document.write("<!-- Web Form Generator 2.0 --><center><form method=\"post\" action=\"http://www.aweber.com/scripts/addlead.pl\"><input type=\"hidden\" name=\"meta_web_form_id\" value=\"831617277\"><input type=\"hidden\" name=\"meta_split_id\" value=\"\"><input type=\"hidden\" name=\"unit\" value=\"offerteto260809\"><input type=\"hidden\" name=\"redirect\" value=\"http://www.aweber.com/thankyou-coi.htm?m=audio\" id=\"redirect_1e944c5799c464865bbf099d7e9976f9\"><input type=\"hidden\" name=\"meta_redirect_onlist\" value=\"\"><input type=\"hidden\" name=\"meta_adtracking\" value=\"\"><input type=\"hidden\" name=\"meta_message\" value=\"1\"><input type=\"hidden\" name=\"meta_required\" value=\"name,from,custom adres,custom Postcode,custom Woonplaats,custom Telefoon nr,custom Datum evenement,custom Levering\"><input type=\"hidden\" name=\"meta_forward_vars\" value=\"0\"><table><tr><td colspan=2><center><DIV><FONT color=#660066 size=5>Vul hier onder uw gegevens in voor een vrijblijvende offerte&nbsp;</FONT></DIV></center></td></tr><tr><td>Naam*:</td><td><input type=\"text\" name=\"name\" value=\"\" size=\"20\"></td></tr><tr><td>Bedrijfsnaam:</td><td><input type=\"text\" name=\"custom Bedrijfsnaam\" value=\"\" size=\"20\"></td></tr><tr><td>Email*:</td><td><input type=\"text\" name=\"from\" value=\"\" size=\"20\"></td></tr><tr><td>Adres*:</td><td><input type=\"text\" name=\"custom adres\" value=\"\" size=\"20\"></td></tr><tr><td>Postcode*:</td><td><input type=\"text\" name=\"custom Postcode\" value=\"\" size=\"20\"></td></tr><tr><td>Woonplaats*:</td><td><input type=\"text\" name=\"custom Woonplaats\" value=\"\" size=\"20\"></td></tr><tr><td>Telefoon nr*:</td><td><input type=\"text\" name=\"custom Telefoon nr\" value=\"\" size=\"20\"></td></tr><tr><td>Datum evenement*:</td><td><input type=\"text\" name=\"custom Datum evenement\" value=\"\" size=\"20\"></td></tr><tr><td>Levering*:</td><td><select name=\"custom Levering\"><option value=\"Bezorgen\">Bezorgen</option><option value=\"Afhalen\">Afhalen</option></select></td></tr><tr><td valign=\"top\">Gewenste artikelen:</td><td><textarea name=\"custom Gewenste artikelen\" rows=\"10\" cols=\"30\">Wilt U zo vriendelijk zijn onze codes te gebruiken?</textarea></td></tr><tr><td>Eventuele aktie code:</td><td><input type=\"text\" name=\"custom Eventuele aktie code\" value=\"\" size=\"20\"></td></tr>    <tr><td colspan=2><center><DIV align=center><FONT color=#660066 size=2>Wij zullen uw informatie onder geen beding overdragen aan derden.</FONT></DIV><DIV align=center><FONT color=#660066 size=2>Wij respecteren Uw e-mail privacy en verwerpen iedere vorm van Spam.</FONT></DIV><DIV align=center><FONT color=#660066 size=2>Vergeet niet Uw bevestigings mail te bevestigen!</FONT></DIV><DIV align=center><FONT size=2>&nbsp;</FONT></DIV></center></td></tr><tr><td align=\"center\" colspan=\"2\"><input type=\"submit\" name=\"submit\" value=\"Verstuur\"></td></tr></table></form></center>");

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