Bestellung / Werbeeintrag

Formular Werbeeintrag

<input type="text" name="firma" id="mailformfirma" size="30" maxlength="65" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<select name="Anrede" id="mailformAnrede" size="1"><option value="Familie">Familie</option><option value="Frau">Frau</option><option value="Herr" selected="selected">Herr</option></select>
<input type="text" name="Vor-/Nachname" id="mailformVor-/Nachname" size="30" maxlength="65" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="Strasse" id="mailformStrasse" size="30" maxlength="65" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="PLZ" id="mailformPLZ" size="5" maxlength="5" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="Ort" id="mailformOrt" size="30" maxlength="65" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="email" id="mailformemail" size="30" maxlength="65" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="homepage" id="mailformhomepage" size="30" maxlength="65" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="Telefon" id="mailformTelefon" size="20" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="Telefax" id="mailformTelefax" size="20" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
 
Bitte wählen Sie eine oder mehrere Kategorien:
<input type="text" name="rubrik1" id="mailformrubrik1" size="30" maxlength="100" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="rubrik2" id="mailformrubrik2" size="30" maxlength="100" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
 
Kurzbeschreibung für die Übersicht:
(Hier können Sie eine kurze Beschreibung Ihrer Firma angeben)
<textarea name="Kurzbeschreibung" id="mailformKurzbeschreibung" cols="40" rows="3" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal"> (3 Zeilen, ca. 250 Zeichen)</textarea>
 
Detailbeschreibung für den Inhalt:
(Hier können Sie eine lange Beschreibung Ihrer Firma angeben)
<textarea name="lange-Beschreibung" id="mailformlange-Beschreibung" cols="40" rows="10" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal"> (20-40 Zeilen)</textarea>
Oder Daten hochladen (z.B. Word Datei, PDF, Text Datei max. 3 MB)
<input type="file" name="attachment1" id="mailformattachment1" size="20" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
 
 
1 Logo für Bildeintrag: (max. 1 MB)
<input type="file" name="attachment2" id="mailformattachment2" size="20" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
 
6 Bilder für Bildeintrag: (max. 1 MB)
<input type="file" name="attachment3" id="mailformattachment3" size="20" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="file" name="attachment4" id="mailformattachment4" size="20" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="file" name="attachment5" id="mailformattachment5" size="20" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="file" name="attachment6" id="mailformattachment6" size="20" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="file" name="attachment7" id="mailformattachment7" size="20" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="file" name="attachment8" id="mailformattachment8" size="20" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
 
Ich bin mit dem Lastschriftenverfahren einverstanden und habe die Allgemeinen Geschäftsbedingungen (AGB) gelesen.
<select name="AGB_gelesen" id="mailformAGB_gelesen" size="1"><option value="">nein</option><option value="ja">ja</option></select>
<input type="text" name="kontoinhaber" id="mailformkontoinhaber" size="35" maxlength="65" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="Name_der_Bank" id="mailformName_der_Bank" size="35" maxlength="65" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="IBAN" id="mailformIBAN" size="30" maxlength="25" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
<input type="text" name="BIC" id="mailformBIC" size="20" maxlength="13" value="" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal" />
 
Hier können Sie eine Nachricht eingeben:
<textarea name="Mitteilung" id="mailformMitteilung" cols="40" rows="5" onfocus="this.select(); this.className='active';" onBlur="this.className='normal';" class="normal"> </textarea>
 
Kostenlose Informationen über das Mittelalter
(kann jederzeit wieder abbestellt werden)
<input type="checkbox" value="1" name="Newsletter" id="mailformNewsletter" class="csc-mailform-check" />
<input type="submit" name="formtype_mail" id="mailformformtype_mail" value="Formular senden" class="csc-mailform-submit" />

alle mit *(Stern) gekennzeichneten Felder müssen ausgefüllt werden.

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