Untitled
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<script src="https://cdn.jotfor.ms/static/prototype.forms.js" type="text/javascript"></script>
<script src="https://cdn.jotfor.ms/static/jotform.forms.js?3.3.9832" type="text/javascript"></script>
<script src="https://cdn.jotfor.ms/js/paypal.js?v=3.3.9832" type="text/javascript"></script>
<script type="text/javascript">
	JotForm.init(function(){
      JotForm.highlightInputs = false;
      JotForm.alterTexts({"ageVerificationError":"You must be older than {minAge} years old to submit this form.","alphabetic":"This field can only contain letters","alphanumeric":"This field can only contain letters and numbers.","ccDonationMinLimitError":"Minimum amount is {minAmount} {currency}","ccInvalidCVC":"CVC number is invalid.","ccInvalidExpireDate":"Expire date is invalid.","ccInvalidNumber":"Credit Card Number is invalid.","ccMissingDetails":"Please fill up the Credit Card details.","ccMissingDonation":"Please enter numeric values for donation amount.","ccMissingProduct":"Please select at least one product.","characterLimitError":"Too many Characters.  The limit is","characterMinLimitError":"Too few characters. The minimum is","confirmClearForm":"Are you sure you want to clear the form?","confirmEmail":"E-mail does not match","currency":"This field can only contain currency values.","cyrillic":"This field can only contain cyrillic characters","dateInvalid":"This date is not valid. The date format is {format}","dateInvalidSeparate":"This date is not valid. Enter a valid {element}.","dateLimited":"This date is unavailable.","disallowDecimals":"Please enter a whole number.","email":"Enter a valid e-mail address","fillMask":"Field value must fill mask.","freeEmailError":"Free email accounts are not allowed","generalError":"Veuillez indiquer le montant à payer avant de continuer.","generalPageError":"There are errors on this page. Please fix them before continuing.","gradingScoreError":"Score total should only be less than or equal to","incompleteFields":"There are incomplete required fields. Please complete them.","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","lessThan":"Your score should be less than or equal to","maxDigitsError":"The maximum digits allowed is","maxSelectionsError":"The maximum number of selections allowed is ","minSelectionsError":"The minimum required number of selections is ","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_fileLimitError":"Only {fileLimit} file uploads allowed.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","nextButtonText":"Next","numeric":"This field can only contain numeric values","pastDatesDisallowed":"Date must not be in the past.","pleaseWait":"Please wait...","prevButtonText":"Previous","progressMiddleText":"of","required":"Ce champs est requis.","requireEveryCell":"Every cell is required.","requireEveryRow":"Every row is required.","requireOne":"At least one field required.","reviewBackText":"Back to Form","reviewSubmitText":"Review and Submit","seeAllText":"See All","submissionLimit":"Sorry! Only one entry is allowed.  Multiple submissions are disabled for this form.","submitButtonText":"Submit","uploadExtensions":"You can only upload following files:","uploadFilesize":"File size cannot be bigger than:","uploadFilesizemin":"File size cannot be smaller than:","url":"This field can only contain a valid URL","wordLimitError":"Too many words. The limit is","wordMinLimitError":"Too few words.  The minimum is"});
      JotForm.alterTexts({"couponApply":"Appliquer","couponBlank":"Entrez un code coupon.","couponChange":"","couponEnter":"Enter coupon","couponExpired":"Ce code coupon est expiré, choisissez-en un autre.","couponInvalid":"Coupon is invalid.","couponValid":"Le code coupon est valide.","shippingShipping":"Livraison","taxTax":"Taxes","totalSubtotal":"Sous-total","totalTotal":"TOTAL :"}, true);
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   JotForm.prepareCalculationsOnTheFly([null,{"name":"soumettre","qid":"1","text":"PAYER","type":"control_button"},{"description":"","name":"montant","qid":"2","text":"Montant :","type":"control_paypal"},{"description":"","labelText":"","name":"image","qid":"3","text":"paiement_securise_paypal","type":"control_image"},{"name":"cliquezPour","qid":"4","text":"Comment payer par CB sans compte Paypal ?\n1) Indiquez le montant &agrave; payer ci-dessus.\n2) Cliquez sur \"PAYER\" : vous &ecirc;tes redirig&eacute; sur une page de paiement s&eacute;curis&eacute;e par Paypal.\n3) Cliquez sur \"Payer par carte\" pour payer par CB sans &ecirc;tre inscrit &agrave; Paypal !","type":"control_text"},{"name":"paiementCb5","qid":"5","text":"Paiement CB","type":"control_head"}]);
   setTimeout(function() {
JotForm.paymentExtrasOnTheFly([null,{"name":"soumettre","qid":"1","text":"PAYER","type":"control_button"},{"description":"","name":"montant","qid":"2","text":"Montant :","type":"control_paypal"},{"description":"","labelText":"","name":"image","qid":"3","text":"paiement_securise_paypal","type":"control_image"},{"name":"cliquezPour","qid":"4","text":"Comment payer par CB sans compte Paypal ?\n1) Indiquez le montant &agrave; payer ci-dessus.\n2) Cliquez sur \"PAYER\" : vous &ecirc;tes redirig&eacute; sur une page de paiement s&eacute;curis&eacute;e par Paypal.\n3) Cliquez sur \"Payer par carte\" pour payer par CB sans &ecirc;tre inscrit &agrave; Paypal !","type":"control_text"},{"name":"paiementCb5","qid":"5","text":"Paiement CB","type":"control_head"}]);}, 20); 
</script>
<link href="https://cdn.jotfor.ms/static/formCss.css?3.3.9832" rel="stylesheet" type="text/css" />
<link type="text/css" media="print" rel="stylesheet" href="https://cdn.jotfor.ms/css/printForm.css?3.3.9832" />
<link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/css/styles/nova.css?3.3.9832" />
<link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/themes/CSS/566a91c2977cdfcd478b4567.css?themeRevisionID=59fb4852cf3bfe589c6c6f21"/>
<style type="text/css">
    .form-label-left{
        width:150px;
    }
    .form-line{
        padding-top:10px;
        padding-bottom:10px;
    }
    .form-label-right{
        width:150px;
    }
    .form-all{
        width:330px;
        color:#000000 !important;
        font-family:"Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Verdana, sans-serif;
        font-size:20px;
    }
</style>

<style type="text/css" id="form-designer-style">
    /* Injected CSS Code */
.form-all:after {
  content: "";
  display: table;
  clear: both;
}
.form-all {
  font-family: "Lucida Grande", sans-serif;
}
.form-all {
  width: 330px;
}
.form-label-left,
.form-label-right {
  width: 150px;
}
.form-label {
  white-space: normal;
}
.form-label.form-label-auto {
  display: inline-block;
  float: left;
  text-align: right;
  width: 150px;
}
.form-label-left {
  display: inline-block;
  white-space: normal;
  float: left;
  text-align: left;
}
.form-label-right {
  display: inline-block;
  white-space: normal;
  float: left;
  text-align: right;
}
.form-label-top {
  white-space: normal;
  display: block;
  float: none;
  text-align: left;
}
.form-radio-item label:before {
  top: 0;
}
.form-all {
  font-size: 20px;
}
.form-label {
  font-weight: bold;
}
.form-checkbox-item label,
.form-radio-item label {
  font-weight: normal;
}
.supernova {
  background-color: #ffffff;
}
.supernova body {
  background-color: transparent;
}
/*
@width30: (unit(@formWidth, px) + 60px);
@width60: (unit(@formWidth, px)+ 120px);
@width90: (unit(@formWidth, px)+ 180px);
*/
/* | */
@media screen and (min-width: 480px) {
  .supernova .form-all {
    border: 1px solid #e6e6e6;
    -webkit-box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);
    -moz-box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);
    box-shadow: 0 3px 9px rgba(0, 0, 0, 0.1);
  }
}
/* | */
/* | */
@media screen and (max-width: 480px) {
  .jotform-form .form-all {
    margin: 0;
    width: 100%;
  }
}
/* | */
/* | */
@media screen and (min-width: 480px) and (max-width: 767px) {
  .jotform-form .form-all {
    margin: 0;
    width: 100%;
  }
}
/* | */
/* | */
@media screen and (min-width: 480px) and (max-width: 329px) {
  .jotform-form .form-all {
    margin: 0;
    width: 100%;
  }
}
/* | */
/* | */
@media screen and (min-width: 768px) {
  .jotform-form {
    padding: 60px 0;
  }
}
/* | */
/* | */
@media screen and (max-width: 329px) {
  .jotform-form .form-all {
    margin: 0;
    width: 100%;
  }
}
/* | */
.supernova .form-all,
.form-all {
  background-color: #ffffff;
  border: 1px solid transparent;
}
.form-header-group {
  border-color: #e6e6e6;
}
.form-matrix-table tr {
  border-color: #e6e6e6;
}
.form-matrix-table tr:nth-child(2n) {
  background-color: #f2f2f2;
}
.form-all {
  color: #000000;
}
.form-header-group .form-header {
  color: #000000;
}
.form-header-group .form-subHeader {
  color: #1a1a1a;
}
.form-sub-label {
  color: #1a1a1a;
}
.form-label-top,
.form-label-left,
.form-label-right,
.form-html {
  color: #000000;
}
.form-checkbox-item label,
.form-radio-item label {
  color: #1a1a1a;
}
.form-line.form-line-active {
  -webkit-transition-property: all;
  -moz-transition-property: all;
  -ms-transition-property: all;
  -o-transition-property: all;
  transition-property: all;
  -webkit-transition-duration: 0.3s;
  -moz-transition-duration: 0.3s;
  -ms-transition-duration: 0.3s;
  -o-transition-duration: 0.3s;
  transition-duration: 0.3s;
  -webkit-transition-timing-function: ease;
  -moz-transition-timing-function: ease;
  -ms-transition-timing-function: ease;
  -o-transition-timing-function: ease;
  transition-timing-function: ease;
  background-color: #ffffff;
}
/* omer */
.form-radio-item,
.form-checkbox-item {
  padding-bottom: 0px !important;
}
.form-radio-item:last-child,
.form-checkbox-item:last-child {
  padding-bottom: 0;
}
/* omer */
.form-single-column .form-checkbox-item,
.form-single-column .form-radio-item {
  width: 100%;
}
.form-checkbox-item .editor-container div,
.form-radio-item .editor-container div {
  position: relative;
}
.form-checkbox-item .editor-container div:before,
.form-radio-item .editor-container div:before {
  display: inline-block;
  vertical-align: middle;
  -moz-box-sizing: border-box;
  -webkit-box-sizing: border-box;
  box-sizing: border-box;
  left: 0;
  width: 18px;
  height: 18px;
}
.supernova {
  height: 100%;
  background-repeat: no-repeat;
  background-attachment: scroll;
  background-position: center top;
  background-repeat: repeat;
}
.supernova {
  background-image: none;
}
#stage {
  background-image: none;
}
/* | */
.form-all {
  background-repeat: no-repeat;
  background-attachment: scroll;
  background-position: center top;
  background-repeat: repeat;
}
.form-header-group {
  background-repeat: no-repeat;
  background-attachment: scroll;
  background-position: center top;
}
.form-line {
  margin-top: 10px;
  margin-bottom: 10px;
}
.form-line {
  padding: 12px 30px;
}
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
  -webkit-border-radius: 100px;
  -moz-border-radius: 100px;
  border-radius: 100px;
}
.form-all .form-sub-label {
  margin-left: 3px;
}
.form-all .qq-upload-button,
.form-all .form-submit-button,
.form-all .form-submit-reset,
.form-all .form-submit-print {
  height: 60px;
  width: 250px;
  font-size: 1.15em;
  padding: 12px 18px;
  font-family: "Lucida Grande", sans-serif;
  font-size: 20px;
  font-weight: lighter;
}
.form-all .form-submit-print {
  margin-left: 0 !important;
  margin-right: 0 !important;
}
.form-all .form-pagebreak-back,
.form-all .form-pagebreak-next {
  font-size: 1em;
  padding: 9px 15px;
  font-family: "Lucida Grande", sans-serif;
  font-size: 20px;
  font-weight: normal;
}
/*
& when ( @buttonFontType = google ) {
	@import (css) "@{buttonFontLink}";
}
*/
h2.form-header {
  line-height: 1.618em;
  font-size: 1.714em;
}
h2 ~ .form-subHeader {
  line-height: 1.5em;
  font-size: 1.071em;
}
.form-header-group {
  text-align: left;
}
/*.form-dropdown,
.form-radio-item,
.form-checkbox-item,
.form-radio-other-input,
.form-checkbox-other-input,*/
.form-captcha input,
.form-spinner input,
.form-error-message {
  padding: 4px 3px 2px 3px;
}
.form-header-group {
  font-family: "Lucida Grande", sans-serif;
}
.form-section {
  padding: 0px 0px 0px 0px;
}
.form-header-group {
  margin: 12px 36px 12px 36px;
}
.form-header-group {
  padding: 24px 0px 24px 0px;
}
.form-textbox,
.form-textarea {
  padding: 4px 3px 2px 3px;
}
[data-type="control_dropdown"] .form-input,
[data-type="control_dropdown"] .form-input-wide {
  width: 150px;
}
.form-label {
  margin-right: 0px;
  margin-bottom: 0;
}
.form-label {
  font-family: "Lucida Grande", sans-serif;
}
li[data-type="control_image"] div {
  text-align: left;
}
li[data-type="control_image"] img {
  border: none;
  border-width: 0px !important;
  border-style: solid !important;
  border-color: false !important;
}
.form-line-column {
  width: auto;
}
.form-line-error {
  background-color: #ffffff;
  -webkit-box-shadow: inset 0px 3px 11px -7px #ff3200;
  -moz-box-shadow: inset 0px 3px 11px -7px #ff3200;
  box-shadow: inset 0px 3px 11px -7px #ff3200;
}
.form-line-error input:not(#coupon-input),
.form-line-error textarea,
.form-line-error .form-validation-error {
  -webkit-transition-property: none;
  -moz-transition-property: none;
  -ms-transition-property: none;
  -o-transition-property: none;
  transition-property: none;
  -webkit-transition-duration: 0.3s;
  -moz-transition-duration: 0.3s;
  -ms-transition-duration: 0.3s;
  -o-transition-duration: 0.3s;
  transition-duration: 0.3s;
  -webkit-transition-timing-function: ease;
  -moz-transition-timing-function: ease;
  -ms-transition-timing-function: ease;
  -o-transition-timing-function: ease;
  transition-timing-function: ease;
  border: 1px solid #fff4f4;
  -moz-box-shadow: 0 0 3px #fff4f4;
  -webkit-box-shadow: 0 0 3px #fff4f4;
  box-shadow: 0 0 3px #fff4f4;
}
.form-line-error .form-error-message {
  margin: 0;
  position: absolute;
  color: #fff;
  display: inline-block;
  right: 0;
  font-size: 10px;
  position: absolute!important;
  box-shadow: none;
  top: 0px;
  line-height: 20px;
  color: #FFF;
  background: #ff3200;
  padding: 0px 5px;
  bottom: auto;
  min-width: 105px;
  -webkit-border-radius: 0;
  -moz-border-radius: 0;
  border-radius: 0;
}
.form-line-error .form-error-message img,
.form-line-error .form-error-message .form-error-arrow {
  display: none;
}
.ie-8 .form-all {
  margin-top: auto;
  margin-top: initial;
}
.ie-8 .form-all:before {
  display: none;
}
[data-type="control_clear"] {
  display: none;
}
/* | */
@media screen and (max-width: 480px), screen and (max-device-width: 767px) and (orientation: portrait), screen and (max-device-width: 415px) and (orientation: landscape) {
  .testOne {
    letter-spacing: 0;
  }
  .form-all {
    border: 0;
    max-width: initial;
  }
  .form-sub-label-container {
    width: 100%;
    margin: 0;
    margin-right: 0;
    float: left;
    -moz-box-sizing: border-box;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
  }
  span.form-sub-label-container + span.form-sub-label-container {
    margin-right: 0;
  }
  .form-sub-label {
    white-space: normal;
  }
  .form-address-table td,
  .form-address-table th {
    padding: 0 1px 10px;
  }
  .form-submit-button,
  .form-submit-print,
  .form-submit-reset {
    width: 100%;
    margin-left: 0!important;
  }
  div[id*=at_] {
    font-size: 14px;
    font-weight: 700;
    height: 8px;
    margin-top: 6px;
  }
  .showAutoCalendar {
    width: 20px;
  }
  img.form-image {
    max-width: 100%;
    height: auto;
  }
  .form-matrix-row-headers {
    width: 100%;
    word-break: break-all;
    min-width: 40px;
  }
  .form-collapse-table,
  .form-header-group {
    margin: 0;
  }
  .form-collapse-table {
    height: 100%;
    display: inline-block;
    width: 100%;
  }
  .form-collapse-hidden {
    display: none !important;
  }
  .form-input {
    width: 100%;
  }
  .form-label {
    width: 100% !important;
  }
  .form-label-left,
  .form-label-right {
    display: block;
    float: none;
    text-align: left;
    width: auto!important;
  }
  .form-line,
  .form-line.form-line-column {
    padding: 2% 5%;
    -moz-box-sizing: border-box;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
  }
  input[type=text],
  input[type=email],
  input[type=tel],
  textarea {
    width: 100%;
    -moz-box-sizing: border-box;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
    max-width: initial !important;
  }
  .form-radio-other-input,
  .form-checkbox-other-input {
    max-width: 55% !important;
  }
  .form-dropdown,
  .form-textarea,
  .form-textbox {
    width: 100%!important;
    -moz-box-sizing: border-box;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
  }
  .form-input,
  .form-input-wide,
  .form-textarea,
  .form-textbox,
  .form-dropdown {
    max-width: initial!important;
  }
  .form-checkbox-item:not(#foo),
  .form-radio-item:not(#foo) {
    width: 100%;
  }
  .form-address-city,
  .form-address-line,
  .form-address-postal,
  .form-address-state,
  .form-address-table,
  .form-address-table .form-sub-label-container,
  .form-address-table select,
  .form-input {
    width: 100%;
  }
  div.form-header-group {
    padding: 24px 0px !important;
    margin: 0 12px 2% !important;
    margin-left: 5%!important;
    margin-right: 5%!important;
    -moz-box-sizing: border-box;
    -webkit-box-sizing: border-box;
    box-sizing: border-box;
  }
  div.form-header-group.hasImage img {
    max-width: 100%;
  }
  [data-type="control_button"] {
    margin-bottom: 0 !important;
  }
  [data-type=control_fullname] .form-sub-label-container {
    width: 48%;
  }
  [data-type=control_fullname] .form-sub-label-container:first-child {
    margin-right: 4%;
  }
  [data-type=control_phone] .form-sub-label-container {
    width: 65%;
    margin-right: 0;
    margin-left: 0;
    float: left;
  }
  [data-type=control_phone] .form-sub-label-container:first-child {
    width: 31%;
    margin-right: 4%;
  }
  [data-type=control_datetime] .allowTime-container {
    width: 100%;
  }
  [data-type=control_datetime] .form-sub-label-container:first-child {
    width: 10%!important;
    margin-left: 0;
    margin-right: 0;
  }
  [data-type=control_datetime] .form-sub-label-container + .form-sub-label-container {
    width: 24%!important;
    margin-left: 6%;
    margin-right: 0;
  }
  [data-type=control_datetime] span + span + span > span:first-child {
    display: block;
    width: 100% !important;
  }
  [data-type=control_birthdate] .form-sub-label-container,
  [data-type=control_time] .form-sub-label-container {
    width: 27.3%!important;
    margin-right: 6% !important;
  }
  [data-type=control_time] .form-sub-label-container:last-child {
    width: 33.3%!important;
    margin-right: 0 !important;
  }
  .form-pagebreak-back-container,
  .form-pagebreak-next-container {
    min-height: 1px;
    width: 50% !important;
  }
  .form-pagebreak-back,
  .form-pagebreak-next,
  .form-product-item.hover-product-item {
    width: 100%;
  }
  .form-pagebreak-back-container {
    padding: 0;
    text-align: right;
  }
  .form-pagebreak-next-container {
    padding: 0;
    text-align: left;
  }
  .form-pagebreak {
    margin: 0 auto;
  }
  .form-buttons-wrapper {
    margin: 0!important;
    margin-left: 0!important;
  }
  .form-buttons-wrapper button {
    width: 100%;
  }
  .form-buttons-wrapper .form-submit-print {
    margin: 0 !important;
  }
  table {
    width: 100%!important;
    max-width: initial!important;
  }
  table td + td {
    padding-left: 3%;
  }
  .form-checkbox-item,
  .form-radio-item {
    white-space: normal!important;
  }
  .form-checkbox-item input,
  .form-radio-item input {
    width: auto;
  }
  .form-collapse-table {
    margin: 0 5%;
    display: block;
    zoom: 1;
    width: auto;
  }
  .form-collapse-table:before,
  .form-collapse-table:after {
    display: table;
    content: '';
    line-height: 0;
  }
  .form-collapse-table:after {
    clear: both;
  }
  .fb-like-box {
    width: 98% !important;
  }
  .form-error-message {
    clear: both;
    bottom: -10px;
  }
  .date-separate,
  .phone-separate {
    display: none;
  }
  .custom-field-frame,
  .direct-embed-widgets,
  .signature-pad-wrapper {
    width: 100% !important;
  }
}
/* | */

/*__INSPECT_SEPERATOR__*/
.form-textbox {
    height : 20px;
}

.form-sub-label-container {
    text-align : justify;
    font-size : 20px;
}

.form-line {

}


    /* Injected CSS Code */
</style>

<link type="text/css" rel="stylesheet" href="https://cdn.jotfor.ms/css/styles/buttons/form-submit-button-book_blue2.css?3.3.9832"/>
<form class="jotform-form" action="https://submit.jotformeu.com/submit/90224809117353/" method="post" name="form_90224809117353" id="90224809117353" accept-charset="utf-8">
  <input type="hidden" name="formID" value="90224809117353" />
  <div class="form-all">
    <link type="text/css" rel="stylesheet" media="all" href="https://cdn.jotfor.ms/wizards/languageWizard/custom-dropdown/css/lang-dd.css?3.3.9832" />
    <div class="cont">
      <input type="text" id="input_language" name="input_language" style="display:none" />
      <div class="language-dd" id="langDd" style="display:none">
        <div class="dd-placeholder lang-emp">
          Language
        </div>
        <ul class="lang-list dn" id="langList">
          <li data-lang="fr" class="fr">
            Français
          </li>
        </ul>
      </div>
    </div>
    <script type="text/javascript" src="https://cdn.jotfor.ms/js/formTranslation.v2.js?3.3.9832"></script>
    <ul class="form-section page-section">
      <li id="cid_5" class="form-input-wide" data-type="control_head">
        <div class="form-header-group ">
          <div class="header-text httac htvam">
            <h3 id="header_5" class="form-header" data-component="header">
              Paiement CB
            </h3>
          </div>
        </div>
      </li>
      <li class="form-line jf-required" data-type="control_paypal" id="id_2">
        <label class="form-label form-label-right" id="label_2" for="input_2">
          Montant :
          <span class="form-required">
            *
          </span>
        </label>
        <div id="cid_2" class="form-input jf-required">
          <div data-wrapper-react="true">
            <input type="hidden" name="simple_fpc" data-payment_type="paypal" data-component="payment1" value="2" />
            <input type="hidden" name="payment_total_checksum" id="payment_total_checksum" data-component="payment2" />
            <span class="form-sub-label-container" style="vertical-align:top">
              <input type="text" class="form-textbox validate[required, Numeric]" id="input_2_donation" name="q2_montant[price]" value="" data-component="paymentDonation" />
              EUR
              <label class="form-sub-label" for="input_2_donation" style="min-height:13px">  </label>
            </span>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_button" id="id_1">
        <div id="cid_1" class="form-input-wide">
          <div style="text-align:center" class="form-buttons-wrapper">
            <button id="input_1" type="submit" class="form-submit-button form-submit-button-book_blue2" data-component="button">
              PAYER
            </button>
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_image" id="id_3">
        <div id="cid_3" class="form-input-wide">
          <div style="text-align:center">
            <img alt="" class="form-image" style="border:0" src="https://www.atelierdufuturpapa.com/media/images/upload/paiement_securise_paypal.png" height="65px" width="258px" data-component="image" />
          </div>
        </div>
      </li>
      <li class="form-line" data-type="control_text" id="id_4">
        <div id="cid_4" class="form-input-wide">
          <div id="text_4" class="form-html" data-component="text">
            <p style="text-align: center;"><span style="color: #000080; font-size: 12pt;"><strong>Comment payer par CB sans compte Paypal ?</strong></span></p>
            <p style="text-align: center;"><span style="color: #000000;"><span style="font-size: 10pt;">1) Indiquez le montant à payer ci-dessus.<br /></span></span></p>
            <p style="text-align: center;"><span style="color: #000000;"><span style="font-size: 10pt;">2) Cliquez sur &quot;PAYER&quot; : vous êtes redirigé sur une page de paiement sécurisée par Paypal.</span></span></p>
            <p style="text-align: center;"><span style="color: #000000;"><span style="font-size: 10pt;">3) Cliquez sur &quot;Payer par carte&quot; pour payer par CB sans être inscrit à Paypal !<br /></span></span></p>
          </div>
        </div>
      </li>
      <li style="display:none">
        Should be Empty:
        <input type="text" name="website" value="" />
      </li>
    </ul>
  </div>