{"id":393410,"date":"2024-12-16T16:34:32","date_gmt":"2024-12-16T15:34:32","guid":{"rendered":"https:\/\/te.alsace\/happy-gaz\/?page_id=393410"},"modified":"2026-01-06T14:52:53","modified_gmt":"2026-01-06T13:52:53","slug":"demande-de-subvention-happy-gaz-vert","status":"publish","type":"page","link":"https:\/\/te.alsace\/happy-gaz\/demande-de-subvention-happy-gaz-vert\/","title":{"rendered":"Demande de subvention Happy Gaz Vert"},"content":{"rendered":"<p>[et_pb_section fb_built=\u00a0\u00bb1&Prime; _builder_version=\u00a0\u00bb4.22.2&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb da_disable_devices=\u00a0\u00bboff|off|off\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb da_is_popup=\u00a0\u00bboff\u00a0\u00bb da_exit_intent=\u00a0\u00bboff\u00a0\u00bb da_has_close=\u00a0\u00bbon\u00a0\u00bb da_alt_close=\u00a0\u00bboff\u00a0\u00bb da_dark_close=\u00a0\u00bboff\u00a0\u00bb da_not_modal=\u00a0\u00bbon\u00a0\u00bb da_is_singular=\u00a0\u00bboff\u00a0\u00bb da_with_loader=\u00a0\u00bboff\u00a0\u00bb da_has_shadow=\u00a0\u00bbon\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_margin=\u00a0\u00bb25px||25px||true|false\u00a0\u00bb custom_margin_tablet=\u00a0\u00bb25px||25px||true|false\u00a0\u00bb custom_margin_phone=\u00a0\u00bb25px||25px||true|false\u00a0\u00bb custom_margin_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.17.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.22.2&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_2_font=\u00a0\u00bb|700|||||||\u00a0\u00bb header_2_font_size=\u00a0\u00bb50px\u00a0\u00bb z_index=\u00a0\u00bb0&Prime; width=\u00a0\u00bb100%\u00a0\u00bb max_width=\u00a0\u00bb100%\u00a0\u00bb custom_margin=\u00a0\u00bb||-10px||false|false\u00a0\u00bb header_2_font_size_tablet=\u00a0\u00bb45px\u00a0\u00bb header_2_font_size_phone=\u00a0\u00bb35px\u00a0\u00bb header_2_font_size_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h2>Formulaire de demande de subvention<\/h2>\n<p>[\/et_pb_text][et_pb_divider show_divider=\u00a0\u00bboff\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb use_background_color_gradient=\u00a0\u00bbon\u00a0\u00bb background_color_gradient_direction=\u00a0\u00bb30deg\u00a0\u00bb background_color_gradient_stops=\u00a0\u00bb#32b9c8 0%|#a0328c 100%\u00a0\u00bb z_index=\u00a0\u00bb10&Prime; width=\u00a0\u00bb632px\u00a0\u00bb width_tablet=\u00a0\u00bb474px\u00a0\u00bb width_phone=\u00a0\u00bb0px\u00a0\u00bb width_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb height=\u00a0\u00bb7px\u00a0\u00bb custom_margin=\u00a0\u00bb||||false|false\u00a0\u00bb custom_padding=\u00a0\u00bb|205px|||false|false\u00a0\u00bb border_radii=\u00a0\u00bboff|20px||20px|\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_divider][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.22.2&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_padding=\u00a0\u00bb15px|||||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.22.2&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_font_size=\u00a0\u00bb16px\u00a0\u00bb text_line_height=\u00a0\u00bb1.6em\u00a0\u00bb text_orientation=\u00a0\u00bbjustified\u00a0\u00bb custom_margin=\u00a0\u00bb||20px|||\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p><strong>L\u2019offre \u00ab Happy Gaz Vert \u00bb<\/strong> est une subvention destin\u00e9e aux associations, aux particuliers et aux professionnels de <span style=\"text-decoration: underline; color: #a0328c;\"> <a href=\"https:\/\/te.alsace\/happy-gaz\/wp-content\/uploads\/2023\/11\/Liste-158communes-eligibles.pdf\" target=\"_blank\" rel=\"noopener\"><strong>158 communes desservies par<\/strong><\/a><\/span><br \/><a href=\"https:\/\/te.alsace\/happy-gaz\/wp-content\/uploads\/2023\/11\/Liste-158communes-eligibles.pdf\" target=\"_blank\" rel=\"noopener\"><strong><span style=\"text-decoration: underline;\">GRDF<\/span><\/strong><\/a>, qui choisissent une solution de chauffage gaz performante install\u00e9e par un artisan <strong><span style=\"text-decoration: underline;\"><a href=\"https:\/\/lesprofessionnelsdugaz.com\/particulier\/les-professionnels-du-gaz\/recherche\">agr\u00e9\u00e9 Professionnel du Gaz (PG)<\/a><\/span><\/strong>.<\/p>\n<p>L\u2019offre est valable pour les installations <strong>factur\u00e9es entre le 1\u1d49\u02b3 janvier 2026 et le 31 d\u00e9cembre 2026,<\/strong> dans les b\u00e2timents construits <strong>depuis plus de 2 ans<\/strong> et o\u00f9 les compteurs gaz ont un <strong>d\u00e9bit \u2264 10m\u00b3\/h.<br \/><\/strong><br \/><strong>La souscription a un Contrat Gaz Vert (minimum 5 %) est obligatoire<\/strong> <strong>pour b\u00e9n\u00e9ficier d&rsquo;une subvention.<\/strong><br \/>Comparez les offres de fourniture de gaz sur <span style=\"text-decoration: underline; color: #a0328c;\"> <strong><a href=\"https:\/\/comparateur-offres.energie-info.fr\" target=\"_blank\" rel=\"noopener\">le site du M\u00e9diateur National de l\u2019Energie.<\/a><\/strong><\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.22.2&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb border_radii=\u00a0\u00bbon|10px|10px|10px|10px\u00a0\u00bb box_shadow_style=\u00a0\u00bbpreset1&Prime; box_shadow_blur=\u00a0\u00bb16px\u00a0\u00bb box_shadow_color=\u00a0\u00bbrgba(0,0,0,0.23)\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.22.2&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_padding=\u00a0\u00bb|33px||33px|false|true\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' style='display:none'><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_3' id='gform_3'  action='\/happy-gaz\/wp-json\/wp\/v2\/pages\/393410#gf_3' data-formid='3' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_3_8\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">IDENTIT\u00c9 DU DEMANDEUR DE L\u2019AIDE<\/h3><\/div><div id=\"field_3_50\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_50'>Type de demandeur<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_50' id='input_3_50' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Particulier' >Particulier<\/option><option value='Pro (dont bailleur - SCI)' >Pro (dont bailleur - SCI)<\/option><option value='Association' >Association<\/option><\/select><\/div><\/div><div id=\"field_3_41\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_41'>Raison sociale<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_3_41' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_3_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_51'>SIRET<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_3_51' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_3_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Identit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_1'>\n                            \n                            <span id='input_3_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_3_1_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_3_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_3_1_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_1.6' id='input_3_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_3_46\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Votre adresse postale (pour les correspondances)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_3_46' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_46_1_container' >\n                                        <label for='input_3_46_1' id='input_3_46_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                        <input type='text' name='input_46.1' id='input_3_46_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_46_3_container' >\n                                    <label for='input_3_46_3' id='input_3_46_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                    <input type='text' name='input_46.3' id='input_3_46_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_46.4' id='input_3_46_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_3_46_5_container' >\n                                    <label for='input_3_46_5' id='input_3_46_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                    <input type='text' name='input_46.5' id='input_3_46_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_46.6' id='input_3_46_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_3_2\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_3_2_container'>\n                                <span id='input_3_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_3_2' class='gform-field-label gform-field-label--type-sub '>Saisissez un e-mail<\/label>\n                                    <input class='' type='email' name='input_2' id='input_3_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_3_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_3_2_2' class='gform-field-label gform-field-label--type-sub '>Confirmez l\u2019e-mail<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_3_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_3_44\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_44'>TYPE DE B\u00c2TIMENT CONCERN\u00c9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_44' id='input_3_44' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Maison individuelle' >Maison individuelle<\/option><option value='Appartement' >Appartement<\/option><option value='Local Professionnel' >Local Professionnel<\/option><option value='G\u00eete\/Meubl\u00e9 de tourisme' >G\u00eete\/Meubl\u00e9 de tourisme<\/option><\/select><\/div><\/div><div id=\"field_3_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">ADRESSE DU B\u00c2TIMENT CONCERN\u00c9<\/h3><div class='gsection_description' id='gfield_description_3_15'><p style=\"color:#f52f57;\">Le b\u00e2timent doit imp\u00e9rativement \u00eatre situ\u00e9 dans <strong><a style=\"text-decoration:underline;\"href=\"https:\/\/te.alsace\/happy-gaz\/wp-content\/uploads\/2023\/11\/Liste-158communes-eligibles.pdf\">l\u2019une des 158 communes concern\u00e9es par l\u2019op\u00e9ration\u00a0<\/a><\/strong><\/p><\/div><\/div><fieldset id=\"field_3_3\" class=\"gfield gfield--type-address gfield--input-type-address field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse du b\u00e2timent concern\u00e9 (si diff\u00e9rente de l&#039;adresse de contact)<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_3_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_3_1_container' >\n                                        <label for='input_3_3_1' id='input_3_3_1_label' class='gform-field-label gform-field-label--type-sub '>Nom et num\u00e9ro de la rue<\/label>\n                                        <input type='text' name='input_3.1' id='input_3_3_1' value=''    aria-required='false'   autocomplete=\"address-line1\" \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_3_3_container' >\n                                    <label for='input_3_3_3' id='input_3_3_3_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                    <input type='text' name='input_3.3' id='input_3_3_3' value=''    aria-required='false'   autocomplete=\"address-level2\" \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_3.4' id='input_3_3_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_3_3_5_container' >\n                                    <label for='input_3_3_5' id='input_3_3_5_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                    <input type='text' name='input_3.5' id='input_3_3_5' value=''    aria-required='false'   autocomplete=\"postal-code\" \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_3_3_6' value='France' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_3_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Comment avez-vous entendu parler de cette aide ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_52'>\n\t\t\t<div class='gchoice gchoice_3_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Professionnels du Gaz (PG)'  id='choice_3_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_0' id='label_3_52_0' class='gform-field-label gform-field-label--type-inline'>Professionnels du Gaz (PG)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='GRDF'  id='choice_3_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_1' id='label_3_52_1' class='gform-field-label gform-field-label--type-inline'>GRDF<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_52_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Site internet de TEA'  id='choice_3_52_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_2' id='label_3_52_2' class='gform-field-label gform-field-label--type-inline'>Site internet de TEA<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_52_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='R\u00e9seaux Sociaux'  id='choice_3_52_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_3' id='label_3_52_3' class='gform-field-label gform-field-label--type-inline'>R\u00e9seaux Sociaux<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_52_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Bouche \u00e0 oreille'  id='choice_3_52_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_4' id='label_3_52_4' class='gform-field-label gform-field-label--type-inline'>Bouche \u00e0 oreille<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_52_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Mairie\/\u00e9lus locaux'  id='choice_3_52_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_5' id='label_3_52_5' class='gform-field-label gform-field-label--type-inline'>Mairie\/\u00e9lus locaux<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_52_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='gf_other_choice'  id='choice_3_52_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_6' id='label_3_52_6' class='gform-field-label gform-field-label--type-inline'>Autre<\/label><br \/><input id='input_3_52_other' class='gchoice_other_control' name='input_52_other' type='text' value='Autre' aria-label='Autre choix, veuillez sp\u00e9cifier'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_10\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">TYPE D\u2019AIDE(S) DEMAND\u00c9E(S)<\/h3><\/div><fieldset id=\"field_3_48\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Veuillez s\u00e9lectionner le service dont vous avez besoin\u2026<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_48'>\n\t\t\t<div class='gchoice gchoice_3_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='J&#039;ai fait une conversion d\u2019autres \u00e9nergies vers une chaudi\u00e8re THPE et j&#039;ai souscrit un Contrat de fourniture gaz vert'  id='choice_3_48_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_48_0' id='label_3_48_0' class='gform-field-label gform-field-label--type-inline'>J'ai fait une conversion d\u2019autres \u00e9nergies vers une chaudi\u00e8re THPE et j'ai souscrit un Contrat de fourniture gaz vert<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='J&#039;ai fait une conversion d\u2019autres \u00e9nergies vers une PAC hybride gaz et j&#039;ai souscrit un Contrat de fourniture gaz vert'  id='choice_3_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_48_1' id='label_3_48_1' class='gform-field-label gform-field-label--type-inline'>J'ai fait une conversion d\u2019autres \u00e9nergies vers une PAC hybride gaz et j'ai souscrit un Contrat de fourniture gaz vert<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_48_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='J\u2019ai remplac\u00e9 une ancienne chaudi\u00e8re gaz par une THPE et j&#039;ai souscrit un Contrat de fourniture gaz vert'  id='choice_3_48_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_48_2' id='label_3_48_2' class='gform-field-label gform-field-label--type-inline'>J\u2019ai remplac\u00e9 une ancienne chaudi\u00e8re gaz par une THPE et j'ai souscrit un Contrat de fourniture gaz vert<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_48_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='J\u2019ai remplac\u00e9 une ancienne chaudi\u00e8re gaz par une PAC hydride gaz et j&#039;ai souscrit un Contrat de fourniture gaz vert'  id='choice_3_48_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_48_3' id='label_3_48_3' class='gform-field-label gform-field-label--type-inline'>J\u2019ai remplac\u00e9 une ancienne chaudi\u00e8re gaz par une PAC hydride gaz et j'ai souscrit un Contrat de fourniture gaz vert<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_45\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_45'>Quel \u00e9tait votre moyen de chauffage jusqu&#039;alors utilis\u00e9 ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_45' id='input_3_45' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Fioul' >Fioul<\/option><option value='Bois' >Bois<\/option><option value='Pellet\/Plaquette' >Pellet\/Plaquette<\/option><option value='Electricit\u00e9' >Electricit\u00e9<\/option><option value='Pompe \u00e0 chaleur' >Pompe \u00e0 chaleur<\/option><option value='Gaz' >Gaz<\/option><\/select><\/div><\/div><div id=\"field_3_18\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><b>Je certifie sur l\u2019honneur l\u2019exactitude des renseignements fournis et j'atteste avoir pris connaissance des conditions d'\u00e9ligibilit\u00e9.<\/b><\/p>\n<\/div><div id=\"field_3_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_21'>Fait \u00e0<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_3_21' type='text' value='' class='large'  aria-describedby=\"gfield_description_3_21\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_3_21'>Ville<\/div><\/div><div id=\"field_3_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_22'>Le<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_3_22' type='text' value='' class='large'  aria-describedby=\"gfield_description_3_22\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_3_22'>Date<\/div><\/div><div id=\"field_3_19\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_19'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><input type='hidden' value='' name='input_19' id='input_3_19_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_3_19_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_3_19' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/te.alsace\/happy-gaz\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_3_19_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_3_19_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_3_19_data' name='input_3_19_data' value=''><\/div><\/div><fieldset id=\"field_3_20\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >RGPD<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_20.1' id='input_3_20_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_3_20_1' >En soumettant ce formulaire, j'accepte que les informations saisies soient exploit\u00e9es dans le cadre de la demande de renseignements qui peut en d\u00e9couler. Conform\u00e9ment \u00e0 la loi \u00ab informatique et libert\u00e9s \u00bb, et \u00e0 <a style=\"text-decoration:underline;\" href=\"http:\/\/te.alsace\/politique-de-confidentialite\/\">notre politique de confidentialit\u00e9<\/a> vous pouvez exercer votre droit d'acc\u00e8s aux donn\u00e9es vous concernant et les faire rectifier en nous contactant.<\/label><input type='hidden' name='input_20.2' value='En soumettant ce formulaire, j&#039;accepte que les informations saisies soient exploit\u00e9es dans le cadre de la demande de renseignements qui peut en d\u00e9couler. 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