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<form method="[post|get]" action="[url der ziel seite]">
</form>
<input type="[text|password|hidden|file|button]" name="[string]">
<html>
<head>
<meta http-equiv="Content-Language" content="de">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<title>Möchten Sie ein Angebot oder</title>
</head>
<body style="text-align: center">
<form method="POST" action="--WEBBOT-SELF--">
<p align="center">Möchten Sie ein <input type="checkbox" name="C1" value="ON">[b]Angebot[/b]
oder eine <input type="checkbox" name="C2" value="ON">[b]Bestellung[/b]
aufgeben ?</p>
<p align="center">Bitte wählen Sie ihre Lieferart
<input type="checkbox" name="C5" value="ON"> [b]Zufuhr[/b] oder
<input type="checkbox" name="C6" value="ON"> [b]Abhohlung[/b] </p>
<p align="center">Bitte kreuzen Sie ihren gewünschten [b]Abholort[/b] an.</p>
<div align="center">
<table border="1" style="border-collapse: collapse" width="407" height="175" bordercolor="#FF9933">
<tr>
<td height="59" width="136">
<p style="margin-top: 0; margin-bottom: 0">
<input type="checkbox" name="C3" value="ON"></p>
<p style="margin-top: 0; margin-bottom: 0">[b]69190 Walldorf[/b]</p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">
Siemensstr. 2</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Tel.:
06227 9037 od. 1082</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Fax: 06227
30634</font></p>
<p style="margin-top: 0; margin-bottom: 0"></td>
<td height="59" width="126">
<p style="margin-top: 0; margin-bottom: 0">
<input type="checkbox" name="C4" value="ON"></p>
<p style="margin-top: 0; margin-bottom: 0">[b]04626 Göllnitz bei[/b]</p>
<p style="margin-top: 0; margin-bottom: 0">[b]Altenburg / Thür.[/b]</p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">
Gewerbegebiet</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Tel.:
034495 70031</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Fax:
034495 70022</font></td>
<td height="59" width="134">
<p style="margin-top: 0; margin-bottom: 0">
<input type="checkbox" name="C7" value="ON"></p>
<p style="margin-top: 0; margin-bottom: 0">[b]15827 Dahlewitz bei
Berlin[/b]</p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">
Ludwig-Erhard-Ring 17</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Tel.:
033708 7630</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Fax:
033708 76363</font></td>
</tr>
<tr>
<td height="106" width="136">
<p style="margin-top: 0; margin-bottom: 0">
<input type="checkbox" name="C8" value="ON"></p>
<p style="margin-top: 0; margin-bottom: 0">[b]59199 Bönen[/b]</p>
<p style="margin-top: 0; margin-bottom: 0">[b]Fa. Heyer Türen[/b]</p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">
Marmelinghöfener Weg 20</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Tel.:
02383 913852</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Fax: 02383
913854</font></td>
<td height="106" width="264" colspan="2">
<p style="margin-top: 0; margin-bottom: 0"></td>
</tr>
</table>
</div>
<p style="margin-top: 0; margin-bottom: 0"></p>
<div align="center">
<table border="1" style="border-collapse: collapse" width="721" height="473" bordercolordark="#808080" bordercolor="#000000">
<tr>
<td height="14" width="33" align="center" bgcolor="#CCCCCC">[b]Pos[/b]</td>
<td height="14" width="44" align="center" bgcolor="#CCCCCC">[b]Stück[/b]</td>
<td height="14" width="100" align="center" bgcolor="#CCCCCC">[b]
Breite x Höhe[/b]</td>
<td height="14" width="113" align="center" bgcolor="#CCCCCC">[b]
Wandstärke[/b]</td>
<td height="14" width="71" align="center" bgcolor="#CCCCCC">[b]R/L
[/b]</td>
<td height="14" width="4" align="center" bgcolor="#CCCCCC">[b]LA[/b]</td>
<td height="14" width="176" align="center" bgcolor="#CCCCCC">[b]
Holzart-MOD. / Sonstiges[/b]</td>
<td height="14" width="73" align="center" bgcolor="#CCCCCC">[b]
Einzelpreis[/b]</td>
<td height="14" width="102" align="center" bgcolor="#CCCCCC">[b]
Gesamtpreis[/b]</td>
</tr>
<tr>
<td height="19" width="33" align="center" bgcolor="#CCCCCC">[b]1[/b]</td>
<td height="19" width="44"><input type="text" name="T1" size="7"></td>
<td height="19" width="100"><input type="text" name="T2" size="15"></td>
<td height="19" width="113"><input type="text" name="T41" size="15"></td>
<td height="19" width="71"><input type="text" name="T61" size="6"></td>
<td height="19" width="4"><input type="text" name="T141" size="6"></td>
<td height="19" width="176"><input type="text" name="T81" size="24"></td>
<td height="19" width="73"><input type="text" name="T101" size="19"></td>
<td height="19" width="102">
<input type="text" name="T121" size="19"></td>
</tr>
<tr>
<td height="15" width="33" align="center" bgcolor="#CCCCCC">[b]2[/b]</td>
<td height="15" width="44"><input type="text" name="T3" size="7"></td>
<td height="15" width="100"><input type="text" name="T22" size="15"></td>
<td height="15" width="113"><input type="text" name="T42" size="15"></td>
<td height="15" width="71"><input type="text" name="T142" size="6"></td>
<td height="15" width="4"><input type="text" name="T179" size="6"></td>
<td height="15" width="176"><input type="text" name="T82" size="24"></td>
<td height="15" width="73"><input type="text" name="T102" size="19"></td>
<td height="15" width="102">
<input type="text" name="T122" size="19"></td>
</tr>
<tr>
<td height="5" width="33" align="center" bgcolor="#CCCCCC">[b]3[/b]</td>
<td height="5" width="44"><input type="text" name="T4" size="7"></td>
<td height="5" width="100"><input type="text" name="T23" size="15"></td>
<td height="5" width="113"><input type="text" name="T43" size="15"></td>
<td height="5" width="71"><input type="text" name="T143" size="6"></td>
<td height="5" width="4"><input type="text" name="T178" size="6"></td>
<td height="5" width="176"><input type="text" name="T83" size="24"></td>
<td height="5" width="73"><input type="text" name="T103" size="19"></td>
<td height="5" width="102"><input type="text" name="T123" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]4[/b]</td>
<td height="24" width="44"><input type="text" name="T5" size="7"></td>
<td height="24" width="100"><input type="text" name="T24" size="15"></td>
<td height="24" width="113"><input type="text" name="T44" size="15"></td>
<td height="24" width="71"><input type="text" name="T144" size="6"></td>
<td height="24" width="4"><input type="text" name="T177" size="6"></td>
<td height="24" width="176"><input type="text" name="T84" size="24"></td>
<td height="24" width="73"><input type="text" name="T104" size="19"></td>
<td height="24" width="102">
<input type="text" name="T124" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]5[/b]</td>
<td height="24" width="44"><input type="text" name="T6" size="7"></td>
<td height="24" width="100"><input type="text" name="T25" size="15"></td>
<td height="24" width="113"><input type="text" name="T45" size="15"></td>
<td height="24" width="71"><input type="text" name="T145" size="6"></td>
<td height="24" width="4"><input type="text" name="T176" size="6"></td>
<td height="24" width="176"><input type="text" name="T85" size="24"></td>
<td height="24" width="73"><input type="text" name="T105" size="19"></td>
<td height="24" width="102">
<input type="text" name="T125" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]6[/b]</td>
<td height="24" width="44"><input type="text" name="T7" size="7"></td>
<td height="24" width="100"><input type="text" name="T26" size="15"></td>
<td height="24" width="113"><input type="text" name="T46" size="15"></td>
<td height="24" width="71"><input type="text" name="T146" size="6"></td>
<td height="24" width="4"><input type="text" name="T175" size="6"></td>
<td height="24" width="176"><input type="text" name="T86" size="24"></td>
<td height="24" width="73"><input type="text" name="T106" size="19"></td>
<td height="24" width="102">
<input type="text" name="T126" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]7[/b]</td>
<td height="24" width="44"><input type="text" name="T8" size="7"></td>
<td height="24" width="100"><input type="text" name="T27" size="15"></td>
<td height="24" width="113"><input type="text" name="T47" size="15"></td>
<td height="24" width="71"><input type="text" name="T147" size="6"></td>
<td height="24" width="4"><input type="text" name="T174" size="6"></td>
<td height="24" width="176"><input type="text" name="T87" size="24"></td>
<td height="24" width="73"><input type="text" name="T107" size="19"></td>
<td height="24" width="102">
<input type="text" name="T127" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]8[/b]</td>
<td height="24" width="44"><input type="text" name="T9" size="7"></td>
<td height="24" width="100"><input type="text" name="T28" size="15"></td>
<td height="24" width="113"><input type="text" name="T48" size="15"></td>
<td height="24" width="71"><input type="text" name="T148" size="6"></td>
<td height="24" width="4"><input type="text" name="T173" size="6"></td>
<td height="24" width="176"><input type="text" name="T88" size="24"></td>
<td height="24" width="73"><input type="text" name="T108" size="19"></td>
<td height="24" width="102">
<input type="text" name="T128" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]9[/b]</td>
<td height="24" width="44"><input type="text" name="T10" size="7"></td>
<td height="24" width="100"><input type="text" name="T29" size="15"></td>
<td height="24" width="113"><input type="text" name="T49" size="15"></td>
<td height="24" width="71"><input type="text" name="T149" size="6"></td>
<td height="24" width="4"><input type="text" name="T172" size="6"></td>
<td height="24" width="176"><input type="text" name="T89" size="24"></td>
<td height="24" width="73"><input type="text" name="T109" size="19"></td>
<td height="24" width="102">
<input type="text" name="T129" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]10[/b]</td>
<td height="24" width="44"><input type="text" name="T11" size="7"></td>
<td height="24" width="100"><input type="text" name="T30" size="15"></td>
<td height="24" width="113"><input type="text" name="T50" size="15"></td>
<td height="24" width="71"><input type="text" name="T150" size="6"></td>
<td height="24" width="4"><input type="text" name="T171" size="6"></td>
<td height="24" width="176"><input type="text" name="T90" size="24"></td>
<td height="24" width="73"><input type="text" name="T110" size="19"></td>
<td height="24" width="102">
<input type="text" name="T130" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]11[/b]</td>
<td height="24" width="44"><input type="text" name="T12" size="7"></td>
<td height="24" width="100"><input type="text" name="T31" size="15"></td>
<td height="24" width="113"><input type="text" name="T51" size="15"></td>
<td height="24" width="71"><input type="text" name="T151" size="6"></td>
<td height="24" width="4"><input type="text" name="T170" size="6"></td>
<td height="24" width="176"><input type="text" name="T91" size="24"></td>
<td height="24" width="73"><input type="text" name="T111" size="19"></td>
<td height="24" width="102">
<input type="text" name="T131" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]12[/b]</td>
<td height="24" width="44"><input type="text" name="T13" size="7"></td>
<td height="24" width="100"><input type="text" name="T32" size="15"></td>
<td height="24" width="113"><input type="text" name="T52" size="15"></td>
<td height="24" width="71"><input type="text" name="T152" size="6"></td>
<td height="24" width="4"><input type="text" name="T169" size="6"></td>
<td height="24" width="176"><input type="text" name="T92" size="24"></td>
<td height="24" width="73"><input type="text" name="T112" size="19"></td>
<td height="24" width="102">
<input type="text" name="T132" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]13[/b]</td>
<td height="24" width="44"><input type="text" name="T14" size="7"></td>
<td height="24" width="100"><input type="text" name="T33" size="15"></td>
<td height="24" width="113"><input type="text" name="T53" size="15"></td>
<td height="24" width="71"><input type="text" name="T153" size="6"></td>
<td height="24" width="4"><input type="text" name="T168" size="6"></td>
<td height="24" width="176"><input type="text" name="T93" size="24"></td>
<td height="24" width="73"><input type="text" name="T113" size="19"></td>
<td height="24" width="102">
<input type="text" name="T133" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]14[/b]</td>
<td height="24" width="44"><input type="text" name="T15" size="7"></td>
<td height="24" width="100"><input type="text" name="T34" size="15"></td>
<td height="24" width="113"><input type="text" name="T54" size="15"></td>
<td height="24" width="71"><input type="text" name="T154" size="6"></td>
<td height="24" width="4"><input type="text" name="T167" size="6"></td>
<td height="24" width="176"><input type="text" name="T94" size="24"></td>
<td height="24" width="73"><input type="text" name="T114" size="19"></td>
<td height="24" width="102">
<input type="text" name="T134" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]15[/b]</td>
<td height="24" width="44"><input type="text" name="T16" size="7"></td>
<td height="24" width="100"><input type="text" name="T35" size="15"></td>
<td height="24" width="113"><input type="text" name="T55" size="15"></td>
<td height="24" width="71"><input type="text" name="T155" size="6"></td>
<td height="24" width="4"><input type="text" name="T166" size="6"></td>
<td height="24" width="176"><input type="text" name="T95" size="24"></td>
<td height="24" width="73"><input type="text" name="T115" size="19"></td>
<td height="24" width="102">
<input type="text" name="T135" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]16[/b]</td>
<td height="24" width="44"><input type="text" name="T17" size="7"></td>
<td height="24" width="100"><input type="text" name="T36" size="15"></td>
<td height="24" width="113"><input type="text" name="T56" size="15"></td>
<td height="24" width="71"><input type="text" name="T156" size="6"></td>
<td height="24" width="4"><input type="text" name="T165" size="6"></td>
<td height="24" width="176"><input type="text" name="T96" size="24"></td>
<td height="24" width="73"><input type="text" name="T116" size="19"></td>
<td height="24" width="102">
<input type="text" name="T136" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]17[/b]</td>
<td height="24" width="44"><input type="text" name="T18" size="7"></td>
<td height="24" width="100"><input type="text" name="T37" size="15"></td>
<td height="24" width="113"><input type="text" name="T57" size="15"></td>
<td height="24" width="71"><input type="text" name="T157" size="6"></td>
<td height="24" width="4"><input type="text" name="T164" size="6"></td>
<td height="24" width="176"><input type="text" name="T97" size="24"></td>
<td height="24" width="73"><input type="text" name="T117" size="19"></td>
<td height="24" width="102">
<input type="text" name="T137" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]18[/b]</td>
<td height="24" width="44"><input type="text" name="T19" size="7"></td>
<td height="24" width="100"><input type="text" name="T38" size="15"></td>
<td height="24" width="113"><input type="text" name="T58" size="15"></td>
<td height="24" width="71"><input type="text" name="T158" size="6"></td>
<td height="24" width="4"><input type="text" name="T163" size="6"></td>
<td height="24" width="176"><input type="text" name="T98" size="24"></td>
<td height="24" width="73"><input type="text" name="T118" size="19"></td>
<td height="24" width="102">
<input type="text" name="T138" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]19[/b]</td>
<td height="24" width="44"><input type="text" name="T20" size="7"></td>
<td height="24" width="100"><input type="text" name="T39" size="15"></td>
<td height="24" width="113"><input type="text" name="T59" size="15"></td>
<td height="24" width="71"><input type="text" name="T159" size="6"></td>
<td height="24" width="4"><input type="text" name="T162" size="6"></td>
<td height="24" width="176"><input type="text" name="T99" size="24"></td>
<td height="24" width="73"><input type="text" name="T119" size="19"></td>
<td height="24" width="102">
<input type="text" name="T139" size="19"></td>
</tr>
<tr>
<td height="25" width="33" align="center" bgcolor="#CCCCCC">[b]20[/b]</td>
<td height="25" width="44"><input type="text" name="T21" size="7"></td>
<td height="25" width="100"><input type="text" name="T40" size="15"></td>
<td height="25" width="113"><input type="text" name="T60" size="15"></td>
<td height="25" width="71"><input type="text" name="T160" size="6"></td>
<td height="25" width="4"><input type="text" name="T161" size="6"></td>
<td height="25" width="176">
<input type="text" name="T100" size="24"></td>
<td height="25" width="73"><input type="text" name="T120" size="19"></td>
<td height="25" width="102">
<input type="text" name="T140" size="19"></td>
</tr>
</table>
</div>
</p>
<div align="center">
<table border="0" style="border-collapse: collapse" width="563" height="163">
<tr>
<td height="24" width="68">Besteller:</td>
<td height="24" colspan="2">
<input type="text" name="T180" size="45"></td>
</tr>
<tr>
<td height="24" width="68">Straße:</td>
<td height="24" colspan="2">
<input type="text" name="T181" size="45"></td>
</tr>
<tr>
<td height="24" width="68">PLZ/Ort:</td>
<td height="24" colspan="2">
<input type="text" name="T182" size="45"></td>
</tr>
<tr>
<td height="24" width="68">Telefon:</td>
<td height="24" colspan="2">
<input type="text" name="T183" size="45"></td>
</tr>
<tr>
<td height="24" width="68">Telefax:</td>
<td height="24" colspan="2">
<input type="text" name="T184" size="45"></td>
</tr>
<tr>
<td height="24" width="68">E-Mail:</td>
<td height="24" width="480">
<input type="text" name="T185" size="45"></td>
<td height="24" width="-4"></td>
</tr>
<tr>
<td height="25" width="552" colspan="2">Gewünschter Abholtermin:*<input type="text" name="T186" size="45"></td>
<td height="25" width="4"></td>
</tr>
</table>
</div>
<input type="submit" value="Absenden" name="B1"><input type="reset" value="Zurücksetzen" name="B2"></p>
</form>
</body>
</html>
<html>
<head>
<meta http-equiv="Content-Language" content="de">
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<title>Möchten Sie ein Angebot oder</title>
</head>
<body style="text-align: center">
<form method="POST" action="http://www.nettz.de/Formular-Chef/Formular-Chef.cgi" enctype="multipart/form-data">
<input type="hidden" name="empfaenger" value="[email protected] ">
<p align="center">Möchten Sie ein <input type="checkbox" name="C1" value="ON">[b]Angebot[/b]
oder eine <input type="checkbox" name="C2" value="ON">[b]Bestellung[/b]
aufgeben ?</p>
<p align="center">Bitte wählen Sie ihre Lieferart
<input type="checkbox" name="C5" value="ON"> [b]Zufuhr[/b] oder
<input type="checkbox" name="C6" value="ON"> [b]Abhohlung[/b] </p>
<p align="center">Bitte kreuzen Sie ihren gewünschten [b]Abholort[/b] an.</p>
<div align="center">
<table border="1" style="border-collapse: collapse" width="407" height="175" bordercolor="#FF9933">
<tr>
<td height="59" width="136">
<p style="margin-top: 0; margin-bottom: 0">
<input type="checkbox" name="C3" value="ON"></p>
<p style="margin-top: 0; margin-bottom: 0">[b]69190 Walldorf[/b]</p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">
Siemensstr. 2</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Tel.:
06227 9037 od. 1082</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Fax: 06227
30634</font></p>
<p style="margin-top: 0; margin-bottom: 0"> </td>
<td height="59" width="126">
<p style="margin-top: 0; margin-bottom: 0">
<input type="checkbox" name="C4" value="ON"></p>
<p style="margin-top: 0; margin-bottom: 0">[b]04626 Göllnitz bei[/b]</p>
<p style="margin-top: 0; margin-bottom: 0">[b]Altenburg / Thür.[/b]</p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">
Gewerbegebiet</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Tel.:
034495 70031</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Fax:
034495 70022</font></td>
<td height="59" width="134">
<p style="margin-top: 0; margin-bottom: 0">
<input type="checkbox" name="C7" value="ON"></p>
<p style="margin-top: 0; margin-bottom: 0">[b]15827 Dahlewitz bei
Berlin[/b]</p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">
Ludwig-Erhard-Ring 17</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Tel.:
033708 7630</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Fax:
033708 76363</font></td>
</tr>
<tr>
<td height="106" width="136">
<p style="margin-top: 0; margin-bottom: 0">
<input type="checkbox" name="C8" value="ON"></p>
<p style="margin-top: 0; margin-bottom: 0">[b]59199 Bönen[/b]</p>
<p style="margin-top: 0; margin-bottom: 0">[b]Fa. Heyer Türen[/b]</p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">
Marmelinghöfener Weg 20</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Tel.:
02383 913852</font></p>
<p style="margin-top: 0; margin-bottom: 0"><font size="2">Fax: 02383
913854</font></td>
<td height="106" width="264" colspan="2">
<p style="margin-top: 0; margin-bottom: 0"> </td>
</tr>
</table>
</div>
<p style="margin-top: 0; margin-bottom: 0"> </p>
<div align="center">
<table border="1" style="border-collapse: collapse" width="721" height="473" bordercolordark="#808080" bordercolor="#000000">
<tr>
<td height="14" width="33" align="center" bgcolor="#CCCCCC">[b]Pos[/b]</td>
<td height="14" width="44" align="center" bgcolor="#CCCCCC">[b]Stück[/b]</td>
<td height="14" width="100" align="center" bgcolor="#CCCCCC">[b]
Breite x Höhe[/b]</td>
<td height="14" width="113" align="center" bgcolor="#CCCCCC">[b]
Wandstärke[/b]</td>
<td height="14" width="71" align="center" bgcolor="#CCCCCC">[b]R/L
[/b]</td>
<td height="14" width="4" align="center" bgcolor="#CCCCCC">[b]LA[/b]</td>
<td height="14" width="176" align="center" bgcolor="#CCCCCC">[b]
Holzart-MOD. / Sonstiges[/b]</td>
<td height="14" width="73" align="center" bgcolor="#CCCCCC">[b]
Einzelpreis[/b]</td>
<td height="14" width="102" align="center" bgcolor="#CCCCCC">[b]
Gesamtpreis[/b]</td>
</tr>
<tr>
<td height="19" width="33" align="center" bgcolor="#CCCCCC">[b]1[/b]</td>
<td height="19" width="44"><input type="text" name="T1" size="7"></td>
<td height="19" width="100"><input type="text" name="T2" size="15"></td>
<td height="19" width="113"><input type="text" name="T41" size="15"></td>
<td height="19" width="71"><input type="text" name="T61" size="6"></td>
<td height="19" width="4"><input type="text" name="T141" size="6"></td>
<td height="19" width="176"><input type="text" name="T81" size="24"></td>
<td height="19" width="73"><input type="text" name="T101" size="19"></td>
<td height="19" width="102">
<input type="text" name="T121" size="19"></td>
</tr>
<tr>
<td height="15" width="33" align="center" bgcolor="#CCCCCC">[b]2[/b]</td>
<td height="15" width="44"><input type="text" name="T3" size="7"></td>
<td height="15" width="100"><input type="text" name="T22" size="15"></td>
<td height="15" width="113"><input type="text" name="T42" size="15"></td>
<td height="15" width="71"><input type="text" name="T142" size="6"></td>
<td height="15" width="4"><input type="text" name="T179" size="6"></td>
<td height="15" width="176"><input type="text" name="T82" size="24"></td>
<td height="15" width="73"><input type="text" name="T102" size="19"></td>
<td height="15" width="102">
<input type="text" name="T122" size="19"></td>
</tr>
<tr>
<td height="5" width="33" align="center" bgcolor="#CCCCCC">[b]3[/b]</td>
<td height="5" width="44"><input type="text" name="T4" size="7"></td>
<td height="5" width="100"><input type="text" name="T23" size="15"></td>
<td height="5" width="113"><input type="text" name="T43" size="15"></td>
<td height="5" width="71"><input type="text" name="T143" size="6"></td>
<td height="5" width="4"><input type="text" name="T178" size="6"></td>
<td height="5" width="176"><input type="text" name="T83" size="24"></td>
<td height="5" width="73"><input type="text" name="T103" size="19"></td>
<td height="5" width="102"><input type="text" name="T123" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]4[/b]</td>
<td height="24" width="44"><input type="text" name="T5" size="7"></td>
<td height="24" width="100"><input type="text" name="T24" size="15"></td>
<td height="24" width="113"><input type="text" name="T44" size="15"></td>
<td height="24" width="71"><input type="text" name="T144" size="6"></td>
<td height="24" width="4"><input type="text" name="T177" size="6"></td>
<td height="24" width="176"><input type="text" name="T84" size="24"></td>
<td height="24" width="73"><input type="text" name="T104" size="19"></td>
<td height="24" width="102">
<input type="text" name="T124" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]5[/b]</td>
<td height="24" width="44"><input type="text" name="T6" size="7"></td>
<td height="24" width="100"><input type="text" name="T25" size="15"></td>
<td height="24" width="113"><input type="text" name="T45" size="15"></td>
<td height="24" width="71"><input type="text" name="T145" size="6"></td>
<td height="24" width="4"><input type="text" name="T176" size="6"></td>
<td height="24" width="176"><input type="text" name="T85" size="24"></td>
<td height="24" width="73"><input type="text" name="T105" size="19"></td>
<td height="24" width="102">
<input type="text" name="T125" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]6[/b]</td>
<td height="24" width="44"><input type="text" name="T7" size="7"></td>
<td height="24" width="100"><input type="text" name="T26" size="15"></td>
<td height="24" width="113"><input type="text" name="T46" size="15"></td>
<td height="24" width="71"><input type="text" name="T146" size="6"></td>
<td height="24" width="4"><input type="text" name="T175" size="6"></td>
<td height="24" width="176"><input type="text" name="T86" size="24"></td>
<td height="24" width="73"><input type="text" name="T106" size="19"></td>
<td height="24" width="102">
<input type="text" name="T126" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]7[/b]</td>
<td height="24" width="44"><input type="text" name="T8" size="7"></td>
<td height="24" width="100"><input type="text" name="T27" size="15"></td>
<td height="24" width="113"><input type="text" name="T47" size="15"></td>
<td height="24" width="71"><input type="text" name="T147" size="6"></td>
<td height="24" width="4"><input type="text" name="T174" size="6"></td>
<td height="24" width="176"><input type="text" name="T87" size="24"></td>
<td height="24" width="73"><input type="text" name="T107" size="19"></td>
<td height="24" width="102">
<input type="text" name="T127" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]8[/b]</td>
<td height="24" width="44"><input type="text" name="T9" size="7"></td>
<td height="24" width="100"><input type="text" name="T28" size="15"></td>
<td height="24" width="113"><input type="text" name="T48" size="15"></td>
<td height="24" width="71"><input type="text" name="T148" size="6"></td>
<td height="24" width="4"><input type="text" name="T173" size="6"></td>
<td height="24" width="176"><input type="text" name="T88" size="24"></td>
<td height="24" width="73"><input type="text" name="T108" size="19"></td>
<td height="24" width="102">
<input type="text" name="T128" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]9[/b]</td>
<td height="24" width="44"><input type="text" name="T10" size="7"></td>
<td height="24" width="100"><input type="text" name="T29" size="15"></td>
<td height="24" width="113"><input type="text" name="T49" size="15"></td>
<td height="24" width="71"><input type="text" name="T149" size="6"></td>
<td height="24" width="4"><input type="text" name="T172" size="6"></td>
<td height="24" width="176"><input type="text" name="T89" size="24"></td>
<td height="24" width="73"><input type="text" name="T109" size="19"></td>
<td height="24" width="102">
<input type="text" name="T129" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]10[/b]</td>
<td height="24" width="44"><input type="text" name="T11" size="7"></td>
<td height="24" width="100"><input type="text" name="T30" size="15"></td>
<td height="24" width="113"><input type="text" name="T50" size="15"></td>
<td height="24" width="71"><input type="text" name="T150" size="6"></td>
<td height="24" width="4"><input type="text" name="T171" size="6"></td>
<td height="24" width="176"><input type="text" name="T90" size="24"></td>
<td height="24" width="73"><input type="text" name="T110" size="19"></td>
<td height="24" width="102">
<input type="text" name="T130" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]11[/b]</td>
<td height="24" width="44"><input type="text" name="T12" size="7"></td>
<td height="24" width="100"><input type="text" name="T31" size="15"></td>
<td height="24" width="113"><input type="text" name="T51" size="15"></td>
<td height="24" width="71"><input type="text" name="T151" size="6"></td>
<td height="24" width="4"><input type="text" name="T170" size="6"></td>
<td height="24" width="176"><input type="text" name="T91" size="24"></td>
<td height="24" width="73"><input type="text" name="T111" size="19"></td>
<td height="24" width="102">
<input type="text" name="T131" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]12[/b]</td>
<td height="24" width="44"><input type="text" name="T13" size="7"></td>
<td height="24" width="100"><input type="text" name="T32" size="15"></td>
<td height="24" width="113"><input type="text" name="T52" size="15"></td>
<td height="24" width="71"><input type="text" name="T152" size="6"></td>
<td height="24" width="4"><input type="text" name="T169" size="6"></td>
<td height="24" width="176"><input type="text" name="T92" size="24"></td>
<td height="24" width="73"><input type="text" name="T112" size="19"></td>
<td height="24" width="102">
<input type="text" name="T132" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]13[/b]</td>
<td height="24" width="44"><input type="text" name="T14" size="7"></td>
<td height="24" width="100"><input type="text" name="T33" size="15"></td>
<td height="24" width="113"><input type="text" name="T53" size="15"></td>
<td height="24" width="71"><input type="text" name="T153" size="6"></td>
<td height="24" width="4"><input type="text" name="T168" size="6"></td>
<td height="24" width="176"><input type="text" name="T93" size="24"></td>
<td height="24" width="73"><input type="text" name="T113" size="19"></td>
<td height="24" width="102">
<input type="text" name="T133" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]14[/b]</td>
<td height="24" width="44"><input type="text" name="T15" size="7"></td>
<td height="24" width="100"><input type="text" name="T34" size="15"></td>
<td height="24" width="113"><input type="text" name="T54" size="15"></td>
<td height="24" width="71"><input type="text" name="T154" size="6"></td>
<td height="24" width="4"><input type="text" name="T167" size="6"></td>
<td height="24" width="176"><input type="text" name="T94" size="24"></td>
<td height="24" width="73"><input type="text" name="T114" size="19"></td>
<td height="24" width="102">
<input type="text" name="T134" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]15[/b]</td>
<td height="24" width="44"><input type="text" name="T16" size="7"></td>
<td height="24" width="100"><input type="text" name="T35" size="15"></td>
<td height="24" width="113"><input type="text" name="T55" size="15"></td>
<td height="24" width="71"><input type="text" name="T155" size="6"></td>
<td height="24" width="4"><input type="text" name="T166" size="6"></td>
<td height="24" width="176"><input type="text" name="T95" size="24"></td>
<td height="24" width="73"><input type="text" name="T115" size="19"></td>
<td height="24" width="102">
<input type="text" name="T135" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]16[/b]</td>
<td height="24" width="44"><input type="text" name="T17" size="7"></td>
<td height="24" width="100"><input type="text" name="T36" size="15"></td>
<td height="24" width="113"><input type="text" name="T56" size="15"></td>
<td height="24" width="71"><input type="text" name="T156" size="6"></td>
<td height="24" width="4"><input type="text" name="T165" size="6"></td>
<td height="24" width="176"><input type="text" name="T96" size="24"></td>
<td height="24" width="73"><input type="text" name="T116" size="19"></td>
<td height="24" width="102">
<input type="text" name="T136" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]17[/b]</td>
<td height="24" width="44"><input type="text" name="T18" size="7"></td>
<td height="24" width="100"><input type="text" name="T37" size="15"></td>
<td height="24" width="113"><input type="text" name="T57" size="15"></td>
<td height="24" width="71"><input type="text" name="T157" size="6"></td>
<td height="24" width="4"><input type="text" name="T164" size="6"></td>
<td height="24" width="176"><input type="text" name="T97" size="24"></td>
<td height="24" width="73"><input type="text" name="T117" size="19"></td>
<td height="24" width="102">
<input type="text" name="T137" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]18[/b]</td>
<td height="24" width="44"><input type="text" name="T19" size="7"></td>
<td height="24" width="100"><input type="text" name="T38" size="15"></td>
<td height="24" width="113"><input type="text" name="T58" size="15"></td>
<td height="24" width="71"><input type="text" name="T158" size="6"></td>
<td height="24" width="4"><input type="text" name="T163" size="6"></td>
<td height="24" width="176"><input type="text" name="T98" size="24"></td>
<td height="24" width="73"><input type="text" name="T118" size="19"></td>
<td height="24" width="102">
<input type="text" name="T138" size="19"></td>
</tr>
<tr>
<td height="24" width="33" align="center" bgcolor="#CCCCCC">[b]19[/b]</td>
<td height="24" width="44"><input type="text" name="T20" size="7"></td>
<td height="24" width="100"><input type="text" name="T39" size="15"></td>
<td height="24" width="113"><input type="text" name="T59" size="15"></td>
<td height="24" width="71"><input type="text" name="T159" size="6"></td>
<td height="24" width="4"><input type="text" name="T162" size="6"></td>
<td height="24" width="176"><input type="text" name="T99" size="24"></td>
<td height="24" width="73"><input type="text" name="T119" size="19"></td>
<td height="24" width="102">
<input type="text" name="T139" size="19"></td>
</tr>
<tr>
<td height="25" width="33" align="center" bgcolor="#CCCCCC">[b]20[/b]</td>
<td height="25" width="44"><input type="text" name="T21" size="7"></td>
<td height="25" width="100"><input type="text" name="T40" size="15"></td>
<td height="25" width="113"><input type="text" name="T60" size="15"></td>
<td height="25" width="71"><input type="text" name="T160" size="6"></td>
<td height="25" width="4"><input type="text" name="T161" size="6"></td>
<td height="25" width="176">
<input type="text" name="T100" size="24"></td>
<td height="25" width="73"><input type="text" name="T120" size="19"></td>
<td height="25" width="102">
<input type="text" name="T140" size="19"></td>
</tr>
</table>
</div>
</p>
<div align="center">
<table border="0" style="border-collapse: collapse" width="563" height="163">
<tr>
<td height="24" width="68">Besteller:</td>
<td height="24" colspan="2">
<input type="text" name="T180" size="45"></td>
</tr>
<tr>
<td height="24" width="68">Straße:</td>
<td height="24" colspan="2">
<input type="text" name="T181" size="45"></td>
</tr>
<tr>
<td height="24" width="68">PLZ/Ort:</td>
<td height="24" colspan="2">
<input type="text" name="T182" size="45"></td>
</tr>
<tr>
<td height="24" width="68">Telefon:</td>
<td height="24" colspan="2">
<input type="text" name="T183" size="45"></td>
</tr>
<tr>
<td height="24" width="68">Telefax:</td>
<td height="24" colspan="2">
<input type="text" name="T184" size="45"></td>
</tr>
<tr>
<td height="24" width="68">E-Mail:</td>
<td height="24" width="480">
<input type="text" name="T185" size="45"></td>
<td height="24" width="-4"> </td>
</tr>
<tr>
<td height="25" width="552" colspan="2">Gewünschter Abholtermin:*<input type="text" name="T186" size="45"></td>
<td height="25" width="4"> </td>
</tr>
</table>
</div>
<input type="submit" value="Absenden" name="B1"><input type="reset" value="Zurücksetzen" name="B2"></p>
</form>
</body>
</html>