Neem contact op

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" rowspan="2" width=210 BGCOLOR="#99CC99" TEXT="#080000" bgproperties="fixed" background="0408dfc3.jpg"> <div> <B><IMG SRC="0837b940.gif" border=0 width="123" height="148" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <bR> <bR> <bR> <bR> <div> <B>       <IMG SRC="0a4545e0.gif" border=0 width="84" height="94" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> </td> <td valign="top" colspan=2 height=82 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0418dfe1esnpes.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>VERKEERSSCHOOL   W.J.van den BERG Wzn</B></FONT><B>     </B><B>|</B><B>     </B><A HREF="index.htm" TARGET="_top" TITLE="VERKEERSSCHOOL W.J.van den BERG Wzn"><U><B>home</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Wie zijn wij?"><U>Wie zijn wij?</U></A>   |   <B>Neem contact op</B>   |   <A HREF="id22.htm" TARGET="_top" TITLE="Onze Producten"><U>Onze Producten</U></A>   |   <A HREF="id32.htm" TARGET="_top" TITLE="Nieuws van de wetten"><U>Nieuws van de wetten</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=398 colspan=2 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0418dfc3.jpg"> <div> <I>Neem contact op</I></div> <div> <B>Wij kijken er naar uit, om</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT><B>met u in contact te treden. </B></div> <bR> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="Voornaam,Achternaam,Email adres,Zaak,Adres,Nummer,Plaats,Provincie,Postcode,Telefoon,Fax,MailingList,Mededelingen,Gsm:"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request for information."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="info@wjvandenbergwzn.nl"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">Voornaam:<br> <input type="text" name="Voornaam" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Achternaam:<br> <input type="text" name="Achternaam" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Email adres:<br> <input type="text" name="Email adres" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Zaak:<br> <input type="text" name="Zaak" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Adres:<br> <input type="text" name="Adres" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Nummer:<br> <input type="text" name="Nummer" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Plaats:<br> <input type="text" name="Plaats" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Provincie:<br> <input type="text" name="Provincie" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Postcode:<br> <input type="text" name="Postcode" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Telefoon:<br> <input type="text" name="Telefoon" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Fax :<br> <input type="text" name="Fax" size="14" maxlength="14"></td> </tr> <tr> <td> <input type="checkbox" name="MailingList" value="yes"> Add me to your mailing list</td> </tr> <tr> <td align="left">Mededelingen:<br> <textarea name="Mededelingen" rows="10" cols="35"></textarea></td> </tr> <tr> <td align="left">Gsm::<br> <input type="text" name="Gsm:" size="30" maxlength="100"></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>            </div> <div> <B>W.J. van den Berg wzn.</B>                                     <B>Postgiro:2627715</B></div> <div> <B>Oudedijk 227</B>                                                        <B>Rabo:      311874185</B></div> <div> <B>3061 AG Rotterdam</B>                                               </div> <div> <B>Tel:010-4523316</B>                                                  <B>Fax:         010-4522808</B></div> <bR> <div> De verkeersschool als mede het transport bedrijf is op het zelfde adres </div> <div> gevestigd en gebruiken de zelfde telefoonnummers.</div> </td> </tr></table></body>