document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://133065.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana">Affiliate Bewerbung</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana" size="1">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="tahoma" size="1">Name*</font></td>');
document.write('      <td><font face="tahoma" size="1">');
document.write('        <input style=" font-family: tahoma;" type="text" name="user_input[id8]" value="" size="13">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="tahoma" size="1">Website URL*</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="13">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Tahoma" size="1">Elite oder Top Affiliate?</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id5]" value="" size="13">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="tahoma" size="1">E-Mail *</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="13">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Tahoma" size="1">Besucher pro Tag*</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="" size="13">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="tahoma" size="1">Deine Nachricht</font></td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="3"></textarea>');
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="133065">');
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('    <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>');
document.write('    </tr>');
document.write('</form>');
document.write('  </table>');
document.write('');