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<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<style type="text/css">
<!--
.style4 {font-family: Arial, Helvetica, sans-serif; font-size: 16; }
.style7 {
font-family: Arial, Helvetica, sans-serif;
font-weight: bold;
font-size: 14px;
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.style9 {font-family: Arial, Helvetica, sans-serif; font-size: 14px; }
.style10 {font-size: 14px}
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.txtfield{width: 180px; height: 20px;}
.txtfield2{width: 150px; height: 20px;}
.txtfield3{width: 145px; height: 20px;}
.txtfield5{width: 80px; height: 20px;}
.textarea{width: 180px; height: 50px;}
body,td,th {
	color: #444995;
}
</style>
<form action="" method="post" name="mainForm" id="mainForm">
<table align="center" border="0" width="100%">
<tr>
<td height="141" colspan="2"><span class="style7 style10">Contact Form<br />
    <br />
Many thanks for contacting us. <br />
I will answer your request asap. </span></td>
</tr>
<tr>
<td width="92" align="right" valign="top"><span class="style9 style10" style="color: #ff0000"> *</span><span class="style9 style10">Name:</span></td>
<td align="left" valign="top"><input name="first_name" type="text" class="txtfield" value=""  ></td>
</tr>
<tr>
<td align="right" valign="top"><span class="style9 style10">First Name:</span></td>
<td align="left" valign="top">	<input name="last_name" type="text" class="txtfield" value=""></td>
</tr>
<!--<tr>
<td align="right" valign="top"><span class="style9 style10" style="color: #ff0000">*</span><span class="style9 style10">Strasse:</span></td>
<td align="left" valign="top">	<input name="street" type="text" class="txtfield" value=""  ></td>
</tr>
<tr>
<td align="right" valign="top"><span class="style9 style10" style="color: #ff0000">*</span><span class="style9 style10">PLZ:</span></td>
<td align="left" valign="top">	<span class="style9 style10">
<input  name="ziport1" value=""  type="text"  class="txtfield"></span></td>
</tr>
<tr>
<td class="style4"><div align="right" class="style9 style10"><span style="color: #ff0000">*</span>Ort:</div></td>
<td><input name="ziport2" type="text" class="txtfield" value=""  ></td>
</tr>
<tr>
<td align="right" valign="top"><span class="style9 style10"><span class="style9 style10" style="color: #ff0000">*</span>Tel.:</span></td>
<td align="left" valign="top">	<input name="work_phone" type="text" class="txtfield" value=""  ></td>
</tr>-->
<tr>
<td align="right" valign="top"><span class="style9 style10" style="color: #ff0000">*</span><span class="style9 style10">Email:</span></td>
<td align="left" valign="top">	<input name="email" type="text" class="txtfield" value=""  ></td>
</tr>
<tr>
<td align="right" valign="top"><span class="style9 style10">Your Message:</span></td>
<td align="left" valign="top">	<span class="style9 style10">
<textarea name="comment" class="textarea" rows="4" size="41"></textarea>
</span></td>
</tr>
<tr>
<td width="85" align="right" valign="bottom"><span class="style4">Please enter code:</span>:</td>
<td align="left" valign="middle" colspan="2">
<iframe name="a" src="captcha/captcha_code_file.php" alt="generate" frameborder="0" width="140" height="50" scrolling="no"></iframe>
<a href="captcha/captcha_code_file.php" target="a"><img src="captcha/refresh.png" alt="Refresh code" title="Refresh Code" width="20" height="20"  border="0" /></a><br />
<input name="captcha" type="text"  class="txtfield5" value="" maxlength="10"  cols="10" />
</td>
</tr>
<tr>
<td align="right" valign="top">&nbsp;</td>
<td align="left" valign="top">	<input name="submit" type="submit" class="style10" value="Send"></td>
</tr>
<tr>
<td>&nbsp;</td>
<td align="left" valign="top"><span class="style9 style10"><font color="red"><b>*</b></font> Mandatory field</span></td>
</tr>
</table>
</form>