document.write('');
document.write('  <table align="center">');
document.write('<form method="post" action="http://60678.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2">Kontaktformular</td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2">mit * gekennzeichnete Felder müssen ausgefüllt werden</td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#B5B5B5" face="Verdana" size="1">Name*</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="25">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="1">eMail *</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="1">Strasse*</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id6]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="1">PLZ*</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="" size="10">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="1">Ort*</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id8]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="1">Ihre Nachricht: *</font></td>');
document.write('      <td valign="middle">');
document.write('        <textarea name="user_input[id9]" style="width:100%" rows="4"></textarea>');
document.write('      </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="60678">');
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('');