{if $user->isLoggedIn()}{assign var="pgLayout" value="file:layouts/withLeftNav.tpl"}{/if}
{include_php file="shared_handle:contactForm"}

<h1>Contact Us</h1>

<strong>For more information on creating an employee wellness program that fits your company's health goals and objectives, please contact us using the form below </strong><br><br>

<form name="contactForm" action="index.php" method="post">
<input type="hidden" name="pg" value="{$page.name}">
<input type="hidden" name="no_expire" value="true">

<table>
<tr>
	<td><span>Your Name:</span></td>
	<td><input type="text" name="mfName" value="{$smarty.request.mfName|stripslashes|htmlspecialchars}"></td>
</tr>
<tr>
	<td><span>Your E-mail Address:</span></td>
	<td><input type="text" name="mfEmail" value="{$smarty.request.mfEmail|stripslashes|htmlspecialchars}"></td>
</tr>
<tr>
	<td><span>Your Phone:</span></td>
	<td><input type="text" name="mfPhone" value="{$smarty.request.mfPhone|stripslashes|htmlspecialchars}"></td>
</tr>

<tr>
	<td><span>Subject:</span></td>
	<td><input type="text" name="mfSubject" value="{$smarty.request.mfSubject|stripslashes|htmlspecialchars}"></td>
</tr>
<tr>
	<td><span>Message Body:</span></td>
	<td><textarea cols="35" rows="6" name="mfMessage">{$smarty.request.mfMessage|stripslashes|htmlspecialchars}</textarea></td>
</tr>
<tr>
	<td><span>&nbsp;</span></td>
	<td><input type="submit" value="Send Now"></td>
</tr>
</table>
{if $smarty.session.company.preferences.contact_email eq ""}
	<div class="underline">&nbsp;</div>
	<br />
	<table>
	<tr>
		<td><span>E-Mail:</span></td>
		<td><span><strong>Fill out the form above or email us at <br>{mailto address="contact@ehealthcompete.com" text="contact@ehealthcompete.com" encode="javascript"}</strong></span></td>
	</tr>
	<tr>
		<td><span>Phone:</span></td>
		<td><span><strong>801.443.4823</strong></span></td>
	</tr>
	<!--tr>
		<td><span>Fax:</span></td>
		<td><span><strong>1-801-555-5555 </strong></span></td>
	</tr-->
	<tr>
		<td valign="top" nowrap><span><br>U.S. Mail: &nbsp; &nbsp; </span></td>
		<td><span><strong><br>eHealthCompete, L.L.C. <br>
				963 W. 670 S. Ste 23<br>
				Pleasant Grove, Ut 84062</strong></span></td>
	</tr>
	</table>
{/if}
</form>
