<style></style>

<form action="" method="POST"><input name="action" type="hidden" value="booking_request" />
<fieldset><legend> Reserveringsaanvraag </legend><label for="rtb-date">
Datum </label>
<input id="rtb-date" name="rtb-date" required="" type="text" value="" aria-required="true" />
<label for="rtb-time">
Tijd </label>
<input id="rtb-time" name="rtb-time" required="" type="text" value="" aria-required="true" />
<label for="rtb-party">
Aantal </label>
<select id="rtb-party" name="rtb-party" required="" aria-required="true" data-selected="">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58">58</option>
<option value="59">59</option>
<option value="60">60</option>
<option value="61">61</option>
<option value="62">62</option>
<option value="63">63</option>
<option value="64">64</option>
<option value="65">65</option>
<option value="66">66</option>
<option value="67">67</option>
<option value="68">68</option>
<option value="69">69</option>
<option value="70">70</option>
<option value="71">71</option>
<option value="72">72</option>
<option value="73">73</option>
<option value="74">74</option>
<option value="75">75</option>
<option value="76">76</option>
<option value="77">77</option>
<option value="78">78</option>
<option value="79">79</option>
<option value="80">80</option>
<option value="81">81</option>
<option value="82">82</option>
<option value="83">83</option>
<option value="84">84</option>
<option value="85">85</option>
<option value="86">86</option>
<option value="87">87</option>
<option value="88">88</option>
<option value="89">89</option>
<option value="90">90</option>
<option value="91">91</option>
<option value="92">92</option>
<option value="93">93</option>
<option value="94">94</option>
<option value="95">95</option>
<option value="96">96</option>
<option value="97">97</option>
<option value="98">98</option>
<option value="99">99</option>
<option value="100">100</option>
</select></fieldset>
<fieldset><legend> Uw contactgegevens </legend><label for="rtb-name">
Naam </label>
<input id="rtb-name" name="rtb-name" required="" type="text" value="" aria-required="true" />
<label for="rtb-email">
E-mail </label>
<input id="rtb-email" name="rtb-email" required="" type="email" value="" aria-required="true" />
<label for="rtb-phone">
Telefoon </label>
<input id="rtb-phone" name="rtb-phone" type="tel" value="" />
<a href="#">
Voeg een bericht toe </a>
<label for="rtb-message">
Bericht </label>
<textarea id="rtb-message" name="rtb-message"></textarea></fieldset>
<fieldset><button type="submit">Reserveer</button></fieldset>
</form>