document.write('');
document.write('  <table bgcolor="#B8C4E0" style="border: 1px solid Black">');
document.write('<form method="post" action="http://11344.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2"><b>BUCHBESTELLFORMULAR</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Buchtitel *<br></b></font><font face="Arial" size="2">Bitte wählen Sie hier den gewünschten Buchtitel</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <select style=" font-family: Arial;" name="user_input[id203]">');
document.write('          <option value="0">Bitte wählen Sie hier den Buchtitel:');
document.write('</option>');
document.write('          <option value="1">Allgäu € 9,80');
document.write('</option>');
document.write('          <option value="2">Bayerisch Schwaben € 9,80');
document.write('</option>');
document.write('          <option value="3">Berlin € 14,95');
document.write('</option>');
document.write('          <option value="4">Bodensee € 9,80');
document.write('</option>');
document.write('          <option value="5">Franken € 9,80');
document.write('</option>');
document.write('          <option value="6">Karlsruhe € 9,80');
document.write('</option>');
document.write('          <option value="7">München € 9,80');
document.write('</option>');
document.write('          <option value="8">Oberbayern Süd € 9,80');
document.write('</option>');
document.write('          <option value="9">Rhein-Neckar € 9,80');
document.write('</option>');
document.write('          <option value="10">Schwarzwald-Bodensee-Schwäb.Alb € 14,95');
document.write('</option>');
document.write('          <option value="11">Stuttgart € 9,80</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Vorname *</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>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>Straße *</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>PLZ - Ort *</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>Tel. *</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>Anzahl *</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="1" size="5" maxlength="3">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Mitteilung<br></b></font><font face="Arial" size="1">Anregungen oder weitere Buchbestellungen</font></td>');
document.write('      <td><font face="Arial">');
document.write('        <textarea name="user_input[id204]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2">*Felder müssen ausgefüllt werden');
document.write('<BR>');
document.write('<BR>');
document.write('Bitte beachten Sie die Liefer- und Versandbedingungen:');
document.write('<BR>');
document.write('Warenwert bis € 9,00: Versandpauschale € 3,-');
document.write('<BR>');
document.write('Warenwert bis € 19,98: Versandpauschale € 1,50');
document.write('<BR>');
document.write('Warenwert ab € 19,99: porto- u. versandkostenfrei</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Akzeptanz<br></b></font><font face="Arial" size="2">Ich habe die Lieferbedingungen gelesen und akzeptiert</font></td>');
document.write('      <td>');
document.write('        <input style=" font-family: Arial;" type="checkbox" name="user_input[id205]" value="1" >');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>test<br>testbeschreibung</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id206]" value="" size="20">');
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="11344">');
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('');