Kontaktformular

Modehaus Havekost GmbH

Bahnhofstr. 28

D-26939 Ovelgönne

Telefon 

 

0 44 01 - 98 0 98 

Telefax

 

0 44 01 - 81 9 85 

 

 

Anfrage Formular

<label for="mailformAnrede">Anrede</label> <select name="Anrede" id="mailformAnrede" size="1"><option value=""></option><option value="Frau">Frau</option><option value="Herr">Herr</option></select>
<label for="mailformVorname">Vorname</label> <input type="text" name="Vorname" id="mailformVorname" size="20" value="" />
<label for="mailformName">Name*</label> <input type="text" name="Name" id="mailformName" size="20" value="" />
<label for="mailformFirma">Firma</label> <input type="text" name="Firma" id="mailformFirma" size="20" value="" />
<label for="mailformStrasse">Straße</label> <input type="text" name="Strasse" id="mailformStrasse" size="20" value="" />
<label for="mailformPLZ__Ort">PLZ / Ort</label> <input type="text" name="PLZ__Ort" id="mailformPLZ__Ort" size="20" value="" />
<label for="mailformemail">Email*</label> <input type="text" name="email" id="mailformemail" size="20" value="" />
<label for="mailformTelefon">Telefon</label> <input type="text" name="Telefon" id="mailformTelefon" size="20" value="" />
<label for="mailformTelefax">Telefax</label> <input type="text" name="Telefax" id="mailformTelefax" size="20" value="" />
<label for="mailformmitteilung">Mitteilung</label> <textarea name="mitteilung" id="mailformmitteilung" cols="40" rows="5"> </textarea>
<label for="mailformformtype_mail"> </label> <input type="submit" name="formtype_mail" id="mailformformtype_mail" value="senden" class="csc-mailform-submit" />