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<div class="wFormContainer" >
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    <style type="text/css">
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<div class="codesection" id="code-4959940"></div>
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<div class="oneField field-container-D    " id="tfa_63-D">
<label id="tfa_63-L" class="label preField " for="tfa_63">Onderwerp</label><br><div class="inputWrapper"><select id="tfa_63" name="tfa_63" title="Onderwerp" class=""><option value="">Maak een keuze</option>
<option value="tfa_64" id="tfa_64" class="">Offerte aanvragen</option>
<option value="tfa_65" id="tfa_65" class="">Vraag / opmerking</option></select></div>
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<div class="oneField field-container-D    " id="tfa_1-D">
<label id="tfa_1-L" class="label preField reqMark" for="tfa_1">Voornaam</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1" name="tfa_1" value="" autocomplete="off" title="Voornaam" class="required"></div>
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<div class="oneField field-container-D    " id="tfa_26-D">
<label id="tfa_26-L" class="label preField reqMark" for="tfa_26">Achternaam</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_26" name="tfa_26" value="" autocomplete="off" title="Achternaam" class="required"></div>
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<div class="oneField field-container-D    " id="tfa_58-D">
<label id="tfa_58-L" class="label preField reqMark" for="tfa_58">Telefoonnummer</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_58" name="tfa_58" value="" autocomplete="off" title="Telefoonnummer" class="validate-integer required"></div>
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<div class="oneField field-container-D    " id="tfa_12-D">
<label id="tfa_12-L" class="label preField reqMark" for="tfa_12">E-mailadres</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_12" name="tfa_12" value="" autocomplete="off" title="E-mailadres" class="validate-email required"></div>
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<div class="oneField field-container-D   hintsBelow " id="tfa_44-D">
<label id="tfa_44-L" class="label preField " for="tfa_44">Wat is je vraag?</label><br><div class="inputWrapper"><textarea maxlength="400" id="tfa_44" name="tfa_44" title="Wat is je vraag?" class=""></textarea></div>
</div>
<div class="oneField field-container-D    " id="tfa_66-D" role="radiogroup" aria-labelledby="tfa_66-L" data-tfa-labelledby="-L tfa_66-L">
<label id="tfa_66-L" class="label preField reqMark" data-tfa-check-label-for="tfa_66">Ik geef toestemming voor het gebruik van mijn gegevens voor gepersonaliseerde communicatie.</label><br><div class="inputWrapper"><span id="tfa_66" class="choices vertical required"><span class="oneChoice"><input type="radio" value="tfa_67" class="" id="tfa_67" name="tfa_66" aria-required="true" aria-labelledby="tfa_67-L" data-tfa-labelledby="tfa_66-L tfa_67-L" data-tfa-parent-id="tfa_66"><label class="label postField" id="tfa_67-L" for="tfa_67"><span class="input-radio-faux"></span>Ja</label></span><span class="oneChoice"><input type="radio" value="tfa_68" class="" id="tfa_68" name="tfa_66" aria-required="true" aria-labelledby="tfa_68-L" data-tfa-labelledby="tfa_66-L tfa_68-L" data-tfa-parent-id="tfa_66"><label class="label postField" id="tfa_68-L" for="tfa_68"><span class="input-radio-faux"></span>Nee</label></span></span></div>
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<div class="oneField field-container-D     wf-acl-hidden" id="tfa_49-D">
<label id="tfa_49-L" class="label preField reqMark" for="tfa_49">Taal</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_49" name="tfa_49" value="nl_NL" default="nl_NL" title="Taal" class="required"></div>
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<label id="tfa_62-L" class="label preField " for="tfa_62">Subjectline bevestigingsmail (bij leeg veld wordt default Marketing Cloud waarde gebruikt)</label><br><div class="inputWrapper"><textarea maxlength="300" id="tfa_62" name="tfa_62" title="Subjectline bevestigingsmail (bij leeg veld wordt default Marketing Cloud waarde gebruikt)" class=""></textarea></div>
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<div class="actions" id="4959940-A" data-contentid="submit_button"><input type="submit" data-label="Verzenden" class="primaryAction" id="submit_button" value="Verzenden"></div>
<div style="clear:both"></div>
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</form>
</div></div><div class="wFormFooter"><p class="supportInfo"><br></p></div>
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      </p>
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