<form id="form1" name="form1" method="post" action="">
<table width="600" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="295">Vorname:<span class="Stil1">*</span></td>
<td width="10"> </td>
<td width="295"><label>
<input type="text" name="vorname" value="{vorname}" />
</label></td>
</tr>
<tr>
<td>Name:<span class="Stil1">*</span></td>
<td> </td>
<td><input type="text" name="name" value="{name}"/></td>
</tr>
<tr>
<td>Firmenname:</td>
<td> </td>
<td><input type="text" name="firma" value="{firma} "/></td>
</tr>
<tr>
<td>Straße:<span class="Stil1">*</span></td>
<td> </td>
<td><input type="text" name="street" value="{street}" /></td>
</tr>
<tr>
<td>Ort:<span class="Stil1">*</span></td>
<td> </td>
<td><input type="text" name="ort" value="{ort}" /></td>
</tr>
<tr>
<td>Telefonnummer:</td>
<td> </td>
<td><input type="text" name="tel" value="{tel}" /></td>
</tr>
<tr>
<td>Homepage:<span class="Stil1">*</span></td>
<td> </td>
<td><input type="text" name="hp" value="{tel}" /></td>
</tr>
<tr>
<td>Kontaktmöglichkeit (ICQ, MSN) <span class="Stil1">*</span></td>
<td> </td>
<td><input type="text" name="icq" value="{icq}" /></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td>Produktauswahl:</td>
<td> </td>
<td><label>
<select name="product">{opts}</select>
</label></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr>
<td colspan="3">Falls Sie einen Bankeinzug wünschen, können Sie hier vorab Ihre Bankdaten hinterlassen. </td>
</tr>
<tr>
<td>Kontoinhaber:</td>
<td> </td>
<td><input type="text" name="kontoname" value="{kontoname}" /></td>
</tr>
<tr>
<td>Kontonummer:</td>
<td> </td>
<td><input type="text" name="kontonr" value="{kontonr}" /></td>
</tr>
<tr>
<td>Bankleitzahl:</td>
<td> </td>
<td><input type="text" name="blz" value="{blz}" /></td>
</tr>
<tr>
<td>Bankname:</td>
<td> </td>
<td><input type="text" name="bankname" value="{bankname}" /></td>
</tr>
<tr>
<td colspan="3"><span class="Stil1">* Pflichtfelder</span> </td>
</tr>
<tr>
<td colspan="3"><input type="submit" name="submit" value="abschicken" /></td>
</tr>
</table>
</form>