52 lines
1.3 KiB
Smarty
52 lines
1.3 KiB
Smarty
<h2>Reservierungsanfrage</h2>
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<table>
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<tr>
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<td>Anrede</td>
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<td><input type="select" id="input_anrede"/></td>
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</tr>
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<tr>
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<td>Name</td>
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<td><input type="text" id="input_name"/></td>
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</tr>
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<tr>
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<td>Vorname</td>
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<td><input type="text" id="input_vorname"/></td>
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</tr>
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<tr>
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<td>Strasse</td>
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<td><input type="text" id="input_strasse"/></td>
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</tr>
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<tr>
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<td>Plz</td>
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<td><input type="text" id="input_plz"/></td>
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</tr>
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<tr>
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<td>Ort</td>
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<td><input type="text" id="input_ort"/></td>
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</tr>
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<tr>
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<td>Land</td>
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<td><input type="text" id="input_land"/></td>
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</tr>
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<tr>
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<td>Telefon</td>
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<td><input type="text" id="input_telefon"/></td>
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</tr>
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<tr>
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<td>Handy</td>
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<td><input type="text" id="input_handy"/></td>
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</tr>
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<tr>
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<td>Mail</td>
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<td><input type="text" id="input_mail"/></td>
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</tr>
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<tr>
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<td>Bemerkung</td>
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<td><input type="text" id="input_bemerkung"/></td>
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</tr>
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</table>
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<div id="red_star_info">
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Mit <font color='red'>*</font> markierte Felder müssen ausgefüllt werden
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</div>
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<input type="button" id="input_send" value="Absenden"/>
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<input type="button" id="input_clear" value="Löschen"/> |