<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>