<FORM name=opret action=/shop/web/scripts/kunde_opret.php method=post>
<INPUT
type=hidden value=jep name=action>
<TABLE border=0>
<TBODY>
<TR>
<TD><B>Fornavn:</B></TD>
<TD><INPUT name=fornavn size="20"></TD></TR>
<TR>
<TD><B>Efternavn:</B></TD>
<TD><INPUT name=efternavn size="20"></TD></TR>
<TR>
<TD><B>Firma:</B></TD>
<TD><INPUT name=firma size="20"></TD></TR>
<TR>
<TD><B>Adresse:</B></TD>
<TD><INPUT name=adresse size="20"></TD></TR>
<TR>
<TD><B>Postnr:</B></TD>
<TD><INPUT name=postnr size="20"></TD></TR>
<TR>
<TD><B>By:</B></TD>
<TD><INPUT name=byen size="20"></TD></TR>
<TR>
<TD><B>Stilling:</B></TD>
<TD><INPUT name=stilling size="20"></TD></TR>
<TR>
<TD><B>Telefon Arbejde:</B></TD>
<TD><INPUT name=telefon_arb size="20"></TD></TR>
<TR>
<TD><B>Telefon Privat:</B></TD>
<TD><INPUT name=telefon_privat size="20"> <A onclick=telefon()
href="
http://shoplift.linder.dk/shop/web/scripts/kunde_opret.php#"> <IMG
src="kunde_opret_php-filer/search.gif" border=_blank width="16" height="16"></A> </TD></TR>
<TR>
<TD><B>Mobil:</B></TD>
<TD><INPUT name=telefon_mobil size="20"></TD></TR>
<TR>
<TD><B>Fødselsdato:</B></TD>
<TD><INPUT name=fodselsdato size="20"></TD></TR>
<TR>
<TD><B>E-mail:</B></TD>
<TD><INPUT name=email size="20"></TD></TR>
<TR>
<TD><B>Henvist:</B></TD>
<TD><INPUT name=henvist size="20"></TD></TR>
<TR>
<TD><B>Kontaktperson:</B></TD>
<TD><SELECT name=medarbejder> <OPTION value=22 selected>Louise
Madsen</OPTION><OPTION value=33>Margrethe Wilhelm</OPTION><OPTION
value=19>Martin Trenter</OPTION><OPTION value=21>Sandra Engelbrecht
Petersen</OPTION><OPTION value=35>Maja G. Paulsen</OPTION><OPTION
value=25></OPTION></SELECT> </TD></TR></TBODY></TABLE>
<TABLE>
<INPUT type=image alt="Send Forespørgsel"
src="kunde_opret_php-filer/button.png" border=0 width="100" height="20"> </FORM></FONT>
<TBODY></TBODY></TABLE></BODY></HTML>