MOBILITÉ - Transport Individuel

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<div class="shortcode-container"><div class="wpforms-container wpforms-container-full wpforms-render-modern" id="wpforms-542"><form id="wpforms-form-542" class="wpforms-validate wpforms-form wpforms-ajax-form" data-formid="542" method="post" enctype="multipart/form-data" action="/besoin-dun-service/" data-token="be4c45d20f027c36e4752019adae6c5b" data-token-time="1734590537"><noscript class="wpforms-error-noscript">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.</noscript><div class="wpforms-hidden" id="wpforms-error-noscript">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.</div><div class="wpforms-field-container"><div id="wpforms-542-field_2-container" class="wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-field-select-style-classic" data-field-id="2"><label class="wpforms-field-label" for="wpforms-542-field_2">Ville de départ <span class="wpforms-required-label" aria-hidden="true">*</span></label><select id="wpforms-542-field_2" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][2]" required="required"><option value="" class="placeholder" disabled  selected='selected'>&#8230;</option><option value="Pau" >Pau</option><option value="Tarbes" >Tarbes</option><option value="Marseille" >Marseille</option></select></div><div id="wpforms-542-field_3-container" class="wpforms-field wpforms-field-select wpforms-one-half wpforms-field-select-style-classic" data-field-id="3"><label class="wpforms-field-label" for="wpforms-542-field_3">Ville d'arrivée <span class="wpforms-required-label" aria-hidden="true">*</span></label><select id="wpforms-542-field_3" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][3]" required="required"><option value="" class="placeholder" disabled  selected='selected'>&#8230;</option><option value="Pau" >Pau</option><option value="Tarbes" >Tarbes</option><option value="Marseille" >Marseille</option></select></div><div id="wpforms-542-field_18-container" class="wpforms-field wpforms-field-text wpforms-one-half wpforms-first" data-field-id="18"><label class="wpforms-field-label" for="wpforms-542-field_18">Nom de famille <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-542-field_18" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][18]" aria-errormessage="wpforms-542-field_18-error" required></div><div id="wpforms-542-field_19-container" class="wpforms-field wpforms-field-text wpforms-one-half" data-field-id="19"><label class="wpforms-field-label" for="wpforms-542-field_19">Prénom <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-542-field_19" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][19]" aria-errormessage="wpforms-542-field_19-error" required></div><div id="wpforms-542-field_5-container" class="wpforms-field wpforms-field-email wpforms-one-half wpforms-first" data-field-id="5"><label class="wpforms-field-label" for="wpforms-542-field_5">E-mail <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="email" id="wpforms-542-field_5" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][5]" spellcheck="false" aria-errormessage="wpforms-542-field_5-error" required></div><div id="wpforms-542-field_9-container" class="wpforms-field wpforms-field-text wpforms-one-half" data-field-id="9"><label class="wpforms-field-label" for="wpforms-542-field_9">N° de téléphone <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-542-field_9" class="wpforms-field-large wpforms-field-required wpforms-masked-input" data-rule-inputmask-incomplete="1" data-inputmask-mask="99 99 99 99 99" name="wpforms[fields][9]" aria-errormessage="wpforms-542-field_9-error" required></div><div id="wpforms-542-field_10-container" class="wpforms-field wpforms-field-textarea" data-field-id="10"><label class="wpforms-field-label" for="wpforms-542-field_10">Description de la demande <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-542-field_10" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][10]" aria-errormessage="wpforms-542-field_10-error" aria-describedby="wpforms-542-field_10-description" required></textarea><div id="wpforms-542-field_10-description" class="wpforms-field-description">Exemple : Je suis un étudiant et je cherche un moyen de me rendre au salon étudiant de Bordeaux.</div></div><div id="wpforms-542-field_12-container" class="wpforms-field wpforms-field-text" data-field-id="12"><label class="wpforms-field-label" for="wpforms-542-field_12">Adresse de départ <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-542-field_12" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][12]" aria-errormessage="wpforms-542-field_12-error" required></div><div id="wpforms-542-field_13-container" class="wpforms-field wpforms-field-text wpforms-one-half wpforms-first" data-field-id="13"><label class="wpforms-field-label" for="wpforms-542-field_13">Date de départ</label><input type="text" id="wpforms-542-field_13" class="wpforms-field-large wpforms-masked-input" data-rule-inputmask-incomplete="1" data-inputmask-mask="99/99/9999" name="wpforms[fields][13]" aria-errormessage="wpforms-542-field_13-error" ></div><div id="wpforms-542-field_14-container" class="wpforms-field wpforms-field-text wpforms-one-half" data-field-id="14"><label class="wpforms-field-label" for="wpforms-542-field_14">Heure de départ</label><input type="text" id="wpforms-542-field_14" class="wpforms-field-large wpforms-masked-input" data-rule-inputmask-incomplete="1" data-inputmask-mask="99h99" name="wpforms[fields][14]" aria-errormessage="wpforms-542-field_14-error" ></div><div id="wpforms-542-field_15-container" class="wpforms-field wpforms-field-text" data-field-id="15"><label class="wpforms-field-label" for="wpforms-542-field_15">Adresse d'arrivée <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-542-field_15" class="wpforms-field-large wpforms-field-required" name="wpforms[fields][15]" aria-errormessage="wpforms-542-field_15-error" required></div><div id="wpforms-542-field_16-container" class="wpforms-field wpforms-field-text wpforms-one-half wpforms-first" data-field-id="16"><label class="wpforms-field-label" for="wpforms-542-field_16">Date d'arrivée</label><input type="text" id="wpforms-542-field_16" class="wpforms-field-large wpforms-masked-input" data-rule-inputmask-incomplete="1" data-inputmask-mask="99/99/9999" name="wpforms[fields][16]" aria-errormessage="wpforms-542-field_16-error" ></div><div id="wpforms-542-field_17-container" class="wpforms-field wpforms-field-text wpforms-one-half" data-field-id="17"><label class="wpforms-field-label" for="wpforms-542-field_17">Heure d'arrivée</label><input type="text" id="wpforms-542-field_17" class="wpforms-field-large wpforms-masked-input" data-rule-inputmask-incomplete="1" data-inputmask-mask="99h99" name="wpforms[fields][17]" aria-errormessage="wpforms-542-field_17-error" ></div></div><div class="wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v3" ><input type="hidden" name="wpforms[recaptcha]" value=""></div><div class="wpforms-submit-container" ><input type="hidden" name="wpforms[id]" value="542"><input type="hidden" name="page_title" value="Besoin d&#8217;un service ?"><input type="hidden" name="page_url" value="https://navettedesjeunesetetudiants.fr/besoin-dun-service/"><input type="hidden" name="page_id" value="564"><input type="hidden" name="wpforms[post_id]" value="564"><button type="submit" name="wpforms[submit]" id="wpforms-submit-542" class="wpforms-submit" data-alt-text="Validation en cours..." data-submit-text="Valider" aria-live="assertive" value="wpforms-submit">Valider</button><img src="https://navettedesjeunesetetudiants.fr/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></form></div>  </div>