
<form name="PAT" action="/pat/senddynamisksporsmaal" method="post">
<table border="0" cellpadding="0" cellspacing="0" width="611">
	<tr>
		<td width="99"></td>
		</td>
		<td width="292"><font color="red" face="Arial,Helvetica" size="1"><b></b></font><font face="Arial,Helvetica" size="1"> </font><br>
		</td>
		<td width="10"></td>
		<td width="200"></td>
	</tr>
	<tr>
		<td width="99" valign="top" align="left"><font size="1" face="Arial,Helvetica">Navn</font></td>
		<td width="292" valign="top" align="left"><input type="text" size="40" name="NAVN" maxlength="40" value=""></td>
		<td width="10"></td>
		<td width="200" rowspan="5" valign="top" align="left">
				
			</td>
	</tr>
	<tr>
		<td width="99" valign="top" align="left"><font size="1" face="Arial,Helvetica">E-post</font></td>
		<td width="292" valign="top" align="left"><input type="text" size="40" name="EPOST" maxlength="40" value=""></td>
		<td width="10"></td>
	</tr>
	<tr>
		<td width="99" valign="top" align="left"><font size="1" face="Arial,Helvetica">Kundenr</font></td>
		<td width="292" valign="top" align="left"><input type="text" size="40" name="KUNDENR" maxlength="30" value=""></td>
		<td width="10"></td>
	</tr>
	<tr>
		<td width="99" valign="top" align="left"><font size="1" face="Arial,Helvetica">Telefonnr</font></td>
		<td width="292"><input type="text" size="40" name="TLF" maxlength="15" value=""></td>
		<td width="10" valign="top" align="left"></td>
	</tr>
	<tr>
		<td width="99" valign="top" align="left"><font size="1" face="Arial,Helvetica">Type spørsmål:</font></td>
		<td width="292"><select name="KATEGORI_ID" size="1">
				<option value="6">Adresse-endringer</option><option value="440">Altibox</option><option value="5">Annet</option><option value="421">Betalingsvarsel</option><option value="10">Bredbånd</option><option value="1">e-Faktura</option><option value="2">e-kunde</option><option value="12">Kabel-tv</option><option value="4">Måleravlesning</option><option value="3">Nettleie</option><option value="380">Om www.bkk.no</option><option value="7">Pålogging</option><option value="299">Varmepumper</option> 
			</select></td>
		<td width="10" valign="top" align="left"></td>
	</tr>
	<tr>
		<td width="99"></td>
		<td colspan="3" valign="top" align="left"><textarea name="SPM" rows="5" cols="32" wrap="physical"></textarea></td>
	</tr>
	<tr>
		<td width="99"></td>
		<td width="292"><input type="submit" value=" Send " name="Submit"></td>
		<td width="10"></td>
		<td width="200"><input type="hidden" value="send.html" name="FILNAVN"><input type="hidden" value="" name="KATEGORI_ID"><input type="hidden" value="" name="SELSKAP"><input type="hidden" value="" name="INFRAME"></td>
	</tr>
	<tr>
		<td width="99"><font size="1" face="Arial,Helvetica"><strong>&nbsp;</strong></font></td>
		<td colspan="3">
				
			</td>
	</tr>
</table>
</form>

