<p>Name<br />
    [text* your-name] </p>

<p>E-mail<br />
    [email* email-prospect placeholder "e-mail@stichtinglarisa.org"]</p>

<p>Subscription Chamver of Commerce<br />
    [file* ChamberofCommerce]</p>

<p>Properly filled End User Statement<br />
    [file* EnduserStatement] </p>

<p>Copy of identification<br />
    [file* copyofidentification] </p>

<p>If in Europe Tax Number<br />
    [text btw /12 placeholder "NL999999999B99"]</p>

<p>To proceed reed terms and conditions<br /> I reed and agree with the Terms and Conditions from GBL Europe 
   [acceptance acceptance-termsandconditiona]</p>

<p>[submit "Send"]</p>