document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://130530.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2">Werter Besucher, werte Besucherin! ');
document.write('<BR>');
document.write('Hier können Sie Ihr Anliegen und Ihre Wünsche eintragen - ');
document.write('<BR>');
document.write('Dear Visitor! please enter your message here. </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2">Mit * gekennzeichnete Felder müssen ausgefüllt werden - *These fields must be completed</td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Anrede*</td>');
document.write('      <td>');
document.write('        <select name="user_input[id17]">');
document.write('          <option value="0">Frau/Mrs');
document.write('</option>');
document.write('          <option value="1">Herr/Mr');
document.write('</option>');
document.write('          <option value="2">Firma/Firm</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Vorname/First-name,  Name/Last-name, Titel/Titel*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Strasse-Nr/Street-Nr*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id8]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>PLZ/Zip*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id9]" value="" size="7">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Wohnort/City*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id10]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Land/State*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id16]" value="" size="3">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>E-Mail *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Url</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id15]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Telefon</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id11]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Mobil</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id12]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Betreff/Subject</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id5]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Nachricht /Message*</td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="10"></textarea>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Hinweis<br>Ihre Adressangaben werden von uns selbstverständlich vertraulich behandelt und nicht an Dritte weitergegeben!</td>');
document.write('      <td></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="130530">');
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('');