document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://153476.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#8c6342">Online CD Bestellung</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#8c6342">mit * gekennzeichnete Felder muessen ausgefuellt werden</font></td>');
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document.write('    <tr>');
document.write('      <td><font color="#8c6342">Name *</font></td>');
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document.write('        <input style=" color: #8c6342;" type="text" name="user_input[id3]" value="" size="20">');
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document.write('    <tr>');
document.write('      <td><font color="#8c6342">E-Mail *</font></td>');
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document.write('        <input style=" color: #8c6342;" type="text" name="user_input[id4]" value="" size="20">');
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document.write('    <tr>');
document.write('      <td><font color="#8c6342">Nachricht</font></td>');
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document.write('        <textarea style=" color: #8c6342;" name="user_input[id5]" style="width:100%" rows="7"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#8c6342">Stueck</font></td>');
document.write('      <td><font color="#8c6342">');
document.write('        <select style=" color: #8c6342;" name="user_input[id6]">');
document.write('          <option value="0">1');
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document.write('          <option value="1">2');
document.write('</option>');
document.write('          <option value="2">3');
document.write('</option>');
document.write('          <option value="3">4');
document.write('</option>');
document.write('          <option value="4">5');
document.write('</option>');
document.write('          <option value="5">6');
document.write('</option>');
document.write('          <option value="6">7');
document.write('</option>');
document.write('          <option value="7">8');
document.write('</option>');
document.write('          <option value="8">9');
document.write('</option>');
document.write('          <option value="9">10');
document.write('</option>');
document.write('          <option value="10">11');
document.write('</option>');
document.write('          <option value="11">12');
document.write('</option>');
document.write('          <option value="12">13');
document.write('</option>');
document.write('          <option value="13">14');
document.write('</option>');
document.write('          <option value="14">15');
document.write('</option>');
document.write('          <option value="15">16');
document.write('</option>');
document.write('          <option value="16">17');
document.write('</option>');
document.write('          <option value="17">18');
document.write('</option>');
document.write('          <option value="18">19');
document.write('</option>');
document.write('          <option value="19">20</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#8c6342">Bezahlung<br></font><font color="#8c6342">Waehlen Sie die Art der Bezahlung aus</font></td>');
document.write('      <td><font color="#8c6342">');
document.write('        <select style=" color: #8c6342;" name="user_input[id7]">');
document.write('          <option value="0">Bar bei Abholung');
document.write('</option>');
document.write('          <option value="1">Ueberweisung');
document.write('</option>');
document.write('          <option value="2">Nachnahme</option>');
document.write('        </select>');
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="153476">');
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('');