{"form":"<form action=\"http:\/\/www.jestimonline.com\/bien-validate.action\" method=\"get\" class=\"form\" target=\"_blank\">\n    <input name=\"etape\" value=\"1\" id=\"bien-validate_etape\" type=\"hidden\">\n    <input name=\"agenceId\" id=\"agenceId\" value=\"538\" type=\"hidden\">\n\n    <div class=\"title-page\">\n        <div class=\"first-row\">Estimez votre bien<\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n        <label class=\"label -required\">Type<\/label>\n\n        <div class=\"container-select\">\n            <select name=\"bien.type\" class=\"select\">\n                <option value=\"appartement\">Appartement<\/option>\n                <option value=\"maison\">Maison<\/option>\n            <\/select>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n        <label class=\"label\">\u00c9tage<\/label>\n        <div class=\"container-select\">\n            <select name=\"bien.etage\" id=\"\" class=\"select\">\n                <option><\/option>\n                <option value=\"0\">RDC<\/option>\n\n                                <option value=\"1\">1<\/option>\n                                <option value=\"2\">2<\/option>\n                                <option value=\"3\">3<\/option>\n                                <option value=\"4\">4<\/option>\n                                <option value=\"5\">5<\/option>\n                                <option value=\"6\">6<\/option>\n                                <option value=\"7\">7<\/option>\n                                <option value=\"8\">8<\/option>\n                                <option value=\"9\">9<\/option>\n                                <option value=\"10\">10<\/option>\n                                <option value=\"11\">11<\/option>\n                                <option value=\"12\">12<\/option>\n                                <option value=\"13\">13<\/option>\n                                <option value=\"14\">14<\/option>\n                                <option value=\"15\">15<\/option>\n                                <option value=\"16\">16<\/option>\n                                <option value=\"17\">17<\/option>\n                                <option value=\"18\">18<\/option>\n                                <option value=\"19\">19<\/option>\n                            <\/select>\n        <\/div>\n    <\/div>\n\n\n    <div class=\"row\">\n        <label class=\"label -required\">Num\u00e9ro de voie<\/label>\n        <input type=\"text\" class=\"inputtext\" name=\"bien.numero\">\n    <\/div>\n\n    <div class=\"row\">\n        <label class=\"label -required\">Nom de voie<\/label>\n        <input type=\"text\" class=\"inputtext\" name=\"bien.rue\">\n    <\/div>\n\n    <div class=\"row\">\n        <label class=\"label -required\">Code postal<\/label>\n        <input type=\"text\" class=\"inputtext\" name=\"bien.codePostal\">\n    <\/div>\n\n    <div class=\"row\">\n        <label class=\"label -required\">Ville<\/label>\n        <input type=\"text\" class=\"inputtext\" name=\"bien.ville\">\n    <\/div>\n\n\n    <div class=\"row\">\n        <div class=\"info\">\n\t\t\t\tLes champs suivis d'une ast\u00e9risque (*) sont obligatoires.<br>\n\n            <input name=\"conditions\" value=\"true\" id=\"acceptCGU\" type=\"checkbox\">\n            <label for=\"acceptCGU\"><a href=\"http:\/\/www.andelim.com\/cgu\" target=\"_blank\">J'ai lu et j'accepte les conditions d'utilisation<\/a><\/label>\n        <\/div>\n    <\/div>\n\n\n    <!-- envoyer -->\n    <div class=\"row container-submit\">\n        <button type=\"submit\" class=\"submit\">Envoyer<\/button>\n    <\/div>\n<\/form>\n"}