Request: Request form

My request *

0 / 750

Please describe as precisely as possible how you would like us to design your form.

Which industry do you use the form for? *

Culture/Theater/Art Services Medicine/Fitness Crafts/Technology Construction People Miscellaneous

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If a similar form already exists, please provide us with three examples.
You can also show us your own draft here.

Homepage example 1

Please use this format: https://

Homepage example 2

Please use this format: https://

Homepage example 3

Please use this format: https://

You can now enter up to 3 email addresses to which the form will be sent.

Your primary recipient email address *

The form will be sent to this address

Additional, second email address

Enter an additional recipient address.

Additional, third email address

Enter an additional recipient address.

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Here you can determine which basic functions we should use. Multiple selections are permitted.

Selection of basic functions *

Imprint in the footer   Captcha spam protection   Without Captcha spam protection   Conversion to PDF   My font   No selection  

FONT

Please use only standard fonts, no exotic fonts

LANGUAGE *

Please enter here the language in which the form should be written.

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MY CONTACT DETAILS

First and last name *

Company name

URL of your website *

Enter the URL/domain to which the form will be transferred. Only one address is possible.

E-Mailadresse *

We use this address to notify you or send you an offer.

I am not a robot *

Please confirm that you are not a robot

Data protection *

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: info@agentur28.de. agentur28 assures you that it will treat this (your) data with the utmost confidentiality and use it only for internal purposes. It will not be disclosed to third parties. Please read our PRIVACY POLICY.

Captcha spam protection: Please enter the data shown on the right into this field. Upper/lower case letters can be ignored. Captcha - Green circle arrow generates new data.

Spam protection

IMPRINT
agentur28-Design for digital media
Claus Juntke
Birkenweg 25
28865 Lilienthal
Ust-IdNr.: DE263364940

T 04298-697042
M 0152-29569563
E mail@agentur28.de
https:/agentur28.de
https:/webdesign28.de
https://mobirise.webdesign28.de/mobirisewebdesign

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