@if($errors->any())
@include('errors.list')
@endif
Ihre Anfrage
{!! Form::textarea('message', null, ['class' => 'form-control message', 'placeholder' => 'Ihre Nachricht*']) !!}
Persönliche Daten
{!! Form::select('title', ['herr' => 'Herr', 'frau' => 'Frau'], null, ['class' => 'form-control']) !!}
{!! Form::text('first_name', null, ['class' => 'form-control', 'placeholder' => 'Vorname']) !!}
{!! Form::text('last_name', null, ['class' => 'form-control', 'placeholder' => 'Nachname']) !!}
{!! Form::text('street', null, ['class' => 'form-control', 'placeholder' => 'Straße']) !!}
{!! Form::text('zipcode', null, ['class' => 'form-control', 'placeholder' => 'PLZ']) !!}
{!! Form::text('city', null, ['class' => 'form-control', 'placeholder' => 'Ort']) !!}
{!! Form::text('mobile', null, ['class' => 'form-control', 'placeholder' => 'Telefonnummer']) !!}
{!! Form::text('email', null, ['class' => 'form-control', 'placeholder' => 'E-Mail-Adresse*']) !!}
* Mit einem Stern gekennzeichnete Formularfelder sind Pflichtangaben.