contactformular_en.php

gehe zur Dokumentation dieser Datei

<?php
?>
<table border="0" cellpadding="0" cellspacing="0" width="80%">
<tr>
<td valign="middle">
<center>
<h1>Write us</h1>
</center>
<p>
</td>
</tr>
<tr>
<td valign="top">
<table cols="2" border="0">
<tr valign="top">
<form action="/cgi-bin/FormMail2.pl" method="POST">
<input type="hidden" name="recipient" value="mailto@juelich-bonn.com"><input type="hidden" name="subject" value="Formular, Englisch"><input type="hidden" name="redirect" value="http://www.juelich-bonn.de/site/contact/confirmation/index_en.html"><input type="hidden" name="env_report" value="REMOTE_HOST,HTTP_USER_AGENT"><input type="hidden" name="print_blank_fields" value="1"><input type="hidden" name="required" value="Name,Strasse,Ort,PLZ,email">
<td colspan="2" valign="top">
<center>
<h3><font size="3" face="Helv">You can use the following form in order to send us a Mail.</font></h3>
</center>
</td>
<td width="9%"></td>
</tr>
<tr height="24">
<td colspan="2" height="24">
<h5>(with * charecterized fields must be filled out!)</h5>
</td>
<td rowspan="12" width="9%" valign="top"></td>
</tr>
<tr height="25">
<td width="15%" height="25">
<address>Company:</address>
</td>
<td width="53%" height="25"><input type="text" size="46" maxlength="200" name="Firma"></td>
</tr>
<tr height="25">
<td width="15%" height="25">
<address>Last name, first name*:</address>
</td>
<td width="53%" height="25"><input type="text" size="46" maxlength="100" name="Name"></td>
</tr>
<tr height="25">
<td width="15%" height="25">
<address>Street*:</address>
</td>
<td width="53%" height="25"><input type="text" size="46" maxlength="100" name="Strasse"></td>
</tr>
<tr height="25">
<td width="15%" height="25">
<address>Postal zip code*:</address>
</td>
<td width="53%" height="25"><input type="text" size="6" maxlength="5" name="PLZ"></td>
</tr>
<tr height="25">
<td width="15%" height="25">
<address>City*:</address>
</td>
<td width="53%" height="25"><input type="text" size="46" maxlength="100" name="Ort"></td>
</tr>
<tr height="25">
<td width="15%" height="25">
<address>Telephone:</address>
</td>
<td width="53%" height="25"><input type="text" size="46" maxlength="50" name="Telefon"></td>
</tr>
<tr height="25">
<td width="15%" height="25">
<address>Telefax:</address>
</td>
<td width="53%" height="25"><input type="text" size="46" maxlength="50" name="Telefax"></td>
</tr>
<tr height="25">
<td width="15%" height="25">
<address>e-mail*:</address>
</td>
<td width="53%" height="25"><input type="text" size="46" maxlength="100" name="email"></td>
</tr>
<tr height="100">
<td width="15%" height="100" valign="top">
<address>Your request:</address>
</td>
<td width="53%" height="100"><textarea rows="5" cols="62" name="Anmerkung"></textarea></td>
</tr>
<tr>
<td width="15%"><br>
</td>
<td width="53%"><br>
</td>
</tr>
<tr>
<td colspan="2">Thank you very much for your interest. We will take up contact soon with you!</td>
</tr>
<tr>
<td colspan="2" valign="top"><input type="submit" value="Submit"><input type="reset" value="Reset"></td>
<td width="9%"></td>
</tr>
</form>

<tr>
<td width="15%"></td>
<td width="53%"></td>
<td width="9%"></td>
</tr>
</table>

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