=form.hidden_field :particular_type
=form.hidden_field :skip_validation, :class => "skip_validation"
=form.hidden_field :pro
=#form.input :price_in_bl, :label => "Afficher les prix dans le BL ?"
%div{:style => "max-width:600px;"}
  
  %table
    %tr
      %td{:style => "width:20%;padding-right:4px;"}
        =form.input :civilite, :label => false, :placeholder => "Civilité"#, :as => :select, :collection => [[qit("don-particular-civilite-mme","Mme."), "Mme"], [qit("don-particular-civilite-m","M."), "M"]], :include_blank => true
      %td{:style => "width:40%;padding-right:4px;"}
        =form.input :name, :label => false, :placeholder => "Nom"
      
      %td{:style => "width:40%"}
        =form.input :firstname, :label => false, :placeholder => "Prénom"
      
  =form.input :address_2, :label => false, :placeholder => "Adresse"
  =form.input :address_3, :label => false, :placeholder => "Adresse suite"
  %table
    %tr
      %td{:style => "width:30%;padding-right:4px;"}
        =form.input :cp, :label => false, :placeholder => "Code postal"
      %td{:style => "width:70%"}
        =form.input :city, :label => false, :placeholder => "Ville"

  =form.input :country, :label => false, :placeholder => "Pays", :priority_countries => ["FR", "CH", "BE"], :include_blank => false, :locale => @lang.slug
  =#form.input :email, :label => false, :placeholder => qit("don-particular-email","Email")
  =form.input :tel, :label => false, :placeholder => qit("don-particular-phone","Téléphone")