document.write('');
document.write('  <table align="center">');
document.write('<form method="post" action="http://82072.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td valign="middle" colspan="2"><font face="Berlin Sans FB" size="3"><b>This Service is only in our List registred Members. Dieser Service ist ausschließlich für bei uns eingetragene Züchter.</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td align="center" valign="middle" colspan="2"><font face="Berlin Sans FB" size="3">mit * gekennzeichnete Felder müssen ausgefüllt werden</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Catteryname *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id3]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Katername incl. titel / Malename incl. Titel *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id5]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Rasse / Breed*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id11]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>E-Mail *</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id4]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Website*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id7]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Tests ( PKD, HCM )*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id8]" value="" size="12">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Registration at / bei ( CFA,Tica, Fifé)</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id9]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Deckgebühr / Tax*</td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id10]" value="" size="10">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td>Information*</td>');
document.write('      <td>');
document.write('        <textarea 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="82072">');
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('');