<div class="col1">
 <h1>Contact Us!</h1>
[text* name class:defaultText "Name"] [text* class:defaultText email-285 "Email"] [text phone class:defaultText "Phone"] [text address class:defaultText "Address"] [text city class:defaultText "City"] [text state class:defaultText "State"] [text zip class:defaultText "Zip Code"] 
</div>

<div class="col2">[textarea comments class:defaultText "Comments"]
[captchac captcha-243 class:captcha-contact size:s]
Type the characters in the image above:
[captchar captcha-243]
[submit id:register "Submit"]
</div>
Contact Form Inquiry From e-Group-us.com
[name] <[email-285]>
From: [name] <[email-285]>
Subject: Contact Form Inquiry From e-Group-us.com

Message:
Name: [name]
Email: [email-285]
Phone: [phone]
Address: [address]
City: [city]
State: [state]
Zipcode: [zip]

Comments: [comments]

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This e-mail was sent from a contact form on eGroup (http://egroup.jasonmangone.com)
rich.young@eGroup-us.com




[your-subject]
[your-name] <[your-email]>
Message Body:
[your-message]

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This e-mail was sent from a contact form on eGroup (http://egroup.jasonmangone.com)
[your-email]



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