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HOME
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KONTAKT
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<h4><FONT STYLE="color: rgb(000,000,000)"><B STYLE="font-weight: 500">İRTİBAT / ÜYELİK</B> </h4></FONT>
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&nbsp; &nbsp; <FONT STYLE="color:darkblue; font-size: 17px">İrtibat / &Uumlyelik formu</FONT>
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<center>		
		
		<form action="/cgi-bin/send_form_mail.php.cgi" method="post">
<DIV>
<p style="background:#e6e6fa; width:450; height:auto ;border: 1px solid darkblue;">
		İrtibat nedeni :&nbsp;&nbsp;&nbsp <input type="radio" name="basvuru_nedeni" value="&Üumlyelik"  size="40" /> &Uumlyelik
		&nbsp; <input type="radio" name="basvuru_nedeni" value="&oumlneri"  size="40" /> &Oumlneri
		&nbsp; <input type="radio" name="basvuru_nedeni" value="bilgi"  size="40" /> Bilgi &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp
		
<br>
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<br>		
                                  
		İsim* &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp <input type="text" name="adi" value="" size="40" />
		<input type="hidden" name="required[İsim]" value="adi" >
<br>				
		Soyisim* &nbsp;&nbsp;&nbsp <input type="text" name="soyadi" value="" size="40" />
		<input type="hidden" name="required[Soyisim]" value="soyadi" >
<br>            
		E-Posta* &nbsp;&nbsp <input type="text" name="e_maili" size="40" />
		<input type="hidden" name="required[E-Posta]" value="e_maili" >
            		
			<!--___________Überprüft die e-mail adresse______-->
             		<input type="hidden" name="reg_check[email]" value="e_maili">
						
<br>				
		Telefon &nbsp;&nbsp;&nbsp;&nbsp <input type="text" name="telefonu" size="40" />
<br>		
		Fax &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp <input type="text" name="faxi" size="40" /><br>
<br>
</p></div>
<DIV>
<p style="background:#e6e6fa; width:450; height:auto ;border: 1px solid darkblue;">
<br>					
	        &Uumlyeliğini istediğiniz site &nbsp;&nbsp;&nbsp; <select name="istedigi_üyelik">
	        <option value="Kiraciyim">www.Kiraciyim.de</option>
	        <option value="Evsahibiyim">www.Evsahibiyim.de</option>
           	</select>		
<br />
<br>
		İstediğiniz üyelik şekli :&nbsp;&nbsp;&nbsp <input type="radio" name="uyelik_sekli" value="brons"  size="40" /> Brons
		&nbsp; <input type="radio" name="uyelik_sekli" value="Gümüş"  size="40" /> Gümüş
		&nbsp; <input type="radio" name="uyelik_sekli" value="Altın"  size="40" /> Altın <br>
<br>
</p>
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<br>	
	Sayfamızı nasıl buluyorsunuz : 
<br><br>
	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp<input type="radio" name="düsüncesi" value="cok iyi"  size="40" /> Çok iyi <br>
	<input type="radio" name="düsüncesi" value="iyi" size="40" /> İyi<br>
	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp<input type="radio" name="düsüncesi" value="Fena degil" size="40" /> Fena değil<br>
	&nbsp;&nbsp;&nbsp;&nbsp<input type="radio" name="düsüncesi" value="Kötü" size="40" /> K&oumlt&uuml<br>
<br>
</p><div>
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<br>			
	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp Arzunuz / &Oumlnerileriniz :  <br>
	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp	<textarea name="mesaji" rows="6" cols="40"></textarea>
<br><br>
		

		<input type="hidden" name="r_email" value="info@kiraciyim.de" >
		<input type="hidden" name="form_type" value="http://www.kiraciyim.de/kontaktformular.html" >
</p></div>
		&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp<input type="reset" value="Hepsini Sil" />
		&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp<input type="submit" value="Gonder" /><br>
		<!--______________Bestätigungsseite festlegen____________________>
		<INPUT type=hidden name="redirect" value="http://www.kiraciyim.de/Bestaetigung.htm">	
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