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<input type="text" name="Nachname" id="mailformNachname" size="20" value="" class="csc-mailform-text" />
 
<input type="text" name="Vorname" id="mailformVorname" size="20" value="" class="csc-mailform-text" />
 
<input type="text" name="replyto_email" id="mailformreplyto_email" size="20" value="" class="csc-mailform-text" />
 
<input type="text" name="telefon" id="mailformtelefon" size="20" value="" class="csc-mailform-text" />
 
<textarea name="anfrage" id="mailformanfrage" cols="20" rows="5"></textarea>
 

<input type="checkbox" value="1" name="datenschutz" id="mailformdatenschutz" class="csc-mailform-check" />
 
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<input type="submit" name="formtype_mail" id="mailformformtype_mail" value="Anfrage absenden" class="csc-mailform-submit" />

Smart-Wines GmbH

Brückenstr. 21
D-50667 Köln

Telefon +49 221 120447
Fax +49 221 123090

smart(at)smart-wines.de
www.smart-wines.de