{{#options.subHeadline}} <h3 class="contact-form-subheadline"> {{.}} </h3> {{/options.subHeadline}} {{#options.fields.emailAddressNew}} <div class="contact-form-row"> <div class="contact-form-row-item"> {{#options.fields.emailAddressOld}} <div class="contact-form-label {{options.mandetory.emailAddressOld}}"> Ihre alte E-Mail Adresse </div> <div class="contact-form-input"> <input type="text" name="emailAddressOld"/> </div> {{/options.fields.emailAddressOld}} </div> <div class="contact-form-row-item"> {{#options.fields.emailAddressNew}} <div class="contact-form-label {{options.mandetory.emailAddressNew}}"> Ihre neue E-Mail Adresse </div> <div class="contact-form-input"> <input type="text" name="emailAddressNew"/> </div> {{/options.fields.emailAddressNew}} </div> </div> <div class="contact-form-row hint-row"> <div class="hint-container"> Bitte füllen Sie die folgenden Felder aus, damit Ihre neuen Daten geändert werden können: </div> </div> {{/options.fields.emailAddressNew}} {{#options.fields.changeHint}} <div class="contact-form-row hint-row"> <div class="hint-container"> Bitte füllen Sie die folgenden Felder mit den jeweiligen <span class="contact-highlight">ALTEN</span> Daten aus, damit diese geändert werden können: </div> </div> {{/options.fields.changeHint}} <div class="contact-form-row"> {{#options.fields.customernumber}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.customernumber}}"> Kundennummer </div> <div class="contact-form-input"> <input type="text" name="customernumber"{{#data.data.bussinesPartnerNumber}} value="{{.}}"{{/data.data.bussinesPartnerNumber}} {{#data.businessPartnerNumber}} value="{{.}}"{{/data.businessPartnerNumber}}/> </div> </div> {{/options.fields.customernumber}} {{#options.fields.gender}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.gender}}"> Anrede </div> <div class="contact-form-input"> <select name="gender"> <option value="misses">Frau</option> <option value="mister">Herr</option> </select> </div> </div> {{/options.fields.gender}} </div> <div class="contact-form-row"> {{#options.fields.firstName}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.firstName}}"> Vorname </div> <div class="contact-form-input"> <input type="text" name="firstName"{{#data.data.invoiceToAddress.firstName}} value="{{.}}"{{/data.data.invoiceToAddress.firstName}} {{#data.preferredBillingAddress.firstName}} value="{{.}}"{{/data.preferredBillingAddress.firstName}} autocomplete="given-name"/> </div> </div> {{/options.fields.firstName}} {{#options.fields.lastName}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.lastName}}"> Nachname </div> <div class="contact-form-input"> <input type="text" name="lastName"{{#data.data.invoiceToAddress.lastName}} value="{{.}}"{{/data.data.invoiceToAddress.lastName}}{{#data.preferredBillingAddress.lastName}} value="{{.}}"{{/data.preferredBillingAddress.lastName}} autocomplete="family-name"/> </div> </div> {{/options.fields.lastName}} </div> <div class="contact-form-row"> {{#options.fields.street}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.street}}"> Straße/Nr. </div> <div class="contact-form-input two-inputs"> <input type="text" class="first mandatory" name="street"{{#data.data.invoiceToAddress.street}} value="{{.}}"{{/data.data.invoiceToAddress.street}}{{#data.preferredBillingAddress.street}} value="{{.}}"{{/data.preferredBillingAddress.street}}/> <input type="text" class="second space mandatory" name="houseNumber"{{#data.data.invoiceToAddress.houseNumber}} value="{{.}}"{{/data.data.invoiceToAddress.houseNumber}}{{#data.preferredBillingAddress.houseNumber}} value="{{.}}"{{/data.preferredBillingAddress.houseNumber}}/> </div> </div> {{/options.fields.street}} <div class="contact-form-row-item"> {{#options.fields.city}} <div class="contact-form-label {{options.mandetory.city}}"> PLZ/Ort </div> <div class="contact-form-input two-inputs"> <input type="text" class="second mandatory" name="zipCode"{{#data.data.invoiceToAddress.zipCode}} value="{{.}}"{{/data.data.invoiceToAddress.zipCode}}{{#data.preferredBillingAddress.zipCode}} value="{{.}}"{{/data.preferredBillingAddress.zipCode}} autocomplete="postal-code"/> <input type="text" class="first space mandatory" name="city"{{#data.data.invoiceToAddress.city}} value="{{.}}"{{/data.data.invoiceToAddress.city}}{{#data.preferredBillingAddress.city}} value="{{.}}"{{/data.preferredBillingAddress.city}} autocomplete="address-level2"/> </div> {{/options.fields.city}} </div> </div> <div class="contact-form-row"> <div class="contact-form-row-item"> {{#options.fields.emailAddress}} <div class="contact-form-label {{options.mandetory.emailAddress}}"> E-Mail </div> <div class="contact-form-input"> <input type="text" name="emailAddress"{{#data.data.bussinessPartnerEmail}} value="{{.}}"{{/data.data.bussinessPartnerEmail}}{{#data.preferredBillingAddress.emailAddress}} value="{{.}}"{{/data.preferredBillingAddress.emailAddress}} autocomplete="email"/> </div> {{/options.fields.emailAddress}} </div> <div class="contact-form-row-item"> {{#options.fields.phoneNumber}} <div class="contact-form-label {{options.mandetory.primaryPhoneNumber}}"> Telefon </div> <div class="contact-form-input"> <input type="tel" class="primaryPhoneNumber" autocomplete="tel" value="{{#data.data.invoiceToAddress.primaryPhoneNumber.prefix}}{{.}}{{/data.data.invoiceToAddress.primaryPhoneNumber.prefix}}{{#data.data.invoiceToAddress.primaryPhoneNumber.number}}{{.}}{{/data.data.invoiceToAddress.primaryPhoneNumber.number}}{{#data.preferredBillingAddress.primaryPhoneNumber.prefix}}{{.}}{{/data.preferredBillingAddress.primaryPhoneNumber.prefix}}{{#data.preferredBillingAddress.primaryPhoneNumber.number}}{{.}}{{/data.preferredBillingAddress.primaryPhoneNumber.number}}"> </div> <div class=""> <input type="hidden" class="second" name="primaryPhoneNumber[prefix]"{{#data.data.invoiceToAddress.primaryPhoneNumber.prefix}} value="{{.}}"{{/data.data.invoiceToAddress.primaryPhoneNumber.prefix}}{{#data.preferredBillingAddress.primaryPhoneNumber.prefix}} value="{{.}}"{{/data.preferredBillingAddress.primaryPhoneNumber.prefix}} /> <input type="hidden" class="first space" name="primaryPhoneNumber[number]"{{#data.data.invoiceToAddress.primaryPhoneNumber.number}} value="{{.}}"{{/data.data.invoiceToAddress.primaryPhoneNumber.number}}{{#data.preferredBillingAddress.primaryPhoneNumber.number}} value="{{.}}"{{/data.preferredBillingAddress.primaryPhoneNumber.number}} /> </div> {{/options.fields.phoneNumber}} </div> </div> <div class="contact-form-row"> <div class="contact-form-row-item"> {{#options.fields.birthdate}} <div class="contact-form-label {{options.mandetory.birthdate}}"> Geburtsdatum (TT.MM.JJJJ) </div> <div class="contact-form-input"> <input type="text" name="birthdate"/> </div> {{/options.fields.birthdate}} </div> </div> {{#options.fields.changeHint}} <div class="contact-form-row hint-row"> <div class="hint-container"> Bitte füllen Sie die folgenden Felder mit den jeweiligen <span class="contact-highlight">NEUEN</span> Daten aus, damit diese geändert werden können: </div> </div> {{/options.fields.changeHint}} {{#options.fields.newDatacustomernumber}} <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.newDatacustomernumber}}"> Kundennummer </div> <div class="contact-form-input"> <input type="text" name="newData[customernumber]"/> </div> </div> {{#options.fields.newDatagender}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.newDatagender}}"> Anrede </div> <div class="contact-form-input"> <select name="newData[gender]"> <option value="misses">Frau</option> <option value="mister">Herr</option> </select> </div> </div> {{/options.fields.newDatagender}} </div> {{/options.fields.newDatacustomernumber}} {{#options.fields.newDatafirstName}} <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.newDatafirstName}}"> Vorname </div> <div class="contact-form-input"> <input type="text" name="newData[firstName]"/> </div> </div> {{#options.fields.newLastName}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.newDatalastName}}"> Nachname </div> <div class="contact-form-input"> <input type="text" name="newData[lastName]"/> </div> </div> {{/options.fields.newLastName}} </div> {{/options.fields.newDatafirstName}} {{#options.fields.newDatastreet}} <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.newDatastreet}}"> Straße/Nr. </div> <div class="contact-form-input two-inputs"> <input type="text" class="first mandatory" name="newData[street]"/> <input type="text" class="second space mandatory" name="newData[houseNumber]"/> </div> </div> <div class="contact-form-row-item"> {{#options.fields.newDatacity}} <div class="contact-form-label {{options.mandetory.newDatacity}}"> PLZ/Ort </div> <div class="contact-form-input two-inputs"> <input type="text" class="second mandatory" name="newData[zipCode]"/> <input type="text" class="first space mandatory" name="newData[city]"/> </div> {{/options.fields.newDatacity}} </div> </div> {{/options.fields.newDatastreet}} {{#options.fields.newDataemailAddress}} <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.newDataemailAddress}}"> E-Mail </div> <div class="contact-form-input"> <input type="text" name="newData[emailAddress]"/> </div> </div> <div class="contact-form-row-item"> {{#options.fields.newDataphoneNumber}} <div class="contact-form-label {{options.mandetory.newDataprimaryPhoneNumber}}"> Telefon </div> <div class="contact-form-input two-inputs"> <input type="text" class="second" name="newData[primaryPhoneNumber[prefix]]"/> <input type="text" class="first space" name="newData[primaryPhoneNumber[number]]"/> </div> {{/options.fields.newDataphoneNumber}} </div> </div> {{/options.fields.newDataemailAddress}} {{#options.fields.orderNumber}} <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.ordernumber}}"> Bestellnummer </div> <div class="contact-form-input"> <input type="text" name="orderNumber" value="{{data.data.complaintNumber}}" placeholder="12345678,8765432Y"/> </div> </div> <div class="contact-form-row-item"> {{#options.fields.orderDate}} <div class="contact-form-label {{options.mandetory.orderdate}}"> Rechnungsdatum </div> <div class="contact-form-input order-date"> <input type="text" name="orderDate[Day]" class="order-day" value="" placeholder="TT"/> <input type="text" name="orderDate[Month]" class="order-month" value="" placeholder="MM"/> <input type="text" name="orderDate[Year]" class="order-year" value="" placeholder="YYYY"/> </div> {{/options.fields.orderDate}} </div> </div> {{/options.fields.orderNumber}} {{#options.recall}} <div class="contact-form-row"> <input type="checkbox" value="true" name="newsletter" id="newsletter" {{#data.newsletter}}selected{{/data.newsletter}} /> <label for="newsletter" {{#options.mandetory.newsletter}}class="{{.}}"{{/options.mandetory.newsletter}}>Ich möchte den Newsletter abbestellen.</label> </div> <div class="contact-form-row"> <input type="checkbox" value="true" name="advertising" id="advertising_contact_cb" {{#data.advertising}}selected{{/data.advertising}} /> <label for="advertising_contact_cb" {{#options.mandetory.advertising}}class="{{.}}"{{/options.mandetory.advertising}}>Ich widerspreche der Zusendung von Werbemitteln einschließlich der Kataloge.</label> </div> <div class="contact-form-row"> <input type="checkbox" value="true" name="marketing" id="marketing" {{#data.marketing}}selected{{/data.marketing}} /> <label for="marketing" {{#options.mandetory.marketing}}class="{{.}}"{{/options.mandetory.marketing}}>Ich widerspreche der Nutzung, Verarbeitung und Weitergabe meiner Daten zu Marketingzwecken.</label> </div> {{/options.recall}} {{#options.contact}} {{^options.subjectHidden}} {{#options.subjectDropdown}} <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.mailTopic}}"> Betreff </div> <div class="contact-form-input"> <select name="mailTopic"> <option value="">--bitte auswählen--</option> {{#options.subjects}} <option value="{{key}}" {{#selected}}selected="selected"{{/selected}}>{{localizedText}}</option> {{/options.subjects}} </select> </div> </div> <div class="contact-form-row-item"> </div> </div> {{/options.subjectDropdown}} {{/options.subjectHidden}} {{/options.contact}} {{#options.productadvice}} <div class="contact-form-row"> <div class="contact-form-row-item"> {{#options.fields.message}} <div class="contact-form-label {{options.mandetory.mailTopic}}"> Betreff </div> <div class="contact-form-input"> <select name="mailTopic"> {{#options.subjects.1}} <option value="">--bitte auswählen--</option> {{/options.subjects.1}} {{#options.subjects}} <option value="{{key}}" {{#selected}}selected="selected"{{/selected}}>{{localizedText}}</option> {{/options.subjects}} </select> </div> {{/options.fields.message}} </div> <div class="contact-form-row-item"> </div> </div> {{/options.productadvice}} {{^options.complaint}} {{#options.fields.message}} <div class="contact-form-row"> <div class="contact-form-row-item full-size"> <div class="contact-form-label {{options.mandetory.message}}"> {{#options.paymentProtection}} Bemerkung {{/options.paymentProtection}} {{^options.paymentProtection}} Ihre Nachricht {{/options.paymentProtection}} </div> <div class="contact-form-input"> <textarea name="message">{{message}}</textarea> </div> </div> </div> {{/options.fields.message}} {{/options.complaint}} {{#options.complaint}} <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label"> Reklamationsgrund: </div> <div class="contact-form-input"> <select name="mailTopic"> <option value="">--bitte auswählen--</option> {{#options.subjects}} <option value="{{key}}" {{#selected}}selected="selected"{{/selected}}>{{localizedText}}</option> {{/options.subjects}} </select> </div> </div> <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.bestContact}}"> am besten erreichbar: </div> <div class="contact-form-input"> <input type="text" name="bestContact" value="{{data.bestContact}}" /> </div> </div> </div> <div class="contact-form-row"> {{#options.fields.orderNumber}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.articleNumber}}"> Artikelnummer: </div> <div class="contact-form-input"> <input type="text" class="mandatory" name="articleNumber" value="{{data.data.complaintNumber}}{{articleNumber}}"/> </div> </div> {{/options.fields.orderNumber}} {{#options.fields.articledescription}} <div class="contact-form-row-item"> <div class="contact-form-label {{options.mandetory.articledescription}}"> Artikelbeschreibung: </div> <div class="contact-form-input"> <input type="text" name="articledescription" value="{{data.data.complaintdescription}}{{articledescription}}" /> </div> </div> {{/options.fields.articledescription}} </div> {{#options.fields.message}} <div class="contact-form-row"> <div class="contact-form-row-item full-size"> <div class="contact-form-label {{options.mandetory.message}}"> Mängelbeschreibung: </div> <div class="contact-form-input"> <textarea name="message" class="mandatory">{{message}}</textarea> </div> </div> </div> {{/options.fields.message}} {{#options.fields.replacement}} <div class="contact-form-row full-size"> <div class="full-label"> Benötigen Sie ein Ersatzteil? Ergänzen Sie bitte folgende Angaben: </div> </div> {{/options.fields.replacement}} <div class="contact-form-row full-size"> {{#options.fields.replacement}} <div class="sub-row"> <div class="sub-row-label {{options.mandetory.replacement}}"> Ersatzteilnummer: </div> <div class="sub-row-input"> <input type="text" value="{{replacement}}" name="replacement" /> </div> </div> {{/options.fields.replacement}} {{#options.fields.replacementType}} <div class="sub-row"> <div class="sub-row-label {{options.mandetory.replacementType}}"> Daten-Typenschild: </div> <div class="sub-row-input"> <input type="text" value="{{replacementType}}" name="replacementType" /> </div> </div> {{/options.fields.replacementType}} </div> <div class="contact-form-row full-size"> <div class="full-label"> Lieferadresse (falls abweichend von Kontoanschrift): </div> </div> <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label"> Vorname </div> <div class="contact-form-input"> <input type="text" name="deliveryAddress[firstName]"{{#data.data.deliveryAddress.firstName}} value="{{.}}"{{/data.data.deliveryAddress.firstName}}{{#data.deliveryFirstname}} value="{{.}}"{{/data.deliveryFirstname}} /> </div> </div> <div class="contact-form-row-item"> <div class="contact-form-label"> Nachname </div> <div class="contact-form-input"> <input type="text" name="deliveryAddress[lastName]"{{#data.data.deliveryAddress.lastName}} value="{{.}}"{{/data.data.deliveryAddress.lastName}}{{#data.deliveryLastname}} value="{{.}}"{{/data.deliveryLastname}} /> </div> </div> </div> <div class="contact-form-row"> <div class="contact-form-row-item"> <div class="contact-form-label"> Straße </div> <div class="contact-form-input two-inputs"> <input type="text" class="first" name="deliveryAddress[street]"{{#data.data.deliveryAddress.street}} value="{{.}}"{{/data.data.deliveryAddress.street}}{{#data.deliveryStreet}} value="{{.}}"{{/data.deliveryStreet}} /> <input type="text" class="second space" name="deliveryAddress[houseNumber]"{{#data.data.deliveryAddress.houseNumber}} value="{{.}}"{{/data.data.deliveryAddress.houseNumber}}{{#data.deliveryStreetnumber}} value="{{.}}"{{/data.deliveryStreetnumber}} /> </div> </div> <div class="contact-form-row-item"> <div class="contact-form-label"> Ort </div> <div class="contact-form-input two-inputs"> <input type="text" class="second" name="deliveryAddress[zipCode]"{{#data.data.deliveryAddress.zipCode}} value="{{.}}"{{/data.data.deliveryAddress.zipCode}}{{#data.deliveryPostal}} value="{{.}}"{{/data.deliveryPostal}} /> <input type="text" class="first space" name="deliveryAddress[city]"{{#data.data.deliveryAddress.city}} value="{{.}}"{{/data.data.deliveryAddress.city}}{{#data.deliveryCity}} value="{{.}}"{{/data.deliveryCity}} /> </div> </div> </div> {{/options.complaint}} {{#options.showPriority}} <div class="full-label"> Ihre Anfrage bearbeiten wir während unserer Öffnungszeiten innerhalb von 12 Stunden. </div> {{#options.priorityTopicId}} <div class="contact-form-row full-size"> <div class="contact-form-row-item full-size"> <div class="contact-form-input"> <input id="highPriority" type="checkbox" name="priorityTopicId" value="{{options.priorityTopicId}}" {{#data.data.priorityTopicId}}checked="checked"{{/data.data.priorityTopicId}} /> <label for="highPriority"> Sie benötigen innerhalb von 3 Stunden eine Antwort? Klicken Sie hier! </label> </div> </div> </div> {{/options.priorityTopicId}} {{/options.showPriority}} {{#options.paymentProtection}} <div class="contact-form-row full-size"> <div class="contact-form-row-item full-size payment-protection"> <input type="checkbox" name="paymentProtectionCheckbox" id="paymentProtectionCheckbox"> <label for="paymentProtectionCheckbox"> Ich akzeptiere die <a href="{{options.paymentProtectionConditionsLink}}" target="_blank">Allgemeinen Versicherungsbedingungen</a> und nehme das <a href="{{options.paymentProtectionInfoSheetLink}}" target="_blank">Infoblatt gemäß FernFinG</a> zur Kenntnis. </label> </div> </div> {{/options.paymentProtection}} <div class="contact-form-row full-size"> <div class="full-label"> *diese Felder müssen ausgefüllt werden. </div> </div>