document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://26832.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td>your e-mail</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>your name</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>please send me your price list</td>');
document.write('      <td>');
document.write('        <input type="checkbox" name="user_input[id6]" value="1" checked>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>subject</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="price list, English version" size="30">');
document.write('      </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="26832">');
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('');