<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN"> <html> <head> <style type="text/css"> #myshp_mail_form,body.myshp_block_inner {background: #fff !important;} .myshp_formMail{background: #fff; margin:0 25px; text-align: left;} .myshp_formMail_input{width:297px; font-family:Verdana, Arial, Helvetica, sans-serif; font-size:12px;} .myshp_formMail_em{font-size:11px;} </style> <title></title> </head> <body> <div class="clear"></div> <div class="myshp_formMail"> <br> <br> <table cellpadding="0" cellspacing="0" style="width:536px;"> <tr> <td valign="top" style="width:316;border-right: 2px solid #ccc;"> Heeft u vragen, laat het ons weten via dit formulier en u ontvangt snel een reactie. <br>Bellen kan natuurlijk ook: 023 - 5424656.<br> </td> <td valign="top" style="padding-left:10px;"> Maurits Groen Milieu & Communicatie BV<br> Wilhelminastraat 18<br> 2011 VM Haarlem<br> <b style="color:#000000">T 023-5424656</b> </td> </tr> </table><br> <br> <h2> Uw vraag of opmerking: </h2> <textarea name="vraag" style="width:532px; height: 88px;font-family:Verdana, Arial, Helvetica, sans-serif; font-size:12px;"> </textarea><br> <br> <h2> Uw contactgegevens: </h2><em class="myshp_formMail_em">Velden met een * zijn verplicht.</em><br> <br> <table width="536" border="0" cellpadding="0" cellspacing="0"> <tr> <td valign="top"> Bedrijfsnaam </td> <td width="297" valign="top" height="60"> <input type="text" class="myshp_formMail_input" name="Bedrijfsnaam"> </td> </tr> <tr> <td height="30" valign="top"> Naam* </td> <td valign="top"> <input type="text" class="myshp_formMail_input" name="Naam"> </td> </tr> <tr> <td height="30" valign="top"> Telefoonnummer </td> <td valign="top"> <input type="text" class="myshp_formMail_input" name="Telefoonnummer"> </td> </tr> <tr> <td height="30" valign="top"> E-mail* </td> <td valign="top"> <input type="text" class="myshp_formMail_input" name="E-mail"> </td> </tr> <td height="40" colspan="2" valign="bottom"> <input type="submit" value="Versturen" name="versturen"> </td> </tr> </table> <br> </div> </div> <div class="clear"></div> </div> <div class="clear"></div> <div class="clear"></div> </body> </html>