document.write('<form method="post" action="http://59154.newsletter.onetwomax.de/">');
document.write('  <table align="center" bgcolor="#DDDDDD" cellspacing="2" cellpadding="2" style="border: 1px solid #000000">');
document.write('    <tr>');
document.write('      <td align="center" valign="middle" colspan="2"><font color="#000099" face="Eurostar Regular Extended" size="5"><b>*Gaby Seibold´s Designer-Schmuck*-Newsletter</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="center" valign="middle" colspan="2"><font color="#FF0000" face="Arial" size="1"><b>mit * gekennzeichnete Felder müssen ausgefüllt werden</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>&nbsp;</td>');
document.write('      <td></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Eurostar Regular Extended" size="3"><b>E-Mail *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="email" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Eurostar Regular Extended" size="3"><b>Name &amp; Vorname *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="30" maxlength="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Eurostar Regular Extended" size="3"><b>Strasse &amp; Hausnummer *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id6]" value="" size="30" maxlength="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Eurostar Regular Extended" size="3"><b>Postleitzahl &amp; Stadt *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="" size="30">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>&nbsp;</td>');
document.write('      <td></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="center" valign="middle" colspan="2"><font color="#000000" face="Verdana" size="2">Wichtiger Hinweis:');
document.write('<BR>');
document.write('<BR>');
document.write('Dieser Newsletter ist für Sie unverbindlich und selbstverständlich absolut kostenlos! Sie können sich auch jederzeit wieder ganz problemlos abmelden! Ihre Daten werden nicht an Dritte weiter gegeben, sondern nur firmenintern verwendet! ');
document.write('<BR>');
document.write('Anonyme Einträger erhalten keinen Newsletter!</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>&nbsp;</td>');
document.write('      <td></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="59154">');
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('');
