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<h3><span style="color: #ffffff"><span style="color: #ffffff">Esbi Belgium</span></span></h3>
<p><span style="color: #ffffff"><span style="color: #ffffff">Centrum-Zuid 2066<br />Postbus 102<br />3530 Houthalen<br />T (011) 51 61 81<br />F (011) 51 61 91<br /></span></span><a href="&#109;&#97;&#105;&#108;&#116;&#111;&#58;&#105;&#110;&#102;&#111;&#64;&#101;&#115;&#98;&#105;&#46;&#98;&#101;"><span style="color: #ffffff"><span style="color: #ffffff">info@esbi.be</span></span></a></p>
<h3><span style="color: #ffffff"><span style="color: #ffffff">Regiokantoor Esbi</span></span></h3>
<p><span style="color: #ffffff"><span style="color: #ffffff">Postbus 31168<br />6370 AD Landgraaf<br />T (045) 569 0 569<br />F (045) 569 0 571<br /></span></span><a href="&#109;&#97;&#105;&#108;&#116;&#111;&#58;&#105;&#110;&#102;&#111;&#64;&#101;&#115;&#98;&#105;&#46;&#110;&#108;"><span style="color: #ffffff"><span style="color: #ffffff">info@esbi.nl</span></span></a><br /></p>
<h3><span style="color: #ffffff"><span style="color: #ffffff">Hoofdkantoor &nbsp;Esbi</span></span></h3><span style="color: #ffffff"><span style="color: #ffffff">Abbekesdoel&nbsp;88<br />Postbus 3<br />2970 AA Bleskensgraaf<br />T (0184) 698 698<br />F (0184) 698 699<br /></span></span><a href="&#109;&#97;&#105;&#108;&#116;&#111;&#58;&#105;&#110;&#102;&#111;&#64;&#101;&#115;&#98;&#105;&#46;&#110;&#108;"><span style="color: #ffffff"><span style="color: #ffffff">info@esbi.nl</span></span></a><span style="color: #ffffff"> </span>
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			NIEUW BIJ ESBI !!!
			<p>DE FRONTAL BANNER.
De slimme, dubbelzijdige slide-in banner!  
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door   gemeentelijke instanties, 
winkels en outlet centra, promotors en organisatoren.</p>
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		<h1>Aanvraagformulier Esbi</h1>
		<form name="regForm" id="regForm" method="post" action="javascript:submitReg();">
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			<tr>
				<td colspan="2" style="font-weight:bold;">Contactgegevens</td>
				<td colspan="2" style="font-weight:bold;">Graag ontvang ik meer informatie over</td>
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			<tr>
				<td width="140">Naam bedrijf </td>
				<td width="140"><input type="text" name="Naam_bedrijf" tabindex="1"><font color="red">*</font></td>
				<td><input type="checkbox" name="Reclameborden" tabindex="8">&nbsp;Reclameborden</td>
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				<td><input type="checkbox" name="Vlaggen" tabindex="15">&nbsp;Vlaggen</td>
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				<td colspan="2" style="font-weight:bold;"><br />Opmerkingen</td>
				<td><input type="checkbox" name="Banieren" tabindex="16">&nbsp;Banieren</td>
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				<td colspan="2" rowspan="6" style="font-weight:bold;"><textarea name="opmerkingen" tabindex="7" style="width:238px;height:102px;"></textarea></td>
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