Seitenhistorie

<form class="aui" method="POST" action="mailto:support@kv.digital?subject=Portalregistrierung" enctype="text/plain" accept-charset="UTF-8">
    <div class="field-group">
        <label for="comment-email">E-Mail-Adresse
            <span class="aui-icon icon-required">(required)</span></label>
        <input class="text medium-long-field" type="text"
               id="comment-email" name="Email" placeholder="IhrVorname.IhrNachname@IhreOrganisation.de" data-aui-validation-field required="required" minlength="1" pattern=".+@+..*\...*">
        <div class="description">Ihre geschäftliche E-Mail-Adresse. Private E-Mail-Adressen oder E-Mail-Adressen ohne persönlichen Mandanten, bspw. Info-Adressen, sind nicht erlaubt.</div>
		</div>
    <div class="field-group">
        <label for="text-input">Vorname<span class="aui-icon icon-required">required</span></label>
        <input class="text medium-long-field" type="text" id="text-input" name="Vorname" title="Text input" data-aui-validation-field required="required" minlength="1">
        <div class="description">Vorname (für Erstellung des Benutzernamens)</div>
    </div>
    <div class="field-group">
        <label for="text-input">Nachname<span class="aui-icon icon-required">required</span></label>
        <input class="text medium-long-field" type="text" id="text-input" name="Nachname" title="Text input" data-aui-validation-field required="required" minlength="1">
        <div class="description">Nachname (für Erstellung des Benutzernamens)</div>
    </div>
    <div class="field-group">
        <label for="text-input">Unternehmen<span class="aui-icon icon-required">required</span></label>
        <input class="text medium-long-field" type="text" id="text-input" name="Unternehmen" title="Text input" data-aui-validation-field required="required" minlength="1">
        <div class="description">Unternehmen oder Organisation, für welche(s) Sie arbeiten</div>
    </div>
    <div class="field-group">
        <label for="select-example">Art der Organisation<span class="aui-icon icon-required">required</span></label>
        <select class="select" id="select-example" name="Organisationsart">
            <option value="SWH">Softwarehersteller</option>
            <option value="VSP">Service- und Vertriebs-Dienstleister</option>
            <option value="KV">Kassenärztliche Vereinigung</option>
			<option value="KBV">Kassenärztliche Bundesvereinigung</option>
			<option value="KH">Krankenhaus</option>
			<option value="Lab">Labor</option>
			<option value="Verband">Verband</option>
       </select>
    	<div class="description">Bitte wählen Sie die Art Ihrer Organisation aus.</div>
	</div>
 	<div class="field-group">
        <label for="comment-input">Begründung<span class="aui-icon icon-required">required</span></label>
        <textarea class="textarea medium-long-field" name="Begruendung"
                  id="comment-input" placeholder="Kurze Erklärung, wofür Sie den Zugang zum Partnerportal verwenden möchten" data-aui-validation-field required="required" minlength="1"></textarea>
    </div>
    <div class="buttons-container">
        <div class="buttons">
            <input class="button submit" type="submit" value="Senden" id="comment-save-button">
            <a class="cancel" href="#">Abbrechen</a>
        </div>
    </div>
</form>