<FORM METHOD="post" ACTION="mailto:rossum1@chello.nl" ENCTYPE="text/plain">
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<td width="478" align="center" valign="top" ><h4 align="left" class="style1">Aanvraag Offerte </h4>
<p align="left" class="style1"> Voer het onderstaande formulier in.<br />
U krijgt zo spoedig mogelijk uw antwoord. </p>
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<td width="147" align="right"><div align="left">Afmeting:</div></td>
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<input name="Afmeting" type="text" size="25" value="" />
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<td width="306" align="left"><div align="left">Bijv. Enkel model, L model, Dubbel model. </div></td>
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<td align="right"><div align="left">Dakmodel:</div></td>
<td align="left"><input name="Dakmodel" type="text" size="25" value="" /></td>
<td align="left"><div align="left">Bijv. Puntdak, Pyramidedak, Boederijdak. </div></td>
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<td align="right"><div align="left">Buitenkleding:</div></td>
<td align="left"><input name="Buitenkleding" type="text" size="25" value="" /> </td>
<td align="left"><div align="left">Bijv. Kunststof, Canexel, Red cedar, Profort, steenstrips </div></td>
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<td align="right"><strong>Uw Persoonlijke gegevens</strong> </td>
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<td align="right"><div align="left">Naam:</div></td>
<td align="left"><input name="Naam" type="text" size="25" value="" /> </td>
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<td align="right"><div align="left">Adres</div></td>
<td align="left"><input name="Adres" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Postcode</div></td>
<td align="left"><input name="Postcode" type="text" size="25" value="" /> </td>
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<td align="right"><div align="left">Woonplaats</div></td>
<td align="left"><input name="Woonplaats" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Email</div></td>
<td align="left"><input name="Email" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Telefoon</div></td>
<td align="left"><input name="Telefoon" type="text" size="25" value="" /> </td>
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<td align="right"><div align="left">Fax</div></td>
<td align="left"><input name="Fax" type="text" size="25" value="" /> </td>
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<td align="right"><strong>Uw chalet te plaatsen bij</strong>: </td>
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<td align="right"><div align="left">Naam:</div></td>
<td align="left"><input name="Naam" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Adres</div></td>
<td align="left"><input name="Adres" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Postcode</div></td>
<td align="left"><input name="Postcode" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Woonplaats</div></td>
<td align="left"><input name="Woonplaats" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Email</div></td>
<td align="left"><input name="Email" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Telefoon</div></td>
<td align="left"><input name="Telefoon" type="text" size="25" value="" /> </td>
<td align="left"> </td>
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<td align="right"><div align="left">Fax</div></td>
<td align="left"><input name="Fax" type="text" size="25" value="" /> </td>
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<td valign="top" colspan="2"><strong>Uw algemene beschrijving: </strong></td>
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<td colspan="2" align="center"><textarea name="bericht" rows="10" cols="50"></textarea>
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<input type="hidden" name="user" value="exactchalet">
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<input name="submit" type="submit" value="Verstuur bericht!" />
<input type="reset" name="reset" value="Maak formulier leeg!" />
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