document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub10.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=831633323&formid=3926&formpadding=100\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:831633323:10:3926\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Kontaktaufnahme zum Göttinger Bestattungshaus </div></div> <div class=\"bn-form-desc\"><p>Wir sind gerne für Sie da. Um Ihnen den bestmöglichen Service bieten zu können, möchten wir Sie bitten, in diesem Formular einige Angaben zu Ihrer Person vorzunehmen (bitte beachten Sie dabei besonders die Pflichtfelder, welche mit einem Sternchen (*) gekennzeichnet sind). Wir werden Ihre Anfrage so schnell wie möglich bearbeiten und beantworten.</p></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Titel </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-162471393235928\" placeholder=\"Optional\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Anrede <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-162471236836661[]\" required=\"required\"><option value=\"Frau\">Frau</option><option value=\"Herr\">Herr</option><option value=\"Bitte wählen\" selected=\"\">Bitte wählen</option></select></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Vollständiger Name <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"Vorname und Nachname\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Adresse <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-162471134259770\" placeholder=\"Straße, Hausnummer, Plz, Stadt\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">E-Mail <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"Hier eine gültige E-Mail Adresse eingeben\" validator=\"email\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Telefon Nummer <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-162469744629478\" placeholder=\"Telefon/Mobil\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Telefax Nummer </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-162471816778567\" placeholder=\"Optional\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Bitte angeben <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-1624736934503106\" value=\"Todesfall\"> <span class=\"bn-inner-label\">Todesfall</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-1624736934503106\" value=\"Bestattungsvorsorge\"> <span class=\"bn-inner-label\">Bestattungsvorsorge</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-1624736934503106\" value=\"Körperspende\"> <span class=\"bn-inner-label\">Körperspende</span></label></span><span class=\"bn-optionwrapper\"><label class=\"bn-radio\"><input type=\"radio\" name=\"Field-1624736934503106\" value=\"Allgemeine Information oder Fragen\"> <span class=\"bn-inner-label\">Allgemeine Information oder Fragen</span></label></span></span></div></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Wie sind Sie auf uns aufmerksam geworden? <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-162851119839077[]\" required=\"required\"><option value=\"Internetsuche\">Internetsuche</option><option value=\"Empfehlung\">Empfehlung</option><option value=\"Berichte oder Artikel\">Berichte oder Artikel</option><option value=\"Telefonbuch\">Telefonbuch</option><option value=\"Gelbe Seiten\">Gelbe Seiten</option><option value=\"Zeitungsanzeige\">Zeitungsanzeige</option><option value=\"Ich kenne sie schon\">Ich kenne sie schon</option><option value=\"Keine Angaben\">Keine Angaben</option><option value=\" Bitte wählen\" selected=\"\"> Bitte wählen</option></select></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Ihre Nachricht <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"Bitte den Text eingeben\" validator=\"\" required=\"required\"></textarea></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row rowcb\"><span class=\"bn-label\">Datenschutz <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><span class=\"bn-optionwrapper\"><label class=\"bn-checkbox\"><input type=\"checkbox\" name=\"Field-162471012123094[]\" value=\"Hiermit erkläre ich mich einverstanden, dass meine in das Kontaktformular eingegebenen Daten elektronisch gespeichert und zum Zweck der Kontaktaufnahme verarbeitet und genutzt werden. Mir ist bekannt, dass ich meine Einwilligung jederzeit widerrufen kann.\" required=\"required\"> <span class=\"bn-inner-label\">Hiermit erkläre ich mich einverstanden, dass meine in das Kontaktformular eingegebenen Daten elektronisch gespeichert und zum Zweck der Kontaktaufnahme verarbeitet und genutzt werden. Mir ist bekannt, dass ich meine Einwilligung jederzeit widerrufen kann.</span></label></span></span></div></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"Vielen Dank für Ihre Anfrage. ');
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