document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://58551.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#000099" face="Comic Sans MS" size="3"><b><u>Bestellformular</u></b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#000099" face="Comic Sans MS" size="-2">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Name*</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099;" type="text" name="user_input[id3]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Vorname*</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id4]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">E-Mail *</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id12]" value="@" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">E-Mail bitte wiederholen*<br></font><font color="#000099" face="Comic Sans MS" size="2">                  </font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id13]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Straße, Hausnummer*</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id5]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">PLZ Ort*</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id9]" value="" size="40">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Land</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id28]" value="Deutschland" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Telefon-Nr.:*</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id14]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Fax-Nummer:</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id15]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Bestell-Nummer*</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id22]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Anzahl*</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <input style=" color: #000099; font-family: Comic Sans MS;" type="text" name="user_input[id18]" value="" size="5">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Größe</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <select style=" color: #000099; font-family: Comic Sans MS;" name="user_input[id30]">');
document.write('          <option value="0">-');
document.write('</option>');
document.write('          <option value="1">16/17');
document.write('</option>');
document.write('          <option value="2">18/19');
document.write('</option>');
document.write('          <option value="3">20/21');
document.write('</option>');
document.write('          <option value="4">22/23');
document.write('</option>');
document.write('          <option value="5">24/25');
document.write('</option>');
document.write('          <option value="6">26/27');
document.write('</option>');
document.write('          <option value="7">28');
document.write('</option>');
document.write('          <option value="8">29');
document.write('</option>');
document.write('          <option value="9">30');
document.write('</option>');
document.write('          <option value="10">größer - Anfrage</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Bemerkungen / weitere Bestellungen</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <textarea style=" color: #000099; font-family: Comic Sans MS;" name="user_input[id23]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Express Versand gewünscht?</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <select style=" color: #000099; font-family: Comic Sans MS;" name="user_input[id29]">');
document.write('          <option value="0">Nein');
document.write('</option>');
document.write('          <option value="1">Ja</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">Wie sind Sie auf uns<br></font><font color="#000099" face="Comic Sans MS" size="2">aufmerksam geworden?</font></td>');
document.write('      <td><font color="#000099" face="Comic Sans MS" size="2">');
document.write('        <textarea style=" color: #000099; font-family: Comic Sans MS;" name="user_input[id27]" 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="58551">');
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('');