<form name="frm" action="#" method="post" target="_blank">
<div style="font-size:12px; font-family:Tahoma">Webspace</div><br />
<div style="font-size:12px; font-family:Tahoma">Ihre Domain:<br />
<input maxlength="255" name="user" type="text" />.
<select name="domain" onChange="this.form.action=this.options[this.selectedIndex].value;document.frm.uname.value=document.frm.user.value + '.' + this.options[this.selectedIndex].id;">
<option value="#">Bitte wählen Sie !!!</option>
<option value="http://admin.menkisys.de" id="menkisys.de">menkisys.de</option>
<option value="http://admin.menkisys.at" id="menkisys.at">menkisys.at</option>
<option value="http://admin.menkisys.com" id="menkisys.com">menkisys.com</option>
<option value="http://admin.menkisys.net" id="menkisys.net">menkisys.net</option>
<option value="http://admin.menkisys.org" id="menkisys.org">menkisys.org</option>
</select>
<input type="hidden" name="uname" value="#" />
<br />
</div>
<div style="font-size:12px; font-family:Tahoma"><strong>Ihr Passwort:</strong><br />
<input type="password" maxlength="255" name="upass" /><br />
<div style="font-size:12px; font-family:Tahoma">
<input tabindex="3" type="submit" value=" Anmelden " name="Submit" />
</div>
</div>
</form>