{"id":2169,"date":"2019-07-08T09:42:15","date_gmt":"2019-07-08T09:42:15","guid":{"rendered":"https:\/\/nembutalsolution.org\/appointment\/"},"modified":"2026-05-28T11:52:09","modified_gmt":"2026-05-28T11:52:09","slug":"commander-nembutal-en-ligne","status":"publish","type":"page","link":"https:\/\/nembutalsolution.org\/fr\/order-nembutal-online\/","title":{"rendered":"Commander Nembutal"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p><style id=\"wpforms-css-vars-5448\">\n\t\t\t\t#wpforms-5448 {\n\t\t\t\t--wpforms-field-border-radius: 6px;\n--wpforms-field-background-color: rgba(255, 255, 255, 0.8);\n--wpforms-field-border-color: #a3a9c2;\n--wpforms-field-border-color-spare: #a3a9c2;\n--wpforms-field-text-color: #6a6a6a;\n--wpforms-label-color: #000000;\n--wpforms-label-sublabel-color: #6a6a6a;\n--wpforms-label-error-color: #d80f0f;\n--wpforms-button-border-radius: 5px;\n--wpforms-button-background-color: #2f590f;\n--wpforms-button-border-color: #2f590f;\n--wpforms-container-padding: 60px;\n--wpforms-container-border-radius: 10px;\n--wpforms-background-color: #e5e6ea;\n--wpforms-background-image: stock;\n--wpforms-background-position: top right;\n--wpforms-field-menu-color: #e5e6ea;\n--wpforms-page-break-color: #2f590f;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: 0px 30px 50px -10px rgba(0, 0, 0, 0.15);\n\n\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-css-vars-5448-custom-css\">\n\t\t\t\t#wpforms-5448 {\n\t\t\t\t\t\/* ====================== PROFESSIONAL WPFORMS STYLING - Form 2076 ====================== *\/\r\n\r\n#wpforms-2076 {\r\n    background-color: #ffffff;\r\n    padding: 40px 35px;\r\n    border-radius: 12px;\r\n    box-shadow: 0 10px 30px rgba(0, 0, 0, 0.08);\r\n    max-width: 680px;\r\n    margin: 0 auto;\r\n}\r\n\r\n\/* Labels *\/\r\n#wpforms-2076 .wpforms-field-label {\r\n    font-weight: 600;\r\n    color: #1e2937;\r\n    margin-bottom: 8px;\r\n    font-size: 15px;\r\n}\r\n\r\n\/* Fix Radio Buttons Overlap - Main Fix *\/\r\n#wpforms-2076 .wpforms-field-radio li {\r\n    margin-bottom: 20px !important;\r\n    padding: 4px 0;\r\n}\r\n\r\n#wpforms-2076 .wpforms-field-radio label {\r\n    display: flex !important;\r\n    align-items: center !important;\r\n    gap: 14px !important;\r\n    font-size: 16px;\r\n    line-height: 1.5;\r\n    cursor: pointer;\r\n}\r\n\r\n#wpforms-2076 .wpforms-field-radio input[type=&quot;radio&quot;] {\r\n    margin-right: 12px !important;\r\n    width: 20px;\r\n    height: 20px;\r\n    transform: scale(1.12);\r\n    flex-shrink: 0;\r\n}\r\n\r\n\/* Input Fields *\/\r\n#wpforms-2076 input[type=&quot;text&quot;],\r\n#wpforms-2076 input[type=&quot;email&quot;],\r\n#wpforms-2076 input[type=&quot;tel&quot;],\r\n#wpforms-2076 input[type=&quot;number&quot;],\r\n#wpforms-2076 textarea,\r\n#wpforms-2076 select {\r\n    border: 2px solid #e2e8f0;\r\n    border-radius: 8px;\r\n    padding: 14px 16px;\r\n    font-size: 16px;\r\n    color: #1e2937;\r\n    transition: all 0.3s ease;\r\n    width: 100%;\r\n    box-sizing: border-box;\r\n}\r\n\r\n#wpforms-2076 input:focus,\r\n#wpforms-2076 textarea:focus,\r\n#wpforms-2076 select:focus {\r\n    border-color: #066aab;\r\n    box-shadow: 0 0 0 3px rgba(6, 106, 171, 0.15);\r\n    outline: none;\r\n}\r\n\r\n\/* Submit Button *\/\r\n#wpforms-2076 .wpforms-submit-container button[type=&quot;submit&quot;] {\r\n    background-color: #066aab;\r\n    color: #ffffff;\r\n    font-weight: 600;\r\n    font-size: 17px;\r\n    padding: 16px 32px;\r\n    border-radius: 8px;\r\n    border: none;\r\n    transition: all 0.3s ease;\r\n    width: 100%;\r\n}\r\n\r\n#wpforms-2076 .wpforms-submit-container button[type=&quot;submit&quot;]:hover {\r\n    background-color: #05568f;\r\n    transform: translateY(-2px);\r\n    box-shadow: 0 8px 20px rgba(6, 106, 171, 0.25);\r\n}\r\n\r\n\/* Field Spacing *\/\r\n#wpforms-2076 .wpforms-field {\r\n    margin-bottom: 24px;\r\n}\r\n\r\n\/* Responsive *\/\r\n@media (max-width: 640px) {\r\n    #wpforms-2076 {\r\n        padding: 25px 20px;\r\n    }\r\n}\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-5448\"><form id=\"wpforms-form-5448\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"5448\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/2169\" data-token=\"380aaef69b4236826af806b855d895ac\" data-token-time=\"1780180180\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-5448-field_26-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"26\"><div id=\"wpforms-5448-field_26\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-5448-field_26-error\"><h4>Fill the form below to place an order<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-5448-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-5448-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-5448-field_1-error\" required><label for=\"wpforms-5448-field_1\" class=\"wpforms-field-sublabel after\">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5448-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-5448-field_1-last-error\" required><label for=\"wpforms-5448-field_1-last\" class=\"wpforms-field-sublabel after\">Nom<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-5448-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-5448-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-5448-field_2-error\" required><\/div><div id=\"wpforms-5448-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_3\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-5448-field_3\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-5448-field_3-error\" required><\/div><div id=\"wpforms-5448-field_16-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"16\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-5448-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_14\">Body Weight (Lbs) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5448-field_14\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-5448-field_14-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-5448-field_15-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_15\">Age <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-5448-field_15\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][15]\" min=\"21\" max=\"150\" step=\"any\" aria-errormessage=\"wpforms-5448-field_15-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><\/div>\t\t<div id=\"wpforms-5448-field_8-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"8\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-5448-field_8\" >(g) instructions Order<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-5448-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-5448-field_18-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_18\">Product Formulation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-5448-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- Select formulation ---<\/option><option value=\"Nembutal Powder\" >Nembutal Powder<\/option><option value=\"Nembutal Oral Solution\" >Nembutal Oral Solution<\/option><option value=\"Injectable Nembutal Solution\" >Injectable Nembutal Solution<\/option><option value=\"Nembutal Pills\/tablets\" >Nembutal Pills\/tablets<\/option><\/select><\/div><div id=\"wpforms-5448-field_5-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"5\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (g) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5448-field_5_1\" class=\"wpforms-payment-price\" data-amount=\"380\" name=\"wpforms[fields][5]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_5_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_5_1\">9g Nembutal Powder(Body weight less than 100lb) - <span class=\"wpforms-currency-symbol\">&#8364;380<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5448-field_5_2\" class=\"wpforms-payment-price\" data-amount=\"420\" name=\"wpforms[fields][5]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_5_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_5_2\">12g Nembutal Powder(Body weight ranges between 100lb - 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;420<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-5448-field_5_3\" class=\"wpforms-payment-price\" data-amount=\"530\" name=\"wpforms[fields][5]\" value=\"3\" aria-errormessage=\"wpforms-5448-field_5_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_5_3\">15g Nembutal Powder(Body weight above 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;530<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_19-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"19\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (ml) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5448-field_19_1\" class=\"wpforms-payment-price\" data-amount=\"385\" name=\"wpforms[fields][19]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_19_1\">200ml Nembutal Oral Liquid(Body weight less than 100lb) - <span class=\"wpforms-currency-symbol\">&#8364;385<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-5448-field_19_4\" class=\"wpforms-payment-price\" data-amount=\"506\" name=\"wpforms[fields][19]\" value=\"4\" aria-errormessage=\"wpforms-5448-field_19_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_19_4\">250ml Nembutal Oral Liquid(Body weight ranges between 100lb - 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;506<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5448-field_19_2\" class=\"wpforms-payment-price\" data-amount=\"600\" name=\"wpforms[fields][19]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_19_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_19_2\">300ml Nembutal Oral Liquid(Body weight above 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;600<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_20-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"20\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5448-field_20_1\" class=\"wpforms-payment-price\" data-amount=\"300\" name=\"wpforms[fields][20]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_20_1\">25ml Injectable Nembutal Solution(Body Weight less than 100lb) - <span class=\"wpforms-currency-symbol\">&#8364;300<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5448-field_20_2\" class=\"wpforms-payment-price\" data-amount=\"410\" name=\"wpforms[fields][20]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_20_2\">50ml Injectable Nembutal Solution(Body weight ranges between 100l - 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;410<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-5448-field_20_3\" class=\"wpforms-payment-price\" data-amount=\"600\" name=\"wpforms[fields][20]\" value=\"3\" aria-errormessage=\"wpforms-5448-field_20_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_20_3\">100ml Injectable Nembutal Solution(Body weight above 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;600<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_21-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"21\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (1000mg\/tabs) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-5448-field_21_1\" class=\"wpforms-payment-price\" data-amount=\"360\" name=\"wpforms[fields][21]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_21_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_21_1\">18 Nembutal pills(Body weight less than 100lb) - <span class=\"wpforms-currency-symbol\">&#8364;360<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-5448-field_21_2\" class=\"wpforms-payment-price\" data-amount=\"415\" name=\"wpforms[fields][21]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_21_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_21_2\">24 Nembutal pills(Body weight between 100lb - 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;415<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-5448-field_21_3\" class=\"wpforms-payment-price\" data-amount=\"510\" name=\"wpforms[fields][21]\" value=\"3\" aria-errormessage=\"wpforms-5448-field_21_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_21_3\">30 Nembutal pills(Body weight above 135lb) - <span class=\"wpforms-currency-symbol\">&#8364;510<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_22-container\" class=\"wpforms-field wpforms-field-payment-checkbox wpforms-list-inline\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Additional Options<\/legend><ul id=\"wpforms-5448-field_22\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_22_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M112 96c-26.5 0-48 21.5-48 48V256h96V144c0-26.5-21.5-48-48-48zM0 144C0 82.1 50.1 32 112 32s112 50.1 112 112V368c0 61.9-50.1 112-112 112S0 429.9 0 368V144zM554.9 399.4c-7.1 12.3-23.7 13.1-33.8 3.1L333.5 214.9c-10-10-9.3-26.7 3.1-33.8C360 167.7 387.1 160 416 160c88.4 0 160 71.6 160 160c0 28.9-7.7 56-21.1 79.4zm-59.5 59.5C472 472.3 444.9 480 416 480c-88.4 0-160-71.6-160-160c0-28.9 7.7-56 21.1-79.4c7.1-12.3 23.7-13.1 33.8-3.1L498.5 425.1c10 10 9.3 26.7-3.1 33.8z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_22_1\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"15\" name=\"wpforms[fields][22][]\" value=\"1\" aria-errormessage=\"wpforms-5448-field_22_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Zofran (antiemetic pills) - <span class=\"wpforms-currency-symbol\">&#8364;15<\/span><\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_22_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 640 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M112 0C85.5 0 64 21.5 64 48V96H16c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 272c8.8 0 16 7.2 16 16s-7.2 16-16 16H64 48c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 240c8.8 0 16 7.2 16 16s-7.2 16-16 16H64 16c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 208c8.8 0 16 7.2 16 16s-7.2 16-16 16H64V416c0 53 43 96 96 96s96-43 96-96H384c0 53 43 96 96 96s96-43 96-96h32c17.7 0 32-14.3 32-32s-14.3-32-32-32V288 256 237.3c0-17-6.7-33.3-18.7-45.3L512 114.7c-12-12-28.3-18.7-45.3-18.7H416V48c0-26.5-21.5-48-48-48H112zM544 237.3V256H416V160h50.7L544 237.3zM160 368a48 48 0 1 1 0 96 48 48 0 1 1 0-96zm272 48a48 48 0 1 1 96 0 48 48 0 1 1 -96 0z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_22_2\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"50\" name=\"wpforms[fields][22][]\" value=\"2\" aria-errormessage=\"wpforms-5448-field_22_2-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Express Shipping - <span class=\"wpforms-currency-symbol\">&#8364;50<\/span><\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_22_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 640 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M480 416h96c35.3 0 64-28.7 64-64V160c0-35.3-28.7-64-64-64H480V416zM448 96H192V416H448V96zM64 96C28.7 96 0 124.7 0 160V352c0 35.3 28.7 64 64 64h96V96H64zM248 208a24 24 0 1 1 48 0 24 24 0 1 1 -48 0zm120-24a24 24 0 1 1 0 48 24 24 0 1 1 0-48zM248 304a24 24 0 1 1 48 0 24 24 0 1 1 -48 0zm120-24a24 24 0 1 1 0 48 24 24 0 1 1 0-48z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_22_3\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"35\" name=\"wpforms[fields][22][]\" value=\"3\" aria-errormessage=\"wpforms-5448-field_22_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Barbiturate test kit - <span class=\"wpforms-currency-symbol\">&#8364;35<\/span><\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_4-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5448-field_4\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][4][address1]\" aria-errormessage=\"wpforms-5448-field_4-error\" required><label for=\"wpforms-5448-field_4\" class=\"wpforms-field-sublabel after\">Adresse ligne\u00a01<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-5448-field_4-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][4][address2]\" aria-errormessage=\"wpforms-5448-field_4-address2-error\" ><label for=\"wpforms-5448-field_4-address2\" class=\"wpforms-field-sublabel after\">Adresse ligne 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5448-field_4-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][4][city]\" aria-errormessage=\"wpforms-5448-field_4-city-error\" required><label for=\"wpforms-5448-field_4-city\" class=\"wpforms-field-sublabel after\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-5448-field_4-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][4][state]\" aria-errormessage=\"wpforms-5448-field_4-state-error\" required><label for=\"wpforms-5448-field_4-state\" class=\"wpforms-field-sublabel after\">\u00c9tat \/ Province \/ R\u00e9gion<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-5448-field_4-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][4][postal]\" aria-errormessage=\"wpforms-5448-field_4-postal-error\" required><label for=\"wpforms-5448-field_4-postal\" class=\"wpforms-field-sublabel after\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-5448-field_4-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][4][country]\" aria-errormessage=\"wpforms-5448-field_4-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- S\u00e9lectionner\u00a0: country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/option><option value=\"DE\" >Allemagne<\/option><option value=\"AD\" >Andorre<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctique<\/option><option value=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"SA\" >Arabie Saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahre\u00efn<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbade<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhoutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BQ\" >Bonaire, Saint-Eustache et Saba<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BJ\" >B\u00e9nin<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique de)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\" >France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration Russe<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GF\" >Guyane<\/option><option value=\"GY\" >Guyane<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d\u2019)<\/option><option value=\"IE\" >Irlande (R\u00e9publique d\u2019)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordanie<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KG\" >Kirghizistan<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"RE\" >La R\u00e9union<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MY\" >Malaisie<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malte<\/option><option value=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldova (R\u00e9publique de)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"BN\" >Negara Brunei Darussalam<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nig\u00e9ria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"UG\" >Ouganda<\/option><option value=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie fran\u00e7aise<\/option><option value=\"PR\" >Porto Rico<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"CF\" >R\u00e9publique centrafricaine<\/option><option value=\"DO\" >R\u00e9publique dominicaine<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"CZ\" >R\u00e9publique tch\u00e8que<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"KN\" >Saint-Christophe-et-Nevis<\/option><option value=\"SM\" >Saint-Marin<\/option><option value=\"MF\" >Saint-Martin (partie fran\u00e7aise)<\/option><option value=\"PM\" >Saint-Pierre-et-Miquelon<\/option><option value=\"VC\" >Saint-Vincent-et-les Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"ST\" >Sao Tom\u00e9 et Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SX\" >Sint Maarten (partie hollandaise)<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tadjikistan<\/option><option value=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres australes et antarctiques fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"TH\" >Tha\u00eflande<\/option><option value=\"TL\" >Timor oriental<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinit\u00e9-et-Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"TR\" >Turquie<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis et Futuna<\/option><option value=\"YE\" >Y\u00e9men<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats arabes unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"VA\" >\u00c9tat de la cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"CX\" >\u00cele Christmas<\/option><option value=\"MU\" >\u00cele Maurice<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos (Keeling)<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FK\" >\u00celes Falkland (Malvinas)<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard-et-MacDonald<\/option><option value=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"PN\" >\u00celes Pitcairn<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques et Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (Am\u00e9ricaines)<\/option><option value=\"VG\" >\u00celes Vierges (Britanniques)<\/option><option value=\"SJ\" >\u00celes de Svalbard et Jan Mayen<\/option><option value=\"UM\" >\u00celes mineures am\u00e9ricaines<\/option><option value=\"AX\" >\u00celes \u00c5land<\/option><\/select><label for=\"wpforms-5448-field_4-country\" class=\"wpforms-field-sublabel after\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-5448-field_24-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">How do you want us to Contact you?<\/legend><ul id=\"wpforms-5448-field_24\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #227021;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_24_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M64 112c-8.8 0-16 7.2-16 16v22.1L220.5 291.7c20.7 17 50.4 17 71.1 0L464 150.1V128c0-8.8-7.2-16-16-16H64zM48 212.2V384c0 8.8 7.2 16 16 16H448c8.8 0 16-7.2 16-16V212.2L322 328.8c-38.4 31.5-93.7 31.5-132 0L48 212.2zM0 128C0 92.7 28.7 64 64 64H448c35.3 0 64 28.7 64 64V384c0 35.3-28.7 64-64 64H64c-35.3 0-64-28.7-64-64V128z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_24_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"E-mail\" aria-errormessage=\"wpforms-5448-field_24_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">E-mail<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 depth-1 wpforms-icon-choices-item wpforms-selected\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_24_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M347.1 24.6c7.7-18.6 28-28.5 47.4-23.2l88 24C499.9 30.2 512 46 512 64c0 247.4-200.6 448-448 448c-18 0-33.8-12.1-38.6-29.5l-24-88c-5.3-19.4 4.6-39.7 23.2-47.4l96-40c16.3-6.8 35.2-2.1 46.3 11.6L207.3 368c70.4-33.3 127.4-90.3 160.7-160.7L318.7 167c-13.7-11.2-18.4-30-11.6-46.3l40-96z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_24_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"PhoneCall\" aria-errormessage=\"wpforms-5448-field_24_2-error\"   checked='checked'>\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">PhoneCall<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_24_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 448 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M380.9 97.1C339 55.1 283.2 32 223.9 32c-122.4 0-222 99.6-222 222 0 39.1 10.2 77.3 29.6 111L0 480l117.7-30.9c32.4 17.7 68.9 27 106.1 27h.1c122.3 0 224.1-99.6 224.1-222 0-59.3-25.2-115-67.1-157zm-157 341.6c-33.2 0-65.7-8.9-94-25.7l-6.7-4-69.8 18.3L72 359.2l-4.4-7c-18.5-29.4-28.2-63.3-28.2-98.2 0-101.7 82.8-184.5 184.6-184.5 49.3 0 95.6 19.2 130.4 54.1 34.8 34.9 56.2 81.2 56.1 130.5 0 101.8-84.9 184.6-186.6 184.6zm101.2-138.2c-5.5-2.8-32.8-16.2-37.9-18-5.1-1.9-8.8-2.8-12.5 2.8-3.7 5.6-14.3 18-17.6 21.8-3.2 3.7-6.5 4.2-12 1.4-32.6-16.3-54-29.1-75.5-66-5.7-9.8 5.7-9.1 16.3-30.3 1.8-3.7.9-6.9-.5-9.7-1.4-2.8-12.5-30.1-17.1-41.2-4.5-10.8-9.1-9.3-12.5-9.5-3.2-.2-6.9-.2-10.6-.2-3.7 0-9.7 1.4-14.8 6.9-5.1 5.6-19.4 19-19.4 46.3 0 27.3 19.9 53.7 22.6 57.4 2.8 3.7 39.1 59.7 94.8 83.8 35.2 15.2 49 16.5 66.6 13.9 10.7-1.6 32.8-13.4 37.4-26.4 4.6-13 4.6-24.1 3.2-26.4-1.3-2.5-5-3.9-10.5-6.6z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-5448-field_24_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"Whatsapp\" aria-errormessage=\"wpforms-5448-field_24_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Whatsapp<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_25-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">Multiple Choice<\/legend><ul id=\"wpforms-5448-field_25\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_25_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M243.4 2.6l-224 96c-14 6-21.8 21-18.7 35.8S16.8 160 32 160v8c0 13.3 10.7 24 24 24H456c13.3 0 24-10.7 24-24v-8c15.2 0 28.3-10.7 31.3-25.6s-4.8-29.9-18.7-35.8l-224-96c-8-3.4-17.2-3.4-25.2 0zM128 224H64V420.3c-.6 .3-1.2 .7-1.8 1.1l-48 32c-11.7 7.8-17 22.4-12.9 35.9S17.9 512 32 512H480c14.1 0 26.5-9.2 30.6-22.7s-1.1-28.1-12.9-35.9l-48-32c-.6-.4-1.2-.7-1.8-1.1V224H384V416H344V224H280V416H232V224H168V416H128V224zM256 64a32 32 0 1 1 0 64 32 32 0 1 1 0-64z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-5448-field_25_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Bank Transfer\" aria-errormessage=\"wpforms-5448-field_25_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Bank Transfer<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_25_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M504 256c0 136.967-111.033 248-248 248S8 392.967 8 256 119.033 8 256 8s248 111.033 248 248zm-141.651-35.33c4.937-32.999-20.191-50.739-54.55-62.573l11.146-44.702-27.213-6.781-10.851 43.524c-7.154-1.783-14.502-3.464-21.803-5.13l10.929-43.81-27.198-6.781-11.153 44.686c-5.922-1.349-11.735-2.682-17.377-4.084l.031-.14-37.53-9.37-7.239 29.062s20.191 4.627 19.765 4.913c11.022 2.751 13.014 10.044 12.68 15.825l-12.696 50.925c.76.194 1.744.473 2.829.907-.907-.225-1.876-.473-2.876-.713l-17.796 71.338c-1.349 3.348-4.767 8.37-12.471 6.464.271.395-19.78-4.937-19.78-4.937l-13.51 31.147 35.414 8.827c6.588 1.651 13.045 3.379 19.4 5.006l-11.262 45.213 27.182 6.781 11.153-44.733a1038.209 1038.209 0 0 0 21.687 5.627l-11.115 44.523 27.213 6.781 11.262-45.128c46.404 8.781 81.299 5.239 95.986-36.727 11.836-33.79-.589-53.281-25.004-65.991 17.78-4.098 31.174-15.792 34.747-39.949zm-62.177 87.179c-8.41 33.79-65.308 15.523-83.755 10.943l14.944-59.899c18.446 4.603 77.6 13.717 68.811 48.956zm8.417-87.667c-7.673 30.736-55.031 15.12-70.393 11.292l13.548-54.327c15.363 3.828 64.836 10.973 56.845 43.035z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-5448-field_25_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Crypto\" aria-errormessage=\"wpforms-5448-field_25_2-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Crypto<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_25_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32px\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M326.7 403.7c-22.1 8-45.9 12.3-70.7 12.3s-48.7-4.4-70.7-12.3c-.3-.1-.5-.2-.8-.3c-30-11-56.8-28.7-78.6-51.4C70 314.6 48 263.9 48 208C48 93.1 141.1 0 256 0S464 93.1 464 208c0 55.9-22 106.6-57.9 144c-1 1-2 2.1-3 3.1c-21.4 21.4-47.4 38.1-76.3 48.6zM256 91.9c-11.1 0-20.1 9-20.1 20.1v6c-5.6 1.2-10.9 2.9-15.9 5.1c-15 6.8-27.9 19.4-31.1 37.7c-1.8 10.2-.8 20 3.4 29c4.2 8.8 10.7 15 17.3 19.5c11.6 7.9 26.9 12.5 38.6 16l2.2 .7c13.9 4.2 23.4 7.4 29.3 11.7c2.5 1.8 3.4 3.2 3.7 4c.3 .8 .9 2.6 .2 6.7c-.6 3.5-2.5 6.4-8 8.8c-6.1 2.6-16 3.9-28.8 1.9c-6-1-16.7-4.6-26.2-7.9l0 0 0 0 0 0c-2.2-.7-4.3-1.5-6.4-2.1c-10.5-3.5-21.8 2.2-25.3 12.7s2.2 21.8 12.7 25.3c1.2 .4 2.7 .9 4.4 1.5c7.9 2.7 20.3 6.9 29.8 9.1V304c0 11.1 9 20.1 20.1 20.1s20.1-9 20.1-20.1v-5.5c5.3-1 10.5-2.5 15.4-4.6c15.7-6.7 28.4-19.7 31.6-38.7c1.8-10.4 1-20.3-3-29.4c-3.9-9-10.2-15.6-16.9-20.5c-12.2-8.8-28.3-13.7-40.4-17.4l-.8-.2c-14.2-4.3-23.8-7.3-29.9-11.4c-2.6-1.8-3.4-3-3.6-3.5c-.2-.3-.7-1.6-.1-5c.3-1.9 1.9-5.2 8.2-8.1c6.4-2.9 16.4-4.5 28.6-2.6c4.3 .7 17.9 3.3 21.7 4.3c10.7 2.8 21.6-3.5 24.5-14.2s-3.5-21.6-14.2-24.5c-4.4-1.2-14.4-3.2-21-4.4V112c0-11.1-9-20.1-20.1-20.1zM48 352H64c19.5 25.9 44 47.7 72.2 64H64v32H256 448V416H375.8c28.2-16.3 52.8-38.1 72.2-64h16c26.5 0 48 21.5 48 48v64c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V400c0-26.5 21.5-48 48-48z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-5448-field_25_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Other\" aria-errormessage=\"wpforms-5448-field_25_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Other<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-5448-field_7-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-5448-field_7\">Special instructions (optional)<\/label><textarea id=\"wpforms-5448-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-5448-field_7-error\" ><\/textarea><\/div><div id=\"wpforms-5448-field_6-container\" class=\"wpforms-field wpforms-field-payment-total wpforms-conditional-field wpforms-conditional-show wpforms-field-medium wpforms-summary-enabled\" data-field-id=\"6\" style=\"display:none;\" aria-live=\"polite\" aria-atomic=\"true\"><label class=\"wpforms-field-label\">Order Summary<\/label><div class=\"wpforms-order-summary-container\">\n\t<table class=\"wpforms-order-summary-preview\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\" role=\"presentation\">\n\t\t<caption style=\"display: none;\">R\u00e9sum\u00e9 de la commande<\/caption>\n\t\t<thead>\n\t\t\t<tr>\n\t\t\t\t<th class=\"wpforms-order-summary-item-label\" valign=\"top\">Article<\/th>\n\t\t\t\t<th class=\"wpforms-order-summary-item-quantity\" valign=\"top\">\n\t\t\t\t\t<span class=\"wpforms-order-summary-item-quantity-label-full\">Quantit\u00e9<\/span>\n\t\t\t\t\t<span class=\"wpforms-order-summary-item-quantity-label-short\">Qt\u00e9<\/span>\n\t\t\t\t<\/th>\n\t\t\t\t<th class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">Total<\/th>\n\t\t\t<\/tr>\n\t\t<\/thead>\n\t\t<tbody>\n\t\t\t<tr class=\"wpforms-order-summary-placeholder\" style=\"display: table-row;\">\n\t\t\t\t<td colspan=\"3\" valign=\"top\">Aucun produit n\u2019est s\u00e9lectionn\u00e9.<\/td>\n\t\t\t<\/tr>\n\t\t\t<tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - 9g Nembutal Powder(Body weight less than 100lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;380<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - 12g Nembutal Powder(Body weight ranges between 100lb - 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;420<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - 15g Nembutal Powder(Body weight above 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;530<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - 200ml Nembutal Oral Liquid(Body weight less than 100lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;385<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"4\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - 250ml Nembutal Oral Liquid(Body weight ranges between 100lb - 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;506<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - 300ml Nembutal Oral Liquid(Body weight above 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;600<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - 25ml Injectable Nembutal Solution(Body Weight less than 100lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;300<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - 50ml Injectable Nembutal Solution(Body weight ranges between 100l - 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;410<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - 100ml Injectable Nembutal Solution(Body weight above 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;600<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - 18 Nembutal pills(Body weight less than 100lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;360<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - 24 Nembutal pills(Body weight between 100lb - 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;415<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - 30 Nembutal pills(Body weight above 135lb)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;510<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Zofran (antiemetic pills)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;15<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Express Shipping<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;50<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Barbiturate test kit<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;35<\/td><\/tr><tr class=\"wpforms-order-summary-preview-total\" ><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Total<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\"><\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:7ch;\">&#8364;0<\/td><\/tr>\t\t<\/tbody>\n\t<\/table>\n<\/div>\n<div class=\"wpforms-payment-total\" style=\"display:none\">&#8364;0<\/div><input type=\"hidden\" id=\"wpforms-5448-field_6\" class=\"wpforms-field-medium wpforms-payment-total\" name=\"wpforms[fields][6]\" value=\"0\"><\/div><div id=\"wpforms-5448-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Acknowledgement <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-5448-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5448-field_28_1\" name=\"wpforms[fields][28][]\" value=\"\u00a0\u00a0&lt;strong&gt;I have read, understood, and agree to the following:&lt;\/strong&gt;&lt;br&gt;&lt;br&gt;\" aria-errormessage=\"wpforms-5448-field_28_1-error\" aria-describedby=\"wpforms-5448-field_28-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-5448-field_28_1\">\u00a0\u00a0<strong>I have read, understood, and agree to the following:<\/strong><br><br><\/label><\/li><\/ul><div id=\"wpforms-5448-field_28-description\" class=\"wpforms-field-description\"><div class=\"disclaimer-text\" style=\"margin:20px 0;padding:15px;border:1px solid #e0e0e0;background-color:#f8f8f8;font-size:15px;line-height:1.6;\">\n    \n    I am a legal adult (18+ years old) and I am placing this order <strong>solely at my own risk and responsibility<\/strong>.<br \/><br \/>\n    \n    I acknowledge that <strong>Nembutal (pentobarbital)<\/strong> is a powerful controlled substance. I confirm that:\n    \n    <ul style=\"margin:12px 0 12px 25px;\">\n     \n        <li>This purchase is for <strong>personal use only<\/strong> and I will not resell or distribute it.<\/li>\n        <li>I understand this product is intended for <strong>voluntary euthanasia \/ end-of-life purposes<\/strong> and I am making this decision freely and without coercion.<\/li>\n        <li>I have consulted (or will consult) with appropriate medical and\/or legal professionals where required, and I accept full responsibility for any medical, legal, or other consequences that may arise from the use of this product.<\/li>\n        <li>The information provided on this website is for informational purposes only and <strong>does not<\/strong> constitute medical advice.<\/li>\n        <li>I release Nembutal Solution and its owners\/operators from any liability related to the misuse, improper storage, or unintended effects of this product.<\/li>\n    <\/ul>\n    \n    I confirm that all information I have provided in this order is accurate and truthful.\n    \n<\/div><\/div><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-5448-field_8-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-5448-field_8-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-5448-field_8-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"5448\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/nembutalsolution.org\/fr\/wp-json\/wp\/v2\/pages\/2169\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-5448\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/nembutalsolution.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Chargement en cours\"><\/div><\/form><\/div>  <!-- .wpforms-container --><div id=\"tm-row-6a1b64d4b9b19\" class=\"vc_row vc_row-outer vc_row-fluid\"><div id=\"tm-column-6a1b64d4ba0a8\" class=\"wpb_column vc_column_container vc_col-sm-12\"><div class=\"vc_column-inner \"><div class=\"wpb_wrapper\">\n<div class=\"tm-heading  left tm-animation move-up\" id=\"tm-heading-6a1b64d4ba45d\">\n\t<h5 class=\"heading\" >Disclaimer: For legitimate research, veterinary, or peaceful exit purposes only where legally permitted. By ordering, you confirm you are of legal age and fully compliant with your local laws. We are not responsible for any misuse. All sales final.<\/h5><\/div>\n\n<\/div><\/div><\/div><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.Fill the form below to place an order Name *Pr\u00e9nomNomEmail *Phone *Body Weight (Lbs) *Age *Product Formulation *--- Select formulation ---Nembutal PowderNembutal Oral SolutionInjectable Nembutal SolutionNembutal Pills\/tabletsDosage (g) *9g Nembutal Powder(Body weight less than 100lb) - &#8364;38012g Nembutal Powder(Body weight ranges between 100lb - 135lb) - &#8364;42015g Nembutal Powder(Body weight above 135lb) - &#8364;530Dosage (ml) *200ml Nembutal Oral Liquid(Body weight less than 100lb) - &#8364;385250ml Nembutal Oral Liquid(Body weight ranges between 100lb - 135lb) - &#8364;506300ml Nembutal Oral Liquid(Body weight above 135lb) - &#8364;600Dosage *25ml Injectable Nembutal Solution(Body Weight less than 100lb) - &#8364;30050ml Injectable Nembutal Solution(Body weight ranges between 100l - 135lb) - &#8364;410100ml Injectable Nembutal Solution(Body weight above 135lb) - &#8364;600Dosage (1000mg\/tabs) *18 Nembutal pills(Body weight less than 100lb) - &#8364;36024 Nembutal pills(Body weight between 100lb - 135lb) - &#8364;41530 Nembutal pills(Body weight above 135lb) - &#8364;510 instructions Special (optional) Additional Options Zofran (antiemetic pills) - &#8364;15 Express Shipping - &#8364;50 Barbiturate test kit - &#8364;35 Address *Adresse ligne\u00a01Adresse ligne 2Ville\u00c9tat \/ Province \/ R\u00e9gionCode postal--- S\u00e9lectionner\u00a0: country ---AfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint-Eustache et SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLiberiaLibyeLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalauPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Barth\u00e9lemySaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Pierre-et-MiquelonSaint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres australes et antarctiques fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9-et-TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard-et-MacDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPaysHow do you want us to Contact you? E-mail PhoneCall Whatsapp Multiple Choice Bank Transfer Crypto Other Special instructions (optional)Order Summary R\u00e9sum\u00e9 de la commande Article Quantit\u00e9 Qt\u00e9 Total Aucun produit n\u2019est s\u00e9lectionn\u00e9. Dosage (g) - 9g Nembutal Powder(Body weight less than 100lb)1&#8364;380Dosage (g) - 12g Nembutal Powder(Body weight ranges between 100lb - 135lb)1&#8364;420Dosage (g) - 15g Nembutal Powder(Body weight above 135lb)1&#8364;530Dosage (ml) - 200ml Nembutal Oral Liquid(Body weight less than 100lb)1&#8364;385Dosage (ml) - 250ml Nembutal Oral Liquid(Body weight ranges between 100lb - 135lb)1&#8364;506Dosage (ml) - 300ml Nembutal Oral Liquid(Body weight above 135lb)1&#8364;600Dosage - 25ml Injectable Nembutal Solution(Body Weight less than 100lb)1&#8364;300Dosage - 50ml Injectable Nembutal Solution(Body weight ranges between 100l - 135lb)1&#8364;410Dosage - 100ml Injectable Nembutal Solution(Body weight above 135lb)1&#8364;600Dosage (1000mg\/tabs) - 18 Nembutal pills(Body weight less than 100lb)1&#8364;360Dosage (1000mg\/tabs) - 24 Nembutal pills(Body weight between 100lb - 135lb)1&#8364;415Dosage (1000mg\/tabs) - 30 Nembutal pills(Body weight above 135lb)1&#8364;510Additional Options - Zofran (antiemetic pills)1&#8364;15Additional Options - Express Shipping1&#8364;50Additional Options - Barbiturate test kit1&#8364;35Total&#8364;0 &#8364;0Acknowledgement *\u00a0\u00a0I have read, understood, and agree to the following: I am a legal adult (18+ years old) and I am placing this order solely at my own risk and responsibility. I acknowledge that Nembutal (pentobarbital) is a powerful controlled substance. I confirm that: This purchase is for personal use only and I will not resell or distribute it. I understand this product is intended for voluntary euthanasia \/ end-of-life purposes and I am making this decision freely and without coercion. I have consulted (or will consult) with appropriate medical and\/or legal professionals where required, and I accept full responsibility for any medical, legal, or other consequences that may arise from the use of this product. The information provided on this website is for informational purposes only and does not constitute medical advice. I release Nembutal Solution and its owners\/operators from any liability related to the misuse, improper storage, or unintended effects of this product. I confirm that all information I have provided in this order is accurate and truthful. Submit Disclaimer: For legitimate research, veterinary, or peaceful exit purposes only where legally permitted. By ordering, you confirm you are of legal age and fully compliant with your local laws. We are not responsible for any misuse. All sales final.","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2169","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.6 (Yoast SEO v27.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Order Nembutal Online Securely | Official Order Form<\/title>\n<meta name=\"description\" content=\"Easily and securely order Nembutal online. 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