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<table width='675' border='0' cellpadding='1' cellspacing='0'><tr><td height='21' background='5.jpg'><strong>&nbsp;&nbsp;Contact</strong></td></tr><tr><td background='6.jpg'><table width='100%' border='0' cellspacing='0' cellpadding='1'><form name='form1' method='post' action=''><tr><td width='37%'>&nbsp;Naam*</td><td width='63%'> <input name='naam' type='text' size='40'> </td></tr><tr><td>&nbsp;Email*</td><td><input name='email' type='text' size='40'></td></tr><tr><td>&nbsp;Text*</td><td><textarea name='text' cols='40' rows='4'></textarea></td></tr><tr><td height='35'>&nbsp;</td><td><input type='submit' name='Submit' value='Verstuur'></td></tr></form></table></font></td></tr><tr><td background='6.jpg'><center><font size='1'>* verplichte velden</font></center></td></tr><tr><td height='3' background='7.jpg'></td></tr></table>