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<!DOCTYPE HTML>
<html>
<head>
<meta charset="utf-8">
<title>Untitled Document</title>
</head>
<body><form name="frmFormMail" action='' method='post' enctype='multipart/form-data' onsubmit='return fmgHandler.onsubmit(this);'>
<input type='hidden' name='formmail_submit' value='Y'>
<div id='err_required' class="form_error" style='display:none;'>
<label class='form_error_title'>Please check the required fields</label>
</div>
<ol class='phpfmg_form' >
<li class='field_block' id='field_0_div'><div class='col_label'>
<label class='form_field'>Title</label> <label class='form_required' >*</label> </div>
<div class='col_field'>
<select name='field_0' id='field_0' class='text_select' >
<option value="Mr." >Mr.</option>
<option value="Mrs." >Mrs.</option>
<option value="Ms." >Ms.</option>
<option value="Miss" >Miss</option>
</select>
<div id='field_0_tip' class='instruction'></div>
</div>
</li>
<li class='field_block' id='field_1_div'><div class='col_label'>
<label class='form_field'>Name</label> <label class='form_required' >*</label> </div>
<div class='col_field'>
<input type="text" name="field_1" id="field_1" value="" class='text_box'>
<div id='field_1_tip' class='instruction'></div>
</div>
</li>
<li class='field_block' id='field_2_div'><div class='col_label'>
<label class='form_field'>Email Address</label> <label class='form_required' > </label> </div>
<div class='col_field'>
<input type="text" name="field_2" id="field_2" value="" class='text_box'>
<div id='field_2_tip' class='instruction'></div>
</div>
</li>
<li class='field_block' id='field_3_div'><div class='col_label'>
<label class='form_field'>Your message</label> <label class='form_required' >*</label> </div>
<div class='col_field'>
<textarea name="field_3" id="field_3" rows=4 cols=25 class='text_area'></textarea>
<div id='field_3_tip' class='instruction'></div>
</div>
</li>
<li class='field_block' id='phpfmg_captcha_div'>
<input type='submit' value='Submit' class='form_button'>
<span id='phpfmg_processing' style='display:none;'>
<img id='phpfmg_processing_gif' src='admin.php?mod=image&func=processing' border=0 alt='Processing...'>
<label id='phpfmg_processing_dots '></label>
</span> </li>
</ol>
</form>
</body>
</html>
