document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://100002.formmailer.onetwomax.de/">');
document.write('    <tr class="normtextbold">');
document.write('      <td colspan="2">Die mit * gekennzeichneten Felder müssen ausgefüllt werden.</td>');
document.write('    </tr>');
document.write('    <tr class="normtext">');
document.write('      <td>Betreff *</td>');
document.write('      <td>');
document.write('        <input class="normtext" style=" border: 1px solid #3333ff; background-color: #ccccff;" type="text" name="user_input[id5]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr class="normtext">');
document.write('      <td>Telefon *</td>');
document.write('      <td>');
document.write('        <input class="normtext" style=" border: 1px solid #3333ff; background-color: #ccccff;" type="text" name="user_input[id7]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr class="normtext">');
document.write('      <td>Name *</td>');
document.write('      <td>');
document.write('        <input class="normtext" style=" border: 1px solid #3333ff; background-color: #ccccff;" type="text" name="user_input[id3]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr class="normtext">');
document.write('      <td>E-Mail *</td>');
document.write('      <td>');
document.write('        <input class="normtext" style=" border: 1px solid #3333ff; background-color: #ccccff;" type="text" name="user_input[id4]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr class="normtext">');
document.write('      <td align="left" valign="top">Nachricht *</td>');
document.write('      <td>');
document.write('        <textarea class="normtext" style=" border: 1px solid #3333ff; background-color: #ccccff;" name="user_input[id6]" style="width:100%" rows="10"></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="100002">');
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('');