document.write('');
document.write('  <table align="left">');
document.write('<form method="post" action="http://134608.formmailer.onetwomax.de/">');
document.write('    <tr bgcolor="#9A979E">');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>Name *</b></font></td>');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>');
document.write('        <input style=" border: 1px solid #9A979E; background-color: #FFFFFF; color: #000000; font-family: Arial;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#9A979E">');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>E-Mail *</b></font></td>');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>');
document.write('        <input style=" border: 1px solid #9A979E; background-color: #FFFFFF; color: #000000; font-family: Arial;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#9A979E">');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>Homepage*</b></font></td>');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>');
document.write('        <input style=" border: 1px solid #9A979E; background-color: #FFFFFF; color: #000000; font-family: Arial;" type="text" name="user_input[id5]" value="" size="20">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#9A979E">');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>Betreff*</b></font></td>');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>');
document.write('        <input style=" border: 1px solid #9A979E; background-color: #FFFFFF; color: #000000; font-family: Arial;" type="text" name="user_input[id7]" value="" size="20">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#9A979E">');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>Button 100x35*</b></font></td>');
document.write('      <td bgcolor="#9A979E" align="left" valign="middle"><font color="#94386A" face="Arial" size="2"><b>');
document.write('        <textarea style=" border: 1px solid #9A979E; background-color: #FFFFFF; color: #000000; font-family: Arial;" name="user_input[id6]" style="width:100%" rows="5"></textarea>');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#9A979E">');
document.write('      <td bgcolor="#9A979E" align="center" valign="middle" colspan="2"><font color="#94386A" face="Arial" size="1"><b>* Diese Felder müssen ausgefüllt werden!</b></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="134608">');
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('');