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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" required></textarea></li>
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<li><textarea name="msg" class="contactUs_TextArea" required></textarea></li>
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<div class="g-recaptcha" data-sitekey="6LcXBA4UAAAAAGK_0GnF75Sj1dX_PL8t_88icLnQ"></div>
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<div class="g-recaptcha" data-sitekey="6LcXBA4UAAAAAGK_0GnF75Sj1dX_PL8t_88icLnQ"></div>
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#if($productName)
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	<li><input name="queryType" type="hidden" value="productQuery" style="width:250px;" disabled/></li>
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#else
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	<li><input name="queryType" type="hidden" value="generalQuery" style="width:250px;" disabled/></li>
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#end
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<li><input 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>