document.write('<form method="post" action="http://44740.newsletter.onetwomax.de/">');
document.write('  <table bgcolor="#0000FF" style="border: 1px solid #00FF00">');
document.write('    <tr>');
document.write('      <td align="center" colspan="2"><font color="#FF0000"><b>Gewinnspiel</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#00FF00">E-Mail</font></td>');
document.write('      <td><font color="#00FF00">');
document.write('        <input type="text" name="email" value="" size="10">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#00FF00">ebay-Name</font></td>');
document.write('      <td><font color="#00FF00">');
document.write('        <input type="text" name="user_input[id4]" value="" size="10">');
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="44740">');
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('');