document.write('');
document.write('  <table align="center" style="border: 1px solid Black">');
document.write('<form method="post" action="http://17084.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2"><b>Autoteile Anfrageformular ( Kostenlos )</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Schlüsselnummer zu 2</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>Schlüsselnummer zu 3</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>Hersteller</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>Modell</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id5]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Fahrzeug ID-Nr.</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id6]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Leistung KW</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id7]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Hubraum  ccm</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id8]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Tag der ersten Zulassung</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id9]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Nachricht *</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><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[id10]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Straße</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id11]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>PLZ</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id12]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Ort</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id13]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Bundesland</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id14]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Telefon</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id17]" 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[id15]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>AGBs akzeptieren *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id16]" 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="17084">');
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('');