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document.write('<form method="post" action="http://17825.formmailer.onetwomax.de/">');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2"><b>Anketimiz</b></font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2">* yildizli yerler doldurulmalidir</font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Isminiz *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id1]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>E-Mail *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id2]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Dogum Gununuz *</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id3]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Bulundugunuz Ülke<br></b></font><font face="Arial" size="2"> Tr dende nerelisiniz</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id4]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Telefon<br></b></font><font face="Arial" size="2">Cep Teli Olabilir</font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id5]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Sevdiginiz Cicek</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id6]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Sevdiginiz Sanatci</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id7]" value="" size="20">');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Sevdiginiz Muzik/Sevdiginiz Parca</b></font></td>');
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document.write('        <input style=" 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 face="Arial" size="2"><b>Sevdiginiz Yemekler</b></font></td>');
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document.write('        <input style=" 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 face="Arial" size="2"><b>Sevdiginiz parfüm</b></font></td>');
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document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id10]" value="" size="20">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Tuttugunuz Takim</b></font></td>');
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document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id11]" value="" size="20">');
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document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Sevdiginiz Spor</b></font></td>');
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document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id12]" value="" size="20">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Ugurlu Gun Ve Sayi</b></font></td>');
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document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id13]" value="" size="20">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Sevdiginiz Hayvan</b></font></td>');
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document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id14]" value="" size="20">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Sevdiginiz Kiz ve Erkek Ismi</b></font></td>');
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document.write('        <input style=" font-family: Arial;" type="text" name="user_input[id15]" value="" size="20">');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Giyim Tarziniz</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <input style=" 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><font face="Arial" size="2"><b>Prensipleriniz</b></font></td>');
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document.write('        <textarea style=" font-family: Arial;" name="user_input[id17]" style="width:100%" rows="5"></textarea>');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Sevdiginiz Davranislar</b></font></td>');
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document.write('        <textarea style=" font-family: Arial;" name="user_input[id18]" style="width:100%" rows="5"></textarea>');
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document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Sevmediginiz Davranislar</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id19]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Bir Idealiniz Var Mi?</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id20]" style="width:100%" rows="5"></textarea>');
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document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Hayatta Yapmak istediginiz 3 sey</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id21]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Hobileriniz</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id22]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Fobileriniz</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id23]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Gitmek Istediginiz Ülke/Sehir</b></font></td>');
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document.write('        <textarea style=" font-family: Arial;" name="user_input[id24]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Hayalinizdeki Tatil Nasil Olmali?</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id25]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>En Sevdiginiz Atasözü/Deyim</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id26]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td><font face="Arial" size="2"><b>Ankete Eklemek Istediginiz Varmi</b></font></td>');
document.write('      <td><font face="Arial" size="2">');
document.write('        <textarea style=" font-family: Arial;" name="user_input[id27]" style="width:100%" rows="5"></textarea>');
document.write('      </font></td>');
document.write('    </tr>');
document.write('    <tr>');
document.write('      <td colspan="2"><font face="Arial" size="2">EskiclupMuzik  Tsk eder. Formunuzu Yollamak icin abschickene tiklayiniz.Sizleri Yeniden Görmek Umuduyla..  Hersey Gönlünüzce olsun</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="17825">');
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>');
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