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<html><head><title>Ferienwohnung Pellworm</title><meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"></head><body bgcolor=#ece8dd text="#353b5d">
<form method="post" action="/cgi-bin/mailmanager.pl"
name="Reservierung">
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<font face="Verdana, Arial, Helvetica, sans-serif" size=3><font color="#353b5d" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="4"><b><img src="bilder/logo_klein.jpg" width="160" height="120" border="0" align="middle"></b></font></font></div>
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<font face="Verdana, Arial, Helvetica, sans-serif" size=3><font color="#353b5d" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="4"><b>Anfrage und Reservierungen</b></font></font></div>
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<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Name:</b></font></td>
<td><input type="text" name="Name" size=24>
<font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>*</b></font></td>
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<td> </td>
<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Vorname:</b></font></td>
<td><input type="text" name="Vorname" size=24>
<font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>*</b></font></td>
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<td> </td>
<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Straße,
Nr:</b></font></td>
<td><input type="text" name="Straße" size=24>
<font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>*</b></font></td>
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<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>PLZ/Wohnort</b></font></td>
<td><input
type="text" name="Ort" size=24>
<font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>*</b></font></td>
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<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Telefon:</b></font></td>
<td><input type="text" name="Telefon" size=24>
<font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>*</b></font></td>
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<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Fax:</b></font></td>
<td><input type="text" name="Fax" size=24></td>
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<td width="133"><font size=2 face="Verdana,Arial,Helvetica,sans-serif"><b>Mail:</b></font></td>
<td><input type="text" name="Mail" size=24><br>
<font face="Verdana,helvetica,arial,sans-serif" size="1">die mit einem
* markierten Felder müssen ausgefüllt werden!</font></td>
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<td>.</td>
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<td><b><font face="Verdana,Arial,Helvetica,sans-serif" size="2">Bevorzugte Wohnung:</font></b></td>
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<td width="133"><font face="Verdana, Arial,
Helvetica, sans-serif" size=2 color=#FFFFFF><input type="radio" name="Wohnung" value="Nordermühle"> </font><font face="Verdana,Arial,Helvetica,sans-serif" size="2">Nordermühle</font></td>
<td><font face="Verdana, Arial,
Helvetica, sans-serif" size=2 color=#FFFFFF><input type="radio" name="Wohnung" value="Leuchtturm"></font> <font size="2" face="Verdana,Arial,Helvetica,sans-serif">Leuchtturm</font><font color="#ece8dd" size="2" face="Verdana,Arial,Helvetica,sans-serif">.</font><font color="#ece8dd">. </font><input type="radio" name="Wohnung" value="Vogelkoje"> <font face="Verdana,Arial,Helvetica,sans-serif" size="2">Vogelkoje</font><font color="#ece8dd">..</font><input type="radio" name="Wohnung" value="egal"> <font size="2" face="Verdana,Arial,Helvetica,sans-serif">egal</font></td>
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<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Anzahl:</b></font></td>
<td><font size="2" face="Verdana,Arial,Helvetica,sans-serif">Erwachsene</font><font color="#ece8dd">..</font><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" color="#ece8dd">.</font><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"> </font><input type="text" name="Erwachsene" size=3 maxlength="3"></td>
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<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Anzahl:</b></font></td>
<td><font face="Verdana,Arial,Helvetica,sans-serif" size="2">Kinder </font><font color="#ece8dd" face="Verdana,Arial,Helvetica,sans-serif" size="2">...</font><font color="#ece8dd">..<b>.</b>.<b>.</b>..</font><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b> </b></font><input type="text" name="Kinder" size=3 maxlength="3"> <font size="2" face="Verdana,Arial,Helvetica,sans-serif">Alter<b> </b></font><input type="text" name="Alter" size=8 maxlength="8"></td>
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<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Wunschtermin:</b></font></td>
<td><font face="Verdana,Arial,Helvetica,sans-serif" size="2">vom</font><font color="#ece8dd" face="Verdana,Arial,Helvetica,sans-serif" size="2"> bis..........</font><font size=2 face="Verdana,Arial,Helvetica,sans-serif"><b><select name="Tag Ankunft" size="1" tabindex="1">
<option value="1">1.</option>
<option value="2">2.</option>
<option value="3">3.</option>
<option value="4">4.</option>
<option value="5">5.</option>
<option value="6">6.</option>
<option value="7">7.</option>
<option value="8">8.</option>
<option value="9">9.</option>
<option value="10">10.</option>
<option value="11">11.</option>
<option value="12">12.</option>
<option value="13">13.</option>
<option value="14">14.</option>
<option value="15">15.</option>
<option value="16">16.</option>
<option value="17">17.</option>
<option value="18">18.</option>
<option value="19">19.</option>
<option value="20">20.</option>
<option value="21">21.</option>
<option value="22">22.</option>
<option value="23">23.</option>
<option value="24">24.</option>
<option value="25">25.</option>
<option value="26">26.</option>
<option value="27">27.</option>
<option value="28">28.</option>
<option value="29">29.</option>
<option value="30">30.</option>
<option value="31">31.</option>
</select><select name="Monat Ankunft" size="1">
<option value="Januar">Januar 2009</option>
<option value="Februar">Februar 2009</option>
<option value="März">März 2009</option>
<option value="April">April 2009</option>
<option value="Mai">Mai 2009</option>
<option value="Juni">Juni 2009</option>
<option value="Juli">Juli 2009</option>
<option value="August">August 2009</option>
<option value="September">September 2009</option>
<option value="Oktober">Oktober 2009</option>
<option value="November">November 2009</option>
<option value="Dezember">Dezember 2009</option>
</select></b></font><font face="Verdana,Arial,Helvetica,sans-serif"><br>
</font><font face="Verdana,Arial,Helvetica,sans-serif" size="2">bis </font><font color="#ece8dd" face="Verdana,Arial,Helvetica,sans-serif" size="2">vom..........</font><select name="Tag Abreise" size="1" tabindex="1">
<option value="1">1.</option>
<option value="2">2.</option>
<option value="3">3.</option>
<option value="4">4.</option>
<option value="5">5.</option>
<option value="6">6.</option>
<option value="7">7.</option>
<option value="8">8.</option>
<option value="9">9.</option>
<option value="10">10.</option>
<option value="11">11.</option>
<option value="12">12.</option>
<option value="13">13.</option>
<option value="14">14.</option>
<option value="15">15.</option>
<option value="16">16.</option>
<option value="17">17.</option>
<option value="18">18.</option>
<option value="19">19.</option>
<option value="20">20.</option>
<option value="21">21.</option>
<option value="22">22.</option>
<option value="23">23.</option>
<option value="24">24.</option>
<option value="25">25.</option>
<option value="26">26.</option>
<option value="27">27.</option>
<option value="28">28.</option>
<option value="29">29.</option>
<option value="30">30.</option>
<option value="31">31.</option>
</select><select name="Monat Abreise" size="1">
<option value="Januar">Januar 2009</option>
<option value="Februar">Februar 2009</option>
<option value="März">März 2009</option>
<option value="April">April 2009</option>
<option value="Mai">Mai 2009</option>
<option value="Juni">Juni 2009</option>
<option value="Juli">Juli 2009</option>
<option value="August">August 2009</option>
<option value="September">September 2009</option>
<option value="Oktober">Oktober 2009</option>
<option value="November">November 2009</option>
<option value="Dezember">Dezember 2009</option>
</select></td>
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<td><br>
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<td><font face="Verdana,Arial,Helvetica,sans-serif" size="2"><b>Interessieren Sie sich für unsere Pauschalangebote ?</b></font></td>
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<td><input type="radio" name="Pauschalangebote" value="Gesundheitswoche"> <font size="2" face="Verdana,Arial,Helvetica,sans-serif">Gesundheitswoche</font><font size="2" face="Verdana,Arial,Helvetica,sans-serif" color="#ece8dd">..</font> <input type="radio" name="Pauschalangebote" value="Aktiv entspannen"> <font size="2" face="Verdana,Arial,Helvetica,sans-serif">Aktiv entspannen</font></td>
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<td><input type="radio" name="Pauschalangebote" value="Super Sparwoche"> <font size="2" face="Verdana,Arial,Helvetica,sans-serif">Super Sparwoche</font><font size="2" face="Verdana,Arial,Helvetica,sans-serif" color="#ece8dd">. ..</font><input type="radio" name="Pauschalangebote" value="Frühling/Herbst"><font face="Verdana,Arial,Helvetica,sans-serif"> </font><font face="Verdana,Arial,Helvetica,sans-serif" size="2">Frühling/Herbst<b> </b></font></td>
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<td><br>
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<td><font face="Verdana, Arial,
Helvetica, sans-serif" size=2 color=#FFFFFF><input type="radio" name="Versicherung" value="Rücktrittversicherung ohne Garantie"></font><font size="2" face="Verdana,Arial,Helvetica,sans-serif">Reise-Rücktrittskosten-Versicherung</font></td>
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<td width="133"><b><font size="2" face="Verdana,Arial,Helvetica,sans-serif">Reiseversicherung:</font></b></td>
<td><font face="Verdana, Arial,
Helvetica, sans-serif" size=2 color=#FFFFFF><input type="radio" name="Versicherung" value="Rücktrittversicherung mit Garantie"></font><font size="2" face="Verdana,Arial,Helvetica,sans-serif">Reise-Rücktrittskosten-Versicherung<br>
</font><font color="#ece8dd" size="2" face="Verdana,Arial,Helvetica,sans-serif">.....</font><font size="2" face="Verdana,Arial,Helvetica,sans-serif">mit Feriengarantie</font></td>
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<td><font face="Verdana, Arial,
Helvetica, sans-serif" size=2 color=#FFFFFF><input type="radio" name="Versicherung" value="Keine"></font><font size="2" face="Verdana,Arial,Helvetica,sans-serif">Keine Versicherung</font></td>
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<td><font size="2" face="Verdana,Arial,Helvetica,sans-serif"><a href="reiser%FCcktritt.html">weitere Informationen zur Versicherung</a></font></td>
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<td width="133"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Anmerkung</b></font></td>
<td>
<textarea name="Anmerkung" cols="35"></textarea>
</td>
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<td> </td>
<td colspan="2">
<hr width=450 size=1>
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<td colspan="2"><font face="Verdana, Arial, Helvetica, sans-serif" size=2><b>Keine
Sorge</b>, dieses Formular ist zunächst eine unverbindliche Reservierungsanfrage.<br>Wir schicken Ihnen per Post oder Fax eine Auftragsbestätigung zu.<br>Erst Ihre Unterschrift macht die Reservierung rechtskräftig.<br>
<br>
</font></td>
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<td> </td>
<td align="right" width="133">
<input type="submit" name="Button"
value="Abschicken">
</td>
<td>
<input type="submit" name="Button2" value="Zurücksetzen">
<br>
<!-- SCRIPT CONFIGURATION SECTION -->
<input type="hidden" name="required" value="Name,Vorname,Straße,Ort,Telefon">
<input type="hidden" name="email" value="Reservierungsanfrage">
<input type="hidden" name="title" value="Abschicken">
<input type="hidden" name="recipient" value="[email protected]">
<input type="hidden" name="redirect" value="http://www.hoffmannpellworm.de/antwort/okay.htm">
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</table>
</form></body></html>