[et_pb_cst_contact_form_plus admin_label=”CST Contact Form Plus” use_captcha=”off” captcha=”on” use_redirect=”on” input_border_radius=”0″ title_font_size_tablet=”51″ title_line_height_tablet=”2″ form_field_font_size_tablet=”51″ form_field_line_height_tablet=”2″ use_border_color=”off” border_color=”#ffffff” border_style=”solid” custom_button=”on” button_letter_spacing=”0″ button_use_icon=”on” button_icon_placement=”right” button_on_hover=”on” button_letter_spacing_hover=”0″ form_field_text_color=”#776565″ button_text_color=”#ffffff” button_bg_color=”#595959″ button_icon=”%%151%%” email=”coordinator@sintjan.com” submit_title=”Verstuur uw aanvraag” redirect_url=”https://sintjan.com/pagina-in-onderhoud/” button_icon_color=”#ffffff” button_text_color_hover=”#ffffff” button_bg_color_hover=”#777777″ button_border_color_hover=”#ffffff” button_border_color=”#ffffff” custom_message=”Bericht van de pagina %22Word vriend van de Sint-Jan%22
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N.A.W. gegevens:
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%%Aanhef%% %%Voornaam%% %%Achternaam%%
%%Straat%% %%Postcode%%
Telefoonnr.: %%Telefoonnummer%%
E-mailadres: %%Emailadres%%
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Donatieberag: € %%Bedrag%%
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Rekening: %%IBANnummer%% T.l.v.: %%tnv%%

Aanvraag datum: %%Datumaanvraag%%
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——————MACHTIGING————————
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%%Aanhef%% %%Achternaam%% heeft de Stichting Goudse Sint-Jan toestemming gegeven om jaarlijks € %%Bedrag%% af te schrijven van rekeningnummer: %%IBANnummer%%.
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https://sintjan.com/steun/ik-word-vriend/”] [et_pb_cst_contact_field_plus field_id=”Aanhef” field_title=”.” field_type=”radio” field_date_format=”on” field_radio=”de heer | mevrouw” required_mark=”off” fullwidth_field=”on” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Voornaam” field_title=”Voornaam / Letter” field_type=”input” field_date_format=”on” required_mark=”off” fullwidth_field=”off” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Achternaam” field_title=”Achternaam” field_type=”input” field_date_format=”on” required_mark=”on” fullwidth_field=”off” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Straat” field_title=”Straat + huisnummer” field_type=”input” field_date_format=”on” required_mark=”off” fullwidth_field=”off” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Postcode” field_title=”Postcode + Woonplaats” field_type=”input” field_date_format=”on” required_mark=”off” fullwidth_field=”off” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Telefoonnummer” field_title=”Telefoonnummer” field_type=”input” field_date_format=”on” required_mark=”on” fullwidth_field=”off” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Emailadres” field_title=”E-mailadres” field_type=”email” field_date_format=”on” required_mark=”on” fullwidth_field=”off” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Bedrag” field_title=”Bedrag (per jaar)” field_type=”input” field_date_format=”on” number_min_max=”15″ required_mark=”off” fullwidth_field=”off” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”IBANnummer” field_title=”IBAN-nummer:” field_type=”input” field_date_format=”on” required_mark=”off” fullwidth_field=”off” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”tnv” field_title=”Ten name van” field_type=”input” field_date_format=”on” required_mark=”off” fullwidth_field=”on” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Datumaanvraag” field_title=”Datum aanvraag” field_type=”datepicker” field_date_format=”on” required_mark=”off” fullwidth_field=”on” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus][et_pb_cst_contact_field_plus field_id=”Machtiging” field_title=”Hierbij machtig ik de Stichting Goudse Sint-Jan om jaarlijks het aangegeven bedrag van mijn rekening af te schrijven.” field_type=”terms” field_date_format=”on” required_mark=”off” fullwidth_field=”on” form_field_font_select=”default” form_field_font=”||||” use_border_color=”off” border_style=”solid”] [/et_pb_cst_contact_field_plus] [/et_pb_cst_contact_form_plus]