document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://168735.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#000000" size="4">Wünsch dir was!</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><b>mit * gekennzeichnete Felder müssen ausgefüllt werden</b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Name *</b></td>');
document.write('      <td><b>');
document.write('        <input type="text" name="user_input[id3]" value="" size="20">');
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 type="text" name="user_input[id4]" value="" size="20">');
document.write('      </b></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Was soll es sein?</b></td>');
document.write('      <td>');
document.write('        <select name="user_input[id5]">');
document.write('          <option value="0">Icon(s)');
document.write('</option>');
document.write('          <option value="1">Signatur');
document.write('</option>');
document.write('          <option value="2">Wallpaper');
document.write('</option>');
document.write('          <option value="3">lesezeichen');
document.write('</option>');
document.write('          <option value="4">Stundenplan');
document.write('</option>');
document.write('          <option value="5">Animation (Bitte Video angeben!)</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Was für Bilder bzw. welches Video?</b></td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="5"></textarea>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Wenn Animation: Welchen Teil des Videos?</b></td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id7]" style="width:100%" rows="5"></textarea>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><b>Sonst noch etwas?</b></td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id8]" style="width:100%" rows="5"></textarea>');
document.write('      </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="168735">');
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('');