<?

?>
<?php /* ------------------------- */
$emailadres = "msn@kevtranslatezone.nl"; // Hier je E-mail Adres.
$copyrigt =  false; // Wijzig dit voor een Copyright.


if(isset($_POST['verzenden'])) {
    if(!empty($_POST['Voorletters']) AND !empty($_POST['Achternaam']) AND !empty($_POST['Adres']) AND !empty($_POST['Postc']) AND !empty($_POST['Postl']) AND !empty($_POST['Woonplaats']) AND !empty($_POST['E-mail']))
    {
          $email = $_POST['E-mail'];
        $message = "Voorletters: $Voorletters \n\nTussenvoegsel: $Tussenvoegsel \n\nAchternaam: $Achternaam \n\nAdres: $Adres \n\nPostcode: $Postc $Postl \n\nWoonplaats: $Woonplaats \n\nE-mail Adres: $email \n\nPakket: $Pakket \n\nDomein: www. $Domein $Extentie\n\nOpmerkingen: $Opmerkingen \n\nBestel Systeem kevtranslate"; //bewerk dit naar je eigen message
        mail("$emailadres","Pakket: $Pakket","$message","From: Kevtranslate bestel sysytym <msn@kevtranslatezone.nl>"); 
        echo"Uw Mail Is Verstuurd, Wij zullen u zo snel mogelijk helpen.";
    }
    else
    {
        echo"U heeft iets niet correct ingevult.";
    }
}
?>
<center>
<form method="POST" action="">
<table width="348" height="406" border="0">
<tr>
<td width="30%"><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Voorletters:</font><font color="red">*</font></td>
<td width="70%">
  <input type="text" name="Voorletters" size="7">
  </td>
</tr>
<tr>
<td width="30%"><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Tussenvoegsel:</font></td>
<td width="70%">
<input type="text" name="Tussenvoegsel" size="7">
</td>
</tr>
<tr>
  <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Achternaam:</font><font color="red">*</font></td>
  <td><input type="text" name="Achternaam" size="20">
  </td>
</tr>
<tr>
  <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Adres:</font><font color="red">*</font></td>
  <td><input type="text" name="Adres" size="20">
  </td>
</tr>
<tr>
  <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Postcode:</font><font color="red">*</font></td>
  <td><FONT face="Tahoma" color="#ffffff" size="2">
    <input type="text" maxlength="4" name="Postc" size="5">
    <input type="text" maxLength="2" name="Postl" size="3">
  </FONT></td>
</tr>
<tr>
  <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Woonplaats:</font><font color="red">*</font></td>
  <td><input type="text" name="Woonplaats" size="20">
  </td>
</tr>
<tr>
  <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">E-mail adres:</font><font color="red">*</font></td>
  <td><input type="text" name="E-mail" size="20"></td>
</tr>
<tr>
  <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Domein: www. </font></td>
  <td><p>
      <input type="text" name="Domein" size="20">
      <Select size="1" name="Extentie">
        <option>.nl</option>
        <option>.be</option>
        <option>.com</option>
        <option>.net</option>
        <option>.org</option>
        <option>.info</option>
        <option>.biz</option>
       <option>--</option>
      </select>
  </p></td>
  </tr>
<tr>
  <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Pakket:</font><font color="red">*</font></td>
  <td><p>
      <Select size="1" name="Pakket">
       
        <option>basis hosting paket</option>
        <option>middel hosting pakket</option>
        <option>Xtra hosting paket</option>
       <option>--</option>
      </select>
  </p></td>
  </tr>
 
    <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">layout:</font><font color="red">*</font></td>
  <td><p>
      <Select size="1" name="Pakket">
       
         <option>basis layout</option>
        <option>middel layout</option>
      <option>prof layout</option>
       <option>--</option>
       
       
      </select>
  </p></td>
  </tr>
<tr>

  <td><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">logo/intro</font><font color="red">*</font></td>
  <td><p>
      <Select size="1" name="Pakket">
        <option>logo</option>
        <option>Flash logo</option>
        <option>intro</option>
       <option>--</option>
       
      </select>
  </p></td>
  </tr>
<td width="30%"><font color="#5D5D5D" size="1" face="Verdana, Arial, Helvetica, sans-serif">Opmerkingen:</font></td>
<td width="70%">
<textarea rows="7" name="Opmerkingen" cols="35"></textarea>
</td>
</tr>
<tr>
<td width="30%"><FONT face=Arial color=#000000 size=2><FONT color=#ff0000>*</FONT> = Veplicht veld</FONT>
<td width="70%">
<p align="center"><input type="submit" value="Verzenden" name="verzenden"><input type="reset" value="Opnieuw" name="reset"></td>
</font>
</td>
</tr>
</table>
</form>
</center>
<?
if($copyrigt == true)
{
    echo "©wmcity";
}
?>