document.write('');
document.write('  <table align="center">');
document.write('<form method="post" action="http://97609.formmailer.onetwomax.de/">');
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 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>E-Mail *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Betreff *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <select style=" font-family: Arial;" name="user_input[id7]">');
document.write('          <option value="0">(bitte auswählen)');
document.write('</option>');
document.write('          <option value="1">Autogrammadresse(n)');
document.write('</option>');
document.write('          <option value="2">Fotohüllen');
document.write('</option>');
document.write('          <option value="3">Linktipp');
document.write('</option>');
document.write('          <option value="4">Rückporto');
document.write('</option>');
document.write('          <option value="5">Sonstiges</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Nachricht *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id6]" style="width:100%" rows="7"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2"><b>Mit * gekennzeichnete Felder müssen ausgefüllt werden.</b></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="97609">');
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('');