<table width="320" border="0" cellspacing="10" cellpadding="0">
        <tr>
            <td align="right" valign="top">Name </td>
            <td></td>
            <td><input style="width:183px;" type="text" name="mail_nachname" value="" maxlength="40" /></td>
        </tr>
        <tr>
            <td align="right" valign="top">Mail</td>
            <td></td>
            <td><input style="width:183px;" type="text" name="mail_email" value="" maxlength="40" /></td>
        </tr>
    
        <tr>
            <td align="right" valign="top"></td>
            <td></td>
            <td><input type="submit" name="mail_submit" value="Newsletter bestellen"/></td>
        </tr>
    </table>

<div><a href="Kontakt_id_16_.htm?cms.apps.input.SUBMIT=submit&amp;mail_art=
5.2142.01.91
">-> ANFRAGE</a></div>