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<title>Vragenformulier</title>
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<script type="text/javascript">
var naw="";
var form="";
function controle(form)
{
var naw="";
if(form.bedrijfsnaam.value=="")naw=naw+"Bedrijfsnaam, ";
if(form.straat.value=="")naw=naw+"Straat, ";
if(form.huisnummer.value=="")naw=naw+"Huisnummer, ";
if(form.postcode.value=="")naw=naw+"Postcode, ";
if(form.plaats.value=="")naw=naw+"Plaats, ";
if(form.land.value=="")naw=naw+"Land, ";
if(form.tel.value=="")naw=naw+"Telefoon, ";
if(form.contactpersoon.value=="")naw=naw+"Naam contactpersoon, ";
if(naw!="")
{
naw=naw.substring(0,naw.length-2);
naw="De volgende velden zijn nog niet ingevuld:\n" + naw;
alert(naw);
return false;
}
else{
return true;
}
}
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<div id="central">
<div id="header">
<br />
<a href="inloggen.html">Inloggen</a>
</div>
<ul id="navlist">
<li><a id="n1" href="test.html">button 1</a></li>
<li><a id="n2" href="test.html">button 2</a></li>
<li><a id="n3" href="test.html">button 3</a></li>
<li><a id="n4" href="test.html">button 4</a></li>
<li><a id="n5" href="test.html">button 5</a></li>
<li><a id="n6" href="test.html">button 6</a></li>
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<li><a id="n8" href="test.html">button 8</a></li>
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<div id="leftside">
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<div id="rightside">
<!-- .-->
<br />
<h1>Vragenformulier</h1>
<form onsubmit="return controle(this)" method="post" action="http://www.thermografie-centrum.nl/cgi-bin/cgiemail/vragenformulier.txt">
<fieldset><legend><font size="-1" face="Arial" color="#000000">Vul onderstaand formulier in en wij nemen contact met u op.</font></legend>
<!-- Onder deze regel start de tekst van het formulier-->
<br />
<table>
<tr><td colspan="2" align="left"><em> <font size="-1">velden met een <strong> * </strong> zijn verplicht.</font></em></td></tr>
<tr>
<td> <font face="Arial" color="#000000">* Naam bedrijf:</font></td>
<td><input type="text" name="bedrijfsnaam" size="63" maxlength="73" /></td>
</tr>
<tr>
<td> <font face="Arial" color="#000000">* Straat:</font></td>
<td><input type="text" name="straat" size="34" maxlength="200" /> * Huisnummer: <input type="text" name="huisnummer" size="7" maxlength="7" /></td>
</tr>
<tr>
<td> <font face="Arial" color="#000000">* Postcode:</font></td>
<td><input type="text" name="postcode" size="7" maxlength="7" /></td>
</tr>
<tr>
<td> <font face="Arial" color="#000000">* Plaats:</font></td>
<td><input type="text" name="Plaats" size="63" maxlength="200" /></td>
</tr>
<tr>
<td> <font face="Arial" color="#000000">* Land:</font></td>
<td><font face="Arial" color="#000000"><input type="radio" name="land" value="Nederland" />Nederland <input type="radio" name="land" value="België" />België</font></td>
</tr>
<tr>
<td> <font face="Arial" color="#000000">* E-mail:</font></td>
<td><input type="text" name="email" size="63" maxlength="200" /></td>
</tr>
<tr>
<td> <font face="Arial" color="#000000">* Telefoon:</font></td>
<td><input type="text" name="tel" size="15" maxlength="20" /></td>
</tr>
<tr>
<td> <font face="Arial" color="#000000"> Mobiel:</font></td>
<td><input type="text" name="mobiel" size="15" maxlength="20" /></td>
</tr>
<tr>
<td> <font face="Arial" color="#000000">* Contactpersoon:</font></td>
<td><input type="text" name="contactpersoon" size="63" maxlength="73" /></td>
</tr>
<tr>
<td> </td>
<td></td>
</tr>
<tr>
<td colspan="2"> <font face="Arial" color="#000000"><strong>Ruimte voor extra mededeling.</strong></font></td>
</tr>
<tr>
<td colspan="2"> <textarea cols="71" rows="2" maxlength="400" name="extra_mededeling"></textarea><br /> </td>
</tr>
</table>
<div align="center"><input type="submit" value="verzenden" />
<input type="reset" value="alles wissen" width="20" height="14" />
<br /><br />
</div>
</fieldset>
</form>
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<a href="blanco.html"><em><strong>Copyright ...</strong></em></a></font></div>
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