document.writeln("<form method=\"post\" action=\"http://www.west-gmbh.de/kontakt_php/email_mail.php\">");
  document.writeln("<p>Weitere Infos gew&uuml;nscht?<br />");
  document.writeln("<INPUT TYPE=text name=qpz size=12 maxlength=255 value=\"E-Mail-Adresse\">");
  document.writeln("<INPUT style=\"border-width:1px; background-color:#c0c0c0;\" type=submit name=sa VALUE=\"Senden\"></p>");
  document.writeln(" </form>");