<label> My name is
    [text* your-name] </label>

<label> I'm from (optional organisation name)
    [text* your-organisation] </label>

<label> You can reach me at (email address)
    [email* your-email] </label>

<label> I need your help with (this topic)
    [text* your-subject] </label>

<label> Let me tell you a little about it (optional)
    [textarea your-message] </label>

<FONT COLOR="1D8DB0">[submit "Submit"]