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document.write('<form method="post" action="http://161478.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td>Name *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="20">');
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document.write('      <td>E-Mail *</td>');
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document.write('      <td>URL*</td>');
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document.write('        <input type="text" name="user_input[id7]" value="http://" size="20">');
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document.write('    <tr>');
document.write('      <td>Button URL*<br>100*35 Pixel</td>');
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document.write('      <td>Kategorie/Category*</td>');
document.write('      <td>');
document.write('        <select name="user_input[id9]">');
document.write('          <option value="0">Robert related/Über Robert');
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document.write('          <option value="1">Actor/Schauspieler');
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document.write('          <option value="2">Actress/Schauspielerin');
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document.write('          <option value="4">Music/Musik');
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document.write('          <option value="5">Robs Co Actors/Robs Kollegen');
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document.write('          <option value="6">Twilight related/Twilightverwandtes');
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document.write('          <option value="7">Top Affiliates</option>');
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document.write('      <td>Nachricht/Message</td>');
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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="161478">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('        <input type="reset" name="reset" value="Zur&uuml;cksetzen">');
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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>');
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document.write('</form>');
document.write('  </table>');
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