document.write('');
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document.write('<form method="post" action="http://88804.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#FFFFFF" face="Verdana" size="-2">Hinweis:</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Verdana" size="-2">mit * gekennzeichnete Felder müssen ausgefüllt werden');
document.write('<BR>');
document.write('</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#FFFFFF" face="Verdana" size="-1">Ihr Name *</font></td>');
document.write('      <td align="center"><font face="Verdana">');
document.write('        <input style=" border: 1px solid #FFFFFF; font-family: Verdana;" type="text" name="user_input[id3]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#FFFFFF" face="Verdana" size="-1">Ihr Wohnort *</font></td>');
document.write('      <td align="center"><font face="Verdana">');
document.write('        <input style=" border: 1px solid #FFFFFF; font-family: Verdana;" type="text" name="user_input[id8]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#FFFFFF" face="Verdana" size="-1">Ihre E-Mail *</font></td>');
document.write('      <td align="center"><font face="Verdana">');
document.write('        <input style=" border: 1px solid #FFFFFF; font-family: Verdana;" type="text" name="user_input[id4]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#FFFFFF" face="Verdana" size="-1">Ihr Telefon *</font></td>');
document.write('      <td align="center"><font face="Verdana">');
document.write('        <input style=" border: 1px solid #FFFFFF; font-family: Verdana;" type="text" name="user_input[id9]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#FFFFFF" face="Verdana" size="-1">Ihre Nachricht *</font></td>');
document.write('      <td align="center"><font face="Verdana">');
document.write('        <textarea style=" border: 1px solid #FFFFFF; font-family: Verdana;" name="user_input[id6]" style="width:100%" rows="8"></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="88804">');
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('');