pvform4 - planetpetdiervoeding

<HTML><HEAD><META HTTP-EQUIV='content-type' CONTENT='text/html;charset = UTF-8'><META HTTP-EQUIV='X-UA-Compatible' CONTENT='IE=Edge' /><TITLE>Johnson Petfoods - Profine</TITLE><STYLE TYPE='text/css'>h1{font-size:20px;color:#c0392b;margin-bottom:0px;margin-top:0;}h2{font-size:15px;color:#34495e;margin-bottom:0px;margin-top:0;}.header{color: 808080; text-align:right;padding-bottom:5px;font-size:10px;text-decoration:none;margin-bottom:0px;margin-top:0;}.footer{padding-top:5px;font-size:10px;text-decoration:none;color:#3B5998;margin-bottom:0px;margin-top:0;}a.footer:link {padding-top:5px;font-size:10px;text-decoration:none;color:#3B5998;margin-bottom:0px;margin-top:0; }a.footer:visited {padding-top:5px;font-size:10px;text-decoration:none;color:#3B5998;margin-bottom:0px;margin-top:0; }a.footer:hover {padding-top:5px;font-size:10px;text-decoration:underline;color:#3B5998;margin-bottom:0px;margin-top:0; }a.footer:active {padding-top:5px;font-size:10px;text-decoration:none;color:#3B5998;margin-bottom:0px;margin-top:0; }.label {font-family:Helvetica, Arial, sans-serif; color: #000000;font-size:14px;}.field {font-family:sans-serif;font-size:16px;}.field30d27da4-06a4-4339-bbec-91c7084a7745 {font-family:sans-serif;font-size:16px;display:none}.helptext {font-family:Helvetica, Arial, sans-serif;font-size:12px; color: #000000;}.button{display:inline-block;font-family:'Helvetica', Arial, sans-serif;width:auto;white-space:nowrap;height:32px;margin:5px 5px 0 0;padding:0 22px;text-decoration:none;text-align:center;font-style:normal;font-size:15px;line-height:32px;cursor:pointer;border:0;-moz-border-radius:4px;border-radius:4px;-webkit-border-radius:4px;vertical-align:top;background-color:#2980b9;color:#ffffff}body{background-color:#EEEEEE;font: 11px 'Helvetica', Arial, sans-serif;}div.section { clear: left; }div.corner { width: 550px; padding-top:10px;padding-bottom:5px;padding-right:25px;padding-left:25px; margin: 0px; background: #FFFFFF; }TD {text-align:left;}TD.rightalligned {text-align:right;}.error { border-color:red; border-style:solid; border-width:1px;}input.text,input.title,input[type=email],input[type=password],input[type=tel],input[type=text],select,.field,option,textarea{font-size:11px; padding:14px; color:#4e4e4e; background-color:#f3f3f3; border: 1px solid #bbb;} label {display:block; font-size:11px; padding-bottom:10px;}td {padding-bottom:20px;} h3 {font-size:12px; padding:0; margin:0;}</STYLE><SCRIPT TYPE='text/javascript' src='https://ajax.googleapis.com/ajax/libs/jquery/1.6.1/jquery.min.js'></SCRIPT><SCRIPT TYPE='text/javascript' src='https://resources.perfectview.nl/jquery/jquery.corner.js'></SCRIPT><SCRIPT TYPE='text/javascript'>$(document).ready(function(){$('#wrapper').corner();});</SCRIPT><SCRIPT TYPE='text/javascript' src='https://resources.perfectview.nl/jquery/jquery-ui-1.8.13.custom.min.js'></SCRIPT><SCRIPT TYPE='text/javascript' src='https://resources.perfectview.nl/jquery/jquery.validate.min.js'></SCRIPT><SCRIPT TYPE='text/javascript' src='https://resources.perfectview.nl/jquery/jquery.validate.wrapper.js'></SCRIPT><SCRIPT TYPE='text/javascript' language='javascript'> $(document).ready(function () { var rules =  { '9d549512-dc8a-4774-84d1-27a349e8a8c7~#~Achternaam' : {required: true} , '102eb07f-7f0e-4cc9-87a7-e2b3988960cd~#~Prive emailadres' : {required: true, email: true}  }; var messages =  { '9d549512-dc8a-4774-84d1-27a349e8a8c7~#~Achternaam' : {required: 'Achternaam is verplicht!'} , '102eb07f-7f0e-4cc9-87a7-e2b3988960cd~#~Prive emailadres' : {required: 'Prive emailadres is verplicht!', email: 'Vul een correct e-mail adres in! '}  }; var validator = new jQueryValidatorWrapper('FormToValidate', rules, messages); $('#PROGRESS').hide(); $('#SEND').click(function ()  { if (!validator.validate()) { return; } else { $('#SEND').hide(); $('#PROGRESS').show(); } }); }); </SCRIPT> </HEAD> <BODY> <BR><CENTER>   <div id='wrapper' class='corner'> <FORM ACTION='https://webform.perfectview.nl/form.aspx' id="FormToValidate" NAME='PerfectView' METHOD='POST' ACCEPT-CHARSET='UTF-8' runat='server' enctype='multipart/form-data'> <INPUT TYPE='hidden' NAME='xc' VALUE='163cea86-bf5e-49c6-8b96-9ced1d1cfa79'/> <INPUT TYPE='hidden' NAME='db' VALUE='f02cb275-c18e-489e-9e05-3a39463350c8'/> <INPUT TYPE='hidden' NAME='returnURL' VALUE='https://profinediervoeding.nl'/>    <TABLE BORDER=0 CELLSPACING='5' CELLPADDING='0' WIDTH='550'> <TR><TD><h2>Uw Persoongegevens</h2></TR> <TR><TD style='width:540px'><label>Voorletter(s)</label><INPUT placeholder='Voorletter(s)' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='40' NAME='93dd860b-02d7-4795-a4e7-c4ce9b43d43d~#~Voorletter(s)' /></TD></TR> <TR><TD style='width:540px'><label>Roepnaam</label><INPUT placeholder='Roepnaam' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='100' NAME='17370a54-9ba9-4464-8ceb-c5cd90f3fcc0~#~Roepnaam' /></TD></TR> <TR><TD style='width:540px'><label>Tussenvoegsel(s)</label><INPUT placeholder='Tussenvoegsel(s)' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='20' NAME='2497cacc-e70e-4d66-8817-9f08ab44e938~#~Tussenvoegsel(s)' /></TD></TR>  <TR><TD style='width:540px'><label>Achternaam</label><INPUT placeholder='Achternaam' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='200' NAME='9d549512-dc8a-4774-84d1-27a349e8a8c7~#~Achternaam' /></TD></TR>   <TR><TD style='width:540px'><label>Straatnaam</label><INPUT placeholder='Prive adres straat' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='100' NAME='553defc5-5bb7-4deb-9267-96acdfa0c197~#~Prive adres straat' /></TD></TR> <TR><TD style='width:540px'><label>Huisnummer</label><INPUT placeholder='Prive adres huisnummer' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='20' NAME='3182174a-f331-4b76-b5fd-8fdbf2743f03~#~Prive adres huisnummer' /></TD></TR> <TR><TD style='width:540px'><label>Huisnummer toevoeging</label><INPUT placeholder='Prive adres huisnummer toevoeging' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='15' NAME='37f2a35d-da28-4dea-b0ca-2e97925d349d~#~Prive adres huisnummer toevoeging' /></TD></TR> <TR><TD style='width:540px'><label>Plaats</label><INPUT placeholder='Prive adres plaats' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='100' NAME='192486a6-8b99-476b-b851-7bd544be69a1~#~Prive adres plaats' /></TD></TR> <TR><TD style='width:540px'><label>Postcode</label><INPUT placeholder='Prive adres postcode' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='20' NAME='6881a2de-a855-4a19-9c68-e91e2da2aea8~#~Prive adres postcode' /></TD></TR> <TR><TD style='width:540px'><label>Extra adresregel</label><INPUT placeholder='Prive adres extra adresregel' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='100' NAME='b4e97428-9669-4316-a007-3b5989bef764~#~Prive adres extra adresregel' /></TD></TR> <TR><TD style='width:540px'><label>Land</label><SELECT style='width:540px' CLASS='field' NAME='87e892ef-d49b-4b1a-b9e1-5a0129a830fa~#~Prive adres land'><OPTION VALUE='f15531a1-c67f-4f7f-8733-2195f37b0b01~#~onbekend'>Selecteer</OPTION><OPTION VALUE='35ab5302-d21b-4a08-8e90-3651c25fc737~#~Afghanistan'>Afghanistan</OPTION><OPTION VALUE='0a716288-71fb-421f-9365-b23651aab662~#~Åland'>Åland</OPTION><OPTION VALUE='96b2cc8c-36d5-41d6-884f-408b48b039c1~#~Albanië'>Albanië</OPTION><OPTION VALUE='c5482e6d-c798-481d-9d16-faa1cb11aac6~#~Algerije'>Algerije</OPTION><OPTION VALUE='f38b1a0c-585a-4177-8449-56ad8b998b2a~#~Amerikaanse Maagdeneilanden'>Amerikaanse Maagdeneilanden</OPTION><OPTION VALUE='ebd1a04d-52a5-4bfb-b93e-b9c6c1bd1d37~#~Amerikaans-Samoa'>Amerikaans-Samoa</OPTION><OPTION VALUE='542d910c-2d89-45bf-aa4d-7249bce9b375~#~Andorra'>Andorra</OPTION><OPTION VALUE='539dd9ea-e46c-4b01-b269-776e8cfb5586~#~Angola'>Angola</OPTION><OPTION VALUE='4b24daf4-49f3-4c6f-8b47-e5469e822013~#~Anguilla'>Anguilla</OPTION><OPTION VALUE='ad7a8327-6429-4dd0-8915-ab9846a37ed3~#~Antarctica'>Antarctica</OPTION><OPTION VALUE='585ba8a9-58cc-4b7e-a1be-75dfccc492ea~#~Antigua en Barbuda'>Antigua en Barbuda</OPTION><OPTION VALUE='be2137bc-9aa5-48b0-a38c-70188d7dd8e3~#~Argentinië'>Argentinië</OPTION><OPTION VALUE='1fca520c-fee2-4efb-95bf-c1978d05b86f~#~Armenië'>Armenië</OPTION><OPTION VALUE='2716ff47-71b7-4083-884e-b3e5c5c5af66~#~Aruba'>Aruba</OPTION><OPTION VALUE='ea02613b-add3-402d-8f02-a0d47cda5072~#~Australië'>Australië</OPTION><OPTION VALUE='5dd27507-ca6c-4a86-9c8f-867fd1f3f7d6~#~Azerbeidzjan'>Azerbeidzjan</OPTION><OPTION VALUE='9a3cab97-5fa3-4c64-a931-134907f0e6dd~#~Bahama's'>Bahama's</OPTION><OPTION VALUE='49a291f8-88ae-4d22-974b-f7045c7e69a8~#~Bahrein'>Bahrein</OPTION><OPTION VALUE='a682b3b8-50e2-4e0f-955b-4bfa5accf6b8~#~Bangladesh'>Bangladesh</OPTION><OPTION VALUE='84e736d8-f681-4e6f-a1ea-6842a090c893~#~Barbados'>Barbados</OPTION><OPTION VALUE='c20446ca-640b-48e4-bc6b-682f01a17565~#~België'>België</OPTION><OPTION VALUE='3a42269d-2dfa-41f1-957c-ebdb0d2ce62f~#~Belize'>Belize</OPTION><OPTION VALUE='4516c9e2-21e8-49f2-ad5b-85bbc71a1674~#~Benin'>Benin</OPTION><OPTION VALUE='7c66eafc-c358-4596-a44a-a8c5bd607d07~#~Bermuda'>Bermuda</OPTION><OPTION VALUE='f33f2032-d87c-4544-8c82-5a4a9b245aaa~#~Bhutan'>Bhutan</OPTION><OPTION VALUE='0d71f3a6-ecaf-4a31-9d6b-26899625c948~#~Bolivia'>Bolivia</OPTION><OPTION VALUE='73a3b97c-380b-4a88-9cd4-e7d7b08faa92~#~Bosnië en Herzegovina'>Bosnië en Herzegovina</OPTION><OPTION VALUE='3b87e5ac-cc02-4643-b732-d491d0a8b583~#~Botswana'>Botswana</OPTION><OPTION VALUE='b1149d5e-16b3-4a47-acef-8ff1822ffd93~#~Bouvet'>Bouvet</OPTION><OPTION VALUE='65793225-8b7a-42b9-a7dc-cc16a3536235~#~Brazilië'>Brazilië</OPTION><OPTION VALUE='ca180719-87c8-4642-a1e4-f4b54756edf9~#~Brits Territorium in de Indische Oceaan'>Brits Territorium in de Indische Oceaan</OPTION><OPTION VALUE='59c4ed78-5ae2-4d72-88a3-ebe36f374a57~#~Britse Maagdeneilanden'>Britse Maagdeneilanden</OPTION><OPTION VALUE='b46a64ca-d119-4427-b121-90e95a63dcb6~#~Brunei'>Brunei</OPTION><OPTION VALUE='001b6682-2ef7-4c9a-9781-caf9e492e5ef~#~Bulgarije'>Bulgarije</OPTION><OPTION VALUE='882d5302-f1a2-4f79-b230-8bae03f07961~#~Burkina Faso'>Burkina Faso</OPTION><OPTION VALUE='99050b01-db38-4cd8-a764-a1e483e5f8e8~#~Burundi'>Burundi</OPTION><OPTION VALUE='438d27e0-683d-48f3-ba73-ec93b4ebbc9c~#~Cambodja'>Cambodja</OPTION><OPTION VALUE='3e412884-8fdb-4422-84bf-65ce5158fa57~#~Canada'>Canada</OPTION><OPTION VALUE='3c2d81a6-074f-4150-a58d-6fcafde48d22~#~Caribisch Nederland'>Caribisch Nederland</OPTION><OPTION VALUE='9f8d8dc0-959d-438c-8496-21e3feebc2d6~#~Centraal-Afrikaanse Republiek'>Centraal-Afrikaanse Republiek</OPTION><OPTION VALUE='94659da9-6ab0-45bc-b5bb-1170f3dc7879~#~Chili'>Chili</OPTION><OPTION VALUE='d3e5c6e2-a0de-4dfd-ba84-3c31b5136b31~#~China'>China</OPTION><OPTION VALUE='58d3c2a0-dd55-4e74-a720-b686b5763356~#~Christmaseiland'>Christmaseiland</OPTION><OPTION VALUE='5617d2ed-3989-4f44-8333-6f7dfc6856d1~#~Cocoseilanden'>Cocoseilanden</OPTION><OPTION VALUE='90cb132e-8b7c-4cd8-8726-b23e4ae22943~#~Colombia'>Colombia</OPTION><OPTION VALUE='94f00650-8ed1-4f19-9f8b-b8fc69275641~#~Comoren'>Comoren</OPTION><OPTION VALUE='cff50dce-9336-4da1-b081-e8d94c55f66d~#~Congo-Brazzaville'>Congo-Brazzaville</OPTION><OPTION VALUE='c61ee431-e958-4de0-b2d6-348b1c695e3e~#~Congo-Kinshasa'>Congo-Kinshasa</OPTION><OPTION VALUE='26cf3659-49ee-4939-953f-17d9f55b8fdc~#~Cookeilanden'>Cookeilanden</OPTION><OPTION VALUE='ca3ab21a-6514-461d-9034-45f74fefc780~#~Costa Rica'>Costa Rica</OPTION><OPTION VALUE='2c8b8030-5349-4639-8c45-6463afa25942~#~Cuba'>Cuba</OPTION><OPTION VALUE='847360e4-50d3-4003-8498-2ba2125a09f8~#~Curaçao'>Curaçao</OPTION><OPTION VALUE='a4ac2473-1613-4be3-ad26-d38bb7e6df85~#~Cyprus'>Cyprus</OPTION><OPTION VALUE='eb881745-b538-4637-af33-96e65bd44643~#~Denemarken'>Denemarken</OPTION><OPTION VALUE='ca77b4e0-d909-4d44-8aa8-16948d87b32e~#~Djibouti'>Djibouti</OPTION><OPTION VALUE='889d6d2e-d83c-4199-9022-8fe74fc2d0a9~#~Dominica'>Dominica</OPTION><OPTION VALUE='5dcd9d16-a6ad-40f1-a4cd-f742c828e826~#~Dominicaanse Republiek'>Dominicaanse Republiek</OPTION><OPTION VALUE='278b5e9a-87ee-4d3c-b275-0c9bd1ccbd60~#~Duitsland'>Duitsland</OPTION><OPTION VALUE='ec884f12-2001-48aa-8743-1cf2deebae97~#~Ecuador'>Ecuador</OPTION><OPTION VALUE='066897f9-c9c0-43fb-9992-b4323b20f89f~#~Egypte'>Egypte</OPTION><OPTION VALUE='697ab09a-3360-42c1-81cb-cfce883086d4~#~El Salvador'>El Salvador</OPTION><OPTION VALUE='a784b742-234c-4dd9-82e2-bceaf1d51522~#~Equatoriaal-Guinea'>Equatoriaal-Guinea</OPTION><OPTION VALUE='60edc837-a803-484a-a9af-f1dbcc4b2aa6~#~Eritrea'>Eritrea</OPTION><OPTION VALUE='46ce5d63-42da-4b9e-a9cd-ad74446d4362~#~Estland'>Estland</OPTION><OPTION VALUE='d13e13ac-6378-4c43-9fac-c6e3477a5dea~#~Ethiopië'>Ethiopië</OPTION><OPTION VALUE='c9da6859-d02f-4ba8-9a72-2fc389173427~#~Faeröer'>Faeröer</OPTION><OPTION VALUE='829ebe38-6280-45fc-b377-df79d85c0c34~#~Falklandeilanden'>Falklandeilanden</OPTION><OPTION VALUE='672b5487-8b86-44e8-be41-75ff69635695~#~Fiji'>Fiji</OPTION><OPTION VALUE='3027b521-6c31-44e0-ab57-12ecc5335358~#~Filipijnen'>Filipijnen</OPTION><OPTION VALUE='2b06e93a-5bb5-4a1d-95c4-1abb2df508a6~#~Finland'>Finland</OPTION><OPTION VALUE='044f9e00-1007-4cd2-b666-ac1e9072a315~#~Frankrijk'>Frankrijk</OPTION><OPTION VALUE='aca3fac1-d7f5-474a-b809-aa8b015233f8~#~Franse Zuidelijke en Antarctische Gebieden'>Franse Zuidelijke en Antarctische Gebieden</OPTION><OPTION VALUE='f72a7a91-82fb-448a-a80f-4c77e1f14c07~#~Frans-Guyana'>Frans-Guyana</OPTION><OPTION VALUE='74cdb780-26b0-4f5b-bf19-ed773e5df090~#~Frans-Polynesië'>Frans-Polynesië</OPTION><OPTION VALUE='3b8bd097-eda3-4e55-8459-32c20c436f5b~#~Gabon'>Gabon</OPTION><OPTION VALUE='9c78aaeb-e791-4d04-8d5e-0b75a8dccf57~#~Gambia'>Gambia</OPTION><OPTION VALUE='886ddd70-ae05-4542-9d29-d926dd9b3af3~#~Georgië'>Georgië</OPTION><OPTION VALUE='a30e6638-1be6-4bdd-a996-5e89f885e353~#~Ghana'>Ghana</OPTION><OPTION VALUE='9abfbea8-7c2e-4c24-9cb2-418e1c9c00e6~#~Gibraltar'>Gibraltar</OPTION><OPTION VALUE='27b10092-0943-487e-968d-c9eb8c588327~#~Grenada'>Grenada</OPTION><OPTION VALUE='acb1d280-28e0-4b20-b717-87758b8ad7a1~#~Griekenland'>Griekenland</OPTION><OPTION VALUE='93461594-0952-4c6b-abf9-ecd793a7f3fd~#~Groenland'>Groenland</OPTION><OPTION VALUE='0f2f9dd6-f0fc-44bc-a3cc-44413af81e5a~#~Guadeloupe'>Guadeloupe</OPTION><OPTION VALUE='68685f2c-e2d2-4276-a22e-eea42e5f7ee7~#~Guam'>Guam</OPTION><OPTION VALUE='c653488f-332e-44f7-9db0-23b1e3e88113~#~Guatemala'>Guatemala</OPTION><OPTION VALUE='59f748d9-812f-4c74-8d04-96e3d360d0e5~#~Guernsey'>Guernsey</OPTION><OPTION VALUE='51667291-31b6-45e7-bd1d-2576b9292cde~#~Guinee'>Guinee</OPTION><OPTION VALUE='52391152-9caf-4f39-9b80-74e6cf0b62c0~#~Guinee-Bissau'>Guinee-Bissau</OPTION><OPTION VALUE='f78b3d6b-30e6-4be2-ac43-cc3c2b00435f~#~Guyana'>Guyana</OPTION><OPTION VALUE='ba13358b-04f9-4c81-b259-beb62a0fe6a1~#~Haïti'>Haïti</OPTION><OPTION VALUE='09ff87b1-08ab-421a-843b-754cb83b5fc4~#~Heard en McDonaldeilanden'>Heard en McDonaldeilanden</OPTION><OPTION VALUE='a8d66e1a-655c-4f73-b2ea-7075eb0e5762~#~Honduras'>Honduras</OPTION><OPTION VALUE='4061fe27-d542-4d3b-a714-f054869dc293~#~Hongarije'>Hongarije</OPTION><OPTION VALUE='e4460cf7-a758-4eb4-8492-91d435601dc4~#~Hongkong'>Hongkong</OPTION><OPTION VALUE='37f9bd78-d781-4003-ac87-4faffe77348f~#~Ierland'>Ierland</OPTION><OPTION VALUE='1b36babb-b339-42f5-a6eb-957b6f84b4e9~#~IJsland'>IJsland</OPTION><OPTION VALUE='843f0385-01bb-4c20-acfd-584480987d9c~#~India'>India</OPTION><OPTION VALUE='94b937c9-cb0a-4c91-9bb7-cafe68b68773~#~Indonesië'>Indonesië</OPTION><OPTION VALUE='1d72ce7f-e01c-49d4-8bb7-4c0e101892b5~#~Irak'>Irak</OPTION><OPTION VALUE='16074b50-e8a3-47b5-9894-3642e6506b13~#~Iran'>Iran</OPTION><OPTION VALUE='62cb84d8-8c8d-49cc-9774-f2900287b9f9~#~Isle of Man'>Isle of Man</OPTION><OPTION VALUE='260448ea-4561-4a30-8b39-abbff1dc1e82~#~Israël'>Israël</OPTION><OPTION VALUE='8dd7a4a2-da12-4cb3-ab1b-2b82311c1c45~#~Italië'>Italië</OPTION><OPTION VALUE='67303bd0-84df-49db-aa1a-4d58a1d1c086~#~Ivoorkust'>Ivoorkust</OPTION><OPTION VALUE='7f2cf11d-f171-4733-9d8b-3fd6d4e3094b~#~Jamaica'>Jamaica</OPTION><OPTION VALUE='9e6a24ac-2b1b-4263-a934-530bc479d00e~#~Japan'>Japan</OPTION><OPTION VALUE='5c4aba08-b8ad-46c5-957e-b8c1584f9f6a~#~Jemen'>Jemen</OPTION><OPTION VALUE='233175f6-8385-478a-ac7f-5576bbdcee7d~#~Jersey'>Jersey</OPTION><OPTION VALUE='42823d11-703e-4006-afc0-63575ebfb15d~#~Jordanië'>Jordanië</OPTION><OPTION VALUE='2e254781-c69c-4cb7-8374-fef88b749976~#~Kaaimaneilanden'>Kaaimaneilanden</OPTION><OPTION VALUE='6a446a1a-6525-4574-a879-14fb7c8d5a49~#~Kaapverdië'>Kaapverdië</OPTION><OPTION VALUE='e1faf480-cf12-434c-9b49-9b9faf00f31c~#~Kameroen'>Kameroen</OPTION><OPTION VALUE='f3d6bfc3-5d46-4c32-8f48-186d79415122~#~Kazachstan'>Kazachstan</OPTION><OPTION VALUE='14ecfbb4-3ff1-4f1c-b61e-ec305737018a~#~Kenia'>Kenia</OPTION><OPTION VALUE='6d106c5d-fe41-4b5d-b873-1340b343de71~#~Kirgizië'>Kirgizië</OPTION><OPTION VALUE='9349b85b-8a7b-4dc7-81f4-f5bddba9af7f~#~Kiribati'>Kiribati</OPTION><OPTION VALUE='ddfdb26c-0dee-4cc2-8fbf-1bff2417e49e~#~Kleine Pacifische eilanden van de Verenigde Staten'>Kleine Pacifische eilanden van de Verenigde Staten</OPTION><OPTION VALUE='857913b2-f83c-4aba-b6aa-ba144bcbde7c~#~Koeweit'>Koeweit</OPTION><OPTION VALUE='1c4eeb00-47f3-4a9a-83b0-e1a41fe06928~#~Kroatië'>Kroatië</OPTION><OPTION VALUE='cba1737e-5b29-4223-8650-d84881b69e89~#~Laos'>Laos</OPTION><OPTION VALUE='ba1eaddd-01ae-44d5-ba0b-10bb2a15252f~#~Lesotho'>Lesotho</OPTION><OPTION VALUE='bb9a27b9-0f07-4966-979d-1f13990e1572~#~Letland'>Letland</OPTION><OPTION VALUE='90f27299-8df4-4b6d-91ab-2d1d27c3a043~#~Libanon'>Libanon</OPTION><OPTION VALUE='ca9ad960-0040-4473-8c52-08fc523d9fed~#~Liberia'>Liberia</OPTION><OPTION VALUE='7ae5fa1f-5b8d-4527-9437-d7ff42dd6fdb~#~Libië'>Libië</OPTION><OPTION VALUE='7b5b4955-9db6-4c26-8a9a-d8f11a9a2a62~#~Liechtenstein'>Liechtenstein</OPTION><OPTION VALUE='e186fef7-ebd3-45ae-b66a-590d70a46c69~#~Litouwen'>Litouwen</OPTION><OPTION VALUE='e0271110-66fe-4f31-a36a-f3dd27628709~#~Luxemburg'>Luxemburg</OPTION><OPTION VALUE='741fdbc9-9b1a-447f-8efe-7e22328a4596~#~Macau'>Macau</OPTION><OPTION VALUE='dad39133-a438-46e0-82c1-62c2b72479e2~#~Macedonië'>Macedonië</OPTION><OPTION VALUE='126e5a25-95f1-4959-8813-7b1ecb799d2e~#~Madagaskar'>Madagaskar</OPTION><OPTION VALUE='ddc9c58d-de46-4917-bf05-e7cdfe3efbd0~#~Malawi'>Malawi</OPTION><OPTION VALUE='be09c2c8-5e6d-4c08-bc6b-1e3e8ce080bf~#~Maldiven'>Maldiven</OPTION><OPTION VALUE='339c03a9-4e36-415b-970a-453314e9b65f~#~Maleisië'>Maleisië</OPTION><OPTION VALUE='75084f85-37a4-49e7-892c-679a436088d9~#~Mali'>Mali</OPTION><OPTION VALUE='13d42a30-79b9-4f98-b3cc-36ca110936fd~#~Malta'>Malta</OPTION><OPTION VALUE='65eda5e1-0048-479d-a61c-45c59b72b29e~#~Marokko'>Marokko</OPTION><OPTION VALUE='9c4b0058-3e64-4f1e-b99b-8817a588a5ea~#~Marshalleilanden'>Marshalleilanden</OPTION><OPTION VALUE='b64419e6-468b-43e1-a5e5-ef685af3fbda~#~Martinique'>Martinique</OPTION><OPTION VALUE='6196bc72-ddd8-4a2e-985e-0e8d2e560561~#~Mauritanië'>Mauritanië</OPTION><OPTION VALUE='71e939ce-1a9a-492d-a9f4-9f0549eefbba~#~Mauritius'>Mauritius</OPTION><OPTION VALUE='0069286c-8c2c-4a1a-bb4f-4e9faf4ec25b~#~Mayotte'>Mayotte</OPTION><OPTION VALUE='a42569db-0b13-4aaf-a9f1-e5ff4729f049~#~Mexico'>Mexico</OPTION><OPTION VALUE='3905f6fd-27d5-49d1-9662-814c85b520e2~#~Micronesia'>Micronesia</OPTION><OPTION VALUE='15145cc2-237f-415e-87e7-71d58ca74eac~#~Moldavië'>Moldavië</OPTION><OPTION VALUE='ac0078b5-dc2d-4f45-b3dd-84c4b223575a~#~Monaco'>Monaco</OPTION><OPTION VALUE='ca226619-66eb-4fea-84be-e4b6fbf15832~#~Mongolië'>Mongolië</OPTION><OPTION VALUE='3f2c84b9-7e48-45d5-8eac-658b11301749~#~Montenegro'>Montenegro</OPTION><OPTION VALUE='2ca04148-2e89-4956-9fc7-8e225ad61b0f~#~Montserrat'>Montserrat</OPTION><OPTION VALUE='372cbbfc-24cd-4da8-ae97-59c2d32cce24~#~Mozambique'>Mozambique</OPTION><OPTION VALUE='4a1897df-d37f-4cc7-a5cd-1c37d9189c7b~#~Myanmar'>Myanmar</OPTION><OPTION VALUE='a2f3e8e9-e161-4552-8626-30bca233d3a3~#~Namibië'>Namibië</OPTION><OPTION VALUE='60f9b84c-648e-4d17-bef0-666d9938446c~#~Nauru'>Nauru</OPTION><OPTION VALUE='dda99368-8a05-43f0-8b8a-b1860cf0a0b8~#~Nederland'>Nederland</OPTION><OPTION VALUE='146fa206-6aa3-4e60-b42c-5152349f2c0a~#~Nederlandse Antillen'>Nederlandse Antillen</OPTION><OPTION VALUE='8710f12b-aa42-4556-aca0-49a22ad5f4e3~#~Nepal'>Nepal</OPTION><OPTION VALUE='ad2e1a54-aa86-492a-ac59-34fd8ce36b40~#~Nicaragua'>Nicaragua</OPTION><OPTION VALUE='d3e23ad3-7d11-4d09-a0c1-87a14c4bee9d~#~Nieuw-Caledonië'>Nieuw-Caledonië</OPTION><OPTION VALUE='d6c77dd3-82b3-41c8-8452-31f00ffae413~#~Nieuw-Zeeland'>Nieuw-Zeeland</OPTION><OPTION VALUE='7504a2ec-05bd-462b-8ad5-efaea8383811~#~Niger'>Niger</OPTION><OPTION VALUE='91ac6d08-2c50-44bd-8715-0b0a167af592~#~Nigeria'>Nigeria</OPTION><OPTION VALUE='44c4023d-0d65-4151-bd9b-930de09eae2a~#~Niue'>Niue</OPTION><OPTION VALUE='f784d634-f3af-4463-b74b-bdb550e067a8~#~Noordelijke Marianen'>Noordelijke Marianen</OPTION><OPTION VALUE='c0d14e32-705c-423d-8bec-f74a0480f1fd~#~Noord-Korea'>Noord-Korea</OPTION><OPTION VALUE='8dc6377c-792a-4a38-ae75-cfff4ac05dd3~#~Noorwegen'>Noorwegen</OPTION><OPTION VALUE='917c40c9-49f1-490e-af35-fb8129349e78~#~Norfolk'>Norfolk</OPTION><OPTION VALUE='75945ec9-b479-48d1-aa92-091f664a9ab2~#~Oeganda'>Oeganda</OPTION><OPTION VALUE='0c1c650e-73ff-45e9-a130-0524feff926b~#~Oekraïne'>Oekraïne</OPTION><OPTION VALUE='744b71f9-a922-496b-a72e-7f215d4bec92~#~Oezbekistan'>Oezbekistan</OPTION><OPTION VALUE='457c5ebf-f57f-466a-8704-85d91a089d4a~#~Oman'>Oman</OPTION><OPTION VALUE='872fede7-dede-4417-84a6-e6763b8e618b~#~Oostenrijk'>Oostenrijk</OPTION><OPTION VALUE='a9cddecd-2031-454d-bc4b-a05040e830a8~#~Oost-Timor'>Oost-Timor</OPTION><OPTION VALUE='a45a9931-1002-48b9-9bd0-6bc38190a340~#~Pakistan'>Pakistan</OPTION><OPTION VALUE='6ea9adb0-97b6-4805-a5bc-d999ecd11f39~#~Palau'>Palau</OPTION><OPTION VALUE='53a0c9d0-0a2c-43cb-a5a6-82317d25e7b7~#~Palestijnse Autoriteit'>Palestijnse Autoriteit</OPTION><OPTION VALUE='19b2f137-0f0d-4c1c-879a-6434e989a2a1~#~Panama'>Panama</OPTION><OPTION VALUE='d46021b6-018c-4e3d-b2af-9b2ab8d2ba2d~#~Papoea-Nieuw-Guinea'>Papoea-Nieuw-Guinea</OPTION><OPTION VALUE='ddb46e67-556c-403f-975b-152e9a940b3c~#~Paraguay'>Paraguay</OPTION><OPTION VALUE='c627170b-760b-4c35-9e66-70bacd4c501e~#~Peru'>Peru</OPTION><OPTION VALUE='68baf62a-6190-4c1b-b7c7-1a1b7fb7aacd~#~Pitcairneilanden'>Pitcairneilanden</OPTION><OPTION VALUE='17a38dd2-cf6b-484f-ac9e-5ca5d5cb3526~#~Polen'>Polen</OPTION><OPTION VALUE='7403b574-3a8e-4ee8-86df-17a31ae021b9~#~Portugal'>Portugal</OPTION><OPTION VALUE='7b507377-3ea7-40c1-ad29-48afb0e50652~#~Puerto Rico'>Puerto Rico</OPTION><OPTION VALUE='8f476080-04f1-4fa9-92ac-e966678202b5~#~Qatar'>Qatar</OPTION><OPTION VALUE='3c2d81a6-074f-4150-a58d-6fcafde48d23~#~Republiek Kosovo'>Republiek Kosovo</OPTION><OPTION VALUE='13729464-bb10-409b-9aa9-b3c8dd3df3c1~#~Réunion'>Réunion</OPTION><OPTION VALUE='e162ae32-c7ef-47d8-8956-cc386ad120b9~#~Roemenië'>Roemenië</OPTION><OPTION VALUE='35980335-c99c-4279-bbb9-b54c0b958615~#~Rusland'>Rusland</OPTION><OPTION VALUE='344d9c12-5ed6-423a-a3df-b332650c63cc~#~Rwanda'>Rwanda</OPTION><OPTION VALUE='5f035e7e-3d27-4397-a5da-c0823d642469~#~Saint Kitts en Nevis'>Saint Kitts en Nevis</OPTION><OPTION VALUE='0d043ae8-aef1-4efe-b2af-2db41c36296a~#~Saint Lucia'>Saint Lucia</OPTION><OPTION VALUE='01d2d509-becf-41e1-bed4-5799c32e9143~#~Saint Vincent en de Grenadines'>Saint Vincent en de Grenadines</OPTION><OPTION VALUE='655a4592-b333-499c-b965-3876f1d7150a~#~Saint-Barthélemy'>Saint-Barthélemy</OPTION><OPTION VALUE='6b68c6bb-df56-4a47-a922-da6c1bb3dab5~#~Saint-Pierre en Miquelon'>Saint-Pierre en Miquelon</OPTION><OPTION VALUE='5d343da5-28d9-403e-8783-d60aeb4068a8~#~Salomonseilanden'>Salomonseilanden</OPTION><OPTION VALUE='f6a25220-178a-467d-bef0-908278c1350c~#~Samoa'>Samoa</OPTION><OPTION VALUE='ee5ef78d-2b3f-45aa-afac-83824cc451bb~#~San Marino'>San Marino</OPTION><OPTION VALUE='a01eb9c1-2779-4014-aa35-ce91a4205ac7~#~Sao Tomé en Principe'>Sao Tomé en Principe</OPTION><OPTION VALUE='5e06cc86-586c-40d2-90ac-151eb58264d5~#~Saoedi-Arabië'>Saoedi-Arabië</OPTION><OPTION VALUE='d93afe25-df11-4c59-858a-88ba341f6eb8~#~Senegal'>Senegal</OPTION><OPTION VALUE='eceb2b53-d585-44fc-91ab-c6942e6a1f72~#~Servië'>Servië</OPTION><OPTION VALUE='393bd761-9e72-45d2-85c0-e4191e2a4735~#~Seychellen'>Seychellen</OPTION><OPTION VALUE='f8390bba-dbac-40bb-bdd4-f6949ac409da~#~Sierra Leone'>Sierra Leone</OPTION><OPTION VALUE='24da3101-602f-4907-8ad8-fb9f19339f73~#~Singapore'>Singapore</OPTION><OPTION VALUE='d6ba6ef8-f1e0-47ac-9bb3-b27b71734e33~#~Sint Maarten'>Sint Maarten</OPTION><OPTION VALUE='813a8201-b57f-449f-8082-7793a7bb693a~#~Sint-Helena, Ascension en Tristan da Cunha'>Sint-Helena, Ascension en Tristan da Cunha</OPTION><OPTION VALUE='c5535306-a029-4830-9be6-8d66b80efd8a~#~Sint-Maarten'>Sint-Maarten</OPTION><OPTION VALUE='e7a4b911-8bc1-4626-a789-db239eb55ec0~#~Slovenië'>Slovenië</OPTION><OPTION VALUE='d9353107-5080-490a-8088-5a22c5581b26~#~Slowakije'>Slowakije</OPTION><OPTION VALUE='58722026-608a-446d-94c0-3f7a8b6e269a~#~Soedan'>Soedan</OPTION><OPTION VALUE='de0bfebf-de63-48ae-b885-572860b3be66~#~Somalië'>Somalië</OPTION><OPTION VALUE='1b286903-4d50-4ed4-9381-e4f615127a84~#~Spanje'>Spanje</OPTION><OPTION VALUE='b1f30623-a420-4f6d-bb3a-5d968fd0b802~#~Spitsbergen en Jan Mayen'>Spitsbergen en Jan Mayen</OPTION><OPTION VALUE='0bbf01b8-4271-41d4-9453-ab4eedbaf82b~#~Sri Lanka'>Sri Lanka</OPTION><OPTION VALUE='a6107998-abc1-42e0-8cb3-ce174931aee6~#~Suriname'>Suriname</OPTION><OPTION VALUE='ac1e4502-0084-4cc2-bf1a-d83562af3baa~#~Swaziland'>Swaziland</OPTION><OPTION VALUE='3a757998-35ed-48cd-8da9-ace2c10148ba~#~Syrië'>Syrië</OPTION><OPTION VALUE='9f488fb1-b8db-429a-904d-8c72f0f63aaa~#~Tadzjikistan'>Tadzjikistan</OPTION><OPTION VALUE='2fdad6bc-696d-4d2e-84f3-886f18a25056~#~Taiwan'>Taiwan</OPTION><OPTION VALUE='eabf3846-1f1d-49bf-a44a-47ff997fc683~#~Tanzania'>Tanzania</OPTION><OPTION VALUE='1c442302-b29b-4eca-b41e-c4db1f093c9c~#~Thailand'>Thailand</OPTION><OPTION VALUE='8c6f1197-a66d-4ca2-bed5-5cc3dbfd334e~#~Togo'>Togo</OPTION><OPTION VALUE='1d4d9eb0-33e1-4093-92e8-9c09aefc46d2~#~Tokelau-eilanden'>Tokelau-eilanden</OPTION><OPTION VALUE='9d040916-68de-4bb5-b377-9cf3af198789~#~Tonga'>Tonga</OPTION><OPTION VALUE='0cc8f8af-24eb-409c-9b4b-1a70527cb624~#~Trinidad en Tobago'>Trinidad en Tobago</OPTION><OPTION VALUE='cec73af8-d262-4fea-854d-2649b5888fdb~#~Tsjaad'>Tsjaad</OPTION><OPTION VALUE='136fd412-6203-4239-beab-270e7adf25ec~#~Tsjechië'>Tsjechië</OPTION><OPTION VALUE='6eb65f52-74d3-49d9-be02-ed441587a946~#~Tunesië'>Tunesië</OPTION><OPTION VALUE='9dfe85ce-7a0e-4558-8a30-b6a42933a3bd~#~Turkije'>Turkije</OPTION><OPTION VALUE='0dfcf897-785a-49f3-a170-0dd093ab5226~#~Turkmenistan'>Turkmenistan</OPTION><OPTION VALUE='7143fde2-9a69-4c94-9d73-7c9faff1ec05~#~Turks- en Caicoseilanden'>Turks- en Caicoseilanden</OPTION><OPTION VALUE='445e6f5d-c0af-4228-9d25-8fc6d2527e18~#~Tuvalu'>Tuvalu</OPTION><OPTION VALUE='2f3da2ff-e9ad-4907-b97f-ac7e903fba38~#~Uruguay'>Uruguay</OPTION><OPTION VALUE='031213ca-9cf1-4b98-bbb8-134b2cf7b4ec~#~Vanuatu'>Vanuatu</OPTION><OPTION VALUE='7b1413d4-ce18-469d-83fe-76d8ef93202e~#~Vaticaanstad'>Vaticaanstad</OPTION><OPTION VALUE='9e286f5a-32a6-4284-9570-d4ddeb7261af~#~Venezuela'>Venezuela</OPTION><OPTION VALUE='ba08bb1e-3a45-4b63-8cbd-e17c2f8fb184~#~Verenigd Koninkrijk'>Verenigd Koninkrijk</OPTION><OPTION VALUE='6965e610-6aa0-44a2-ae28-71a7ccdc6003~#~Verenigde Arabische Emiraten'>Verenigde Arabische Emiraten</OPTION><OPTION VALUE='45eee91b-a60e-4e3d-bd86-12458ba24dbb~#~Verenigde Staten'>Verenigde Staten</OPTION><OPTION VALUE='151952d9-8c1f-4b95-8c3a-1b14458d0478~#~Vietnam'>Vietnam</OPTION><OPTION VALUE='ca991c94-2148-4786-8345-76e32a8a2050~#~Wallis en Futuna'>Wallis en Futuna</OPTION><OPTION VALUE='a923712c-a7a6-49a2-8d3c-c4d051f631bc~#~Westelijke Sahara'>Westelijke Sahara</OPTION><OPTION VALUE='b3a5c7c5-51b4-4d43-86a2-e715982347fb~#~Wit-Rusland'>Wit-Rusland</OPTION><OPTION VALUE='a2916d62-fc17-463e-a243-6093af3f115c~#~Zambia'>Zambia</OPTION><OPTION VALUE='ca2eaee0-a4e4-4cc6-bc5e-47fe811bdeef~#~Zimbabwe'>Zimbabwe</OPTION><OPTION VALUE='fd869d96-b106-44e0-905a-0d2fc7c878bf~#~Zuid-Afrika'>Zuid-Afrika</OPTION><OPTION VALUE='6be9a23e-dc61-4d9f-b27e-ccaf0d8be337~#~Zuid-Georgia en de Zuidelijke Sandwicheilanden'>Zuid-Georgia en de Zuidelijke Sandwicheilanden</OPTION><OPTION VALUE='3007c1b2-432d-47c3-b103-6c41a8ab6a89~#~Zuid-Korea'>Zuid-Korea</OPTION><OPTION VALUE='9c7f4cfd-e656-4757-9e37-855c08476d31~#~Zuid-Soedan'>Zuid-Soedan</OPTION><OPTION VALUE='81274c3e-90d4-4720-877e-19fd15402b3a~#~Zweden'>Zweden</OPTION><OPTION VALUE='0c20f36b-63e6-4798-ad80-93b04d1d2295~#~Zwitserland'>Zwitserland</OPTION></SELECT></TD></TR>  <TR><TD style='width:540px'><label>Mobiel nummer</label><INPUT placeholder='Prive mobielnummer' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='255' NAME='12a5c609-ead9-46f2-84c6-34c4c0b00e1e~#~Prive mobielnummer' /></TD></TR> <TR><TD style='width:540px'><label>Telefoonnummer</label><INPUT placeholder='Prive telefoonnummer' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='100' NAME='0d84ea95-a5f5-46b0-9a78-ab9cba988bea~#~Prive telefoonnummer' /></TD></TR> <TR><TD style='width:540px'><label>E-mailadres</label><INPUT placeholder='Prive emailadres' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='255' NAME='102eb07f-7f0e-4cc9-87a7-e2b3988960cd~#~Prive emailadres' /></TD></TR>  <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='eddddec6-751d-4dfb-b854-e8f368732218~#~Geslacht'><OPTION VALUE='1~#~onbekend'>Selecteer</OPTION><OPTION VALUE='2~#~man'>man</OPTION><OPTION VALUE='3~#~vrouw'>vrouw</OPTION></SELECT></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='f1012ccd-949d-4406-b489-7e484c822cd5~#~Geboortedatum' /></TD></TR> <TR><TD style='width:540px'><label>Facebook</label><INPUT placeholder='Facebook' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='500' NAME='8ad1f2c9-bf30-4b2c-ae0f-cc98a2e909e1~#~Facebook' /></TD></TR> <TR><TD><h2>Informatie over uw honden</h2></TR> <TR><TD><h3>Hond 1</h3></TR> <TR><TD style='width:540px'><label>Naam</label><INPUT placeholder='Naam hond1' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='5bbb208e-f3d7-4d8e-8a34-4a433313b18d~#~Naam hond1' /></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum hond1' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='7cb6a19e-5189-4755-956a-2e02281a448d~#~Geboortedatum hond1' /></TD></TR> <TR><TD style='width:540px'><label>Ras</label><INPUT placeholder='Ras hond1' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='004146ea-9aee-49ec-93fd-ead62c0f6a31~#~Ras hond1' /></TD></TR> <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='9a340778-5efe-4f28-9306-44878755f2de~#~Geslacht hond1'><OPTION VALUE='3b243bfe-f4ee-4504-abea-22400e725bad~#~selecteer'>Selecteer</OPTION><OPTION VALUE='17f03c8e-b282-4e46-971f-047b8d2a6b6e~#~Reu'>Reu</OPTION><OPTION VALUE='7447e548-4d12-4358-83a4-b5028e655cbb~#~Teef'>Teef</OPTION></SELECT></TD></TR>  <TR><TD><h3>Hond 2</h3></TR> <TR><TD style='width:540px'><label>Naam</label><INPUT placeholder='Naam hond2' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='0f03f63e-4421-4183-998b-85d9b28a26f2~#~Naam hond2' /></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum hond2' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='fe110475-c9c6-4988-8392-eb6c330d72ba~#~Geboortedatum hond2' /></TD></TR> <TR><TD style='width:540px'><label>Ras</label><INPUT placeholder='Ras hond2' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='e4f3306d-3fa6-4866-9d13-503c71318a13~#~Ras hond2' /></TD></TR> <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='15f00c22-2f63-415f-9548-bbe0bb31c8cc~#~Geslacht hond2'><OPTION VALUE='3b243bfe-f4ee-4504-abea-22400e725bad~#~selecteer'>Selecteer</OPTION><OPTION VALUE='17f03c8e-b282-4e46-971f-047b8d2a6b6e~#~Reu'>Reu</OPTION><OPTION VALUE='7447e548-4d12-4358-83a4-b5028e655cbb~#~Teef'>Teef</OPTION></SELECT></TD></TR>  <TR><TD><h3>Hond 3</h3></TR>  <TR><TD style='width:540px'><label>Naam</label><INPUT placeholder='Naam hond3' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='ecc91a11-c212-4c0c-9f23-84eace041e25~#~Naam hond3' /></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum hond3' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='db6c974d-248c-454b-8a1b-ad5557b7db39~#~Geboortedatum hond3' /></TD></TR> <TR><TD style='width:540px'><label>Ras</label><INPUT placeholder='Ras hond3' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='df9853b2-77f7-413f-9992-776926362979~#~Ras hond3' /></TD></TR> <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='ccf05277-a803-4716-a726-8c845ddc87c2~#~Geslacht hond3'><OPTION VALUE='3b243bfe-f4ee-4504-abea-22400e725bad~#~selecteer'>Selecteer</OPTION><OPTION VALUE='17f03c8e-b282-4e46-971f-047b8d2a6b6e~#~Reu'>Reu</OPTION><OPTION VALUE='7447e548-4d12-4358-83a4-b5028e655cbb~#~Teef'>Teef</OPTION></SELECT></TD></TR>  <TR><TD><h3>Hond 4</h3></TR> <TR><TD style='width:540px'><label>Naam</label><INPUT placeholder='Naam hond4' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='c8b505ac-796f-4a48-ac38-5993434504e2~#~Naam hond4' /></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum hond4' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='def1ebc9-5015-4b90-8f1b-bbfd20490cf3~#~Geboortedatum hond4' /></TD></TR> <TR><TD style='width:540px'><label>Ras</label><INPUT placeholder='Ras hond4' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='972b7979-ad03-4de2-86d6-f7419dc99569~#~Ras hond4' /></TD></TR> <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='f7ae3240-81b1-406a-84f7-a6b7db0060ac~#~Geslacht hond4'><OPTION VALUE='3b243bfe-f4ee-4504-abea-22400e725bad~#~selecteer'>Selecteer</OPTION><OPTION VALUE='17f03c8e-b282-4e46-971f-047b8d2a6b6e~#~Reu'>Reu</OPTION><OPTION VALUE='7447e548-4d12-4358-83a4-b5028e655cbb~#~Teef'>Teef</OPTION></SELECT></TD></TR>   <TR><TD><h2>Informatie over uw katten</h2></TR> <TR><TD><h3>Kat 1</h3></TR>  <TR><TD style='width:540px'><label>Naam</label><INPUT placeholder='Naam kat1' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='32105db9-fdce-48b0-a85c-4840cb9d5932~#~Naam kat1' /></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum kat1' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='9ccbda98-3e2a-473a-a60f-54a2509084b6~#~Geboortedatum kat1' /></TD></TR> <TR><TD style='width:540px'><label>Ras</label><INPUT placeholder='Ras kat1' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='f8c74eb7-31ef-4360-8173-9d627145ad3c~#~Ras kat1' /></TD></TR> <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='377844f2-4b17-49cb-807b-9843ad0728f8~#~Geslacht kat1'><OPTION VALUE='0f3bf135-5d86-4652-987f-0aad089ae36f~#~selecteer'>Selecteer</OPTION><OPTION VALUE='60f446c9-7b38-4f27-9d50-f4344ec1df91~#~Kater'>Kater</OPTION><OPTION VALUE='f902f373-8ec0-464c-93b8-ba61c2ac1389~#~Poes'>Poes</OPTION></SELECT></TD></TR>  <TR><TD><h3>Kat 2</h3></TR>  <TR><TD style='width:540px'><label>Naam</label><INPUT placeholder='Naam kat2' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='99626a9a-35d1-46d3-bb64-a8163a1b6c2b~#~Naam kat2' /></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum kat2' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='ff2d5b3d-8af4-40e1-b9a1-92de4eccdbfe~#~Geboortedatum kat2' /></TD></TR> <TR><TD style='width:540px'><label>Ras</label><INPUT placeholder='Ras kat2' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='a6b7af10-c2e6-479d-91cf-6ea1e9d07108~#~Ras kat2' /></TD></TR> <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='4e3acdc2-54c3-4609-9410-9d5d8e42dad4~#~Geslacht kat2'><OPTION VALUE='0f3bf135-5d86-4652-987f-0aad089ae36f~#~selecteer'>Selecteer</OPTION><OPTION VALUE='60f446c9-7b38-4f27-9d50-f4344ec1df91~#~Kater'>Kater</OPTION><OPTION VALUE='f902f373-8ec0-464c-93b8-ba61c2ac1389~#~Poes'>Poes</OPTION></SELECT></TD></TR>  <TR><TD><h3>Kat 3</h3></TR>  <TR><TD style='width:540px'><label>Naam</label><INPUT placeholder='Naam kat3' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='914c0f9f-714a-42b9-bd17-c22ebba3ed88~#~Naam kat3' /></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum kat3' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='b6fa9bf8-6a4e-48ab-9886-31ad93eb0fa2~#~Geboortedatum kat3' /></TD></TR> <TR><TD style='width:540px'><label>Ras</label><INPUT placeholder='Ras kat3' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='5c18e046-0cfa-4ad8-ae59-89dbb846cbf4~#~Ras kat3' /></TD></TR> <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='c9a34a00-7eec-42ba-82fe-d3eba7759769~#~Geslacht kat3'><OPTION VALUE='0f3bf135-5d86-4652-987f-0aad089ae36f~#~selecteer'>Selecteer</OPTION><OPTION VALUE='60f446c9-7b38-4f27-9d50-f4344ec1df91~#~Kater'>Kater</OPTION><OPTION VALUE='f902f373-8ec0-464c-93b8-ba61c2ac1389~#~Poes'>Poes</OPTION></SELECT></TD></TR>  <TR><TD><h3>Kat 4</h3></TR>  <TR><TD style='width:540px'><label>Naam</label><INPUT placeholder='Naam kat4' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='0879b8ac-cbaa-40d8-8270-62cbbe6e24f5~#~Naam kat4' /></TD></TR> <TR><TD style='width:540px'><label>Geboortedatum</label><INPUT placeholder='Geboortedatum kat4' style='width:540px' CLASS='field' TYPE='date' value='2017-12-14' NAME='49950c4a-765d-477b-b313-4135fcdd371f~#~Geboortedatum kat4' /></TD></TR> <TR><TD style='width:540px'><label>Ras</label><INPUT placeholder='Ras kat4' style='width:540px' CLASS='field' TYPE='text' MAXLENGTH='250' NAME='af917d8c-5f85-4378-b41a-b3a7b09fba35~#~Ras kat4' /></TD></TR> <TR><TD style='width:540px'><label>Geslacht</label><SELECT style='width:540px' CLASS='field' NAME='0db6e9aa-863d-46dc-8d7b-d078d3786412~#~Geslacht kat4'><OPTION VALUE='0f3bf135-5d86-4652-987f-0aad089ae36f~#~selecteer'>Selecteer</OPTION><OPTION VALUE='60f446c9-7b38-4f27-9d50-f4344ec1df91~#~Kater'>Kater</OPTION><OPTION VALUE='f902f373-8ec0-464c-93b8-ba61c2ac1389~#~Poes'>Poes</OPTION></SELECT></TD></TR> </TABLE>  <TABLE BORDER=0 CELLSPACING='5' CELLPADDING='0' WIDTH='550'> <INPUT TYPE='hidden' NAME='9f2650d7-ea41-4c05-8755-383ef6609544~#~Onderwerp' VALUE='Opsturen spaarkaart Profine'/> <INPUT TYPE='hidden' NAME='cb6af200-741b-4368-8767-c2bb550bebe2~#~Type taak' VALUE='b95f342e-b750-40b1-86b0-7a9f69834928'/> </TABLE>  <TEXTAREA style='width:540px' CLASS='field30d27da4-06a4-4339-bbec-91c7084a7745' NAME=PVHP ROWS=5></TEXTAREA>  <TABLE BORDER=0 CELLSPACING='5' CELLPADDING='0' WIDTH='550'> <TR><TD><BR/><h2>Opmerkingen<h2><TEXTAREA style='width:540px' CLASS='field' NAME=REMARKS ROWS=5></TEXTAREA></TD></TR> </TABLE><BR>  <TABLE BORDER=0 CELLSPACING='5' CELLPADDING='0' WIDTH='550'> <TR><TD align='right'><INPUT ID='SEND' TYPE='submit' CLASS='button' NAME='SEND' VALUE='Versturen'/></TD></TR> </TABLE>  <TABLE ID='PROGRESS'> <TR ALIGN=LEFT VALIGN=MIDDLE><TD width='50px'><IMG src='https://resources.perfectview.nl/icons/48x48_icon_progress.gif'></TD><TD><h2>Uw aanvraag wordt verwerkt.</h2></TD></TR> </TABLE> </FORM><BR/> </BODY></HTML>