<div id="contactform">
    <form id="contactformForm" action="<?php $_SERVER['PHP_SELF']; ?>" method="post">

        <label for="contact_naam">Name</label>
        <input type="text" id="contact_naam" value="Name" />

        <label for="contact_geslacht">Gender</label>

        <input type="radio" name="contact_geslacht" id="contact_geslacht_man" value="man" />
        <label id="contact_geslacht_manLabel" class="geslacht" for="contact_geslacht_man">Male</label>
        <input type="radio" name="contact_geslacht" id="contact_geslacht_vrouw" value="vrouw" />
        <label id="contact_geslacht_vrouwLabel" class="geslacht" for="contact_geslacht_vrouw">Female</label>

        <label for="contact_bedrijfsnaam">Company</label>
        <input type="text" id="contact_bedrijfsnaam" value="Company" />

        <label for="contact_telefoonnummer">Telephone number</label>
        <input type="text" id="contact_telefoonnummer" value="Telephone number" />

        <label for="contact_emailadres">E-mail</label>
        <input type="text" id="contact_emailadres" value="E-mail" />

        <label for="contact_opmerkingen" class="textareaLabel">Your question/remark</label>
        <textarea id="contact_opmerkingen">Your question/remark</textarea>

        <input type="hidden" id="contact_type" value="<?php if($pagina == "contact"){ echo("contact"); }else{ echo("offerte"); } ?>" />

        <input type="hidden" id="vorige_pagina" value="<?php echo($_SESSION['prev_page_url']); ?>" />

        <a <?php if($pagina == "contact"){ echo("onClick=\"_gaq.push(['_trackEvent', 'formulier', 'verstuur', 'contact']);\""); }else{ echo("onClick=\"_gaq.push(['_trackEvent', 'formulier', 'verstuur', 'offerte']);\""); } ?> class="contactformSubmit actionBtn knopMedium"><span class="text">Send</span><span class="up"></span><span class="hover"></span><span class="upRight"></span><span class="hoverRight"></span></a>
        <div id="foutmelding"><p>Please fill out all fields correctly.</p></div>
    </form>

</div>
<div id="contactformReplacement">
    <h2 class="blauw">Sent successfully</h2>
    <?php if($pagina == "contact"){ ?>
    <p>Many thanks for your interest Rooymans Neckwear!<br /><br />Your data have been sent successfully. You will receive a confirmation through e-mail.</p>
    <?php }else{ ?>
    <p>Many thanks for your interest in Rooymans Neckwear!<br /><br />Your request for a quotation has been successfully sent. You will receive a confirmation with additional information through e-mail.</p>
    <?php } ?>
</div>