document.write('');
document.write('  <table align="left" bgcolor="#DAEBFE" cellspacing="1" cellpadding="1" style="border: 1px solid White">');
document.write('<form method="post" action="http://3585.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td bgcolor="#0099FF" colspan="2"><font color="White" face="Verdana" size="2"><b>Schicken Sie mir bitte eine Nachricht !</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana" size="2">(Felder mit * müssen ausgefüllt werden)</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#808080" face="Verdana" size="2"><b>Name *</b></font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" background-color: #F8FCA0; font-family: Verdana;" type="text" name="user_input[id1]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#808080" face="Verdana" size="2"><b>E-Mail oder Homepage *</b></font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" background-color: #F8FCA0; font-family: Verdana;" type="text" name="user_input[id2]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#808080" face="Verdana" size="2"><b>Betreff</b></font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" background-color: #F8FCA0; font-family: Verdana;" type="text" name="user_input[id3]" value="" size="30">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#808080" face="Verdana" size="2"><b>Text *<br></b></font><font face="Verdana" size="2">Teilen Sie bitte Ihre Frage oder Anregung hier mit !');
document.write('<BR>');
document.write('</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <textarea style=" background-color: #F8FCA0; font-family: Verdana;" name="user_input[id4]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#808080" face="Verdana" size="2"><b>www.hannowka.de gefunden durch:</b></font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <select style=" background-color: #F8FCA0; font-family: Verdana;" name="user_input[id6]">');
document.write('          <option value="0">Suchmaschine');
document.write('</option>');
document.write('          <option value="1">Bessarabiendeutsche');
document.write('</option>');
document.write('          <option value="2">Freunde/Bekannte');
document.write('</option>');
document.write('          <option value="3">www.bessarabien.de</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#808080" face="Verdana" size="2"><b>oder gefunden durch:</b></font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" background-color: #F8FCA0; font-family: Verdana;" type="text" name="user_input[id9]" value="" size="30">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>&nbsp;</td>');
document.write('      <td></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="3585">');
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('');