document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://133523.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td><font color="#513c6e" face="Tahoma" size="1">Name *</font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #b7c0cf; background-color: #e4e4ea; color: #513c6e; font-family: Tahoma;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#513c6e" face="Tahoma" size="1">E-Mail *</font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #b7c0cf; background-color: #e4e4ea; color: #513c6e; font-family: Tahoma;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#513c6e" face="Tahoma" size="1">Homepage*</font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #b7c0cf; background-color: #e4e4ea; color: #513c6e; font-family: Tahoma;" type="text" name="user_input[id5]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#513c6e" face="Tahoma" size="1">Nachricht *<br></font><font color="#513c6e">Normal, Top, Elite?</font></td>');
document.write('      <td>');
document.write('        <textarea style=" border: 1px solid #b7c0cf; background-color: #e4e4ea; color: #513c6e; font-family: Tahoma;" 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="133523">');
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('');