document.write('<form method="post" action="http://1858.formmailer.onetwomax.de/">');
document.write('  <table align="center" bgcolor="#666666" style="border: 1px solid Black">');
document.write('    <tr>');
document.write('      <td bgcolor="#006633" colspan="2"><font face="Arial" size="2"><b>Kontaktformular</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td bgcolor="#669999" colspan="2"><font face="Arial" size="2">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Name *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" background-color: #999999; font-family: Arial;" type="text" name="user_input[id1]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>E-Mail *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" background-color: #999999; font-family: Arial;" type="text" name="user_input[id2]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Banner Url *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" background-color: #999999; font-family: Arial;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Homepage Url *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" background-color: #999999; font-family: Arial;" type="text" name="user_input[id5]" value="" size="20">');
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="1858">');
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('  </table>');
document.write('</form>');
document.write('');