document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://33005.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="blue"><b>Die mit * gekennzeichnete Felder müssen ausgefüllt werden.</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Nachricht</b></td>');
document.write('      <td><b>');
document.write('        <textarea style=" font-weight: bold;" name="user_input[id6]" style="width:100%" rows="7"></textarea>');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Name *</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="text" name="user_input[id3]" value="" size="20" maxlength="100">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>E-Mail *</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Strasse *</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="text" name="user_input[id7]" value="" size="20">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>PLZ *</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="text" name="user_input[id8]" value="" size="20">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Ort *</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="text" name="user_input[id9]" value="" size="20">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Land *</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="text" name="user_input[id12]" value="" size="20">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Telefon *</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="text" name="user_input[id10]" value="" size="20">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Fax</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="text" name="user_input[id11]" value="" size="20">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Kataloganforderung</b></td>');
document.write('      <td><b>');
document.write('        <input style=" font-weight: bold;" type="checkbox" name="user_input[id14]" value="1" >');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>bitte senden Sie mir Ihren</b></td>');
document.write('      <td><b>');
document.write('        <select style=" font-weight: bold;" name="user_input[id13]">');
document.write('          <option value="0">Katalog als pdf-Datei ca. 6 MB');
document.write('</option>');
document.write('          <option value="1">Katalog per Post </option>');
document.write('        </select>');
document.write('      </b></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="33005">');
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('');