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document.write('      <td><font face="Verdana" size="2">E-Mail</font></td>');
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document.write('        <input style=" font-family: Verdana;" type="text" name="email" value="" size="20">');
document.write('      </font></td>');
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document.write('    <tr>');
document.write('      <td><font face="Verdana" size="2">Name</font></td>');
document.write('      <td><font face="Verdana" size="2">');
document.write('        <input style=" font-family: Verdana;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </font></td>');
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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="45129">');
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>');
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