<form name="formulier" action="mailto:bla@bla.nl?subject=www.dinges.nl fomulier ingevuld" method="post"
enctype="text/plain">
<table width="761" height="550" border="0" align="left" cellpadding="0" cellspacing="0" valign="top">
<tr>
<td width="122" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="226" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Afhaaladres : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Afhaaladres : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Afleveradres : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Afleveradres : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td height="1" align="left" valign="top" colspan="2">
<center>
<b> klantengegevens : </b>
</center>
</td>
<tr>
<td width="122" height="1" align="left" valign="top">
klantennummer : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Klantennummer : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Naam : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Naam : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Adres : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Adres : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Postcode : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Postcode : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Plaats : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Plaats : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Telefoonnummer : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Telefoonnummer : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Faxnummer : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Faxnummer : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
B.T.W nummer : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "BTW nummer : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
Contaktpersoon : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "Contactpersoon : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td width="122" height="1" align="left" valign="top">
referentienummer : </td>
<td height="1" align="left" valign="top">
<input type="text" name = "referentienummer : " size="30">
</td>
<td width="131" height="1" align="left" valign="top">
Opdrachtgever : </td>
<td width="280" height="1" align="left" valign="top">
<input type="text" name = "Opdrachtgever : " size="30">
</td>
</tr>
<tr>
<td height="1" align="left" valign="top" colspan="2">
<center>
<input type="submit" value="Formulier versturen">
<input type="reset" value="Formulier wissen">
</center>
</td>
</tr>
</table>
</form>