document.write('');
document.write('  <table align="center" bgcolor="#DDDDDD" cellspacing="10" cellpadding="5" style="border: 1px solid #FFFFFF">');
document.write('<form method="post" action="http://82988.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td align="center" valign="middle" colspan="2"><font color="#000000" face="Arial" size="3"><b>Kontaktformular von Dentallabor / Dentalstudio / Dentaltechnik ');
document.write('<BR>');
document.write('<BR>');
document.write('Harald Schneider / Gersthofen bei Augsburg');
document.write('<BR>');
document.write('<BR>');
document.write('</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="center" valign="middle" colspan="2"><font color="#CC0000" face="Arial" size="1"><b>mit * gekennzeichnete Felder müssen ausgefüllt werden');
document.write('<BR>');
document.write('<BR>');
document.write('</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Arial" size="3"><b>Name *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Arial" size="3"><b>E-Mail *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Arial" size="3"><b>Betreff *</b></font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id5]" value="" size="40">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#000000" face="Arial" size="3"><b>Nachricht *</b></font></td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id6]" style="width:100%" rows="10"></textarea>');
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="Arial" size="2">Inhaber dieser Domains (www.Dental-Schneider.de &amp; www.Dentallabor-Gersthofen-Augsburg.de) ist ');
document.write('<BR>');
document.write('<BR>');
document.write('Firma *Dental-Studio Harald Schneider*');
document.write('<BR>');
document.write('<BR>');
document.write('Adresse: Bahnhofstrasse 7A (im City-Center) / 86368 Gersthofen');
document.write('<BR>');
document.write('<BR>');
document.write('Telefon: 0821-472401 / Telefax: 0821-2991940 ');
document.write('<BR>');
document.write('<BR>');
document.write('Bitte gültige Mailadresse angeben, sonst kann ich mich nicht mit Ihnen in Verbindung setzen! Danke! ');
document.write('<BR>');
document.write('<BR>');
document.write('Ihre Daten und Angaben werden vertraulich behandelt und nicht an Dritte weitergegeben!');
document.write('<BR>');
document.write('<BR>');
document.write('<BR>');
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="82988">');
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('');
