document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://110640.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font size="2"><b>TS-Mitschnitt einsenden</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font size="1">mit * gekennzeichnete Felder muessen ausgefuellt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="1">Name (Nick) *</font></td>');
document.write('      <td><font size="1">');
document.write('        <input type="text" name="user_input[id3]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="1">Name des Mitschnittes *</font></td>');
document.write('      <td><font size="1">');
document.write('        <input type="text" name="user_input[id4]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="1">Downloadlink *</font></td>');
document.write('      <td><font size="1">');
document.write('        <input type="text" name="user_input[id5]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="1">Zustimmung aller Beteiligten*</font></td>');
document.write('      <td><font size="1">');
document.write('        <input type="checkbox" name="user_input[id7]" value="1" >');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="1">Kurze Beschreibung des Mitschnittes</font></td>');
document.write('      <td><font size="1">');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="3"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font size="1">E-Mail fuer das Gewinnspiel<br></font><font size="1">(optional)</font></td>');
document.write('      <td><font size="1">');
document.write('        <input type="text" name="user_input[id8]" value="" size="20">');
document.write('      </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="110640">');
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('');