Extras
<style> </style>
<script language="JavaScript"> </script>
<form name="frm_a44fe5509d" id="frm_a44fe5509d" method="POST" enctype="multipart/form-data" action="http://website138.server127.mienert.eu/kbhome/phpformular3/index.php" onSubmit="return false;"> <input type="hidden" name="act" value="idx"> <input type="hidden" name="code" value="01"> <input type="hidden" name="fid" value="a44fe5509d">
<script language="JavaScript"> </script>
|
Bestellung von Anpassung-an-den-Klimawandel Kühlschrank-Magneten. Lieferung nur in Sets von jeweils 13 verschiedenen für 7 Euro / Set einschl. Versand und Mehrwertsteuer. | |
Gemeinde / Stadt / Kreis oder Organisation
|
<input type="text" name="fld_e7f8cc30f4" id="fld_e7f8cc30f4" value="" style="width:100%;"> |
Herr / Frau
|
<input type="radio" name="fld_90439e858b" id="943e54f6ba" value="Herr" style=""><label for="943e54f6ba">Herr</label> <input type="radio" name="fld_90439e858b" id="27185ee145" value="Frau" style=""><label for="27185ee145">Frau</label> |
Titel
|
<input type="text" name="fld_bb18a80969" id="fld_bb18a80969" value="" style="width:100%;"> |
Nachname
|
<input type="text" name="fld_db32e57734" id="fld_db32e57734" value="" style="width:100%;"> |
Vorname
|
<input type="text" name="fld_a5f25098b8" id="fld_a5f25098b8" value="" style="width:100%;"> |
Abteilung
|
<input type="text" name="fld_abb2dcecf1" id="fld_abb2dcecf1" value="" style="width:100%;"> |
Funktion
|
<input type="text" name="fld_3e596c226c" id="fld_3e596c226c" value="" style="width:100%;"> |
Straße / Postfach
|
<input type="text" name="fld_3930d783d7" id="fld_3930d783d7" value="" style="width:100%;"> |
PLZ
|
<input type="text" name="fld_b0086d694f" id="fld_b0086d694f" value="" style="width:100%;"> |
Ort
|
<input type="text" name="fld_f72a9042f2" id="fld_f72a9042f2" value="" style="width:100%;"> |
Telefonvorwahl
|
<input type="text" name="fld_d1ac14048c" id="fld_d1ac14048c" value="" style="width:100%;"> |
Telefonnummer
|
<input type="text" name="fld_b9005a7adc" id="fld_b9005a7adc" value="" style="width:100%;"> |
E-Mail
|
<input type="text" name="fld_65932e4db7" id="fld_65932e4db7" value="" style="width:100%;"> |
Bestellmenge Anzahl Sets
|
<input type="text" name="fld_5fd20b6f48" id="fld_5fd20b6f48" value="" style="width:100%;"> |
Bemerkung
|
<textarea name="fld_68a0838baf" id="fld_68a0838baf" rows="5" style="width:100%;"></textarea> |
<input type="button" value="Absenden" onClick='CheckPageb034b4d61e();' style="width:30%; background-color : #a2a2a2" class="phpForms_btn"> |
|
</form>
Hier Magnete bewerben
Link zum Bestellformular
http://website138.server127.mienert.eu/kbhome/phpformular3/index.php?fid=a44fe5509d
