Contact Form - Concept Heidelberg GmbH

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</div> </div> </header>  </div> <div class="nosearchhi"> <div class="custom"> <div id="ImageSlider"> <div class="inside"> <div class="mod_article first last block" id="article-212"> <div class="ce_text first last block"> <div class="textBackground" style="background-image:url(files/userImages/header/header-kontakt.jpg);"> <div class="onclick-area" ><div><p> </p></div></div> </div> </div> </div>  <nav class="mod_navigation block">  <ul class="level_1"> <li class="sibling first"><a href="contact/address.html" title="Address" class="sibling first">Address</a></li> <li class="active last"><span class="active last">Contact Form</span></li> </ul>  </nav>  </div> </div> </div> </div> <div id="preWrapper"><div id="wrapper"> <div id="container"> <div id="main"> <div class="inside"> <div class="mod_article first last block" id="article-213"> <div class="ce_text first block"> <h1>Contact</h1> <p>For questions or comments you can leave a message with this form. <br>After filling in the form please click the "Submit form" button. </p> </div>  <div class="ce_form tableless block"> <form action="contact/contact-form.html" id="f3" method="post" enctype="application/x-www-form-urlencoded"> <div class="formbody"> <input type="hidden" name="FORM_SUBMIT" value="auto_form_3"> <input type="hidden" name="REQUEST_TOKEN" value="39cf8a1611cd57baa32547f1f67daf17"> <div class="widget widget-radio ix-Nebeneinander mandatory"> <fieldset id="ctrl_19" class="radio_container ix-Nebeneinander mandatory"> <legend> <span class="invisible">Mandatory field </span>Salutation<span class="mandatory">*</span> </legend> <span><input type="radio" name="Anrede" id="opt_19_0" class="radio" value="Frau" required> <label id="lbl_19_0" for="opt_19_0">Mrs</label></span> <span><input type="radio" name="Anrede" id="opt_19_1" class="radio" value="Herr" required> <label id="lbl_19_1" for="opt_19_1">Mr</label></span> <span><input type="radio" name="Anrede" id="opt_19_2" class="radio" value="Divers" required> <label id="lbl_19_2" for="opt_19_2">Mx</label></span> </fieldset> </div> <div class="widget widget-text mandatory"> <label for="ctrl_20" class="mandatory"> <span class="invisible">Mandatory field </span>First name<span class="mandatory">*</span> </label> <input type="text" name="Vorname" id="ctrl_20" class="text mandatory" value="" required> </div> <div class="widget widget-text mandatory"> <label for="ctrl_21" class="mandatory"> <span class="invisible">Mandatory field </span>Last name<span class="mandatory">*</span> </label> <input type="text" name="Nachname" id="ctrl_21" class="text mandatory" value="" required> </div> <div class="widget widget-text"> <label for="ctrl_22"> Company </label> <input type="text" name="Firma" id="ctrl_22" class="text" value=""> </div> <div class="widget widget-text"> <label for="ctrl_23"> Street </label> <input type="text" name="Stra脽e" id="ctrl_23" class="text" value=""> </div> <div class="widget widget-text ix-Plz"> <label for="ctrl_24" class="ix-Plz"> ZIP Code/City </label> <input type="text" name="PLZ" id="ctrl_24" class="text ix-Plz" value=""> </div> <div class="widget widget-text ix-Ort"> <input type="text" name="o" id="ctrl_25" class="text ix-Ort" value=""> </div> <div class="widget widget-text"> <label for="ctrl_26"> Country </label> <input type="text" name="Land" id="ctrl_26" class="text" value=""> </div> <div class="widget widget-text"> <label for="ctrl_27"> Phone </label> <input type="tel" name="Telefon" id="ctrl_27" class="text" value=""> </div> <div class="widget widget-text mandatory"> <label for="ctrl_29" class="mandatory"> <span class="invisible">Mandatory field </span>E-mail<span class="mandatory">*</span> </label> <input type="email" name="email" id="ctrl_29" class="text mandatory" value="" required> </div> <hr> <div class="widget widget-textarea mandatory"> <label for="ctrl_31" class="mandatory"> <span class="invisible">Mandatory field </span>Message<span class="mandatory">*</span> </label> <textarea name="Nachricht" id="ctrl_31" class="textarea mandatory" rows="4" cols="40" required></textarea> </div> <div style="display: none !important"> <label for="ctrl_60">Don't fill this field</label> <input type="text" name="email-2" id="ctrl_60" class="rsas-field" value=""><label for="ctrl_60_2">Don't fill this field</label><input type="text" name="url" id="ctrl_60_2" class="rsas-field" value=""><label for="ctrl_60_3">Don't fill this field</label><input type="text" name="qUhugtehaejIDch1pkhwjA" id="ctrl_60_3" class="rsas-field" value="4oS1ear8L-arQnAsEODffQ"><script>(function(){var a=document.getElementById('ctrl_60_3'),b=a.value;a.value=a.name;a.name=b})()</script> </div> <hr> <div><input value="T" name="R_50" required="" type="checkbox"> I agree that my details from this form will be collected and processed in order to answer my inquiry. This permission may be withdrawn at any time by writing an email to <a href="mailto:datenschutz@concept-heidelberg.de">datenschutz@concept-heidelberg.de</a>. Detailed information about our handling of personal data can be found in our <a href="https://www.concept-heidelberg.com/privacy-policy.html">privacy policy</a>. </div> <div class="widget widget-explanation explanation"> <p>* mandatory fields</p> </div> <div class="submit_container"> <input type="submit" id="ctrl_36" class="submit" value="Submit form"> </div> </div> </form> </div>  <div class="ce_text Absatz first block"> <h2>Further information</h2> </div> <div class="ce_download download block"> <img src="/files/userImages/icons/icon-pdf.png" width="20" height="21" alt="" class="mime_icon"> <a href="contact/contact-form.html?file=files/userFiles/pdf/Unternehmensbroschuere_englisch.pdf" title="Download Unternehmensbroschuere_englisch.pdf">Company brochure <span class="size">(431.3 KiB)</span></a> </div> <div class="ce_download download block"> <img src="/files/userImages/icons/icon-pdf.png" width="20" height="21" alt="" class="mime_icon"> <a href="contact/contact-form.html?file=files/userFiles/pdf/Supplier_information_form.pdf" title="Supplier Information Form">Supplier Information Form <span class="size">(74.3 KiB)</span></a> </div> </div> </div> </div>  <aside id="right"> <div class="inside"> <div class="mod_article first last block" id="article-214"> <div class="ce_image first block"> <figure class="image_container"> <img src="files/userImages/teaser/teaser-gebaeude.jpg" width="300" height="300" alt="Adresse"> </figure> </div> <div class="ce_text Absatz Kontakt first last block"> <h2>We are there for you!</h2> <p><strong>Contact</strong><br><img src="files/userImages/icons/icon-phone.png" alt="Telefon" width="16" height="16"> <a href="tel:+49 6221 84 44 0">+49 6221 84 44 0</a><br><img src="files/userImages/icons/icon-mail.png" alt="E-Mail" width="16" height="16"> <a href="mailto:info@concept-heidelberg.de" class="email">info@concept-heidelberg.de</a></p> </div> </div> </div> </aside>  </div>  <a 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class="submenu Footer" aria-haspopup="true">Conferences</a> <ul class="level_2"> <li class="first last"><a href="conferences/international-conferences.html" title="International Conferences" class="first last">International Conferences</a></li> </ul> </li> <li class="submenu Footer"><a href="service/consulting.html" title="Services" class="submenu Footer" aria-haspopup="true">Services</a> <ul class="level_2"> <li class="first"><a href="service/consulting.html" title="Consulting" class="first">Consulting</a></li> <li><a href="service/gmp-certification-europe.html" title="GMP Certification">GMP Certification</a></li> <li><a href="service/apic-audit-programme.html" title="APIC Audit Programme">APIC Audit Programme</a></li> <li><a href="service/pharmschul.html" title="PharmSchul">PharmSchul</a></li> <li><a href="service/gmp-reports.html" title="GMP Reports">GMP Reports</a></li> <li><a href="service/gmp-journal.html" title="GMP Journal">GMP Journal</a></li> <li><a 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