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Form Mail Kodlari

faras

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faras

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Arkadaslar asagida verdigim kodlarin basina ve sonuna ne gelmesi gerekiyorki gönderici mail bana gelsin.Birde alta formu doldurduktan sonra güvenlik kodu yerlestirmem gerekeiyor. Cok acil lazim.yardim eden de etmeyende sagolsun.

<body bgcolor="#7C81B8">

<a name="retour"></a>   

<table border="0" align="center" cellpadding="0" cellspacing="0" width="100%" bgcolor="#7C81B8">

<!-- Anfang Auftraggeber -->

<tr>

<td colspan="5" align="left"><div class="titel">UMZUG OFFERTEANFRAGE</div></td>

</tr>

<tr>

<td colspan="5" ></td>

</tr>

<tr>

<td colspan="5" ></td>

</tr>

<tr>

<td width="20%"><div class="text">Anrede</div></td>

<td colspan="4"><input type="radio" name="Anrede" value="Herr" checked>Herr

<input type="radio" name="Anrede" value="Frau" >Frau

<input type="radio" name="Anrede" value="Familie" >Familie</td>

</tr>

<tr>

<td><div class="text">Name</div></td>

<td><input type="text" name="Kontakt Name" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">Vorname</div></td>

<td><input type="text" name="Kontakt Vorname" size="23" maxlength="40"></td>

</tr>

<tr>

<td><div class="text">Strasse</div></td>

<td><input type="text" name="Kontakt Strasse" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">PLZ/Ort</div></td>

<td><input type="text" name="Kontakt Plz/Ort" size="23" maxlength="40"></td>

</tr>

<tr>

<td><div class="text">Telefon</div></td>

<td><input type="text" name="Kontakt Telefon" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">Tel. Mobile</div></td>

<td><input type="text" name="Konatkt Mobile" size="23" maxlength="40"></td>

</tr>

<tr>

<td><div class="text">Fax</div></td>

<td><input type="text" name="Kontakt fax" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">E-Mail</div></td>

<td><input type="text" name="Kontakt email" size="23" maxlength="40"></td>

</tr>

<tr>

<td colspan="5" ></td>

</tr>

<tr>

<td colspan="5" align="left"><div class="untertitel"><i>Beladeadresse</i></div></td>

</tr>

<tr>

<td colspan="5" ></td>

</tr>

<tr>

<td><div class="text">Name</div></td>

<td><input type="text" name="Belade Name" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">Vorname</div></td>

<td><input type="text" name="Belade Vorname" size="23" maxlength="40"></td>

</tr>

<tr>

<td><div class="text">Strasse</div></td>

<td><input type="text" name="Belade Strasse" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">PLZ/Ort</div></td>

<td><input type="text" name="Belade Plz/Ort" size="23" maxlength="40"></td>

</tr>

<tr>

<td><div class="text">Telefon</div></td>

<td><input type="text" name="Belade Telefon" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">Tel. Mobile</div></td>

<td><input type="text" name="Belade Mobile" size="23" maxlength="40"></td>

</tr>

<tr>

<td><div class="text">Objekt</div></td>

<td><input type="text" name="Belade Objekt" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">Stockwerk</div></td>

<td><input type="text" name="Belade Stockwerk" size="23" maxlength="40"></td>

</tr>

<tr>

<td></td>

<td><font size="-7">z.B. 4 Zimmer, Büros 2 Arbeitsplätze etc.</font></td>

<td></td>

<td></td>

<td><font size="-7">z.B.1. Stock, 2. Stock usw.</font></td>

</tr>

<tr>

<td><div class="text">Distanz</div></td>

<td><input type="text" name="Belade Distanz" size="23" maxlength="40"></td>

<td></td>

<td><div class="text">Hat es einen Lift</div></td>

<td><input type="text" name="Belade Lift" size="23" maxlength="40"></td>

</tr>

<tr>

<td></td>

<td><font size="-7">vom Haus bis zum LKW</font></td>

<td></td>

<td></td>

<td><font size="-7">z.B. nein oder ja / 6 Personen usw.</font></td>

</tr>

<tr>

<td><div class="text">Zusätzlich</div></td>

<td colspan="4" ><input type="checkbox" name="Zusätzlich" value="Keller">Keller

<input type="checkbox" name="Zusätzlich" value="Estrich">Estrich

<input type="checkbox" name="Zusätzlich" value="Garage" >Garage

<input type="checkbox" name="Zusätzlich" value="Bastelraum" >Bastelraum

</tr>

<tr>

<td width="20%"><div class="text">De- und Montieren</div></td>

<td colspan="4"><input type="text" name="De- und Montieren" size="88" maxlength="90"></td>

</tr>

<tr>

<td></td>

<td colspan="4"><font size="-7">z.B. 4 türiger Schrank, Bett, Wohnwand etc.</font></td>

</tr>

<tr>

<td><div class="text">Packmaterial</div></td>

<td><input type="radio" name="Packmaterial" value="Ja" checked>Ja

<input type="radio" name="Packmaterial" value="Nein">Nein</td>

<td></td>

<td><div class="text">Einpacken</div></td>

<td><input type="radio" name="Einpacken" value="Ja" checked>Ja

<input type="radio" name="Einpacken" value="Nein">Nein</td>

</tr>

<tr>

<td colspan="5" ></td>

</tr>

<tr>

<td colspan="5" align="left"><div class="untertitel"><i>Abladeadresse</i></div></td>

</tr>

<tr>

<td colspan="5" ></td>

</tr>

<tr>

<td><div class="text">Name</div></td>

<td><input type="text" name="Ablade Name" size="23" maxlength="20"></td>

<td></td>

<td><div class="text">Vorname</div></td>

<td><input type="text" name="Ablade Vorname" size="23" maxlength="20"></td>

</tr>

<tr>

<td><div class="text">Strasse</div></td>

<td><input type="text" name="Ablade Strasse" size="23" maxlength="30"></td>

<td></td>

<td><div class="text">PLZ/Ort</div></td>

<td><input type="text" name="Ablade Plz/Ort" size="23" maxlength="15"></td>

</tr>

<tr>

<td><div class="text">Telefon</div></td>

<td><input type="text" name="Ablade Telefon" size="23" maxlength="30"></td>

<td></td>

<td><div class="text">Stockwerk</div></td>

<td><input type="text" name="Ablade Stockwerk" size="23" maxlength="30"></td>

</tr>

<tr>

<td><div class="text">Distanz</div></td>

<td><input type="text" name="Ablade Distanz" size="23" maxlength="30"></td>

<td></td>

<td><div class="text">Hat es einen Lift</div></td>

<td><input type="text" name="Ablade Lift" size="23" maxlength="40"></td>

</tr>

<tr>

<td></td>

<td><font size="-7">Tragedistanz</font></td>

<td></td>

<td></td>

<td><font size="-7">nein oder ja </font></td>

</tr>

<tr>

<td><div class="text">Auftragsdatum</div></td>

<td><input type="text" name="Auftragsdatum" size="23" maxlength="30"></td>

<td></td>

<td><div class="text">Zeit</div></td>

<td><input type="text" name="Zeit" size="23" maxlength="30">Uhr</td>

</tr>

<tr>

<td colspan="5"></td>

</tr>

<tr>

<td><div class="text">Schwerlasten</div></td>

<td colspan="4"><input type="text" name="Schwerlasten" size="88" maxlength="88"></td>

</tr>

<tr>

<td></td>

<td colspan="4"><font size="-7">z.B. Klavier, Flügel, Marmortisch, Tresor etc.</font></td>

</tr>

<tr>

<td><div class="text">Sie möchten noch</div></td>

<td colspan="4" ><input type="checkbox" name="Offerte" value="Einlagern">Einlagern

<input type="checkbox" name="Offerte" value="Räumung">Räumung und Entsorgung

<input type="checkbox" name="Offerte" value="Reinigung" >Reinigung mit Übergabegarantie

</td>

</tr>

<tr>

<td><div class="text">Wie haben Sie<br> uns gefunden</div></td>

<td colspan="4"><textarea rows="2" cols="65" input type="text" name="Gefunden" maxlength="100"></textarea></td>

</tr>

<tr>

<td colspan="5"> </td>

</tr>

<tr>

<td valign="top"><div class="text">Bemerkungen : </div></td>

<td colspan="4"><textarea rows="4" cols="65" input type="text" name="Bemerkungen" maxlength="100"></textarea>

</td>

</tr>

</table>

<table border="0" align="center" cellpadding="0" cellspacing="0" width="80%">

<tr>

<td colspan="2"></td>

</tr>

<tr>

<td colspan="2" width="58"></td>

<td><INPUT TYPE="SUBMIT" VALUE="Abschicken">

<INPUT TYPE="reset" VALUE="Abbrechen"></td>

<td colspan="2"></td>

</tr>

</table>

</form>

</body>

</html>

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