document.write('');
document.write('  <table align="center" bgcolor="#66CCFF" cellspacing="2" cellpadding="2" style="border: 1px solid #000099">');
document.write('<form method="post" action="http://67789.formmailer.onetwomax.de/">');
document.write('    <tr bgcolor="#66CCFF">');
document.write('      <td align="center" valign="middle" colspan="2"><font color="#000000" face="Arial"><b>B-Jay\'s Kontaktformular</b></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#66CCFF">');
document.write('      <td align="center" valign="middle" colspan="2"><font color="#FF3333" face="Arial"><b>mit * gekennzeichnete Felder müssen ausgefüllt werden</b></font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#66CCFF">');
document.write('      <td><font color="#000099" face="Arial"><b>Name: *</b></font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #000000; color: #000000; font-family: Arial; font-weight: bold;" type="text" name="user_input[id3]" value="" size="45">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#66CCFF">');
document.write('      <td><font color="#000099" face="Arial"><b>E-Mail: *</b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <input style=" border: 1px solid #000000; color: #000000; font-family: Arial; font-weight: bold;" type="text" name="user_input[id4]" value="" size="45">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#66CCFF">');
document.write('      <td><font color="#000099" face="Arial"><b>Homepage:</b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <input style=" border: 1px solid #000000; color: #000000; font-family: Arial; font-weight: bold;" type="text" name="user_input[id7]" value="http://www." size="45">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#66CCFF">');
document.write('      <td><font color="#000099" face="Arial"><b>Betreff: *</b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <input style=" border: 1px solid #000000; color: #000000; font-family: Arial; font-weight: bold;" type="text" name="user_input[id5]" value="" size="45">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="#66CCFF">');
document.write('      <td><font color="#000099" face="Arial"><b>Nachricht: *</b></font></td>');
document.write('      <td><font color="#000000" face="Arial">');
document.write('        <textarea style=" border: 1px solid #000000; color: #000000; font-family: Arial;" name="user_input[id6]" style="width:100%" rows="10"></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="67789">');
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('');