document.write('');
document.write('  <table align="center" bgcolor="#FF9900" style="border: 1px solid #FF6600">');
document.write('<form method="post" action="http://75523.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana"><b>CONTACT / KONTAKT  goa-project</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana" size="-2">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana"><b>Name *</b></font></td>');
document.write('      <td><font face="Verdana"><b>');
document.write('        <input style=" font-family: Verdana; font-weight: bold;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana"><b>E-Mail *</b></font></td>');
document.write('      <td><font face="Verdana"><b>');
document.write('        <input style=" font-family: Verdana; font-weight: bold;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana"><b>Text*</b></font></td>');
document.write('      <td><font face="Verdana"><b>');
document.write('        <textarea style=" font-family: Verdana; font-weight: bold;" name="user_input[id5]" style="width:100%" rows="7"></textarea>');
document.write('      </b></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="75523">');
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('');