyronin clairet<\/label><\/li><\/ul><\/div><div id=\"wpforms-3129-field_29-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_29\">Quantit\u00e9 (caisses de 6) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3129-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" placeholder=\"ex. 5 rouge; 5 Aline\" required><div class=\"wpforms-field-description\">Min. 10 caisses. \nSi vous commandez plusieurs r\u00e9f\u00e9rences, veuillez pr\u00e9ciser le nombre de caisses de chaque r\u00e9f\u00e9rence.<\/div><\/div><div id=\"wpforms-3129-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-3129-field_13\">Message<\/label><textarea id=\"wpforms-3129-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" placeholder=\"N&#039;h\u00e9sitez pas \u00e0 nous contacter si vous avez des questions ou des demandes particuli\u00e8res !\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3129\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/brojacwine.com\/fr\/wp-json\/wp\/v2\/pages\/3137\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3129\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Envoyer<\/button><img decoding=\"async\" src=\"https:\/\/brojacwine.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Chargement en cours\"><\/div><input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form><\/div>  <!-- .wpforms-container 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