ALTANA

Kontakt

<input type="text" name="Company" id="mailformCompany" size="40" value="" />
<select name="Title" id="mailformTitle" size="1"><option value="Herr">Herr</option><option value="Frau">Frau</option></select>
<input type="text" name="Firstname" id="mailformFirstname" size="40" value="" />
<input type="text" name="Lastname" id="mailformLastname" size="40" value="" />
<input type="text" name="Address" id="mailformAddress" size="40" value="" />
<input type="text" name="ZIP" id="mailformZIP" size="40" value="" />
<input type="text" name="City" id="mailformCity" size="40" value="" />
<input type="text" name="Country" id="mailformCountry" size="40" value="" />
<input type="text" name="email" id="mailformemail" size="40" value="" />
<input type="text" name="Phone" id="mailformPhone" size="40" value="" />
<input type="text" name="Fax" id="mailformFax" size="40" value="" />
<textarea name="Message" id="mailformMessage" cols="40" rows="5"> </textarea>
<input type="submit" name="formtype_mail" id="mailformformtype_mail" value="Kontaktanfrage senden" class="csc-mailform-submit" />