87 lines
4.9 KiB
HTML
87 lines
4.9 KiB
HTML
<section>
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<div class="container py-5">
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<div class="row">
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<div class="col-md-6">
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<p class="h6 text-primary">Neem contact op</p>
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<h2 class="display-3">Benieuwd naar de mogelijkheden?</h2>
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<div class="row g-4">
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<div class="col-12 d-flex align-items-start">
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<div class="contact-icon-circle me-3">
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<i class="bi bi-telephone-fill"></i> </div>
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<div>
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<h5 class="fw-bold mb-1">Telefoon</h5>
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<p class="mb-0 text-muted"><a href="+31341275147" class="text-muted numbers">0341 - 275 147</a> </p>
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</div>
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</div>
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<div class="col-12 d-flex align-items-start">
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<div class="contact-icon-circle me-3">
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<i class="bi bi-envelope-fill"></i>
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</div>
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<div>
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<h5 class="fw-bold mb-1">E-mail</h5>
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<p class="mb-0 text-muted"><a href="info@vanemousmantelzorgwoningen.nl" class="text-muted">info@vanemousmantelzorgwoningen.nl</a></p>
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</div>
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</div>
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<div class="col-12 d-flex align-items-start">
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<div class="contact-icon-circle me-3">
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<i class="bi bi-geo-alt-fill"></i>
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</div>
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<div>
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<h5 class="fw-bold mb-1">Adres</h5>
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<p class="mb-0 text-muted"><a href="https://www.google.com/maps/place/Keizerswoert+19,+3881+LE+Putten/@52.2688553,5.5817873,17z/data=!3m1!4b1!4m6!3m5!1s0x47c6367cdb1ed75f:0x3ee3272c1a65f9ac!8m2!3d52.268852!4d5.5843622!16s%2Fg%2F11c16gl4zp?entry=ttu&g_ep=EgoyMDI2MDIyNS4wIKXMDSoASAFQAw%3D%3D" class="text-muted"> Keizerswoert <span class="numbers">19</span>, <span class="numbers">3881</span> LE Putten</a></p>
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</div>
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</div>
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</div>
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</div>
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<div class="col-md-6">
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<form action="jouw-verwerkings-url" method="POST">
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<div class="row g-4">
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<div class="col-md-6">
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<label for="voornaam" class="form-label">Voornaam</label>
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<input type="text" class="form-control rounded-pill bg-light border-0" id="voornaam" name="voornaam" required aria-required="true">
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</div>
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<div class="col-md-6">
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<label for="achternaam" class="form-label">Achternaam</label>
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<input type="text" class="form-control rounded-pill bg-light border-0" id="achternaam" name="achternaam" required aria-required="true">
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</div>
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<div class="col-md-6">
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<label for="email" class="form-label">E-mailadres</label>
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<input type="email" class="form-control rounded-pill bg-light border-0" id="email" name="email" required aria-required="true">
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</div>
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<div class="col-md-6">
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<label for="telephone" class="form-label">Telefoon</label>
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<input type="tel" class="form-control rounded-pill bg-light border-0" id="telephone" name="telephone" required aria-required="true">
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</div>
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<div class="col-12">
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<label for="bericht" class="form-label">Uw bericht</label>
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<textarea id="bericht" name="bericht" class="form-control bg-light border-0" rows="6" required aria-required="true"></textarea>
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</div>
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<div class="col-12">
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<div class="form-check mb-2">
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<input class="form-check-input" type="checkbox" id="nieuwsbrief" name="nieuwsbrief" checked>
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<label class="form-check-label" for="nieuwsbrief">
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Ja, ik meld mij aan voor de nieuwsbrief en blijf graag op de hoogte.
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</label>
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</div>
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<div class="">
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<p id="privacy-notitie" class="py-2 small">U gaat bij verzenden akkoord met de verwerking van uw gegevens zoals beschreven in het privacybeleid.</p>
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<button type="submit" class="btn btn-cta" aria-describedby="privacy-notitie">Verstuur aanvraag</button>
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</div>
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</div>
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</div>
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</form>
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</div>
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</div>
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</div>
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</section> |