document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://159696.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana"><b>Angebot anfordern</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana" size="1">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Ihr Name *</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Ihre E-Mail *</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Gewünschtes Format</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <select style=" font-family: Verdana;" name="user_input[id12]">');
document.write('          <option value="0">88x31');
document.write('</option>');
document.write('          <option value="1">468x60');
document.write('</option>');
document.write('          <option value="2">160x600');
document.write('</option>');
document.write('          <option value="3">Textlink Artikel');
document.write('</option>');
document.write('          <option value="4">Textlink Sidebar</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Gewünschte Laufzeit</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <select style=" font-family: Verdana;" name="user_input[id10]">');
document.write('          <option value="0">1 Monat');
document.write('</option>');
document.write('          <option value="1">3 Monate');
document.write('</option>');
document.write('          <option value="2">6 Monate');
document.write('</option>');
document.write('          <option value="3">12 Monate</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Andere Laufzeit</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id11]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Anmerkungen</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <textarea style=" font-family: Verdana;" name="user_input[id13]" style="width:100%" rows="5"></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="159696">');
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('</form>');
document.write('  </table>');
document.write('');