document.write('');
document.write('  <table bgcolor="#004080" style="border: 1px solid #004080">');
document.write('<form method="post" action="http://70119.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial"><b>mit * gekennzeichnete Felder müssen ausgefüllt werden</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial">Name *</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial">E-Mail *</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial">Betreff</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial">Nachricht</font></td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="7"></textarea>');
document.write('      </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="70119">');
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('');