document.write('');
document.write('  <table style="border: 1px solid Black">');
document.write('<form method="post" action="http://14282.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2"><b>message to Bea</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2">--- with * marked field must be filled out ---');
document.write('<BR>');
document.write('<BR>');
document.write('for your information:');
document.write('<BR>');
document.write('&quot;Abschicken&quot; means &quot;send&quot;;');
document.write('<BR>');
document.write('&quot;Zurücksetzen&quot; means &quot;erase&quot;</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>name: *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id1]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>e-mail: *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id2]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>topic</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>notice: *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id4]" style="width:100%" rows="7"></textarea>');
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="14282">');
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('');