document.write('');
document.write('  <table align="left" bgcolor="#eccd85" style="border: 1px solid #eccd85">');
document.write('<form method="post" action="http://68650.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td align="left" colspan="2"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id21]" value="Adoptionsbestellung" size="20">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="left" colspan="2"><font color="#b12929" face="Helvetica" size="-1"><i>mit *gekennzeichnete Felder müssen ausgefüllt werden</i></font></td>');
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document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Name *</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">E-Mail *</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">URL *</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id6]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Fairy</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id7]" value="Nr.  " size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Teddy</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id8]" value="Nr.  " size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Girls</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id9]" value="Nr.  " size="20">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Valentine</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id19]" value="Nr.  " size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Samples</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id11]" value="Nr.  " size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Easter</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id12]" value="Nr.  " size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Xmas</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id13]" value="Nr.  " size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Snowman</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id14]" value="Nr.  " size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Friendship</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id15]" value="Nr.  " size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Triggles</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
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document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">SigTag</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
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document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Adoptionsname*</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <input style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" type="text" name="user_input[id23]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="right"><font color="#b12929" face="Comic Sans MS" size="-1">Nachricht</font></td>');
document.write('      <td align="left"><font color="#FFFFFF" face="Comic Sans MS" size="-1">');
document.write('        <textarea style=" border: 1px solid #b12929; background-color: #b12929; color: #FFFFFF; font-family: Comic Sans MS;" name="user_input[id18]" style="width:100%" rows="5"></textarea>');
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="68650">');
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('');