document.write('<form method="post" action="http://60501.newsletter.onetwomax.de/">');
document.write('  <table style="border: 1px solid #123456">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Verdana" size="2"><b><i><u>Unser Newsletter</u></i></b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="1"><i>mit * gekennzeichnete Felder müssen ausgefüllt werden</i></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2"><i>E-Mail *</i></font></td>');
document.write('      <td><font face="Verdana" size="2"><i>');
document.write('        <input style=" font-family: Verdana; font-weight: bold; font-style: italic;" type="text" name="email" value="" size="20">');
document.write('      </i></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2"><i>Name *</i></font></td>');
document.write('      <td><font face="Verdana" size="2"><i>');
document.write('        <input style=" font-family: Verdana; font-weight: bold; font-style: italic;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </i></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="60501">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
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> Newsletter Script</font></td>');
document.write('    </tr>');
document.write('  </table>');
document.write('</form>');
document.write('');