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<script type="text/javascript">
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<div class="float-left wrapper-form-inxmail">
	<form action="" role="form" method="post" class="form-inxmail">
		<input type="hidden" name="INXMAIL_SUBSCRIPTION" value="SOLMACHINE" />
		<input type="hidden" name="INXMAIL_HTTP_REDIRECT" value="http://www.solutionsmachinesoutils.com/nl/wp-json/wp/v2/pages/18447merci/" />
		<input type="hidden" name="INXMAIL_HTTP_REDIRECT_ERROR" value="http://www.solutionsmachinesoutils.com/nl/wp-json/wp/v2/pages/18447?error" />
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				<div class="row">
					<div class="lastname-field col-6">
				
								<div class="form-group">
														<!--<label>Achternaam *</label>-->
										
										
					<input type="text" id="lastname" name="SOLMACH_NOM" required value="" placeholder="Achternaam *" class="form-control" />
					
									
								</div>
							</div>
			
					<div class="firstname-field col-6">
				
								<div class="form-group">
														<!--<label>Voornaam *</label>-->
										
										
					<input type="text" id="firstname" name="SOLMACH_PRENOM" required value="" placeholder="Voornaam *" class="form-control" />
					
									
								</div>
							</div>
			
				</div>
				<div class="row">
					<div class="company-field col-6">
				
								<div class="form-group">
														<!--<label>Bedrijf *</label>-->
										
										
					<input type="text" id="company" name="SOLMACH_SOCIETE" required value="" placeholder="Bedrijf *" class="form-control" />
					
									
								</div>
							</div>
			
					<div class="phone-field col-6">
				
								<div class="form-group">
														<!--<label>Telefoon *</label>-->
										
										
					<input type="text" id="phone" name="SOLMACH_TELEPHONE" required value="" placeholder="Telefoon *" class="form-control" />
					
									
								</div>
							</div>
			
				</div>
				<div class="row">
					<div class="adress-field col-6">
				
								<div class="form-group">
														<!--<label>Adres </label>-->
										
										
					<input type="text" id="adress" name="SOLMACH_ADRESSE"  value="" placeholder="Adres " class="form-control" />
					
									
								</div>
							</div>
			
					<div class="cp-field col-6">
				
								<div class="form-group">
														<!--<label>Postcode *</label>-->
										
										
					<input type="text" id="cp" name="SOLMACH_CP" required value="" placeholder="Postcode *" class="form-control" />
					
									
								</div>
							</div>
			
				</div>
				<div class="row">
					<div class="city-field col-6">
				
								<div class="form-group">
														<!--<label>Stad *</label>-->
										
										
					<input type="text" id="city" name="SOLMACH_VILLE" required value="" placeholder="Stad *" class="form-control" />
					
									
								</div>
							</div>
			
					<div class="country-field col-6">
				
								<div class="form-group">
														<!--<label>country *</label>-->
										
										
					<input type="text" id="country" name="SOLMACH_TITRE" required value="Pays-Bas" placeholder="country *" class="form-control" />
					
									
								</div>
							</div>
			
				</div>
				<div class="row">
					<div class="email-field col-12">
				
								<div class="form-group">
														<!--<label>Email *</label>-->
										
										
					<input type="text" id="email" name="email" required value="" placeholder="Email *" class="form-control" />
					
									
								</div>
							</div>
			
				</div>
				<div class="row">
					<div class="subject-field col-12">
				
								<div class="form-group">
														<!--<label>subject *</label>-->
										
										
					<input type="text" id="subject" name="SOLMACH_DEMANDE" required value="Ons contacteren" placeholder="subject *" class="form-control" />
					
									
								</div>
							</div>
			
				</div>
				<div class="row">
					<div class="message-field col-12">
				
								<div class="form-group">
														<!--<label>Bericht *</label>-->
										
										
					<textarea id="message" name="SOLMACH_COMMENT" required class="form-control" placeholder="Bericht *"></textarea>
					
									
								</div>
							</div>
			
				</div>
				<div class="row">
					<div class="langue-field col-12">
				
														
										
					<input type="hidden" id="langue" name="SOLMACH_LANGUE"  value="NL" placeholder="" />
					
									
							</div>
			
				</div>
				<div class="row">
					<div class="fichier-field col-12">
				
														
										
					<input type="hidden" id="fichier" name="SOLMACH_FICHIER"  value="SMO" placeholder="" />
					
									
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				</div>
				<div class="row">
					<div class="interet-field col-12">
				
								<div class="form-group">
														<!--<label>Geef je interesse aan : *</label>-->
										
										<label>Geef je interesse aan : *</label>
					<ul>
												<li>
							<input type="checkbox" id="interet1" name="SOLMACH_INTERET[]" value="Mechanica"  /> <label for="interet1">Mechanica</label>
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												<li>
							<input type="checkbox" id="interet2" name="SOLMACH_INTERET[]" value="
Plaatwerk"  /> <label for="interet2">
Plaatwerk</label>
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												<li>
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Andere"  /> <label for="interet3">
Andere</label>
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											</ul>
									
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		<div class="note">
			<span class="required">*</span>Champs requis		</div>
		
		<div class="text-center">
			<button id="submitBtn" type="submit" class="btn btn-default mt-3">Envoyer</button>
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