<div class="email-form">
	<p class="text required"><label for="name">{name}*</label><br />
	<input type="text" name="name" id="name" value="$name$" /></p>
	
	<p class="text"><label for="company">{company}</label><br />
	<input type="text" name="company" id="company" value="$company$" /></p>

	<p class="text"><label for="street">{street}</label><br />
	<input type="text" name="street" id="street" value="$street$" /></p>

	<p class="text"><label for="city">{city}</label><br />
	<input type="text" name="city" id="city" value="$city$" /></p>

	<p class="text required"><label for="email">{email}*</label><br />
	<input type="text" name="email" id="email" value="$email$" /></p>

	<p class="text"><label for="phone">{phone}</label><br />
	<input type="text" name="phone" id="phone" value="$phone$" /></p>
	
	<p class="checkbox"><input type="checkbox" name="call-back" id="call-back" /> <label for="call-back">{call-back}</label></p>
	
	<p class="required textarea"><label for="message">{message}*</label><br />
	<textarea name="message" id="message" cols="50" rows="10">$message$</textarea></p>
	
	<p class="note"><small>{required fields}</small></p>
	
	<p class="submit"><input type="submit" name="send" value="{submit}" /></p>
</div>

<!-- SETTINGS -->
<input type="hidden" name="submit-fields" value="name,company,street,city,email,phone,call-back,message" />
<input type="hidden" name="required-fields" value="name,email,message" />