<div class="gcore-line-tr gcore-form-row" id="ftr-name"><div class="gcore-line-td" id="ftd-name"><label for="name" class="gcore-label-left">Name</label>
<div class="gcore-display-table gcore-input" id="fin-name"><input name="name" id="name" value="" placeholder="" class=" validate[&#039;required&#039;]" title="" style="" data-inputmask="" data-load-state="" data-tooltip="" type="text" /></div></div></div><div class="gcore-line-tr gcore-form-row" id="ftr-email"><div class="gcore-line-td" id="ftd-email"><label for="email" class="gcore-label-left">Email</label>
<div class="gcore-display-table gcore-input" id="fin-email"><input name="email" id="email" value="" placeholder="" class=" validate[&#039;required&#039;,&#039;email&#039;]" title="" style="" data-inputmask="" data-load-state="" data-tooltip="" type="text" /></div></div></div><div class="gcore-line-tr gcore-form-row" id="ftr-message"><div class="gcore-line-td" id="ftd-message"><label for="message" class="gcore-label-left">Message</label>
<div class="gcore-display-table gcore-input" id="fin-message"><textarea name="message" id="message" placeholder="" rows="8" cols="60" class=" validate[&#039;required&#039;]" title="" style="" data-wysiwyg="0" data-load-state="" data-tooltip=""></textarea></div></div></div><div class="gcore-line-tr gcore-form-row" id="ftr-phone"><div class="gcore-line-td" id="ftd-phone"><label for="phone" class="gcore-label-left">Phone</label>
<div class="gcore-display-table gcore-input" id="fin-phone"><input name="phone" id="phone" value="" placeholder="" class=" validate[&#039;required&#039;,&#039;phone&#039;]" title="" style="" data-inputmask="" data-load-state="" data-tooltip="" type="text" /></div></div></div><div class="gcore-line-tr gcore-form-row" id="ftr-captcha"><div class="gcore-line-td" id="ftd-captcha"><label for="captcha" class="gcore-label-left">Captcha</label>
<div class="gcore-subinput-container-wide" id="fitem6"><div class="gcore-input-container gcore-display-table gcore-input" id="fin-captcha1"><input placeholder="" size="5" class=" validate[&#039;required&#039;]" title="" style="" type="text" name="captcha" id="captcha1" /><label class="gcore-sub-label">Please enter the code in the image</label></div></div>
<div class="gcore-subinput-container-wide" id="fitem7"><div class="gcore-input-container gcore-display-table gcore-input" id="fin-captcha2">{captcha_img}</div></div></div></div><div class="gcore-line-tr gcore-form-row" id="ftr-submit6"><div class="gcore-line-td" id="ftd-submit6"><div class="gcore-display-table gcore-input" id="fin-submit6"><input name="submit6" id="submit6" type="submit" value="Submit" class="" style="" data-load-state="" /></div></div></div>