document.write('');
document.write('  <table>');
document.write('<form method="post" action="http://94257.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td><font color="#FFFF66">Name *</font></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><font color="#FFFF66">Vorname*</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id14]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#FFFF66">Strasse *</font></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><font color="#FFFF66">Postleitzahl*</font></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><font color="#FFFF66">Ort*</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id13]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#FFFF66">E-Mail Adresse *</font></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><font color="#FFFF66">Telefon-Nummer *</font></td>');
document.write('      <td>');
document.write('        <input type="text" name="user_input[id8]" value="" size="20">');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#FFFF66">Kurswahl<br></font><font color="#FFCCCC">Der von Ihnen gewünschte Kurs ist:</font></td>');
document.write('      <td>');
document.write('        <select name="user_input[id9]">');
document.write('          <option value="0">1-Tages-Kurs Gel Neuset Natural Look, Fr. 450.-');
document.write('</option>');
document.write('          <option value="1">1-Tages-Kurs Gel Neuset French, Variante Clear, Fr. 450.-');
document.write('</option>');
document.write('          <option value="2">1-Tages-Kurs Gel Neuset French direkt auf Schablone, Fr. 450.-');
document.write('</option>');
document.write('          <option value="3">1-Tages-Kurs Gel Neuset Deep Smile French, Fr. 450.-');
document.write('</option>');
document.write('          <option value="4">1-Tages-Kurs Gel Neuset Nagelbettverlängerung, Fr. 450.-');
document.write('</option>');
document.write('          <option value="5">1-Tages-Kurs Gel Auffüllen inkl. French, Fr. 450.-');
document.write('</option>');
document.write('          <option value="6">1-Tages-Kurs Gel Auffüllen mit French, unter Modellage Fr. 450.-');
document.write('</option>');
document.write('          <option value="7">1-Tages-Kurs Gel Professional Power Speed Auffüllen, Fr. 450.- ');
document.write('</option>');
document.write('          <option value="8">1-Tages-Kurs Gel Power Speed Professional Neuset, Fr. 450.-');
document.write('</option>');
document.write('          <option value="9">1-Tages-Kurs Gel Naturnagelverstärkung Soak Off, Fr. 390.-');
document.write('</option>');
document.write('          <option value="10">1-Tages-Kurs Gel Neuset Glasnägel, Fr. 450.-');
document.write('</option>');
document.write('          <option value="11">1-Tages-Kurs Gel Neuset Stilettos, Fr. 450.-');
document.write('</option>');
document.write('          <option value="12">1-Tages-Kurs Gel Neuset Stilettos Extremnagelbettverlängerung, Fr. 450.-');
document.write('</option>');
document.write('          <option value="13">Halbtages-Kurs Gel Fräser-Handhabung, Fr. 350.-');
document.write('</option>');
document.write('          <option value="14">');
document.write('</option>');
document.write('          <option value="15">2-Tages-Kurs Gel Neuset &amp; Auffüllen, Fr. 880.-');
document.write('</option>');
document.write('          <option value="16">2-Tages-Kurs Gel nach Wahl, Fr. 880.-');
document.write('</option>');
document.write('          <option value="17">');
document.write('</option>');
document.write('          <option value="18">3-Tages-Kurs Gel Neuset, Auffüllen &amp; Theorie, Fr. 1200.-');
document.write('</option>');
document.write('          <option value="19">3-Tages-Kurs Gel nach Wahl, Fr. 1200.-');
document.write('</option>');
document.write('          <option value="20">');
document.write('</option>');
document.write('          <option value="21">4-Tages-Kurs Gel, Fr. 1600.-');
document.write('</option>');
document.write('          <option value="22">5-Tages-Kurs Gel, Fr. 1995.-');
document.write('</option>');
document.write('          <option value="23">6-Tages-Kurs Gel, Fr. 2390.-');
document.write('</option>');
document.write('          <option value="24">7-Tages-Kurs Gel, Fr. 2780.-');
document.write('</option>');
document.write('          <option value="25">8-Tages-Kurs Gel, Fr. 3120.-');
document.write('</option>');
document.write('          <option value="26">9-Tages-Kurs Gel, Fr. 3510.-');
document.write('</option>');
document.write('          <option value="27">10-Tages-Kurs Gel Professional, Fr. 3900.-');
document.write('</option>');
document.write('          <option value="28">12-Tages-Kurs Gel Master Professional, Fr. 4620.-');
document.write('</option>');
document.write('          <option value="29">');
document.write('</option>');
document.write('          <option value="30">5-Tages-Kurs Gel/Acryl, Fr. 1995.-');
document.write('</option>');
document.write('          <option value="31">6-Tages-Kurs Gel/Acryl, Fr. 2390.-');
document.write('</option>');
document.write('          <option value="32">7-Tages-Kurs Gel/Acryl, Fr. 2780.-');
document.write('</option>');
document.write('          <option value="33">8-Tages-Kurs Gel/Acryl, Fr. 3120.-');
document.write('</option>');
document.write('          <option value="34">10-Tages-Kurs Gel/Acryl, Fr. 3900.-');
document.write('</option>');
document.write('          <option value="35">12-Tages-Kurs Gel/Acryl Professional, Fr. 4620.-');
document.write('</option>');
document.write('          <option value="36">');
document.write('</option>');
document.write('          <option value="37">1-Tages-Kurs Acryl Neuset French Permanent, Fr. 450.-');
document.write('</option>');
document.write('          <option value="38">1-Tages-Kurs Acryl Neuset Glitter French mit Farbpowder, Fr. 450.-');
document.write('</option>');
document.write('          <option value="39">1-Tages-Kurs Acryl Neuset Fantasy French, ohne 3D, Fr. 450.-');
document.write('</option>');
document.write('          <option value="40">1-Tages-Kurs Acryl Nagelbettverlängerung für Nagelbeisser, Fr. 450.-');
document.write('</option>');
document.write('          <option value="41">1-Tages-Kurs Acryl Neuset mit 3D Finish, Fr. 450.-');
document.write('</option>');
document.write('          <option value="42">1-Tages-Kurs Acryl Neuset mit 3D unter Modellage, Fr. 450.-');
document.write('</option>');
document.write('          <option value="43">1-Tages-Kurs Acryl Extremnagelbettverlängerung Stilettos, Fr. 450.-');
document.write('</option>');
document.write('          <option value="44">1-Tages-Kurs Acryl Klassisches Auffüllen inkl. French, Fr. 450.-');
document.write('</option>');
document.write('          <option value="45">');
document.write('</option>');
document.write('          <option value="46">2-Tages-Kurs Acryl Neuset &amp; Auffüllen, Fr. 880.-');
document.write('</option>');
document.write('          <option value="47">2-Tages-Kurs Acryl nach Wahl, Fr. 880.-');
document.write('</option>');
document.write('          <option value="48">');
document.write('</option>');
document.write('          <option value="49">3-Tages-Kurs Acryl, Neuset, Auffüllen &amp; Nagelbeisser, Fr. 1200.-');
document.write('</option>');
document.write('          <option value="50">3-Tages-Kurs Acryl nach Wahl, Fr. 1200.-');
document.write('</option>');
document.write('          <option value="51">');
document.write('</option>');
document.write('          <option value="52">4-Tages-Kurs Acryl, Fr. 1600.-');
document.write('</option>');
document.write('          <option value="53">5-Tages-Kurs Acryl, Fr. 1995.-');
document.write('</option>');
document.write('          <option value="54">6-Tages-Kurs Acryl, Fr. 2390.-');
document.write('</option>');
document.write('          <option value="55">7-Tages-Kurs Acryl, Fr. 2780.-');
document.write('</option>');
document.write('          <option value="56">8-Tages-Kurs Acryl, Fr. 3120.-</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#FFFF66">Kursdatum (bei mehrtägigen Kursen der 1. Kurstag):</font></td>');
document.write('      <td>');
document.write('        <select name="user_input[id16]">');
document.write('          <option value="0">Samstag, 05. März (nur ab 4-Tages-Kurs Gel, Theorie-Tag)');
document.write('</option>');
document.write('          <option value="1">Samstag, 12. März (1- oder Mehrtageskurse nach Wahl)');
document.write('</option>');
document.write('          <option value="2">Samstag, 19. März (1- oder Mehrtageskurse nach Wahl)');
document.write('</option>');
document.write('          <option value="3">Samstag, 26. März (1- oder Mehrtageskurse nach Wahl)');
document.write('</option>');
document.write('          <option value="4">Samstag, 02. April (1- oder Mehrtageskurse nach Wahl)</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#FFFF66">Starterset<br></font><font color="#FFCCCC">Möchten Sie ein Starterset dazu kaufen? Infos darüber finden Sie auf www.gelnails.ch/starterset.htm . Sie sparen 10%!</font></td>');
document.write('      <td>');
document.write('        <select name="user_input[id15]">');
document.write('          <option value="0">Ja, Starterset Basic 1 Gel für Fr. 255.-');
document.write('</option>');
document.write('          <option value="1">');
document.write('</option>');
document.write('          <option value="2">Ja, das SSB2-1 für Fr. 960.-');
document.write('</option>');
document.write('          <option value="3">Ja, das SSB2-2 für Fr. 1125.-');
document.write('</option>');
document.write('          <option value="4">Ja, das SSB2-3 für Fr. 1024.-');
document.write('</option>');
document.write('          <option value="5">Ja, das SSB2-4 für Fr. 1188.-');
document.write('</option>');
document.write('          <option value="6">');
document.write('</option>');
document.write('          <option value="7">Ja, das SSB3-1 für Fr. 1308.-');
document.write('</option>');
document.write('          <option value="8">Ja, das SSB3-2 für Fr. 1472.-');
document.write('</option>');
document.write('          <option value="9">Ja, das SSB3-3 für Fr. 1370.-');
document.write('</option>');
document.write('          <option value="10">Ja, das SSB3-4 für Fr. 1535.-');
document.write('</option>');
document.write('          <option value="11">');
document.write('</option>');
document.write('          <option value="12">Ja, das SSDL-1 für Fr. 1598.-');
document.write('</option>');
document.write('          <option value="13">Ja, das SSDL-2 für Fr. 1762.-');
document.write('</option>');
document.write('          <option value="14">Ja, das SSDL-3 für Fr. 1660.-');
document.write('</option>');
document.write('          <option value="15">Ja, das SSDL-4 für Fr. 1825.-');
document.write('</option>');
document.write('          <option value="16">');
document.write('</option>');
document.write('          <option value="17">Ja, das SSSD-1 für Fr. 2144.-');
document.write('</option>');
document.write('          <option value="18">Ja, das SSSD-2 für Fr. 2308.-');
document.write('</option>');
document.write('          <option value="19">Ja, das SSSD-3 für Fr. 2207.-');
document.write('</option>');
document.write('          <option value="20">Ja, das SSSD-4 für Fr. 2370.-');
document.write('</option>');
document.write('          <option value="21">');
document.write('</option>');
document.write('          <option value="22">Ja, das SSPR-1 für Fr. 3098.-');
document.write('</option>');
document.write('          <option value="23">Ja, das SSPR-2 für Fr. 3160.-');
document.write('</option>');
document.write('          <option value="24">');
document.write('</option>');
document.write('          <option value="25">Ja, das Acryl Basic 2 für Fr. 234.-');
document.write('</option>');
document.write('          <option value="26">Ja, das Acryl Basic 2 für Fr. 414.-');
document.write('</option>');
document.write('          <option value="27">Ja, das Acryl Basic 3 für Fr. 844.-');
document.write('</option>');
document.write('          <option value="28">Ja, das Acryl Basic 3 inkl. 3D, für Fr. 1062.-');
document.write('</option>');
document.write('          <option value="29">Ja, das Acryl Basic 3 inkl. 3D &amp; Fantasy, für Fr. 1463.-');
document.write('</option>');
document.write('          <option value="30">');
document.write('</option>');
document.write('          <option value="31">Nein, ich wünsche kein Starterset</option>');
document.write('        </select>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#FFFF66">Bemerkungen<br></font><font color="#FFCCCC">Haben Sie noch Fragen?</font></td>');
document.write('      <td>');
document.write('        <textarea name="user_input[id11]" style="width:100%" rows="5"></textarea>');
document.write('      </td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font color="#FFFF66">AGBs *<br></font><font color="#FFCCCC">Ich habe die allgemeinen Geschäftsbedingungen durchgelesen und akzeptiert.</font></td>');
document.write('      <td>');
document.write('        <input type="checkbox" name="user_input[id12]" value="1" >');
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="94257">');
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('');