document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://97260.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td><font color="#993300" face="Arial" size="2"><b>Name *</b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <input type="text" name="user_input[id3]" value="" size="70">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#993300" face="Arial" size="2"><b>E-Mail *</b></font></td>');
document.write('      <td>');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id4]" value="" size="70">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#993300" face="Arial" size="2">Tel.-Nr</font></td>');
document.write('      <td><font face="Arial">');
document.write('        <input type="text" name="user_input[id7]" value="" size="70">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#993300" face="Arial" size="2">Anschrift</font></td>');
document.write('      <td><font face="Arial">');
document.write('        <textarea name="user_input[id8]" style="width:100%" rows="2"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#993300" face="Arial" size="2"><b>Betreff *</b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <input type="text" name="user_input[id5]" value="" size="70">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#993300" face="Arial" size="2"><b>Nachricht *</b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="10"></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="97260">');
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('</form>');
document.write('  </table>');
document.write('');