document.write('<form method="post" action="http://35296.newsletter.onetwomax.de/">');
document.write('  <table align="center" bgcolor="#FFFF66" style="border: 1px solid #000000">');
document.write('    <tr>');
document.write('      <td><font color="#000000"><b>e-mail</b></font></td>');
document.write('      <td><font color="#000000"><b>');
document.write('        <input style=" color: #000000; font-weight: bold;" type="text" name="email" value="" size="10">');
document.write('      </b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000"><b>Name</b></font></td>');
document.write('      <td><font color="#000000"><b>');
document.write('        <input style=" color: #000000; font-weight: bold;" type="text" name="user_input[id4]" value="" size="10">');
document.write('      </b></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="add">');
document.write('        <input type="hidden" name="entry" value="35296">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('      </td>');
document.write('    </tr>');
document.write('  </table>');
document.write('</form>');
document.write('');