document.write('');
document.write('  <table cellspacing="2" cellpadding="2">');
document.write('<form method="post" action="http://61853.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td><font face="arial" size="4"><b>Kontaktformular</b></font></td>');
document.write('      <td></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="arial" size="3">Name *</font></td>');
document.write('      <td><font face="arial">');
document.write('        <input style=" font-family: arial;" type="text" name="user_input[id3]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="arial" size="3">Adresse</font></td>');
document.write('      <td><font face="arial">');
document.write('        <input style=" font-family: arial;" type="text" name="user_input[id7]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="arial" size="3">E-Mail *</font></td>');
document.write('      <td><font face="arial">');
document.write('        <input style=" font-family: arial;" type="text" name="user_input[id4]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="arial" size="3">Betreff</font></td>');
document.write('      <td><font face="arial">');
document.write('        <input style=" font-family: arial;" type="text" name="user_input[id5]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="arial" size="3">Nachricht *</font></td>');
document.write('      <td><font face="arial">');
document.write('        <textarea style=" font-family: arial;" name="user_input[id6]" style="width:100%" rows="9"></textarea>');
document.write('      </font></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 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="61853">');
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('');