document.write('');
document.write('  <table align="left">');
document.write('<form method="post" action="http://112669.formmailer.onetwomax.de/">');
document.write('    <tr class="formfont">');
document.write('      <td colspan="2"><font class="formfont">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td class="formfontbold" align="left" valign="top"><font class="formfontbold">Name *</font></td>');
document.write('      <td class="formfontblack" align="left" valign="middle"><font class="formfontblack">');
document.write('        <input class="formfontblack" type="text" name="user_input[id3]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td class="formfontbold" align="left" valign="top"><font class="formfontbold">E-Mail *</font></td>');
document.write('      <td class="formfontblack" align="left" valign="middle"><font class="formfontblack">');
document.write('        <input class="formfontblack" type="text" name="user_input[id4]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td class="formfontbold" align="left" valign="top"><font class="formfontbold">Betreff *</font></td>');
document.write('      <td class="formfontblack" align="left" valign="middle"><font class="formfontblack">');
document.write('        <input class="formfontblack" type="text" name="user_input[id5]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="left" valign="top"><font class="formfontbold">Nachricht *</font></td>');
document.write('      <td align="left" valign="top"><font class="formfontblack">');
document.write('        <textarea class="formfontblack" 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="112669">');
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('');