Contact form

Contact form
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<input type="text" name="Firma" id="mailform1170Firma" size="30" value="" class="form-control" />
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<fieldset id="mailform1170anrede"><legend>Salutation:</legend><input type="radio" name="anrede" id="mailform1170anredeMrs" value="Mrs." class="input-radio" /><input type="radio" name="anrede" id="mailform1170anredeMr" value="Mr." class="input-radio" /></fieldset>
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<input type="text" name="Vorname" id="mailform1170Vorname" size="30" value="" class="form-control" />
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<input type="text" name="Name" id="mailform1170Name" size="30" value="" class="form-control" />
<input type="text" name="Strasse" id="mailform1170Strasse" size="30" value="" class="form-control" />
<input type="text" name="PLZ_Ort" id="mailform1170PLZ_Ort" size="30" value="" class="form-control" />
<select name="Land" id="mailform1170Land" size="1" class="form-control"><option value="Germany">Germany</option><option value="USA">USA</option><option value="other">other</option></select>
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<input type="text" name="email" id="mailform1170email" size="30" value="" class="form-control" />
<input type="text" name="Telefon" id="mailform1170Telefon" size="30" value="" class="form-control" />
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<input type="text" name="Betreff" id="mailform1170Betreff" size="30" value="" class="form-control" />
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<textarea name="Ihre_Mitteilung" id="mailform1170Ihre_Mitteilung" cols="28" rows="6" class="form-control"> </textarea>
<input type="submit" name="formtype_mail" id="mailform1170formtype_mail" value="Send" class="btn btn-primary" />

* Please fill in mandatory fields