<form name="form1" method="post" action="mailto:info@pixelexpect.com?subject=contact" enctype="text/plain">
<table border="0" cellspacing="1" cellpadding="0" width="60%" bgcolor="#FFFFFF" align="center">
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Anrede:</font></td>
<td colspan="4">
<select name="Anrede">
<option selected>Bitte wählen</option>
<option>Herr</option>
<option>Frau</option>
<option>Firma</option>
</select>
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Firma:</font></td>
<td colspan="4">
<input type="text" name="Firma" size="40" maxlength="40">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Name:</font></td>
<td colspan="4">
<input type="text" name="Name" size="40" maxlength="40">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Vorname:</font></td>
<td colspan="4">
<input type="text" name="Vorname" size="40" maxlength="40">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Strasse, Nr.:
</font></td>
<td colspan="4">
<input type="text" name="Strasse" size="40" maxlength="40">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">PLZ, Ort:</font></td>
<td colspan="4">
<input type="text" name="PLZ" size="8" maxlength="10">
<input type="text" name="Ort" size="27" maxlength="40">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Land:</font></td>
<td colspan="4">
<input type="text" name="Land" size="40" maxlength="40">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Telefon:</font></td>
<td colspan="4">
<input type="text" name="Telefon" size="40" maxlength="40">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Fax:</font></td>
<td colspan="4">
<input type="text" name="Fax" size="40" maxlength="40">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif">Email:</font></td>
<td colspan="4">
<input type="text" name="Email" size="40" maxlength="40">
</td>
</tr>
<tr>
<td width="24%" rowspan="5"> </td>
<td colspan="3"><b><font face="Times New Roman, Times, serif"><br>
Angebot erbeten für angekreuzte Geräte:</font></b></td>
</tr>
<tr>
<td width="19%"><font face="Times New Roman, Times, serif">Gastonomie<br>
</font></td>
<td width="10%"><font face="Times New Roman, Times, serif">2000<br>
</font></td>
<td width="47%"><font face="Times New Roman, Times, serif">
<input type="checkbox" name="Angebot für" value="Gastronomie 2000">
</font></td>
</tr>
<tr>
<td width="19%"><font face="Times New Roman, Times, serif">Handy</font></td>
<td width="10%"><font face="Times New Roman, Times, serif">2000</font></td>
<td width="47%"> <font face="Times New Roman, Times, serif">
<input type="checkbox" name="Angebot für" value="Handy 2000">
</font></td>
</tr>
<tr>
<td width="19%"><font face="Times New Roman, Times, serif">Handy</font></td>
<td width="10%"><font face="Times New Roman, Times, serif">2001</font></td>
<td width="47%"> <font face="Times New Roman, Times, serif">
<input type="checkbox" name="Angebot für" value="Handy 2001">
</font></td>
</tr>
<tr>
<td width="19%"><font face="Times New Roman, Times, serif">Handy </font></td>
<td width="10%"><font face="Times New Roman, Times, serif">2002</font></td>
<td width="47%"> <font face="Times New Roman, Times, serif">
<input type="checkbox" name="Angebot für" value="Handy 2002">
</font></td>
</tr>
<tr>
<td width="24%" rowspan="4"> </td>
<td colspan="3"><br>
<font face="Times New Roman, Times, serif"><b>Angebot gewünscht per:</b></font></td>
</tr>
<tr>
<td><font face="Times New Roman, Times, serif">E-mail</font></td>
<td> </td>
<td>
<input type="checkbox" name="Angebot per" value="per Email">
</td>
</tr>
<tr>
<td><font face="Times New Roman, Times, serif">Fax</font></td>
<td> </td>
<td>
<input type="checkbox" name="Angebot per" value="per Fax">
</td>
</tr>
<tr>
<td><font face="Times New Roman, Times, serif">Post</font></td>
<td> </td>
<td>
<input type="checkbox" name="Angebot per" value="per Post">
</td>
</tr>
<tr>
<td width="24%"><font face="Times New Roman, Times, serif"></font></td>
<td colspan="4">
<input type="submit" value="Abschicken">
<input type="reset" value="Zurücksetzen">
</td>
</tr>
</table>
</form>