<h1>Contact Us</h1>
<table width="100%"  border="0" cellspacing="0" cellpadding="0">
  <tr>
     <td width="10%"><img src="images/email.gif"></td>
     <td width="40%"> info@internetlinked.com</td>
     <td width="37%" align="right"><img src="images/mobile.gif"></td>
     <td width="13%" align="right">027 335 0955</td>
  </tr>
</table>
<fieldset>
   <legend>Contact Information</legend>
   <p>
	<label for="firstname">First name:</label>
	<input name="firstname" type="text" class="txt" id="firstname" value=""  />
	<span class="validationErrors"> * </span><span class="validationErrors"></span>
   </p>
   <p>
	<label for="surname">Surname:</label>
	<input name="surname" type="text" class="txt" id="surname" value="" />
	<span class="validationErrors"> * </span>
   </p>
   <p>
	<label for="telnum">Telephone number:</label>
	<input name="telnum" type="text" class="txt" id="telnum" value="" />
	<span class="validationErrors"> * </span> 
   </p>
   <p>
	<label for="email">E-mail Address:</label>
	<input name="email" type="text" class="txt" id="email" value=""/>    
	<span class="validationErrors"> * </span>
   </p>
</fieldset>
<fieldset>
   <legend>Message Details</legend>
   <p>
	<label for = "subject">Subject</label>
	<select name="subject" id="subject" title="">
	        <option value="">Select subject</option>
		<option>My Testimonial</option>
		<option>Orders</option>
		<option>General Question</option>
		<option>Website Difficulties</option>
	</select>
	<span class="validationErrors"> * </span>
   </p>
   <p>
	<label for="message">Message</label>
	<textarea name="message" cols="23" rows="3" class="txt" id="message" accesskey="d"></textarea>
	<span class="validationErrors"> * </span>
   </p>
</fieldset>
  <fieldset>
  <legend>Verification</legend>
  <p>
    <label for="Verification">Enter Code</label>
	{imageverification}
  </p>
  </fieldset>
<div align="center">
   <input name="Submit" type="submit" id="Request Quote" value="Submit">
</div>