document.write('');
document.write('  <table style="border: 1px solid Black">');
document.write('<form method="post" action="http://17410.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td bgcolor="blue" colspan="2"><font color="#FFFCCC" face="Verdana" size="3"><b>Anfrage</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Name, Vorname</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id1]" value="" size="50" maxlength="25">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">E-Mail</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id2]" value="" size="50" maxlength="30">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Ich interessiere mich für</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <select style=" font-family: Verdana;" name="user_input[id4]">');
document.write('          <option value="0">einen Podenco');
document.write('</option>');
document.write('          <option value="1">einen Galgo');
document.write('</option>');
document.write('          <option value="2">Podencomischling');
document.write('</option>');
document.write('          <option value="3">anderen Mischling');
document.write('</option>');
document.write('          <option value="4">weiss noch nicht</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">gibt es einen / mehrere Favoriten auf der Homepage - Name ?</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id5]" value="" size="50">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Nachricht</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <textarea style=" font-family: Verdana;" name="user_input[id3]" style="width:100%" rows="7"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Telefon<br></font><font face="Verdana" size="1">Bitte FESTNETZnummer angeben, da Anfragen sonst nicht bearbeitet werden.</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: verdana;" type="text" name="user_input[id202]" value="" size="50" maxlength="12">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Postleitzahl und Wohnort</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: verdana;" type="text" name="user_input[id203]" value="" size="50" maxlength="50">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">zur Info</font></td>');
document.write('      <td><font face="Verdana" size="2">Wir bitten um Ihr Verständnis, dass wir ausschließlich Anfragen ernst nehmen und beantworten, wenn Sie Name, Ort und Festnetznummer angeben.</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="17410">');
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('');