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document.write('<form method="post" action="http://65866.formmailer.onetwomax.de/">');
document.write('    <tr bgcolor="white">');
document.write('      <td bgcolor="white" colspan="2"><font color="black" face="arial" size="3"><b>Ticketbestellung</b></font></td>');
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document.write('    <tr bgcolor="white">');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">Name, Vorname</font></td>');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">');
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document.write('    <tr>');
document.write('      <td><font color="black" face="arial" size="2">Strasse, Nr.</font></td>');
document.write('      <td><font color="black" face="arial" size="2">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="black" face="arial" size="2">PLZ/Ort</font></td>');
document.write('      <td><font color="black" face="arial" size="2">');
document.write('        <input style=" border: 1px solid black; color: black; font-family: arial;" type="text" name="user_input[id6]" value="" size="20">');
document.write('      </font></td>');
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document.write('    <tr bgcolor="white">');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">Land</font></td>');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">');
document.write('        <input style=" border: 1px solid black; background-color: white; color: black; font-family: arial;" type="text" name="user_input[id14]" value="" size="20" maxlength="35">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="black" face="arial" size="2">E-Mail</font></td>');
document.write('      <td><font color="black" face="arial" size="2">');
document.write('        <input style=" border: 1px solid black; color: black; font-family: arial;" type="text" name="user_input[id8]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="black" face="arial" size="2">Telefon</font></td>');
document.write('      <td><font color="black" face="arial" size="2">');
document.write('        <input style=" border: 1px solid black; color: black; font-family: arial;" type="text" name="user_input[id9]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="black" face="arial" size="2">Anzahl Tickets</font></td>');
document.write('      <td><font color="black" face="arial" size="2">');
document.write('        <input style=" border: 1px solid black; color: black; font-family: arial;" type="text" name="user_input[id10]" value="" size="5">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2">Datum</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <select style=" font-family: Arial;" name="user_input[id12]">');
document.write('          <option value="0">Samstag, 15 Mai 19.30 Uhr</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="white">');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">Kategorie</font></td>');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">');
document.write('        <select style=" border: 1px solid black; background-color: white; color: black; font-family: arial;" name="user_input[id15]">');
document.write('          <option value="0">Kategorie 1 à 60.-CHF');
document.write('</option>');
document.write('          <option value="1">Kategorie 2 à 57.-CHF');
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document.write('          <option value="2">Kategorie 3 à 50.-CHF');
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document.write('          <option value="3">Kategorie 4 à 70.-CHF');
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document.write('          <option value="4">Kategorie 5 à 65.-CHF');
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document.write('          <option value="5">Kategorie 6 à 60.-CHF');
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document.write('          <option value="6">Kategorie 7 à 70.-CHF');
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document.write('          <option value="7">Kategorie 8 à 60.-CHF');
document.write('</option>');
document.write('          <option value="8">Kategorie 9 à 60.-CHF</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="white">');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">Ticketerhalt</font></td>');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">');
document.write('        <select style=" border: 1px solid black; background-color: white; color: black; font-family: arial;" name="user_input[id13]">');
document.write('          <option value="0">Abholung an der Abendkasse</option>');
document.write('        </select>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr bgcolor="white">');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">Bemerkungen</font></td>');
document.write('      <td bgcolor="white"><font color="black" face="arial" size="2">');
document.write('        <input style=" border: 1px solid black; background-color: white; color: black; font-family: arial;" type="text" name="user_input[id16]" 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="send_mail">');
document.write('        <input type="hidden" name="entry" value="65866">');
document.write('        <input type="submit" name="submit" value="Abschicken">');
document.write('        <input type="reset" name="reset" value="Zur&uuml;cksetzen">');
document.write('      </td>');
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