<h2>Request Form</h2>
{exp:email:contact_form user_recipients="false" recipients="WaterStoneWeb@Gmail.com" charset="utf-8" return="{site_url}static/daf_thank_you"}

<input type="hidden" id="from" name="from" value="waterstone@waterstone.org" />


<p><input type="checkbox" name="message[]" value="Please contact me, I have questions" /><label for="contact_me"> &nbsp; Please contact, I have questions.</label></p>
<p><input type="checkbox" name="message[]" value="I need a referral to local estate planning attorneys" /><label for="refer_me"> &nbsp; I need a referral to local estate planning attorneys.</label></p>

<p><label for="name">Your Name:</label><br />
<input type="text" id="name" name="message[]" size="40" value="" /></p>

<p><label for="from">Your Email:</label><br />
<input type="text" id="from" name="from" size="40" maxlength="35" value="" /></p>

<p><label for="phone">Phone:</label><br />
<input type="text" id="phone" name="message[]" size="40" maxlength="35" value="" /></p>

<input type="hidden" id="subject" name="subject" size="40" value="WaterStone Info Form" />

{if captcha}
    <p><label for="captcha">Please enter the word you see in the image below:</label></p>
    <p>{captcha}<br />
    <input type="text" name="captcha" value="" size="20" maxlength="20" style="width:140px;" /></p>
{/if}


<p><input name="submit" type='submit' value='Submit Form' /></p>

{/exp:email:contact_form}
<p><em>Note: The information provided herein is for informational purposes only and should not be interpreted to constitute legal and/or tax advice. Donors should consult their legal and tax advisors regarding their specific situations. </em></p>