<div class="cbm-sellerContactForm__confirmation">
  <span class="cbm-picto--valid"></span>
  <span class="cbm-sellerContactForm__confirmationLabel"></span>
</div>
<div class="cbm-sellerContactForm__wrapper">
  <form action="{{lcHost}}/mail_send_popup.php" method="GET" id="isc" name="isc" novalidate>
    <input type="hidden" value="123" name="exit_Submit.x" />
    <input type="hidden" value="" id="sand" name="sand" />
    <input type="hidden" value="contact" name="mailing" />
    <input type="hidden" value="sender" name="code" />
    <input type="hidden" value="" name="link_page" />
    <input type="hidden" value="auto" name="categorie" />
    <input type="hidden" value="" name="annonce" />
    <input type="hidden" value="{{classified.reference}}" name="it_reference" />
    <input type="hidden" value="{{classified.referencePro}}" name="proref" />
    <input type="hidden" value="{{classified.ownerCorrelationId}}" name="cu_re" />
    <input type="hidden" value="" name="mode" />
    <input type="hidden" value="send" name="event" />
    <input type="hidden" value="{{classified.vehicle.make}}" name="marque" />
    <input type="hidden" value="{{classified.vehicle.model}}" name="modele" />
    <input type="hidden" value="" name="part" />
    <input type="hidden" value='{{classified.ownerCorrelationId}}' name="classified_owner_correlation_id">
    <input type="hidden" value="La Centrale vous envoie un contact pour votre annonce Num {{classified.reference}} - {{classified.vehicle.make}} - {{classified.vehicle.model}} - {{classified.vehicle.version}}"
      name="objet" />
    <div class="errorSummary"></div>
    <div id="cbm-sellerContactForm__civilite">
      <label class="cbm-radio--3" for="madame">
          <input class="" type="radio" name="type" id="madame" value="Madame" />
          <div class="checkmark"></div>
          <span>Mme</span>
      </label>
      <label class="cbm-radio--3" for="monsieur">
          <input class="" type="radio" name="type" id="monsieur" value="Monsieur" checked="checked" />
          <div class="checkmark"></div>
          <span>M.</span>
      </label>
    </div>
    <div class="cbm-sellerContactForm__coord">
      <div class="cbm-fieldWrapper">
        <div class="inputContainer">
            <input type="text" name="nom_exp" value="" id="nom_exp" placeholder="Votre nom *" required />
        </div>
      </div>
      <div class="cbm-fieldWrapper">
        <div class="inputContainer">
            <input type="text" name="prenom_exp" value="" id="prenom_exp" placeholder="Votre pr&eacute;nom" />
        </div>
      </div>
      <div class="cbm-fieldWrapper">
        <div class="inputContainer">
            <input type="email" name="mail_exp" value="" id="mail_exp" placeholder="Votre e-mail *" required />
        </div>
      </div>
      <div class="cbm-fieldWrapper">
        <div class="inputContainer">
            <input type="tel" name="tel_exp" value="" id="tel_exp" placeholder="Votre t&eacute;l&eacute;phone" />
        </div>
      </div>
    </div>
    <div class="cbm-sellerContactForm__message">
      <div class="inputContainer">
          <textarea name="message" id="message" rows="7" placeholder="Votre message" required></textarea>
      </div>
    </div>
    <div class="cbm-sellerContactForm__control">
      <div class="cbm-sellerContactForm__captcha ">
        <div class="cbm-fieldWrapper">
          <div class="inputContainer">
            <input type="text" name="Kontrol" value="" id="Kontrol" placeholder="V&eacute;rification *" required />
          </div>
        </div>
        <img id="captchaImg" class="captchaImg" src="" name="FC" />
        <a id="regenerateCaptcha" class="regenerateCaptcha" href="javascript:;"><i class="pictoReload"></i></a>
      </div>
    </div>
    {{#if showEmailButton}}
    <div class="cbm-sellerContactForm__btnWrapper">
      <input type="reset" class="cbm-btn--4" data-close="popin" value="Annuler" />
      <input type="submit" class="cbm-btn--1" value="Envoyer" />
    </div>
    {{/if}}
    <div class="cbm-size--1">
      Conform&eacute;ment &agrave; la loi du 6 janvier 1978, vous disposez d'un droit d'acc&egrave;s, de
      modification, de rectification ou de radiation des donn&egrave;es vous concernant.
      Si vous souhaitez exercer ce droit, veuillez vous adresser par courrier &agrave; Lacentrale.fr,
      Service Consommateurs,
      22, rue Joubert 75009 Paris
      ou par email
      <a class="text-light-silver" href="mailto:info-centrale@lacentrale.fr">info-centrale@lacentrale.fr</a>
    </div>
  </form>
</div>
