Dopfer individual - Kontaktformular der einfache Weg zu Ihrem Individualausbau

<body background="images/bg.gif"> <table width="730" border="0" cellspacing="0" cellpadding="0" align="center"> <tr valign="top"> <td width="104" rowspan="2"><img src="kon/img01.jpg" width="195" height="93"><br> <img src="kon/img02.gif" width="195" height="158"> </td> <td width="626"><img src="kon/haedline.gif" width="557" height="59"></td> </tr> <tr valign="top"> <td width="626" valign="top"> <form name="form1" method="post" action="http://www.firmen.local-network.de/dopfer-reise/senden.php3"> <table width="100%" border="0" cellspacing="0" cellpadding="3"> <tr> <td bgcolor="#333333"> <p class="fettw"><span class="fett">Treten Sie mit uns in Verbindung!</span></p> </td> </tr> </table> <table width="100%" border="0" cellspacing="0" cellpadding="2"> <tr> <td colspan="2"> <p>Hier haben Sie dir Möglichkeit weitere Informationen anzufordern oder mit uns einen unverbindlichen Beratungstermin zu vereinbaren.</p> </td> </tr> <tr valign="bottom"> <td colspan="2" height="36"> <p class="fuss_rot" align="right"><font color="#FF0000">Die Kontaktaufnahme ist unverbindlich!<br> Weiterhin versichern wir Ihnen, dass Ihre Daten nicht an Dritte weitergegeben werden!</font></p> </td> </tr> <tr> <td colspan="2"><img src="images/clear.gif" width="5" height="5"></td> </tr> <tr> <td colspan="2" bgcolor="#EDD7B2"> <p class="fett">Ich interessiere mich für:</p> </td> </tr> <tr> <td colspan="2"><img src="images/clear.gif" width="5" height="5"></td> </tr> <tr> <td colspan="2"> <table width="100%" border="0" cellspacing="0" cellpadding="0"> <tr> <td width="4%" height="25"> <p> <input type="checkbox" name="a11" value="Kompaktfahrzeuge"> </p> </td> <td width="26%" height="25"> <p>Kompaktfahrzeuge</p> </td> <td height="25" width="4%"> <p> <input type="checkbox" name="a12" value="Alkoven"> </p> </td> <td height="25" width="16%"> <p>Alkoven</p> </td> <td height="25" width="4%"> <p> <input type="checkbox" name="a13" value="Teilintegrierte"> </p> </td> <td height="25" width="19%"> <p>Telintrgrierte</p> </td> <td height="25" width="2%"> <input type="checkbox" name="a14" value="Vollintegrierte"> </td> <td height="25" width="25%"> <p>Vollintegrierte</p> </td> </tr> <tr> <td width="4%" height="25"> <p> <input type="checkbox" name="a2" value="Rollstuhlmobile"> </p> </td> <td width="26%" height="25"> <p>Rollstuhlmobile</p> </td> <td height="25" width="4%"> <p> <input type="checkbox" name="a3" value="Büromobile"> </p> </td> <td height="25" width="16%"> <p>Büromobile</p> </td> <td height="25" width="4%"> <p> <input type="checkbox" name="a4" value="Sonderfahrzeuge"> </p> </td> <td height="25" width="19%"> <p>Sonderfahrzeuge</p> </td> <td height="25" width="2%"> <p> </p> </td> <td height="25" width="25%"> <p> </p> </td> </tr> <tr> <td width="4%" height="25"> <p> <input type="checkbox" name="a5" value="Gebrauchtmobile"> </p> </td> <td width="26%" height="25"> <p>Gebrauchte - Modell: </p> </td> <td height="25" colspan="6"> <p> <input type="text" name="modell" size="20"> </p> </td> </tr> <tr> <td width="4%" height="25"> <p> <input type="checkbox" name="a6" value="Sonstiges"> </p> </td> <td width="26%" height="25"> <p>Sonstiges</p> </td> <td height="25" colspan="6"> <p> <input type="text" name="a601" size="20"> </p> </td> </tr> </table> </td> </tr> <tr> <td colspan="2"><img src="images/clear.gif" width="5" height="5"></td> </tr> <tr> <td colspan="2" bgcolor="#EDD7B2"> <p class="fett">Bitte geben Sie Ihre persönlichen Daten an:</p> </td> </tr> <tr> <td colspan="2"> <p class="fuss" align="right">* Bitte füllen Sie Felder mit einem Stern in jeden Fall aus. </p> </td> </tr> <tr> <td colspan="2"><img src="images/clear.gif" width="5" height="5"></td> </tr> <tr valign="top"> <td width="17%"> <p> </p> </td> <td width="83%"> <p> <select name="anrede" size="1"> <option value="Frau" selected>Frau</option> <option value="Herr">Herr</option> </select> </p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>Name:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="name" size="37"> *</p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>Firma:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="firma" size="37"> </p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>Straße:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="strasse" size="37"> *</p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>PLZ:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="plz" size="5"> *</p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>Ort:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="ort" size="37"> *</p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>Land:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="land" size="37"> </p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>Telefon:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="telefon" size="37"> *</p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>Fax:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="fax" size="37"> </p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>E-Mail:</p> </td> <td width="83%" height="25"> <p> <input type="text" name="email" size="37"> </p> </td> </tr> <tr valign="top"> <td width="17%" height="25"> <p>Bemerkung:</p> </td> <td width="83%" height="25"> <p> <textarea name="bemerkung" cols="37" rows="5"></textarea> </p> </td> </tr> <tr valign="top"> <td colspan="2" height="25"> <p align="center"> <input type="image" border="0" name="I1" src="kon/senden.jpg" width="557" height="22"> </p> </td> </tr> </table> </form> </td> </tr> <tr valign="top"> <td colspan="2"> <table width="100%" border="0" cellspacing="0" cellpadding="0" align="center"> <tr valign="top"> <td> <div align="right"><a href="JavaScript:"><img src="images/fuss_print.gif" border="0" onClick="druck()" width="21" height="18"></a></div> </td> </tr> <tr valign="top"> <td height="38"> <p align="center" class="fuss"><img src="images/line_br.gif" width="754" height="1" vspace="4"><br> Dopfer Reisemobilbau · Sudetenstraße 7 · 86476 Neuburg/Kammel · Tel. 0 82 83 - 26 10 · Fax 0 82 83 - 26 63<br> E-Mail: <a href="mailto:info@dopfer-reisemobile.de">info@dopfer-reisemobile.de</a></p> </td> </tr> </table> </td> </tr> </table> <p> </p> <p>Diese Seite verwendet Frames. 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