document.write('');
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document.write('<form method="post" action="http://127228.formmailer.onetwomax.de/">');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center" valign="middle"><font size="4">UserHinweis</font></td>');
document.write('      <td bgcolor="#000000" align="left" valign="middle"><font color="#8B0000" size="4">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td colspan="2"><font color="#D3D3D3" size="5"><i></i></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center"><font color="#D3D3D3" face="Verdana" size="2">Name *</font></td>');
document.write('      <td bgcolor="#000000" align="left" valign="middle"><font color="#c0c0c0">');
document.write('        <input style=" border: 1px solid #ffffff; background-color: #ffffff;" type="text" name="user_input[id3]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center"><font color="#D3D3D3" face="Verdana" size="2">Vorname</font></td>');
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document.write('        <input style=" border: 1px solid #ffffff; background-color: #ffffff;" type="text" name="user_input[id8]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center"><font color="#D3D3D3" face="Verdana" size="2">Adresse</font></td>');
document.write('      <td bgcolor="#000000" align="left" valign="middle"><font color="#c0c0c0">');
document.write('        <input style=" border: 1px solid #ffffff; background-color: #ffffff;" type="text" name="user_input[id9]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center"><font color="#D3D3D3" face="Verdana" size="2">Telefon</font></td>');
document.write('      <td bgcolor="#000000" align="left" valign="middle"><font color="#c0c0c0">');
document.write('        <input style=" border: 1px solid #ffffff; background-color: #ffffff;" type="text" name="user_input[id11]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center"><font color="#D3D3D3" face="Verdana" size="2">Url</font></td>');
document.write('      <td bgcolor="#000000" align="left" valign="middle"><font color="#c0c0c0">');
document.write('        <input style=" border: 1px solid #ffffff; background-color: #ffffff;" type="text" name="user_input[id10]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center"><font color="#D3D3D3" face="Verdana" size="2">E-Mail *</font></td>');
document.write('      <td bgcolor="#000000" align="left" valign="middle"><font color="#c0c0c0">');
document.write('        <input style=" border: 1px solid #ffffff; background-color: #ffffff;" type="text" name="user_input[id4]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center"><font color="#D3D3D3" face="Verdana" size="2">Betreff *</font></td>');
document.write('      <td bgcolor="#000000" align="left" valign="middle"><font color="#c0c0c0">');
document.write('        <input style=" border: 1px solid #ffffff; background-color: #ffffff;" type="text" name="user_input[id5]" value="" size="60">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#000000">');
document.write('      <td align="center"><font color="#D3D3D3" face="Verdana" size="2">Nachricht *</font></td>');
document.write('      <td bgcolor="#000000" align="left" valign="middle"><font color="#c0c0c0">');
document.write('        <textarea style=" border: 1px solid #ffffff; background-color: #ffffff;" 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" 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="127228">');
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('    <tr>');
document.write('      <td colspan="2" align="center"><font size="-2">Powered by <a href="http://www.onetwomax.de" target="_blank">OneTwoMax</a> Formmailer Script</font></td>');
document.write('    </tr>');
document.write('</form>');
document.write('  </table>');
document.write('');