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{$from} |
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|
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<table width=90% align="center" cellspacing="0" border="0" cellpadding="0"> |
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<tbody> |
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<form> |
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<tr> |
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<td valign=center align=left>To:</td> |
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<td valign=center align=left>{$email_to}</td> |
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</tr> |
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<tr> |
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<td valign=center align=left>Full Name</td> |
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<td valign=center align=left> |
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<input size=22 name=fullname> |
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</td> |
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</tr> |
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<tr> |
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<td valign=center align=left> |
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<div align="left">Email</div> |
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</td> |
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<td valign=center align=left> |
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<input size=22 name=email> |
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</td> |
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</tr> |
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<tr> |
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<td valign=center align=left> |
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<div align="left">Country</div> |
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</td> |
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<td valign=center align=left> |
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<select size=1 name=country> |
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<option value="" selected>-- Select Your Country |
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--</option> |
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<option value=AG>Antigua</option> |
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<option value=AR>Argentina</option> |
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<option value=AU>Australia</option> |
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<option value=AT>Austria</option> |
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<option value=BS>Bahamas</option> |
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<option value=BH>Bahrain</option> |
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<option value=BD>Bangladesh</option> |
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<option value=BB>Barbados</option> |
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<option value=BY>Belarus</option> |
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<option value=BE>Belgium</option> |
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<option value=BM>Bermuda</option> |
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<option value=BO>Bolivia</option> |
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<option value=BA>Bosnia</option> |
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<option value=BR>Brazil</option> |
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<option value=IO>Britain (UK)</option> |
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<option value=BG>Bulgaria</option> |
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<option value=CA>Canada</option> |
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<option value=KY>Cayman Islands</option> |
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<option value=CL>Chile</option> |
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<option value=CN>China</option> |
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<option value=CO>Colombia</option> |
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<option value=HR>Croatia</option> |
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<option value=CU>Cuba</option> |
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<option value=CY>Cyprus</option> |
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<option value=CZ>Czech Republic</option> |
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<option value=DK>Denmark</option> |
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<option value=DO>Dominican Republic</option> |
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<option value=EC>Ecuador</option> |
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<option value=EG>Egypt</option> |
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<option value=SV>El Salvador</option> |
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<option value=EE>Estonia</option> |
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<option value=FI>Finland</option> |
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<option value=FR>France</option> |
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<option value=DE>Germany</option> |
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<option value=GI>Gibraltar</option> |
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<option value=GR>Greece</option> |
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<option value=GD>Grenada</option> |
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<option value=GY>Guyana</option> |
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<option value=HT>Haiti</option> |
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<option value=HN>Honduras</option> |
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<option value=HK>Hong Kong</option> |
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<option value=HU>Hungary</option> |
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<option value=IN>India</option> |
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<option value=ID>Indonesia</option> |
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<option value=IR>Iran</option> |
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<option value=IQ>Iraq</option> |
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<option value=IE>Ireland</option> |
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<option value=IL>Israel</option> |
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<option value=IT>Italy</option> |
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<option value=JM>Jamaica</option> |
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<option value=JP>Japan</option> |
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<option value=JO>Jordan</option> |
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<option value=KZ>Kazakhstan</option> |
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<option value=KE>Kenya</option> |
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<option value=KP>Korea (South)</option> |
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<option value=KW>Kuwait</option> |
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<option value=KG>Kyrgyzstan</option> |
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<option value=LV>Latvia</option> |
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<option value=LB>Lebanon</option> |
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<option value=LY>Libya</option> |
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<option value=LT>Lithuania</option> |
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<option value=MK>Macedonia</option> |
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<option value=MW>Malawi</option> |
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<option value=MY>Malaysia</option> |
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<option value=MT>Malta</option> |
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<option value=MX>Mexico</option> |
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<option value=MZ>Mozambique</option> |
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<option value=NL>Netherlands</option> |
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<option value=AN>Netherlands Antilles</option> |
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<option value=NZ>New Zealand</option> |
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<option value=NI>Nicaragua</option> |
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<option value=NG>Nigeria</option> |
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<option value=NO>Norway</option> |
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<option value=OM>Oman</option> |
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<option value=PK>Pakistan</option> |
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<option value=PA>Panama</option> |
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<option value=PY>Paraguay</option> |
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<option value=PE>Peru</option> |
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<option value=PH>Philippines</option> |
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<option value=PL>Poland</option> |
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<option value=PT>Portugal</option> |
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<option value=QA>Qatar</option> |
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<option value=RO>Romania</option> |
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<option value=RU>Russian Federation</option> |
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<option value=SA>Saudi Arabia</option> |
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<option value=SG>Singapore</option> |
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<option value=SK>Slovak Republic</option> |
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<option value=SI>Slovenia</option> |
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<option value=ZA>South Africa</option> |
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<option value=ES>Spain</option> |
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<option value=SD>Sudan</option> |
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<option value=SE>Sweden</option> |
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<option value=CH>Switzerland</option> |
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<option value=XX>Switzerland (Basel)</option> |
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<option value=SY>Syria</option> |
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<option value=TW>Taiwan</option> |
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<option value=TH>Thailand</option> |
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<option value=TT>Trinidad and Tobago</option> |
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<option value=TR>Turkey</option> |
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<option value=UA>Ukraine</option> |
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<option value=AE>United Arab Emirates</option> |
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<option value=US>United States</option> |
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<option value=UY>Uruguay</option> |
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<option value=VE>Venezuela</option> |
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<option value=VN>Viet Nam</option> |
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<option value=YE>Yemen</option> |
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<option value=YU>Yugoslavia</option> |
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<option value=ZM>Zambia</option> |
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<option value=ZW>Zimbabwe</option> |
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<option value=ZZ>Other</option> |
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</select> |
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</td> |
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</tr> |
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<tr> |
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<td valign=center align=left> |
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<div align="left">Subject</div> |
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</td> |
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<td valign=center align=left> |
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<input size=22 name=subject> |
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</td> |
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</tr> |
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<tr> |
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<td valign=center align=left colspan=2> |
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<p>Please leave your comments below:</p> |
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<p> |
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<textarea name=comment rows=5 cols=35></textarea> |
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</p> |
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</td> |
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</tr> |
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<tr> |
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<td valign=center colspan=2> </td> |
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</tr> |
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<tr> |
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<td valign=center align=middle colspan=2> |
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<input type=submit value=Submit name="submit"> |
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|
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<input type=reset value=Reset name="reset"> |
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</td> |
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</tr> |
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<tr> |
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<td valign=center colspan=2 align="left"> <i> </i></td> |
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</tr> |
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</form> |
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</tbody> |
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</table> |
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