nicht angemeldet
ja sorry das formular ist hier :)
<form action="submit.php" method="post"> <input type="hidden" name="subject" value="Neue Bestellung Central Card"> <table> <tr> <td width=120><font style=font-size:12pt><b><? echo "$formname"; ?></b></font><br><font><? echo "$datum"; ?></font></td> </tr> <center> <table border="0" width="100%" cellpadding="0" cellspacing="0" align="center"> <tr> <td>Bestellauftrag</td> <td>Hiermit bestelle ich <hr> </td> </tr> <tr> <td>folgende Anzahl der Central ATM / Maestro Debit Card:</td> <td><select name="anzahl" size="1"> <option value="1">1</option> <option value="2">2</option> <option value="3">3</option> </select> zu je 99.- Euro <hr> </td> </tr> <tr> <td>Anrede :</td> <td><select name="Anrede" size="1"> <option value="Herr">Herr</option> <option value="Frau">Frau</option> <option value="Firma">Firma</option> </select></td> </tr> <tr> <td><small><font face="Verdana">Name:</font></small></td> <td><input name="Name" value="">erforderlich</td> </tr> <tr> <td><small><font face="Verdana">Vorname:</font></small></td> <td><input name="Vorname" value=""></td> </tr> <tr> <td><small><font face="Verdana">Straße:</font></small></td> <td><input name="Strasse" value=""></td> </tr> <tr> <td> <hr> </td> <td> <hr> </td> </tr> <tr> <td><small><font face="Verdana">PLZ, Ort:</font></small></td> <td><input name="PLZ" value=""></td> </tr> <tr> <td><small><font face="Verdana">eMail:</font></small></td> <td><input name="from" value=""></td> </tr> <tr> <td><small><font face="Verdana">Telefon:</font></small></td> <td><input name="Tel" value=""></td> </tr> <tr> <td><small><font face="Verdana">Fax:</font></small></td> <td><input name="Fax" value=""></td> </tr> <tr> <td> <div align="right"> </div> </td> <td> <hr> <hr> </td> </tr> <tr> <td> <div align="right"> </div> </td> <td></td> </tr> <tr> <td>Mit Absenden des Antrages bestätige ich die Richtigkeit der o.g. Angaben sowie meine verbindliche Bestellung. Die <a title="AGB" href="agb.html" target="_blank">Liefer- und Bestellbedingungen</a> habe ich gelesen und akzeptiert. <input type="checkbox" name="agb" value="ok" border="0">*<small><font face="Verdana"></font></small></td> <td><small><font face="Verdana"><input type="submit" value="Absenden"></font></small></td> </tr></table></center></form>