SupperRobin6394

Form

Jan 3rd, 2018
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HTML 5 1.24 KB | None | 0 0
  1. <form action="http://system.solar-bouwmarkt.nl/webhook/offerte-mail.php" method="post">
  2.     <div class="form-group">
  3.         <input class="form-control" type="text" name="name" placeholder="*Uw naam" required><br>
  4.     </div>
  5.     <div class="form-group">
  6.         <input class="form-control" type="text" name="streetnumber" placeholder="*Straat en huisnummer" required><br>
  7.     </div>
  8.     <div class="form-group">
  9.         <input class="form-control" type="text" name="zipcode" placeholder="*Postcode" required><br>
  10.     </div>
  11.     <div class="form-group">
  12.         <input class="form-control" type="text" name="town" placeholder="*Plaats" required><br>
  13.     </div>
  14.     <div class="form-group">
  15.         <input class="form-control" type="text" name="phone" placeholder="*Telefoonnummer" required><br>
  16.     </div>
  17.     <div class="form-group">
  18.         <input class="form-control" type="text" name="email" placeholder="*Emailaddress" required><br>
  19.     </div>
  20.     <div class="form-group">
  21.         <input class="form-control" type="text" name="kwh" placeholder="Gewenste jaaropbrengst (kWh)"><br>
  22.     </div>
  23.     <div class="form-group">
  24.         <textarea class="aform-control" rows="5" name="description" placeholder="Geef hier al uw wensen aan voor de offerte"></textarea><br>
  25.     </div>
  26.     <div class="form-group">
  27.         <input type="submit">
  28.     </div>
  29. </form>
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