Contact

Team
Contact

Uw lokale kantoor

België

Aliaxis Belgium S.A.
Parc Industriel des Hauts-Sarts
1ère Avenue 106
4040 Herstal

+32 (0)4 248 89 40
info.be@aliaxis.com

Aliaxis Group | HQ

België

info@aliaxis.com

Form Field:

title_gender

Parameter for E-Mail: {{title_gender}}

Required field?

Disabled field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Field layout:

col1

Title (gender) options:

Form Field:

firstname

Parameter for E-Mail: {{firstname}}

Required field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Field layout:

col1

Form Field:

lastname

Parameter for E-Mail: {{lastname}}

Required field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Field layout:

col1

Form Field:

Parameter for E-Mail: {{email}}

Required field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Field layout:

col1

Form Field:

phone_number

Parameter for E-Mail: {{phone_number}}

Required field?

Disabled field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Field layout:

col1

Form Field:

company

Parameter for E-Mail: {{company}}

Required field?

Disabled field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

lastname

Field layout:

col1

Form Field:

postal_code

Parameter for E-Mail: {{postal_code}}

Required field?

Disabled field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Field layout:

col1

Form Field:

segment

Parameter for E-Mail: {{segment}}

Required field?

Disabled field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Field layout:

col1

Segment options: Option text → Send to address(es) email(s) info [OPTIONAL]
If the option is selected, the addresses set for this option will be added to the internal email.
Multiple addresses can be specified by separating the email addresses with a semicolon.
Example: receiver@pimcore.org; receiver2@pimcore.org

Form Field:

subject

Parameter for E-Mail: {{subject}}

Required field?

Disabled field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Field layout:

col1

Subject options: Option text → Send to address(es) email(s) info [OPTIONAL]
If the option is selected, the addresses set for this option will be added to the internal email.
Multiple addresses can be specified by separating the email addresses with a semicolon.
Example: receiver@pimcore.org; receiver2@pimcore.org

Form Field:

comment

Parameter for E-Mail: {{comment}}

Required field?

Disabled field?

Exclude from email info ? Exclude the field in all email parameters

Put after the template field:

--reset--

Add a limit to comment text: (0 or empty means no limit)

Minimum of characters:

Maximum of characters:

Form Field:

opt_in

Parameter for E-Mail: {{opt_in}}

Required field?

Disabled field?

Exclude from email info ? Exclude the field in all email parameters

Ja, ik wil graag e-mails van Aliaxis ontvangen over inzichten, bronnen, uitnodigingen voor evenementen en diensten. Ik begrijp dat ik mijn toestemming op elk moment kan intrekken, conform de Privacybeleid.

Voornaam *

Naam *

Bedrijfsnaam *

E-mailadres *

Aanvraagtype *

Toelichting *

* Verplicht veld

Aliaxis gebruikt deze informatie om uw vraag zo goed mogelijk te beantwoorden. Door dit formulier in te dienen, gaat u ermee akkoord dat Aliaxis contact met u mag opnemen indien nodig.