<vn>
<div id="title">
	<h1><t>IWantCustomer</t></h1>
</div>
<div id="form" class="contact">
	<div class="box form  vn-w-xs vn-pa-lg">
		<p><t>FillFormData</t></p>
		<p><t>OrCallUs</t></p>
		<form id="contact-form">
			<input type="hidden" name="srv" value="json:client/contact"/>
			<div class="form-group">
				<label><t>Name</t></label>
				<input type="text" name="name"/>
			</div>
			<div class="form-group">
				<label><t>City</t></label>
				<input type="text" name="city"/>
			</div>
			<div class="form-group">
				<label><t>PC</t></label>
				<input type="text" name="pc"/>
			</div>
			<div class="form-group">
				<label><t>Phone</t></label>
				<input type="text" name="phone"/>
			</div>
			<div class="form-group">
				<label><t>EMail</t></label>
				<input type="text" name="email"/>
			</div>
			<div class="form-group">
				<label><t>Message</t></label>
				<textarea name="message"/>
			</div>
			<div class="form-group captcha">
				<label><t>Anti-Spam</t></label>
				<input type="text" name="captcha"/>
				<img alt="Captcha" id="captcha-img"/>
			</div>
			<p class="mandatory-message">
				<t>AllFieldsMandatory</t>
			</p>
			<button>
				<t>Send</t>
			</button>
		</form>
	</div>
</div>
</vn>
