document.write("<table width='580'>");
document.write("<tr> ");
document.write("<td colspan='6' class='overmellem' style='color: #000000'>INFORMATIONER ");
document.write("TIL UDARBEJDELSE AF HOROSKOPET: </td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td width='153' height='30' class='linktegn'>Fornavn:</td>");
document.write("<td colspan='4'><input name='fornavn' type='text' id='fornavn'></td>");
document.write("<td width='183'>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='30' class='linktegn'>Efternavn:</td>");
document.write("<td colspan='4'><input name='efternavn' type='text' id='efternavn'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='30' class='linktegn'>F&oslash;dselsdato:</td>");
document.write("<td width='42' class='linktegn'>Dag: </td>");
document.write("<td width='99' class='linktegn'><select name='fdd' id='select1'>");
document.write("<option value='TOM'>Dag</option>");

for (var x=1; x<32; x++)
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  }
  else
  {
    xx= x
  }
  document.write("<option value='"+xx+"'>"+x+"</option>");
}

document.write("</select></td>");
document.write("<td width='38'><span class='linktegn'>M&aring;ned: </span> </td>");
document.write("<td width='39'><select name='fdm' size='1' id='select5'>");
document.write("<option value='TOM'>M&aring;ned</option>");
document.write("<option value='01'>Januar</option>");
document.write("<option value='02'>Februar</option>");
document.write("<option value='03'>Marts</option>");
document.write("<option value='04'>April</option>");
document.write("<option value='05'>Maj</option>");
document.write("<option value='06'>Juni</option>");
document.write("<option value='07'>Juli</option>");
document.write("<option value='08'>August</option>");
document.write("<option value='09'>September</option>");
document.write("<option value='10'>Oktober</option>");
document.write("<option value='11'>November</option>");
document.write("<option value='12'>December</option>");
document.write("</select></td>");
document.write("<td class='broed'><span class='linktegn'>&Aring;r:</span> <select name='fdaa' size='1' id='Select6'>");
document.write("<option value='TOM'>År</option>");

for (var x=2008; x>1899; x--)
{
  document.write("<option value='"+x+"'>"+x+"</option>");
}
document.write("</select></td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='28' class='linktegn'>F&oslash;dselstidspunkt:</td>");
document.write("<td class='linktegn'><span class='linktegn'>Time:</span> </td>");
document.write("<td class='linktegn'><select name='ftt' id='select7'>");
document.write("<option value='TOM'>Time </option>");
for (var x=0; x<24; x++)
{
  
  if (x>=0 && x<=9) 
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    xx= "0" + x
  }
  else
  {
    xx= x
  }
  document.write("<option value='"+xx+"'>"+xx+"</option>");
}
document.write("</select></td>");
document.write("<td class='linktegn'>Minut: </td>");
document.write("<td class='linktegn'><select name='ftm' id='select8'>");
document.write("<option value='TOM'>Min</option>");
for (var x=0; x<60; x++)
{
  if (x>=0 && x<=9) 
  {
    xx= "0" + x
  }
  else
  {
    xx= x
  }
  document.write("<option value='"+xx+"'>"+xx+"</option>");
}
document.write("</select></td>");
document.write("<td class='linktegn'>&nbsp; </td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td class='linktegn'>F&oslash;deby:</td>");
document.write("<td colspan='4'><input name='Foedeby' type='text' id='Foedeby2' /></td>");
document.write("<td class='broed'>(evt n&aelig;rmeste st&oslash;rre by)</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='31' class='linktegn'>F&oslash;deland:</td>");
document.write("<td colspan='4'><input name='Foedeland' type='text' id='Foedeland' /></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='32' class='linktegn'>K&oslash;n</td>");
document.write("<td colspan='4'><span class='linktegn'>Kvinde</span> <input name='koen' type='radio' checked id='koen' value='kvinde'>");
document.write("<span class='linktegn'>Mand </span> <input name='koen' type='radio' id='koen' value='mand'> </td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='34' class='linktegn'>&nbsp;</td>");
document.write("<td colspan='4'>&nbsp;</td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td colspan='6' class='overmellem'>INFORMATIONER OM BETALINGS- OG LEVERINGSADRESSE:</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='27' class='linktegn'>Fornavn:</td>");
document.write("<td colspan='4'><input name='kfornavn' type='text' id='kfornavn'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='27' class='linktegn'>Efternavn:</td>");
document.write("<td colspan='4'><input name='kefternavn' type='text' id='kefternavn'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='32' class='linktegn'>Adresse:</td>");
document.write("<td colspan='4'><input name='adresse' type='text' id='adresse'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='27' class='linktegn'>Post nr:</td>");
document.write("<td colspan='4'><input name='kpostnr' type='text' id='kpostnr'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='26' class='linktegn'>By:</td>");
document.write("<td colspan='4'><input name='kby' type='text' id='kby'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='32' class='linktegn'>Land:</td>");
document.write("<td colspan='4'><input name='land' type='text' id='land'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='32' class='linktegn'>E-mail adresse:<font color='red'>&nbsp;</font></td>");
document.write("<td colspan='4'><input type='text' name='email'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='28' class='linktegn'>Telefon nr:</td>");
document.write("<td colspan='4'><input name='ktelefon' type='text' id='ktelefon'></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td height='28' class='linktegn'>&nbsp;</td>");
document.write("<td colspan='4'>&nbsp;</td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td colspan='6'><span class='broed'>Husk at hvis du er under 18 ");
document.write("&aring;r, skal bestillingen foretages af dine for&aelig;ldre. <br>");
document.write("<br>");
document.write("Efter bestillingen er afgivet vil du modtage horoskopet direkte med ");
document.write("posten indenfor to til fem dage (den normale leveringstid er to dage). ");
document.write("Prisen er 199,- kr. eksklusiv porto og ekspeditionsgebyr p&aring; 27,25 ");
document.write("kr. Samlet pris kun 226,25 kr. <br>");
document.write("<br>");
document.write("Skulle du opleve problemer med afsendelse af din bestilling - kan du ");
document.write("printe denne udfyldte side ud og sende den med posten til: Astro.dk/Dam,"); 
document.write("Dahliahaven 47, 2830 Virum. Eller sende sidens indhold p&aring; E-mail ");
document.write("til horoskop@astro.dk (v&aelig;lg sidens indhold - ctrl+a - kopier sidens ");
document.write("indhold - ctrl+c - &aring;ben en E-mail og inds&aelig;t den kopierede ");
document.write("side - ctrl+v).</span> <p></p></td>");
document.write("</tr>");
document.write("<tr> ");
document.write("<td></td>");
document.write("<td colspan='4' align='center'><input name='submit' type='submit' value='Bestil' onclick='return chkDitHoroskop(this.form)' /></td>");
document.write("<td>&nbsp;</td>");
document.write("</tr>");
document.write("</table>");