document.write('');
document.write('  <table bgcolor="#99FF00" cellspacing="8" style="border: 1px solid Black">');
document.write('<form method="post" action="http://16835.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td bgcolor="Red" colspan="2"><font color="#000000" face="Arial" size="2"><b>White Vibration - Kontaktformular</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#000000" face="Arial" size="2">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Arial" size="2"><b>Name *</b></font></td>');
document.write('      <td><font color="#000000" face="Arial" size="2">');
document.write('        <input style=" background-color: Yellow; color: #000000; 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 color="#000000" face="Arial" size="2"><b>E-Mail *</b></font></td>');
document.write('      <td><font color="#000000" face="Arial" size="2">');
document.write('        <input style=" background-color: Yellow; color: #000000; 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 color="#000000" face="Arial" size="2"><b>Betreff</b></font></td>');
document.write('      <td><font color="#000000" face="Arial" size="2">');
document.write('        <select style=" background-color: Yellow; color: #000000; font-family: Arial;" name="user_input[id5]">');
document.write('          <option value="0">Terminanfrage');
document.write('</option>');
document.write('          <option value="1">Anforderung Demo-CD');
document.write('</option>');
document.write('          <option value="2">Sonstiges</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Arial" size="2"><b>zusätzlicher Betreff</b></font></td>');
document.write('      <td><font color="#000000" face="Arial" size="2">');
document.write('        <input style=" background-color: Yellow; color: #000000; 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 color="#000000" face="Arial" size="2"><b>Nachricht *</b></font></td>');
document.write('      <td><font color="#000000" face="Arial" size="2">');
document.write('        <textarea style=" background-color: Yellow; color: #000000; font-family: Arial;" name="user_input[id4]" style="width:100%" rows="7"></textarea>');
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="16835">');
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('');