<html>
<head>
<title>Een mailformulier</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head>
<body bgcolor="#dfb4df">
<div align="center">
<p><font color="#441111" face="Arial, Helvetica, sans-serif"><b>E-mail Testformulier</b></font></p>
<p><font face="Arial, Helvetica, sans-serif" color="#441111">Vul het formulier
in en bekijk de mogelijkheden</font></p>
<form enctype="multipart/form-data" action=form-handler.php method=POST>
<input type=hidden name="MAX_FILE_SIZE" value="10000">
<!--input type=hidden name=reply value=1-->
<input type=hidden name=replytemplate value=reply_example.tpl>
<!-- input type=hidden name=replytext value="
Thank you for submitting this form.
If you want to use this script go to: http://formhandler.sourceforge.net.
If you have any questions, problems or suggestions, then let me know:
php@suijsmail.com.
If you'd like to help me develop this script or any new or existing
modules, let me know and I'll try to provide you with any information
necessary.
Thank you.
"-->
<input type=hidden name=modules value="dutchcheck:referer_check">
<input type=hidden name=configfile value="testconfig">
<input type=hidden name=cookie value="Naam_bedrijf,Naam,Functie,Telefoon">
<input type=hidden name=denyfile value="denyfile">
<!--input type=hidden name=recipient value="php@suijsmail.com"-->
<!--input type=hidden name=subject value="Testformulier"-->
<input type=hidden name=formulier value="Testformulier White-Horses">
<input type=hidden name=required value="Naam_bedrijf,Naam,Functie,Telefoon,Vraag">
<!-- input type=hidden name=debug value="1" -->
<input type=hidden name=debuglevel value="3" -->
<input type=hidden name=template value="display_example.tpl">
<!-- input type=hidden name=lang value="english" -->
<input type=hidden name=mailtemplate value="mail_example.tpl">
<input type=hidden name=errortemplate value="error_example.tpl">
<input type=hidden name=env_report value="HTTP_POST_VARS,HTTP_HOST,HTTP_REFERER,HTTP_POST_FILES">
<input type=hidden name=date_include value="1">
<input type=hidden name=bgcolor value="#317C31">
<input type=hidden name=text_color value="#441111">
<input type=hidden name=css value="body{ font-family: Arial, Helvetica, sans-serif; font-size: 11pt; color: #441111; text-decoration: none;}
a{ font-family: Arial, Helvetica, sans-serif; font-size: 11pt; color: #ffffff; text-decoration: underline;}">
<table width="700" border="0" cellpadding="5">
<tr>
<td height="35" width="165"><font color="#441111" face="Arial, Helvetica, sans-serif">Naam
bedrijf</font></td>
<td height="35" width="509"><input type="text" name="Naam_bedrijf"
<? if ($Naam_bedrijf) print "value=\"$Naam_bedrijf\""; ?>></td>
</tr>
<tr>
<td width="165"><font color="#441111" face="Arial, Helvetica, sans-serif">Naam</font></td>
<td width="509"><input type="text" name="Naam"
<? if ($Naam) print "value=\"$Naam\""; ?>></td>
</tr>
<tr>
<td width="165"><font color="#441111" face="Arial, Helvetica, sans-serif">Functie</font></td>
<td width="509"><input type="text" name="Functie"
<? if ($Functie) print "value=\"$Functie\""; ?>></td>
</tr>
<tr>
<td><input type="checkbox" name="debug" value="true">
<font color="#441111" face="Arial, Helvetica, sans-serif">
<b>Debug</b> </font></td>
<td><input name="attachment" type="file">
</tr>
<tr>
<td><input type="checkbox" name="reply" value="1">
<font color="#441111" face="Arial, Helvetica, sans-serif">
<b>Send a reply</b> </font></td>
</tr>
<tr>
<td colspan="2"><input type="checkbox" name="Bel_voor_afspraak" value="Ja">
<font color="#441111" face="Arial, Helvetica, sans-serif">
Belt u mij voor een <b>afspraak</b> </font></td>
</tr>
<tr>
<td colspan="2"><textarea name="Vraag" cols="60" rows="5"></textarea></td>
</tr>
<tr>
<td colspan="2">
<div align="left"></div>
</td>
</tr>
<tr>
<td width="165"><font color="#441111" face="Arial, Helvetica, sans-serif">Email
:</font></td>
<td width="509">
<div align="left"><input type="text" name="Email"></div>
</td>
</tr>
<tr>
<td width="165"><font color="#441111" face="Arial, Helvetica, sans-serif">Telefoon
:</font></td>
<td width="509">
<div align="left"><input type="text" name="Telefoon"
<? if ($Telefoon) print "value=\"$Telefoon\""; ?>></div>
</td>
</tr>
<tr>
<td width="165" valign="top">
<p><font color="#441111" face="Arial, Helvetica, sans-serif"><i>Adres
</i></font></p>
</td>
<td width="509" valign="top">
<p align="left"><input type="text" name="Adres"></p>
</td>
</tr>
<tr>
<td width="165" valign="top"><font color="#441111" face="Arial, Helvetica, sans-serif"><i>Postcode</i></font></td>
<td width="509" valign="top"><input type="text" name="Postcode"></td>
</tr>
<tr>
<td width="165" valign="top"><font color="#441111" face="Arial, Helvetica, sans-serif"><i>Plaats
</i></font></td>
<td width="509" valign="top"><input type="text" name="Plaats"></td>
</tr>
<tr>
<td width="165">
<div align="center"><br>
<input type="submit" name="Submit" value="Versturen">
<input type="reset" name="reset" value="Wissen">
</div>
</td>
<td width="509"><font color="#441111" face="Arial, Helvetica, sans-serif"></font></td>
</tr>
</table>
</form>
</div>
</body>
</html>