document.write('');
document.write('  <table align="center" cellspacing="10" style="border: 1px solid #330066">');
document.write('<form method="post" action="http://24975.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#333366" face="Arial" size="+2"><b><u>Hier kannst Du mir Deine Fragen oder Anregungen senden</u></b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#333366" face="Arial" size="-1"><i><u>mit * gekennzeichnete Felder müssen ausgefüllt werden</u></i></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#333366" face="Arial" size="+1"><b><u>Name*</u></b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#333366" face="Arial" size="+1"><b><u>Vorname*</u></b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#333366" face="Arial" size="+1"><b><u>Strasse_Hausnummer</u></b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id5]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#333366" face="Arial" size="+1"><b><u>Postleitzahl_Ort</u></b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id6]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#333366" face="Arial" size="+1"><b><u>Emailadresse*</u></b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#333366" face="Arial" size="+1"><b><u>Telefon</u></b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id8]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#333366" face="Arial" size="+1"><b><u>Deine_Frage_oder_Anregung*</u></b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <textarea name="user_input[id9]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#333366" face="Arial" size="+1"><b><u>Wie_soll_ich_Dir_antworten</u></b></font></td>');
document.write('      <td>');
document.write('        <select name="user_input[id10]">');
document.write('          <option value="0">per_Email');
document.write('</option>');
document.write('          <option value="1">per_Telefon</option>');
document.write('        </select>');
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="24975">');
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('');