document.write('<form method="post" action="http://39639.newsletter.onetwomax.de/">');
document.write('  <table>');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#BBBBBB" face="Times New Roman">BSE-Newsletter</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#BBBBBB" face="Times New Roman">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#BBBBBB" face="Times New Roman">E-Mail *</font></td>');
document.write('      <td><font color="#BBBBBB" face="Times New Roman">');
document.write('        <input style=" border: 1px solid #888888; background-color: #000000; color: #DDDDDD; font-family: Times New Roman;" type="text" name="email" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#BBBBBB" face="Times New Roman">Name *</font></td>');
document.write('      <td><font color="#BBBBBB" face="Times New Roman">');
document.write('        <input style=" border: 1px solid #888888; background-color: #000000; color: #DDDDDD; font-family: Times New Roman;" type="text" name="user_input[id4]" 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="add">');
document.write('        <input type="hidden" name="entry" value="39639">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('      </td>');
document.write('    </tr>');
document.write('  </table>');
document.write('</form>');
document.write('');