<div class="vc_row wpb_row vc_row-fluid wpb_padding"><div class="wpb_column vc_column_container vc_col-sm-12"><div class="vc_column-inner "><div class="wpb_wrapper">
<div class="wpb_text_column wpb_content_element " >
<div class="wpb_wrapper">
<div role="form" class="wpcf7" id="wpcf7-f535-o1" lang="en-US" dir="ltr">
<div class="screen-reader-response"><p role="status" aria-live="polite" aria-atomic="true"></p> <ul></ul></div>
<form action="/service/affordable-diagnosis/#wpcf7-f535-o1" method="post" class="wpcf7-form init" novalidate="novalidate" data-status="init">
<div style="display: none;">
<input type="hidden" name="_wpcf7" value="535" />
<input type="hidden" name="_wpcf7_version" value="5.3.2" />
<input type="hidden" name="_wpcf7_locale" value="en_US" />
<input type="hidden" name="_wpcf7_unit_tag" value="wpcf7-f535-o1" />
<input type="hidden" name="_wpcf7_container_post" value="0" />
<input type="hidden" name="_wpcf7_posted_data_hash" value="" />
</div>
<h3>Buche ein Techniker</h3>
<div class="row">
<div class="col-sm-3">
<div class="form-box-label">Abholtag</div>
<div class="datetimepicker-wrap"><span class="wpcf7-form-control-wrap date"> <span class="wpcf7-form-control-wrap date-593"><input type="date" name="date-593" value="" class="wpcf7-form-control wpcf7-date wpcf7-validates-as-date" aria-invalid="false" /></span> </span></div>
</p></div>
<div class="col-sm-3">
<div class="form-box-label">Computer / Laptop</div>
<div class="select-wrapper"><span class="wpcf7-form-control-wrap select1"> <span class="wpcf7-form-control-wrap system"><select name="system" class="wpcf7-form-control wpcf7-select wpcf7-validates-as-required" aria-required="true" aria-invalid="false"><option value="Auswahl">Auswahl</option><option value="Computer">Computer</option><option value="Laptop">Laptop</option><option value="Sonstiges">Sonstiges</option></select></span> </span></div>
</p></div>
<div class="col-sm-3">
<div class="form-box-label">Marke</div>
<div class="select-wrapper"><span class="wpcf7-form-control-wrap select2"> <span class="wpcf7-form-control-wrap Marke"><select name="Marke" class="wpcf7-form-control wpcf7-select" aria-invalid="false"><option value="Acer">Acer</option><option value="Apple">Apple</option><option value="Asus">Asus</option><option value="Lenovo">Lenovo</option><option value="Packard">Packard</option><option value="Dell">Dell</option><option value="Toshiba">Toshiba</option><option value="Sonstiges">Sonstiges</option></select></span> </span></div>
</p></div>
<div class="col-sm-3">
<div class="form-box-label">Betriebs System</div>
<div class="select-wrapper"><span class="wpcf7-form-control-wrap select3"> <span class="wpcf7-form-control-wrap system"><select name="system" class="wpcf7-form-control wpcf7-select wpcf7-validates-as-required" aria-required="true" aria-invalid="false"><option value="Microsoft Windows">Microsoft Windows</option><option value="Linux">Linux</option><option value="macOS">macOS</option><option value="Google Chrome OS">Google Chrome OS</option><option value="Sonstiges">Sonstiges</option></select></span> </span></div>
</p></div>
</div>
<div class="row">
<div class="col-sm-4">
<div class="form-box-label">Vorname</div>
<p> <span class="wpcf7-form-control-wrap fname"> <span class="wpcf7-form-control-wrap first-name"><input type="text" name="first-name" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="First Name" /></span> </span> </div>
<div class="col-sm-4">
<div class="form-box-label">Nachname</div>
<p> <span class="wpcf7-form-control-wrap lname"> <span class="wpcf7-form-control-wrap last-name"><input type="text" name="last-name" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Last Name" /></span> </span> </div>
<div class="col-sm-4">
<div class="form-box-label">E-Mail adresse</div>
<p> <span class="wpcf7-form-control-wrap your-email"> <span class="wpcf7-form-control-wrap email"><input type="text" name="email" value="" size="40" class="wpcf7-form-control wpcf7-text" aria-invalid="false" placeholder="Email" /></span> </span> </div>
</div>
<div class="row">
<div class="col-sm-4">
<div class="form-box-label">Kontakt Telefonummer</div>
<p> <span class="wpcf7-form-control-wrap your-phone"> <span class="wpcf7-form-control-wrap phone"><input type="tel" name="phone" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-tel" aria-invalid="false" placeholder="Phone" /></span> </span> </div>
<div class="col-sm-4">
<div class="form-box-label">Adresse</div>
<p> <span class="wpcf7-form-control-wrap address"> <span class="wpcf7-form-control-wrap adresse"><input type="text" name="adresse" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="Adresse" /></span> </span> </div>
<div class="col-sm-4">
<div class="form-box-label">Stadt</div>
<p> <span class="wpcf7-form-control-wrap city"> <span class="wpcf7-form-control-wrap city"><input type="text" name="city" value="" size="40" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" placeholder="City" /></span> </span> </div>
</div>
<div class="row">
<div class="col-sm-12">
<div class="form-box-label">Spezielle Angaben</div>
<p> <span class="wpcf7-form-control-wrap message"> <span class="wpcf7-form-control-wrap textarea-554"><textarea name="textarea-554" cols="40" rows="10" class="wpcf7-form-control wpcf7-textarea" aria-invalid="false"></textarea></span> </span><br />
<br><br />
<input type="submit" value="ANFRAGE" class="wpcf7-form-control wpcf7-submit button pull-right" /></div>
</p></div>
<input type='hidden' class='wpcf7-pum' value='{"closepopup":false,"closedelay":0,"openpopup":false,"openpopup_id":0}' /><div class="wpcf7-response-output" aria-hidden="true"></div></form></div> </div>
</div>
</div></div></div></div>
