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document.write('      <td valign="middle" colspan="2"><font color="#000066" face="Verdana">mit * gekennzeichnete Felder bitte ausfüllen </font></td>');
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document.write('      <td><font color="#000066" face="Verdana">E-Mail *</font></td>');
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document.write('      <td align="center" valign="middle" colspan="2"><font color="#000066" face="Verdana">Für unsere Werbestudien bitten wir Sie um eine kleine (freiwillige) Auskunft.</font></td>');
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document.write('      <td><font color="#000066" face="Verdana">antworten Sie bitte hier</font></td>');
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document.write('          <option value="0">keine Angabe');
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document.write('          <option value="1">durch Erzählung von Freunden');
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document.write('          <option value="2">Bekannter hat mir &quot;Empfehlungsmail&quot; geschickt');
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document.write('          <option value="3">Autoaufkleber gesehen');
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document.write('          <option value="4">selbst gefunden im www');
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document.write('          <option value="5">über Link auf einer Web-Site');
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document.write('          <option value="6">über Google');
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document.write('          <option value="7">über andere Suchmaschine');
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document.write('      <td align="center" valign="middle" colspan="2"><font color="#000066" face="Verdana">Wir bedanken uns für die Mithilfe bei unseren Werbestudien - Sie haben uns geholfen!</font></td>');
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