Firma Name * Vorname Strasse * PLZ * / Ort * Tel Fax E-Mail *     Bemerkungen <table cellspacing="0" cellpadding="2"> <tr> <td class="normal" valign="top" width="100">Sicherheitscode</td> <td class="normal" valign="top"> <font face="verdana,arial" color="cc0000">GBBK</font> <input type="hidden" size="4" value="GBBK" name="fCode_System"> </td> </tr> <tr> <td class="normal" valign="top">Hier eintippen</td> <td class="normal" valign="top"><input maxlength="4" size="4" name="fCode"></td></tr> <tr> <td class="normal" valign="top"> </td> <td class="normal" valign="top"> <br> <input onclick="kontaktformular(this)" type="button" value="senden" name="iSubmit"> </td> </tr> </table> </td> </tr> </table> </form> </body> </html>