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  <option>General</option>
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  <option>General</option>
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  <option>Feedback</option>
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  <option>Feedback</option>
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  <option>Bulk</option>
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  <option>Bulk</option>
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</select></li>
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</select></li>
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<li><textarea name="msg" class="contactUs_TextArea"></textarea></li>
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<li><textarea name="msg" class="contactUs_TextArea"></textarea></li>
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<li><input type="button" class="contactUs_submit" value="SUBMIT" type="submit"/></li>
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<li><input class="contactUs_submit" value="SUBMIT" type="submit"/></li>
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</ul>
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</ul>
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</form>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>