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Rev 20554 Rev 20555
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<div class="contactUs_formContainerRight">
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<div class="contactUs_formContainerRight">
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<form id="contactForm" action="/contact-us" method="post">
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<form id="contactForm" action="/contact-us" method="post">
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<ul class="contactUs_formUL">
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<ul class="contactUs_formUL">
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#if($productName)
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#if($productName)
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	<li><input name="name" type="text" val="$productName" style="width:250px;" disabled/></li>
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	<li><input name="name" type="text" value="$productName" style="width:250px;" disabled/></li>
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#end
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#end
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<li><input name="name" type="text" style="width:250px;" required/></li>
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<li><input name="name" type="text" style="width:250px;" required/></li>
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<li><input name="email" type="email" style="width:250px;" required/></li>
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<li><input name="email" type="email" style="width:250px;" required/></li>
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<li><input name="city" type="text" style="width:250px;" required/></li>
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<li><input name="city" type="text" style="width:250px;" required/></li>
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<li><input name="state" type="text" style="width:250px;" required/></li>
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<li><input name="state" type="text" style="width:250px;" required/></li>