document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://65792.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2">mit * gekennzeichnete Felder müssen ausgefüllt werden</td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Anfrage</td>');
document.write('      <td>');
document.write('        <input type="checkbox" name="user_input[id10]" value="1" >');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Buchung</td>');
document.write('      <td>');
document.write('        <input type="checkbox" name="user_input[id11]" value="1" >');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Unterkunft in</td>');
document.write('      <td>');
document.write('        <select name="user_input[id12]">');
document.write('          <option value="0">Ferienwohnung');
document.write('</option>');
document.write('          <option value="1">Appartement');
document.write('</option>');
document.write('          <option value="2">Doppelzimmer');
document.write('</option>');
document.write('          <option value="3">Einzelzimmer</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Anreisetag</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id13]" value="" size="10">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Abreisetag</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id14]" value="" size="10">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Anzahl Personen</td>');
document.write('      <td>');
document.write('        <select name="user_input[id17]">');
document.write('          <option value="0">1');
document.write('</option>');
document.write('          <option value="1">2');
document.write('</option>');
document.write('          <option value="2">3');
document.write('</option>');
document.write('          <option value="3">4');
document.write('</option>');
document.write('          <option value="4">5');
document.write('</option>');
document.write('          <option value="5">6');
document.write('</option>');
document.write('          <option value="6">7');
document.write('</option>');
document.write('          <option value="7">8');
document.write('</option>');
document.write('          <option value="8">9');
document.write('</option>');
document.write('          <option value="9">10</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>davon Kinder</td>');
document.write('      <td>');
document.write('        <select name="user_input[id16]">');
document.write('          <option value="0">0');
document.write('</option>');
document.write('          <option value="1">1');
document.write('</option>');
document.write('          <option value="2">2');
document.write('</option>');
document.write('          <option value="3">3');
document.write('</option>');
document.write('          <option value="4">4');
document.write('</option>');
document.write('          <option value="5">5');
document.write('</option>');
document.write('          <option value="6">6');
document.write('</option>');
document.write('          <option value="7">7');
document.write('</option>');
document.write('          <option value="8">8');
document.write('</option>');
document.write('          <option value="9">9</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Anrede</td>');
document.write('      <td>');
document.write('        <select name="user_input[id7]">');
document.write('          <option value="0">Herr');
document.write('</option>');
document.write('          <option value="1">Frau');
document.write('</option>');
document.write('          <option value="2">Familie</option>');
document.write('        </select>');
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>Strasse</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>PLZ / Ort</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id9]" 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>Nachricht *</td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="7"></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="65792">');
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('');