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<form method="post" action="
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">

  <p align="center">
    <label for="txtName"><span class="style1">    <span class="style3">    Als u meer wilt weten, of als u zich wilt aanmelden voor een eigen website. <br />
    Vul onderstaand formulier in en wij nemen  zo spoedig mogelijk telefonisch contact met u op. </span><br />
    <br />
    Uw naam: </span></label><span class="style1"><br />
      <input name="txtName" type="text" title="Enter your name" size="75" />
    </span></p>

    <p align="center" class="style1">
      <label for="txtEmail"> Uw e-mail adres :</label>
      <br />
      <input name="txtEmail" type="text" title="Enter your email address" size="75" />
    </p>
    
	<p align="center" class="style1">
      <label for="txttel">Telefoon-nummer :</label><br />
    <input name="txttel" type="text" title="Enter your phone number" size="75" /></p>
    
	<p align="center" class="style1">    
		<label for="txtMessage">Voer hier uw eventuele vraag in:</label>
		<br />
      <textarea name="txtMessage" cols="75" rows="10" title="vraag"></textarea>
  </p>
    <p align="center" class="style1"><label title="Send your message">
    <input type="submit" value="Verstuur" /></label>
    </p>
</form>
  <p align="center">
  </p>
<p align="center" class="style6">Als u zelf kontakt met ons wil opnemen dan is dit natuurlijk ook mogelijk :</p>
<p align="center"><span class="style2"><strong></strong></span><span class="style4"><strong>Dierenplein.com <br />
  Antwoordnummer 30158 <br />
  6370 WB   Landgraaf &nbsp;</strong></span><strong><br />
  <br />
  <span class="style2">Tel:&nbsp;</span></strong> <span class="style2"><strong>045 &ndash; 5310375<br />
  Fax:   045 &ndash; 5311311<br />
  <br />
<a href="mailto:info@dierenplein.com">info@dierenplein.com</a></strong></span> </p>
</body>