document.write('');
document.write('  <table align="left" bgcolor="#002020" style="border: 1px solid #81452D">');
document.write('<form method="post" action="http://140571.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#C0C0C0" face="Verdana" size="-2"><i>mit * gekennzeichnete Felder müssen ausgefüllt werden</i></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#C0C0C0" face="Verdana"><b>Name *</b></font></td>');
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document.write('        <input style=" border: 1px solid #81452D; background-color: #FFFFFF; color: #000000; font-family: Verdana;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#C0C0C0" face="Verdana"><b>E-Mail *</b></font></td>');
document.write('      <td><font color="#C0C0C0" face="Verdana">');
document.write('        <input style=" border: 1px solid #81452D; background-color: #FFFFFF; color: #000000; font-family: Verdana;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#C0C0C0" face="Verdana"><b>Betreff *</b></font></td>');
document.write('      <td><font color="#C0C0C0" face="Verdana">');
document.write('        <input style=" border: 1px solid #81452D; background-color: #FFFFFF; color: #000000; font-family: Verdana;" type="text" name="user_input[id5]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#C0C0C0" face="Verdana"><b>Nachricht *</b></font></td>');
document.write('      <td><font color="#C0C0C0" face="Verdana">');
document.write('        <textarea style=" border: 1px solid #81452D; background-color: #FFFFFF; color: #000000; font-family: Verdana;" name="user_input[id6]" style="width:100%" rows="7"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center" valign="middle">');
document.write('        <input type="hidden" name="mq" value="\'">');
document.write('        <input type="hidden" name="action" value="send_mail">');
document.write('        <input type="hidden" name="entry" value="140571">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('        <input type="reset" name="reset" value="Zur&uuml;cksetzen">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2" align="center"><font size="-2">Powered by <a href="http://www.onetwomax.de" target="_blank">OneTwoMax</a> Formmailer Script</font></td>');
document.write('    </tr>');
document.write('</form>');
document.write('  </table>');
document.write('');