{"id":643,"date":"2021-11-02T00:03:59","date_gmt":"2021-11-01T23:03:59","guid":{"rendered":"https:\/\/www.pay-system.eu\/registracia\/"},"modified":"2021-12-21T14:36:17","modified_gmt":"2021-12-21T13:36:17","slug":"formularz","status":"publish","type":"page","link":"https:\/\/www.pay-system.eu\/pl\/formularz\/","title":{"rendered":"Dane rejestrowe do Umowy udost\u0119pnienia jednostki OBU"},"content":{"rendered":"<div class=\"everest-forms\"><div class=\"evf-container default\" id=\"evf-641\"><form id=\"evf-form-641\" class=\"everest-form\" data-formid=\"641\" data-ajax_submission=\"0\" data-keyboard_friendly_form=\"0\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/pl\/wp-json\/wp\/v2\/pages\/643\"><div class=\"evf-field-container\"><input type=\"hidden\" id=\"_wpnonce641\" name=\"_wpnonce641\" value=\"82bd67e34e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/pl\/wp-json\/wp\/v2\/pages\/643\" \/><div class=\"evf-frontend-row\" data-row=\"row_1\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-641-field_6VtpcZDZts-1-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"6VtpcZDZts-1\"><label class=\"evf-field-label\" for=\"evf-641-field_6VtpcZDZts-1\"><span class=\"evf-label\">Nazwa firmy<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_6VtpcZDZts-1\" class=\"input-text\" name=\"everest_forms[form_fields][6VtpcZDZts-1]\" required><\/div><div id=\"evf-641-field_zArW8wCyH8-9-container\" class=\"evf-field evf-field-email form-row validate-required validate-email\" data-required-field-message=\"Please enter a valid email address.\" data-field-id=\"zArW8wCyH8-9\"><label class=\"evf-field-label\" for=\"evf-641-field_zArW8wCyH8-9\"><span class=\"evf-label\">E-mail kontaktowy<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"email\" id=\"evf-641-field_zArW8wCyH8-9\" class=\"input-text\" name=\"everest_forms[form_fields][zArW8wCyH8-9]\" required ><\/div><div id=\"evf-641-field_fkt13Dy7OR-24-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"fkt13Dy7OR-24\"><label class=\"evf-field-label\" for=\"evf-641-field_fkt13Dy7OR-24\"><span class=\"evf-label\">Kontaktowy numer telefonu<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_fkt13Dy7OR-24\" class=\"input-text\" name=\"everest_forms[form_fields][fkt13Dy7OR-24]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_9\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-641-field_qKwq6LusMB-2-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"qKwq6LusMB-2\"><label class=\"evf-field-label\" for=\"evf-641-field_qKwq6LusMB-2\"><span class=\"evf-label\">REGON firmy<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_qKwq6LusMB-2\" class=\"input-text\" name=\"everest_forms[form_fields][qKwq6LusMB-2]\" required><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-641-field_iABe0WXkox-3-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"iABe0WXkox-3\"><label class=\"evf-field-label\" for=\"evf-641-field_iABe0WXkox-3\"><span class=\"evf-label\">NIP<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_iABe0WXkox-3\" class=\"input-text\" name=\"everest_forms[form_fields][iABe0WXkox-3]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_12\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-641-field_pSMLXDWhta-25-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"pSMLXDWhta-25\"><label class=\"evf-field-label\" for=\"evf-641-field_pSMLXDWhta-25\"><span class=\"evf-label\">VAT UE<\/span> <\/label><input type=\"text\" id=\"evf-641-field_pSMLXDWhta-25\" class=\"input-text\" name=\"everest_forms[form_fields][pSMLXDWhta-25]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_10\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-641-field_O6C2P1tS5e-4-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"O6C2P1tS5e-4\"><label class=\"evf-field-label\" for=\"evf-641-field_O6C2P1tS5e-4\"><span class=\"evf-label\">Ulica<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_O6C2P1tS5e-4\" class=\"input-text\" name=\"everest_forms[form_fields][O6C2P1tS5e-4]\" required><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-641-field_g7tyHq73uw-5-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"g7tyHq73uw-5\"><label class=\"evf-field-label\" for=\"evf-641-field_g7tyHq73uw-5\"><span class=\"evf-label\">Numer (orientacyjny a\/lub porz\u0105dkowy) <\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_g7tyHq73uw-5\" class=\"input-text\" name=\"everest_forms[form_fields][g7tyHq73uw-5]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_2\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-641-field_4cjNJmWkDt-6-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"4cjNJmWkDt-6\"><label class=\"evf-field-label\" for=\"evf-641-field_4cjNJmWkDt-6\"><span class=\"evf-label\">Miasto<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_4cjNJmWkDt-6\" class=\"input-text\" name=\"everest_forms[form_fields][4cjNJmWkDt-6]\" required><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-641-field_e9Aba5m824-7-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"e9Aba5m824-7\"><label class=\"evf-field-label\" for=\"evf-641-field_e9Aba5m824-7\"><span class=\"evf-label\">Kod pocztowy<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_e9Aba5m824-7\" class=\"input-text\" name=\"everest_forms[form_fields][e9Aba5m824-7]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_5\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-641-field_BOIyRdD7pH-19-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"BOIyRdD7pH-19\"><label class=\"evf-field-label\" for=\"evf-641-field_BOIyRdD7pH-19\"><span class=\"evf-label\">Pa\u0144stwo<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_BOIyRdD7pH-19\" class=\"input-text\" name=\"everest_forms[form_fields][BOIyRdD7pH-19]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_4\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-641-field_72Lsuuxi3A-10-container\" class=\"evf-field evf-field-first-name form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"72Lsuuxi3A-10\"><label class=\"evf-field-label\" for=\"evf-641-field_72Lsuuxi3A-10\"><span class=\"evf-label\">Osoba upowa\u017cniona: Imi\u0119 <\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_72Lsuuxi3A-10\" class=\"input-text\" name=\"everest_forms[form_fields][72Lsuuxi3A-10]\" required><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-641-field_0Cmm314ekj-11-container\" class=\"evf-field evf-field-last-name form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"0Cmm314ekj-11\"><label class=\"evf-field-label\" for=\"evf-641-field_0Cmm314ekj-11\"><span class=\"evf-label\">Nazwisko<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_0Cmm314ekj-11\" class=\"input-text\" name=\"everest_forms[form_fields][0Cmm314ekj-11]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_6\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-1\" data-grid=\"grid_1\"><div id=\"evf-641-field_mwW8S80DbH-17-container\" class=\"evf-field evf-field-select form-row\" data-field-id=\"mwW8S80DbH-17\"><label class=\"evf-field-label\" for=\"evf-641-field_mwW8S80DbH-17\"><span class=\"evf-label\">Funkcja<\/span> <\/label><select id=\"evf-641-field_mwW8S80DbH-17\" class=\"input-text\" name=\"everest_forms[form_fields][mwW8S80DbH-17]\" ><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Wybierz funkcj\u0119<\/option><option value=\"Cz\u0142onek organu statutowego\" >Cz\u0142onek organu statutowego<\/option><option value=\"Pe\u0142nomocnik\" >Pe\u0142nomocnik<\/option><\/select><\/div><div id=\"evf-641-field_lMhe3nznTa-12-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"lMhe3nznTa-12\"><label class=\"evf-field-label\" for=\"evf-641-field_lMhe3nznTa-12\"><span class=\"evf-label\">Bank (Nazwa)<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_lMhe3nznTa-12\" class=\"input-text\" name=\"everest_forms[form_fields][lMhe3nznTa-12]\" required><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_3\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-641-field_upvfFKisZD-13-container\" class=\"evf-field evf-field-text form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"upvfFKisZD-13\"><label class=\"evf-field-label\" for=\"evf-641-field_upvfFKisZD-13\"><span class=\"evf-label\">IBAN<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"text\" id=\"evf-641-field_upvfFKisZD-13\" class=\"input-text\" name=\"everest_forms[form_fields][upvfFKisZD-13]\" required><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-641-field_X6jbpa1Ivz-14-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"X6jbpa1Ivz-14\"><label class=\"evf-field-label\" for=\"evf-641-field_X6jbpa1Ivz-14\"><span class=\"evf-label\">SWIFT<\/span> <\/label><input type=\"text\" id=\"evf-641-field_X6jbpa1Ivz-14\" class=\"input-text\" name=\"everest_forms[form_fields][X6jbpa1Ivz-14]\" ><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_8\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-641-field_gGFZxltwJ6-16-container\" class=\"evf-field evf-field-text form-row\" data-field-id=\"gGFZxltwJ6-16\"><label class=\"evf-field-label\" for=\"evf-641-field_gGFZxltwJ6-16\"><span class=\"evf-label\">Numer rejestracji e-Toll<\/span> <\/label><input type=\"text\" id=\"evf-641-field_gGFZxltwJ6-16\" class=\"input-text\" name=\"everest_forms[form_fields][gGFZxltwJ6-16]\" ><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-641-field_e2zLuXANLR-18-container\" class=\"evf-field evf-field-number form-row validate-required\" data-required-field-message=\"Please enter a valid number.\" data-field-id=\"e2zLuXANLR-18\"><label class=\"evf-field-label\" for=\"evf-641-field_e2zLuXANLR-18\"><span class=\"evf-label\">Liczba jednostek OBU<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><input type=\"number\" id=\"evf-641-field_e2zLuXANLR-18\" class=\"input-text\" name=\"everest_forms[form_fields][e2zLuXANLR-18]\" value=\"1\" step=\"1\" min=\"1\" required\/><\/div><\/div><\/div><div class=\"evf-frontend-row\" data-row=\"row_11\" conditional_rules=\"[]\"><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_1\"><div id=\"evf-641-field_TQp1M9hUYw-20-container\" class=\"evf-field evf-field-radio form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"TQp1M9hUYw-20\"><label class=\"evf-field-label\" for=\"evf-641-field_TQp1M9hUYw-20\"><span class=\"evf-label\">Okres rozliczeniowy<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-641-field_TQp1M9hUYw-20\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-641-field_TQp1M9hUYw-20_1\" class=\"input-text\" name=\"everest_forms[form_fields][TQp1M9hUYw-20]\" value=\"6 miesi\u0119cy\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-641-field_TQp1M9hUYw-20_1\">6 miesi\u0119cy<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-641-field_TQp1M9hUYw-20_2\" class=\"input-text\" name=\"everest_forms[form_fields][TQp1M9hUYw-20]\" value=\"12 miesi\u0119cy\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-641-field_TQp1M9hUYw-20_2\">12 miesi\u0119cy<\/label><\/li><\/ul><div class=\"evf-field-description\">P\u0142atno\u015b\u0107 z g\u00f3ry za wybrany okres zostanie wyliczona: Ilo\u015b\u0107 OBU x Op\u0142ata miesi\u0119czna x Ilo\u015b\u0107 miesi\u0119cy \r\nSpos\u00f3b dor\u0119czenia  OBU <\/div><\/div><\/div><div class=\"evf-frontend-grid evf-grid-2\" data-grid=\"grid_2\"><div id=\"evf-641-field_z7o2rvq2uH-21-container\" class=\"evf-field evf-field-radio form-row validate-required\" data-required-field-message=\"This field is required.\" data-field-id=\"z7o2rvq2uH-21\"><label class=\"evf-field-label\" for=\"evf-641-field_z7o2rvq2uH-21\"><span class=\"evf-label\">Spos\u00f3b dor\u0119czenia  OBU<\/span> <abbr class=\"required\" title=\"Required\">*<\/abbr><\/label><ul id=\"evf-641-field_z7o2rvq2uH-21\" class=\" evf-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"evf-641-field_z7o2rvq2uH-21_1\" class=\"input-text\" name=\"everest_forms[form_fields][z7o2rvq2uH-21]\" value=\"Osobi\u015bcie w magazynie dostawcy (Za darmo)\" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-641-field_z7o2rvq2uH-21_1\">Osobi\u015bcie w magazynie dostawcy (Za darmo)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"evf-641-field_z7o2rvq2uH-21_2\" class=\"input-text\" name=\"everest_forms[form_fields][z7o2rvq2uH-21]\" value=\"Kurierem na Tw\u00f3j adres wed\u0142ug uzgodnionych warunk\u00f3w \" required ><label class=\"everest-forms-field-label-inline\" for=\"evf-641-field_z7o2rvq2uH-21_2\">Kurierem na Tw\u00f3j adres wed\u0142ug uzgodnionych warunk\u00f3w <\/label><\/li><\/ul><div class=\"evf-field-description\">Magazyn dostawcy pod adresem ul. Hodon\u00ednska 25, 841 03 Bratys\u0142awa  (Google maps wsp\u00f3\u0142rz\u0119dne: 48.2062, 17.0402)<\/div><\/div><\/div><\/div><\/div><div class=\"evf-honeypot-container evf-field-hp\"><label for=\"evf-641-field-hp\" class=\"evf-field-label\">Name<\/label><input type=\"text\" name=\"everest_forms[hp]\" id=\"evf-641-field-hp\" class=\"input-text\"><\/div><div class=\"evf-recaptcha-container recaptcha-hidden\" style=\"display:block\"><input type=\"hidden\" name=\"everest_forms[recaptcha]\" value=\"\"><\/div><div class=\"evf-submit-container \" ><input type=\"hidden\" name=\"everest_forms[id]\" value=\"641\"><input type=\"hidden\" name=\"everest_forms[author]\" value=\"3\"><button type='submit' name='everest_forms[submit]' class='everest-forms-submit-button button evf-submit ' id='evf-submit-641' value='evf-submit' data-process-text=\"Processing ...\" conditional_rules='&quot;&quot;' conditional_id='evf-submit-641'  id=\"evf-submit-641\" aria-live=\"assertive\">WYS\u0141A\u0106<\/button><\/div><\/form><\/div><!-- .evf-container --><\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":515,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"single-registracia.php","meta":{"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/pages\/643"}],"collection":[{"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/comments?post=643"}],"version-history":[{"count":3,"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/pages\/643\/revisions"}],"predecessor-version":[{"id":646,"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/pages\/643\/revisions\/646"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/media\/515"}],"wp:attachment":[{"href":"https:\/\/www.pay-system.eu\/pl\/wp-json\/wp\/v2\/media?parent=643"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}