<form class="uk-form">
<div class="uk-grid uk-panel uk-panel-box" data-uk-grid-margin>
 
  <div class="uk-width-medium-1-2 uk-width-small-1-1"><div class="uk-panel">
 
    <h3 class="uk-panel-title">UW GEGEVENS</h3>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-1-1"><div class="uk-panel">{bedrijf:caption}<br />{bedrijf:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-medium-1-2"><div class="uk-panel">{voornaam:caption}<br />{voornaam:body}</div></div>
  <div class="uk-width-medium-1-2"><div class="uk-panel">{achternaam:caption}<br />{achternaam:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-hidden-small uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-1-1"><div class="uk-panel">{straat:caption}<br />{straat:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-hidden-small uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-medium-3-10"><div class="uk-panel">{postcode:caption}<br />{postcode:body}</div></div>
  <div class="uk-width-medium-7-10"><div class="uk-panel">{woonplaats:caption}<br />{woonplaats:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-hidden-small uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-medium-1-2"><div class="uk-panel">{land:caption}<br />{land:body}</div></div>
  <div class="uk-width-medium-1-2"><div class="uk-panel">{btw:caption}<br />{btw:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-medium-1-2"><div class="uk-panel">{telefoon:caption}<br />{telefoon:body}</div></div>
  <div class="uk-width-medium-1-2  uk-hidden-small"><div class="uk-panel">{mobiel:caption}<br />{mobiel:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-1-1"><div class="uk-panel">{email:caption}<br />{email:body}</div></div>
<div class="formclr"></div>
</div>
  </div></div>
 
 
 
  <div class="uk-width-medium-1-2 uk-width-small-1-1"><div class="uk-panel">
 
    <h3 class="uk-panel-title">PRODUCT & LOGO</h3>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-medium-3-10"><div class="uk-panel">{aantal:caption}<br />{aantal:body}</div></div>
  <div class="uk-width-medium-7-10"><div class="uk-panel">{product:caption}<br />{product:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-hidden-small uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-1-1"><div class="uk-panel class="uk-form-file">{logo1:caption}<br />{logo1:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-hidden-small uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-1-1"><div class="uk-panel class="uk-form-file">{logo2:caption}<br />{logo2:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-medium-1-1"><div class="uk-panel">{opmerkingen:caption}<br />{opmerkingen:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-medium-1-1"><div class="uk-panel">{levertijd:caption}<br />{levertijd:body}</div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-medium-1-1"><div class="uk-panel">{captcha:caption}<br />{captcha:body}<span class="formClr">{captcha:validation}</span></div></div>
<div class="formclr"></div>
</div>
 
<div class="uk-grid uk-grid-small" data-uk-grid-margin>   
  <div class="uk-width-1-1"><div class="uk-panel">{aanvragen:caption}<br />{aanvragen:body}</div></div>
<div class="formclr"></div>
</div>
 
  </div></div>  
 
</div>
</form>