document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://60613.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font size="-1">CD-Bestellformular </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font size="-2">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Album*</td>');
document.write('      <td>');
document.write('        <select name="user_input[id13]">');
document.write('          <option value="0">No Fear Required - 14,99 € inkl. Versand');
document.write('</option>');
document.write('          <option value="1">Silent Mirror Inside - 14,99 € inkl. Versand');
document.write('</option>');
document.write('          <option value="2">Beide Alben SONDERPREIS - 23,99 € inkl. Versand</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Vorname *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id12]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Name *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>E-Mail *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Anschrift *</td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="5"></textarea>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>CD-Stückzahl *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Anmerkungen<br> </td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id8]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Soll die CD signiert werden? *</td>');
document.write('      <td>');
document.write('        <select name="user_input[id11]">');
document.write('          <option value="0">Ja');
document.write('</option>');
document.write('          <option value="1">Nein</option>');
document.write('        </select>');
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="60613">');
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('');