{"id":27066,"date":"2020-06-27T21:08:40","date_gmt":"2020-06-27T19:08:40","guid":{"rendered":"https:\/\/serviclean.be\/reinigungsangebot\/"},"modified":"2020-06-27T21:08:40","modified_gmt":"2020-06-27T19:08:40","slug":"reinigungsangebot","status":"publish","type":"page","link":"https:\/\/serviclean.be\/de\/reinigungsangebot\/","title":{"rendered":"Reinigungsangebot"},"content":{"rendered":"<h1>Kostenloses &amp; unverbindliches Angebot<\/h1>\n<script type=\"text\/javascript\">if(!gform){document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0});var gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),null==t&&(t=10),gform.hooks[o][n].push({tag:i,callable:r,priority:t})},doHook:function(o,n,r){if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[o][n]){var t,i=gform.hooks[o][n];i.sort(function(o,n){return o.priority-n.priority});for(var e=0;e<i.length;e++)\"function\"!=typeof(t=i[e].callable)&&(t=window[t]),\"action\"==o?t.apply(null,r):r[0]=t.apply(null,r)}if(\"filter\"==o)return r[0]},removeHook:function(o,n,r,t){if(null!=gform.hooks[o][n])for(var i=gform.hooks[o][n],e=i.length-1;0<=e;e--)null!=t&&t!=i[e].tag||null!=r&&r!=i[e].priority||i.splice(e,1)}}}<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_12' ><div id='gf_12' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/de\/wp-json\/wp\/v2\/pages\/27066#gf_12' novalidate>\n        <div id='gf_progressbar_wrapper_12' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Schritt <span class='gf_step_current_page'>1<\/span> von <span class='gf_step_page_count'>5<\/span> - Serviceauswahl\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_green' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_green percentbar_20' style='width:20%;'><span>20%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform_body gform-body'><div id='gform_page_12_1' class='gform_page' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_12\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" >Wenn Sie ein Angebot f\u00fcr eine unserer Dienstleistungen w\u00fcnschen, f\u00fcllen Sie bitte das kurze Formular unten aus.<\/li><li id=\"field_12_13\" class=\"gfield gf_list_2col gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label'  >F\u00fcr welchen Reinigungsservice m\u00f6chten Sie ein Angebot erhalten?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_13'>\n\t\t\t<li class='gchoice gchoice_12_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='B\u00fcroreinigung'  id='choice_12_13_0'    \/>\n\t\t\t\t<label for='choice_12_13_0' id='label_12_13_0'>B\u00fcroreinigung<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='Gesch\u00e4ftsreinigung'  id='choice_12_13_1'    \/>\n\t\t\t\t<label for='choice_12_13_1' id='label_12_13_1'>Gesch\u00e4ftsreinigung<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='HORECA-Reinigung'  id='choice_12_13_2'    \/>\n\t\t\t\t<label for='choice_12_13_2' id='label_12_13_2'>HORECA-Reinigung<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='Reinigung von Solarmodulen'  id='choice_12_13_3'    \/>\n\t\t\t\t<label for='choice_12_13_3' id='label_12_13_3'>Reinigung von Solarmodulen<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_4'>\n\t\t\t\t<input name='input_13' type='radio' value='Fensterreinigung'  id='choice_12_13_4'    \/>\n\t\t\t\t<label for='choice_12_13_4' id='label_12_13_4'>Fensterreinigung<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_5'>\n\t\t\t\t<input name='input_13' type='radio' value='Reinigung von Wohnungen \/ H\u00e4usern'  id='choice_12_13_5'    \/>\n\t\t\t\t<label for='choice_12_13_5' id='label_12_13_5'>Reinigung von Wohnungen \/ H\u00e4usern<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_6'>\n\t\t\t\t<input name='input_13' type='radio' value='Baustellenendreinigung'  id='choice_12_13_6'    \/>\n\t\t\t\t<label for='choice_12_13_6' id='label_12_13_6'>Baustellenendreinigung<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_7'>\n\t\t\t\t<input name='input_13' type='radio' value='Desinfektion von R\u00e4umlichkeiten &amp; Materialien mit Dampf'  id='choice_12_13_7'    \/>\n\t\t\t\t<label for='choice_12_13_7' id='label_12_13_7'>Desinfektion von R\u00e4umlichkeiten &amp; Materialien mit Dampf<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_8'>\n\t\t\t\t<input name='input_13' type='radio' value='Reinigung von Gemeinschaftsbereichen in Geb\u00e4uden'  id='choice_12_13_8'    \/>\n\t\t\t\t<label for='choice_12_13_8' id='label_12_13_8'>Reinigung von Gemeinschaftsbereichen in Geb\u00e4uden<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_9'>\n\t\t\t\t<input name='input_13' type='radio' value='Parkplatzreinigung'  id='choice_12_13_9'    \/>\n\t\t\t\t<label for='choice_12_13_9' id='label_12_13_9'>Parkplatzreinigung<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_13_10'>\n\t\t\t\t<input name='input_13' type='radio' value='Reinigung vor\/nach dem Umzug'  id='choice_12_13_10'    \/>\n\t\t\t\t<label for='choice_12_13_10' id='label_12_13_10'>Reinigung vor\/nach dem Umzug<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_12_2' class='gform_next_button button' value='Weiter'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"2\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"2\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_12_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_14\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label'  >Welche Reinigungsh\u00e4ufigkeit w\u00fcnschen Sie?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_14'>\n\t\t\t<li class='gchoice gchoice_12_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='T\u00e4glich'  id='choice_12_14_0'    \/>\n\t\t\t\t<label for='choice_12_14_0' id='label_12_14_0'>T\u00e4glich<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='Mehrmals pro Woche'  id='choice_12_14_1'    \/>\n\t\t\t\t<label for='choice_12_14_1' id='label_12_14_1'>Mehrmals pro Woche<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_14_2'>\n\t\t\t\t<input name='input_14' type='radio' value='Einmal pro Woche'  id='choice_12_14_2'    \/>\n\t\t\t\t<label for='choice_12_14_2' id='label_12_14_2'>Einmal pro Woche<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_14_3'>\n\t\t\t\t<input name='input_14' type='radio' value='Ein- bis mehrmals pro Monat'  id='choice_12_14_3'    \/>\n\t\t\t\t<label for='choice_12_14_3' id='label_12_14_3'>Ein- bis mehrmals pro Monat<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_14_4'>\n\t\t\t\t<input name='input_14' type='radio' value='Gelegentlich'  id='choice_12_14_4'    \/>\n\t\t\t\t<label for='choice_12_14_4' id='label_12_14_4'>Gelegentlich<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_12_6' class='gform_previous_button button' value='Zur\u00fcck'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"1\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"1\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_12_6' class='gform_next_button button' value='Weiter'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"3\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"3\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_12_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_8\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Wie gro\u00df ist die Fl\u00e4che der betreffenden R\u00e4umlichkeiten?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_8'><li class='gchoice gchoice_12_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='Weniger als 100 m\u00b2'  id='choice_12_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_8_1' id='label_12_8_1'>Weniger als 100 m\u00b2<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='100 m\u00b2 bis 200 m\u00b2'  id='choice_12_8_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_8_2' id='label_12_8_2'>100 m\u00b2 bis 200 m\u00b2<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='200 m\u00b2 bis 500 m\u00b2'  id='choice_12_8_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_8_3' id='label_12_8_3'>200 m\u00b2 bis 500 m\u00b2<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_8_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.4' type='checkbox'  value='500 m\u00b2 bis 2500 m\u00b2'  id='choice_12_8_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_8_4' id='label_12_8_4'>500 m\u00b2 bis 2500 m\u00b2<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_8_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.5' type='checkbox'  value='Mehr als 2500 m\u00b2'  id='choice_12_8_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_8_5' id='label_12_8_5'>Mehr als 2500 m\u00b2<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_12_15' class='gform_previous_button button' value='Zur\u00fcck'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"2\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"2\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_12_15' class='gform_next_button button' value='Weiter'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"4\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"4\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_12_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_26\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" >W\u00e4hlen Sie Datum und Uhrzeit, damit unser Vertriebsmitarbeiter den Ort besichtigen und die Baustelle bewerten kann\n, um Ihnen ein ma\u00dfgeschneidertes Angebot zu erstellen. Sie erhalten die Antwort auf Ihr Angebot innerhalb von 24 Stunden nach unserem Besuch. <\/li><li id=\"field_12_22\" class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_12_22' >Besuchsdatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_22' id='input_12_22' type='text' value='' class='datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_12_22_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_12_22_date_format' class='screen-reader-text'>TT Schr\u00e4gstrich MM Schr\u00e4gstrich JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_12_22' class='gform_hidden' value='https:\/\/serviclean.be\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_12_23\" class=\"gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Besuchszeit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_complex\"><div class=\"clear-multi\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time' id='input_12_23'>\n                            <input type='number' maxlength='2' name='input_23[]' id='input_12_23_1' value=''  min='0' max='24' step='1'  placeholder='Std.' aria-required='true'   \/> <i>:<\/i>\n                            <label class='hour_label screen-reader-text' for='input_12_23_1' >Stunden<\/label>\n                        <\/div>\n                        \n                        <div class='gfield_time_minute ginput_container ginput_container_time'>\n                            <input type='number' maxlength='2' name='input_23[]' id='input_12_23_2' value=''  min='0' max='59' step='1'  placeholder='Min.' aria-required='true'  \/>\n                            <label class='minute_label screen-reader-text' for='input_12_23_2' >Minuten<\/label>\n                        <\/div>\n                        \n                    <\/div><\/div><\/li><li id=\"field_12_16\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Name des Projektleiters<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_12_16'>\n                            \n                            <span id='input_12_16_3_container' class='name_first' >\n                                                    <input type='text' name='input_16.3' id='input_12_16_3' value='' aria-label='First name'   aria-required='true'     \/>\n                                                    <label for='input_12_16_3' >Vorname<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_16_6_container' class='name_last' >\n                                                    <input type='text' name='input_16.6' id='input_12_16_6' value='' aria-label='Last name'   aria-required='true'     \/>\n                                                    <label for='input_12_16_6' >Nachname<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_12_18\" class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_12_18' >Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_18' id='input_12_18' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_17\" class=\"gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_12_17' >E-Mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_17' id='input_12_17' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_12_20' class='gform_previous_button button' value='Zur\u00fcck'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"3\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"3\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_12_20' class='gform_next_button button' value='Weiter'  onclick='jQuery(\"#gform_target_page_number_12\").val(\"5\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_12\").val(\"5\");  jQuery(\"#gform_12\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_5' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_12_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_12_19\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Adresse Ihrer R\u00e4umlichkeiten, in denen die Dienstleistungen erbracht werden<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_12_19' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_12_19_1_container' >\n                                        <input type='text' name='input_19.1' id='input_12_19_1' value=''    aria-required='true'    \/>\n                                        <label for='input_12_19_1' id='input_12_19_1_label' >Adresse<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_12_19_3_container' >\n                                    <input type='text' name='input_19.3' id='input_12_19_3' value=''    aria-required='true'    \/>\n                                    <label for='input_12_19_3' id='input_12_19_3_label' >Stadt<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_19.4' id='input_12_19_4' value=''\/><span class='ginput_right address_zip ginput_address_zip' id='input_12_19_5_container' >\n                                    <input type='text' name='input_19.5' id='input_12_19_5' value=''    aria-required='true'    \/>\n                                    <label for='input_12_19_5' id='input_12_19_5_label' 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data-tabindex='0'  data-badge=''><\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_12' class='gform_previous_button button' value='Zur\u00fcck'  onclick='if(window[\"gf_submitting_12\"]){return false;}  if( !jQuery(\"#gform_12\")[0].checkValidity || jQuery(\"#gform_12\")[0].checkValidity()){window[\"gf_submitting_12\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_12\"]){return false;} if( !jQuery(\"#gform_12\")[0].checkValidity || jQuery(\"#gform_12\")[0].checkValidity()){window[\"gf_submitting_12\"]=true;}  jQuery(\"#gform_12\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_12' class='gform_button button' value='Senden'  onclick='if(window[\"gf_submitting_12\"]){return false;}  if( !jQuery(\"#gform_12\")[0].checkValidity || jQuery(\"#gform_12\")[0].checkValidity()){window[\"gf_submitting_12\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_12\"]){return false;} if( !jQuery(\"#gform_12\")[0].checkValidity || jQuery(\"#gform_12\")[0].checkValidity()){window[\"gf_submitting_12\"]=true;}  jQuery(\"#gform_12\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_12' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='12' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_12' value='WyJbXSIsIjgwODY4YWNlNmRhZjUyZjU3ZmY1ZGIzZTVjMDBkM2EwIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_12' id='gform_target_page_number_12' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_12' id='gform_source_page_number_12' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' 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