document.write('');
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document.write('<form method="post" action="http://157748.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#DADADA" face="Arial" size="2"><b>Kontaktformular - Booking: KiCK iT LiKE FALCO</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font color="#DADADA" face="Arial" size="1"><b>mit * gekennzeichnete Felder müssen ausgefüllt werden. Danke!</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>Firma-Agentur</b></font></td>');
document.write('      <td>');
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document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>Name *</b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <input style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" type="text" name="user_input[id3]" value="" size="25">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>Strasse</b></font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" type="text" name="user_input[id7]" value="" size="25">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>PLZ *</b></font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" type="text" name="user_input[id8]" value="" size="25">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>Stadt *</b></font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" type="text" name="user_input[id9]" value="" size="25">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>Telefon *</b></font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" type="text" name="user_input[id10]" value="" size="25">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>E-Mail *</b></font></td>');
document.write('      <td>');
document.write('        <input style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" type="text" name="user_input[id4]" value="" size="25">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>Konzertstadt *</b></font></td>');
document.write('      <td><font face="Arial">');
document.write('        <input style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" type="text" name="user_input[id5]" value="" size="25">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>Kuenstler *</b></font></td>');
document.write('      <td>');
document.write('        <select style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" name="user_input[id13]">');
document.write('          <option value="0">FALCO-Band Tribute');
document.write('</option>');
document.write('          <option value="1">FALCO-SYMPHONIX Tribute</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#DADADA" face="Arial" size="2"><b>Nachricht *</b></font></td>');
document.write('      <td>');
document.write('        <textarea style=" border: 1px solid #FF0000; background-color: #DADADA; color: #000000; font-family: Arial;" name="user_input[id6]" style="width:100%" rows="7"></textarea>');
document.write('      </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="157748">');
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('    <tr>');
document.write('      <td colspan="2" align="center"><font size="-2">Powered by <a href="http://www.onetwomax.de" target="_blank">OneTwoMax</a> Formmailer Script</font></td>');
document.write('    </tr>');
document.write('</form>');
document.write('  </table>');
document.write('');