« ZURÜCK ZUR FORMULARÜBERSICHT


4 Forms
1. Contact form
2. Appointment form
3. Reservation form
4. Booking form

Created with version 6.1.12
Compatible with: M4 + M5
Browser test: Chrome, Edge, Firefox
Update: Januar 2026

On request: We would be happy to create a complete form for you according to your specifications. Send us your enquiry.

4 Forms

M5 Block / supportm5

INTEGRATION
All forms are inserted into an MBR text block
and are ready for immediate use.
All functions are integrated into the HTML code and CSS
This means that when the form is published, it is transferred in its entirety (encrypted) and sent to a European server
You will receive the form at the email address you provided
(We require this – your address – to set up the form.)
The sender automatically receives a copy.

FUNCTIONALITY
• Form block can be inserted anywhere on any page
• Captcha spam protection
• Additional time query
• Data protection notice
• Imprint

GOOD TO KNOW:
You cannot modify a form in the function.
If you wish to do so, please select:
My desired form ➜

DELIVERY: As mobirise.project.zip
PRICE FOR MOBIRISE USERS: 4 forms for 15.00 €
SHIPPING: Online, by email
PAYMENT: PayPal (order form)

Free trial-Contactform ➜ Free trial-Appointmentform ➜ Free trial-Reservationform ➜ Free trial-Bookingform ➜ My wish form ➜ Buy 4 forms ➜

CONTACTFORMULAR (ENGLISCH)

PLEASE TEST this contact form  

General enquiry

General enquiry

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I consent to my contact details being stored permanently for the purpose of contacting me and assigning any queries. Note: You can revoke this consent at any time with future effect by sending an email to: notiz24@online.de. We (agentur28) assure you that your data will be treated with the utmost confidentiality and will only be used for internal purposes. Your data will not be passed on to third parties under any circumstances. Please read our privacy policy.

* Required fields

Spam protection: Please enter the characters displayed in the spam protection field.
Click to generate a new character string. Upper and lower case letters can be ignored.
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IMPRINT
agentur28
Claus Juntke
Birkenweg 25
28865 Lilienthal
Telefon: 04298 - 69 70 42
Mobil: 0152 - 295 60 563

APPOINTMENT FORM (ENGLISCH)

PLEASE TEST this APPOINTMENT FORM  

Appointment request

Appointment request

Standardformular-Terminanfrage

About you

Appointment selection

Next available appointment

Additional information

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I agree that my contact details and allocation information may be stored permanently for the purpose of responding to any queries. Note: You can revoke this consent at any time with future effect by sending an email to: mail@agentur28.de. We (agentur28) assure you that your data will be treated with the utmost confidentiality and will only be used for internal purposes. Your data will not be passed on to third parties under any circumstances. Please read our privacy policy.

* Pflichtfelder

SPAM PROTECTION: Please enter the characters displayed in the spam protection field.
Green circle arrow: Click to generate a new string of characters. Upper and lower case letters can be ignored.
captcha Neu laden

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RESERVATION FORM (ENGLISCH)

PLEASE TEST this RESERVATION FORM

Reservation

Reservation request

Personal details

Table request

Adults
We are happy to provide high chairs or set up a children's table on request.
(optional) e.g. birthday, wedding anniversary, company celebration

Additional information/requests

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I agree that my contact details and allocation information may be stored permanently for the purpose of responding to any queries. Note: You can revoke this consent at any time with future effect by sending an email to: mail@agentur28.de. We (agentur28) assure you that your data will be treated with the utmost confidentiality and will only be used for internal purposes. Your data will not be passed on to third parties under any circumstances. Please read our privacy policy.

* Pflichtfelder

SPAM PROTECTION: Please enter the characters displayed in the spam protection field.
Green circle arrow: Click to generate a new string of characters. Upper and lower case letters can be ignored.
Input field Spam protection
captcha Neu laden

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BOOKING FORM (ENGLISCH)

PLEASE TEST this BOOKING FORM 

booking request

Booking request

Your travel dates

Personal details

Special requests

0 / 500
I agree that my contact and allocation details may be stored permanently for the purpose of any queries. Note: You can revoke this consent at any time with future effect by sending an email to: mail@agentur28.de. We (agentur28) assure you that your data will be treated with the utmost confidentiality and will only be used for internal purposes. Your data will not be passed on to third parties under any circumstances. Please read our privacy policy.

* Pflichtfelder

SPAM PROTECTION: Please enter the characters displayed in the spam protection field.
Green circular arrow: Click to generate a new character string. Upper and lower case letters can be ignored.
Spam protection input field
captcha

KONTAKT

agentur28

Inhaber: Claus Juntke
Birkenweg 25
28865 Lilienthal
© 2003 -2025 Claus Juntke 

Die agentur28 erstellt Webseiten/Homepages auch in Bremen, Bremerhaven, Lilienthal, Grasberg, Ritterhude, Fischerhude, Worpswede, Ottersberg, Sottrum, Horstedt, Verden, Hoya, Osterholz-Scharmbeck, Wilstedt, in ganz Niedersachsen. Natürlich national und international. Für alle Bildschirme, vom kleinsten Smartphone bis zum größten Desktop.