{"id":39068,"date":"2020-05-22T19:11:24","date_gmt":"2020-05-22T17:11:24","guid":{"rendered":"https:\/\/www.digital-insure.fr\/contact-form\/"},"modified":"2025-10-21T15:01:45","modified_gmt":"2025-10-21T13:01:45","slug":"contact-form","status":"publish","type":"page","link":"https:\/\/www.digital-insure.fr\/en\/contact-form\/","title":{"rendered":"CONTACT FORM"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"39068\" class=\"elementor elementor-39068 elementor-5366\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1d98aca3 elementor-section-stretched elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1d98aca3\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1d1dc7ca\" data-id=\"1d1dc7ca\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5b41ca7 elementor-widget elementor-widget-spacer\" data-id=\"5b41ca7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-c2a35fc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c2a35fc\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-10797e16\" data-id=\"10797e16\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-61cdce26 elementor-widget elementor-widget-webify-section-heading-widget\" data-id=\"61cdce26\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"webify-section-heading-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"tb-section-heading tb-style2\">\n                      <div none=\"\" class=\"tb-f11-lg tb-mt-4 tb-small-heading tb-mb-5 tb-line1-6 tb-spacing2 tb-grayb5b5b5-c text-uppercase\" class=\"tb-f11-lg tb-mt-4 tb-small-heading tb-mb-5 tb-line1-6 tb-spacing2 tb-grayb5b5b5-c text-uppercase\"> formulaire de mise en relation<\/div>\n            <div class=\"empty-space marg-lg-b20\"><\/div>\n                                <h1 class=\"tb-f32-lg tb-f28-sm tb-big-heading tb-font-name tb-mt-6 tb-mb-9 tb-mt-4-sm tb-mb-7-sm\" class=\"tb-f32-lg tb-f28-sm tb-big-heading tb-font-name tb-mt-6 tb-mb-9 tb-mt-4-sm tb-mb-7-sm\">\u00catre mis en relation <\/h1>\n                  <\/div>\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c45aac7 elementor-widget elementor-widget-webify-section-heading-widget\" data-id=\"c45aac7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"webify-section-heading-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"tb-section-heading\">\n          <h2 class=\"tb-f32-lg tb-f28-sm tb-big-heading tb-font-name tb-mt-5 tb-mb-8 tb-mb-6-sm\" class=\"tb-f32-lg tb-f28-sm tb-big-heading tb-font-name tb-mt-5 tb-mb-8 tb-mb-6-sm\">Vous \u00eates client assur\u00e9<\/h2>\n        <\/div>\n      \n      \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-22882ffe elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"22882ffe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-dot-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Do you require information about your policy?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-dot-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Do you not have a client account with your login details?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-dot-circle\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Are you unable to reach your broker?<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d8900a5 elementor-widget elementor-widget-text-editor\" data-id=\"d8900a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>We invite you to complete the &#8220;contact form&#8221; provided here, specifying your policy number. The Digital Insure team will assist you. Your login ID and the access link are available at the top left of your policy and certificate of coverage. <\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2186c29 elementor-widget elementor-widget-webify-section-heading-widget\" data-id=\"2186c29\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"webify-section-heading-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"tb-section-heading\">\n          <h2 class=\"tb-f32-lg tb-f28-sm tb-big-heading tb-font-name tb-mt-5 tb-mb-8 tb-mb-6-sm\" class=\"tb-f32-lg tb-f28-sm tb-big-heading tb-font-name tb-mt-5 tb-mb-8 tb-mb-6-sm\">Vous n'\u00eates pas encore client ou vous ne trouvez pas les coordonn\u00e9es de votre courtier partenaire Digital Insure.<\/h2>\n        <\/div>\n      \n      \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-46c4404 elementor-widget elementor-widget-text-editor\" data-id=\"46c4404\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>To be contacted promptly, please complete this simple form.<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-6cfae9bf\" data-id=\"6cfae9bf\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2df031b0 elementor-widget elementor-widget-webify-contact-form-7-widget\" data-id=\"2df031b0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"webify-contact-form-7-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n    <div class=\"tb-contact-form-wrapper\">\n\n    \n<div class=\"wpcf7 no-js\" id=\"wpcf7-f39310-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"39310\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/39068#wpcf7-f39310-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"39310\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f39310-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:39310,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;regex_numeric&quot;:&quot;^[0-9]+$&quot;,&quot;regex_alphabetic&quot;:&quot;^[a-zA-Z]+$&quot;,&quot;regex_alphanumeric&quot;:&quot;^[a-zA-Z0-9]+$&quot;,&quot;regex_date&quot;:&quot;^(0?[1-9]|1[012])[- .](0?[1-9]|[12][0-9]|3[01])[- \\\/.](19|20)?[0-9]{2}$&quot;,&quot;regex_email&quot;:&quot;^[a-zA-Z0-9._%-]+@[a-zA-Z0-9.-]+.[a-zA-Z]{2,4}$&quot;,&quot;regex_numeric_label&quot;:&quot;numeric&quot;,&quot;regex_alphabetic_label&quot;:&quot;alphabetic&quot;,&quot;regex_alphanumeric_label&quot;:&quot;alphanumeric&quot;,&quot;regex_date_label&quot;:&quot;date&quot;,&quot;regex_email_label&quot;:&quot;email&quot;,&quot;regex_custom_1&quot;:&quot;&quot;,&quot;regex_custom_2&quot;:&quot;&quot;,&quot;regex_custom_3&quot;:&quot;&quot;,&quot;regex_custom_4&quot;:&quot;&quot;,&quot;regex_custom_5&quot;:&quot;&quot;,&quot;regex_custom_1_label&quot;:&quot;custom 1&quot;,&quot;regex_custom_2_label&quot;:&quot;custom 2&quot;,&quot;regex_custom_3_label&quot;:&quot;custom 3&quot;,&quot;regex_custom_4_label&quot;:&quot;custom 4&quot;,&quot;regex_custom_5_label&quot;:&quot;custom 5&quot;,&quot;notice_dismissed_rollback-cf7-5.7.6&quot;:true}}\" \/>\n<\/fieldset>\n<p><label>Subject of Request (required)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-187\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"menu-187\" value=\"Not yet a client, I would like to be connected with one of your partner brokers.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Not yet a client, I would like to be connected with one of your partner brokers.<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"menu-187\" value=\"Already a client, I would like to be connected with my designated broker.\" \/><span class=\"wpcf7-list-item-label\">Already a client, I would like to be connected with my designated broker.<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"menu-187\" value=\"I require assistance, please contact me.\" \/><span class=\"wpcf7-list-item-label\">I require assistance, please contact me.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-68\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-68\" value=\"Mr.\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Mr.<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-68\" value=\"Ms.\" \/><span class=\"wpcf7-list-item-label\">Ms.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Your first name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"votre-prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First name*\" value=\"\" type=\"text\" name=\"votre-prenom\" \/><\/span><\/label>\n<\/p>\n<p><label> Your last name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"votre-nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last name*\" value=\"\" type=\"text\" name=\"votre-nom\" \/><\/span><\/label>\n<\/p>\n<p><label> Email*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"votre-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your email*\" value=\"\" type=\"email\" name=\"votre-email\" \/><\/span><\/label>\n<\/p>\n<p><label> Phone number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"numero-de-telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone*\" value=\"\" type=\"tel\" name=\"numero-de-telephone\" \/><\/span><\/label>\n<\/p>\n<p><label> Postal code*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"code-postal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Postal code*\" value=\"\" type=\"text\" name=\"code-postal\" \/><\/span><\/label>\n<\/p>\n<p><label> City*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ville\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"City*\" value=\"\" type=\"text\" name=\"ville\" \/><\/span><\/label>\n<\/p>\n<p><label> Your message*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"votre-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your message*\" name=\"votre-message\"><\/textarea><\/span><\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-810\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"checkbox-810[]\" value=\"By submitting this form, I accept that the information entered may be used for the purpose of this contact request and any resulting commercial relationship. See our privacy policy for more information.\" \/><span class=\"wpcf7-list-item-label\">By submitting this form, I accept that the information entered may be used for the purpose of this contact request and any resulting commercial relationship. See our privacy policy for more information.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><a href=\"https:\/\/www.digital-insure.fr\/mentions-legales-et-politique-de-confidentialite\/\">Privacy Policy<\/a>\n<\/p>\n<p>* Required fields\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit tb-btn tb-color4 tb-style3 has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n      \n    <\/div>\n      \n  \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-1b944ac4 elementor-widget elementor-widget-spacer\" data-id=\"1b944ac4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>formulaire de mise en relation \u00catre mis en relation Vous \u00eates client assur\u00e9 Do you require information about your policy? Do you not have a client account with your login details? Are you unable to reach your broker? We invite you to complete the &#8220;contact form&#8221; provided here, specifying your policy number. The Digital Insure [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-39068","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.digital-insure.fr\/en\/wp-json\/wp\/v2\/pages\/39068","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.digital-insure.fr\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.digital-insure.fr\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.digital-insure.fr\/en\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/www.digital-insure.fr\/en\/wp-json\/wp\/v2\/comments?post=39068"}],"version-history":[{"count":3,"href":"https:\/\/www.digital-insure.fr\/en\/wp-json\/wp\/v2\/pages\/39068\/revisions"}],"predecessor-version":[{"id":39084,"href":"https:\/\/www.digital-insure.fr\/en\/wp-json\/wp\/v2\/pages\/39068\/revisions\/39084"}],"wp:attachment":[{"href":"https:\/\/www.digital-insure.fr\/en\/wp-json\/wp\/v2\/media?parent=39068"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}