{"id":8843,"date":"2026-02-05T16:41:18","date_gmt":"2026-02-05T16:41:18","guid":{"rendered":"http:\/\/192.168.15.136\/?p=8843"},"modified":"2026-02-23T11:36:11","modified_gmt":"2026-02-23T11:36:11","slug":"formulaire-dassistance","status":"publish","type":"post","link":"https:\/\/pad.cm\/fr\/formulaire-dassistance\/","title":{"rendered":"Formulaire d&rsquo;assistance"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"8843\" class=\"elementor elementor-8843\" data-elementor-post-type=\"post\">\n\t\t\t\t<div class=\"elementor-element elementor-element-582aab29 e-con-full e-flex e-con e-parent\" data-id=\"582aab29\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t<div class=\"elementor-element elementor-element-5ce1da1 e-con-full e-flex e-con e-child\" data-id=\"5ce1da1\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a36f16f elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"a36f16f\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Suivant&quot;,&quot;step_previous_label&quot;:&quot;Pr\\u00e9c\\u00e9dent&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Form de d&#039;assistance\" aria-label=\"Form de d&#039;assistance\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"8843\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"a36f16f\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e8fad69 elementor-col-100\">\n\t\t\t\t\t<h3>Information du demandeur <\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom \/ Raison sociale \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_c994624 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c994624\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tT\u00e9l\u00e9phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_c994624]\" id=\"form-field-field_c994624\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Seuls les caract\u00e8res de num\u00e9ros de t\u00e9l\u00e9phone (#, -, *, etc.) sont accept\u00e9s.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_c1aa994 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c1aa994\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse e-mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_c1aa994]\" id=\"form-field-field_c1aa994\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_e6e36f3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e6e36f3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tQualit\u00e9 \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_e6e36f3]\" id=\"form-field-field_e6e36f3\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Usager \/ visiteur\">Usager \/ visiteur<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Entreprise portuaire\">Entreprise portuaire<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Transporteur\">Transporteur<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Consignataire \/ armateur\">Consignataire \/ armateur<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\" Autre \"> Autre <\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_2d6eccb elementor-col-100\">\n\t\t\t\t\t<h3>Type d\u2019assistance sollicit\u00e9e <\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_0c5b5c8 elementor-col-100\">\n\t\t\t\t\t<h5> (Choix unique pour orientation rapide du service) <\/h5>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_fcd33be elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Acc\u00e8s portuaire \/ badge \/ autorisation d\u2019entr\u00e9e\" id=\"form-field-field_fcd33be-0\" name=\"form_fields[field_fcd33be][]\"> <label for=\"form-field-field_fcd33be-0\">Acc\u00e8s portuaire \/ badge \/ autorisation d\u2019entr\u00e9e<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Incident ou accident (s\u00e9curit\u00e9, circulation, \u00e9quipement)\" id=\"form-field-field_fcd33be-1\" name=\"form_fields[field_fcd33be][]\"> <label for=\"form-field-field_fcd33be-1\">Incident ou accident (s\u00e9curit\u00e9, circulation, \u00e9quipement)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Urgence \u2013 Marin-pompiers \/ secours\" id=\"form-field-field_fcd33be-2\" name=\"form_fields[field_fcd33be][]\"> <label for=\"form-field-field_fcd33be-2\">Urgence \u2013 Marin-pompiers \/ secours<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Entretien \/ panne \/ \u00e9clairage \/ voirie \/ propret\u00e9\" id=\"form-field-field_fcd33be-3\" name=\"form_fields[field_fcd33be][]\"> <label for=\"form-field-field_fcd33be-3\">Entretien \/ panne \/ \u00e9clairage \/ voirie \/ propret\u00e9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Signalement fraude \/ arnaque \/ comportement suspect\" id=\"form-field-field_fcd33be-4\" name=\"form_fields[field_fcd33be][]\"> <label for=\"form-field-field_fcd33be-4\">Signalement fraude \/ arnaque \/ comportement suspect<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Autre demande d\u2019assistance\" id=\"form-field-field_fcd33be-5\" name=\"form_fields[field_fcd33be][]\"> <label for=\"form-field-field_fcd33be-5\">Autre demande d\u2019assistance<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_4e94341 elementor-col-100\">\n\t\t\t\t\t<h3>Localisation <\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_743f64a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_743f64a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZone \/ quai \/ terminal \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_743f64a]\" id=\"form-field-field_743f64a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3847f68 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3847f68\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMe g\u00e9olocaliser \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3847f68]\" id=\"form-field-field_3847f68\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_e6497c9 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e6497c9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescription br\u00e8ve de la situation  (max. 4\u20135 lignes)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_e6497c9]\" id=\"form-field-field_e6497c9\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_7f68b27 elementor-col-100\">\n\t\t\t\t\t<h3>Degr\u00e9 d\u2019urgence <\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_fa191e5 elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Urgent (intervention imm\u00e9diate)\" id=\"form-field-field_fa191e5-0\" name=\"form_fields[field_fa191e5][]\"> <label for=\"form-field-field_fa191e5-0\">Urgent (intervention imm\u00e9diate)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Prioritaire (moins de 2h)\" id=\"form-field-field_fa191e5-1\" name=\"form_fields[field_fa191e5][]\"> <label for=\"form-field-field_fa191e5-1\">Prioritaire (moins de 2h)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Normal\" id=\"form-field-field_fa191e5-2\" name=\"form_fields[field_fa191e5][]\"> <label for=\"form-field-field_fa191e5-2\">Normal<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_5699322 elementor-col-100\">\n\t\t\t\t\t<h3>Pi\u00e8ces jointes (facultatif) <\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_14d7875 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_14d7875\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhoto \/ document (preuve ou illustration)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_14d7875]\" id=\"form-field-field_14d7875\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-md\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Soumettre la demande <\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[15],"tags":[],"class_list":["post-8843","post","type-post","status-publish","format-standard","hentry","category-le-port"],"_links":{"self":[{"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/posts\/8843","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/comments?post=8843"}],"version-history":[{"count":0,"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/posts\/8843\/revisions"}],"wp:attachment":[{"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/media?parent=8843"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/categories?post=8843"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pad.cm\/fr\/wp-json\/wp\/v2\/tags?post=8843"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}