document.write('');
document.write('  <table cellspacing="3" cellpadding="3" style="border: 1px solid Black">');
document.write('<form method="post" action="http://8233.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td bgcolor="Black" colspan="2"><font color="White" face="Arial" size="2"><b>Hier können Sie uns eine Nachricht senden</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Name, Vorname *<br></b></font><font face="Arial" size="2">Bitte geben Sie hier Ihren Namen ein!</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id1]" value="" size="35" maxlength="50">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>PLZ, Wohnort *<br></b></font><font face="Arial" size="2">Bitte geben Sie hier Ihre PLZ und den Ort ein!</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id202]" value="" size="35" maxlength="50">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Ihre Telefonnummer *<br></b></font><font face="Arial" size="2">...für eventuelle Rückfragen!</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id203]" value="" size="35" maxlength="50">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Ihre E-Mail-Adresse *<br></b></font><font face="Arial" size="2">Bitte geben Sie hier Ihre email-Adresse korrekt');
document.write('<BR>');
document.write('an, sonst können wir Ihnen nicht antworten.</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id2]" value="@" size="35">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Betreff *<br></b></font><font face="Arial" size="2">Beschreiben Sie mit einem Wort Ihr Anliegen.</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id3]" value="" size="35">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Nachricht *<br></b></font><font face="Arial" size="2">Bitte geben Sie hier Ihre Nachricht ein!</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id4]" style="width:100%" rows="4"></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="8233">');
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('');