<p><em><strong><span style="font-family: helvetica, arial, sans-serif; font-size: 10pt;">Your name and first name : </strong>(It is more nice to correspond.)</em></span><br />[text* your-name] </p>
<p><em><strong><span style="font-family: helvetica, arial, sans-serif; font-size: 10pt;">Your email : </strong>(Essential so that I can answer you.)</em></span><br />[email* your-email] </p>
<p><em><strong><span style="font-family: helvetica, arial, sans-serif; font-size: 10pt;">Subject : </strong></em></span><br />[text your-subject] </p>
<p><em><strong><span style="font-family: helvetica, arial, sans-serif; font-size: 10pt;">Your message : </strong></em></span><br />[textarea your-message] </p>
<p>[submit "Go !"]</p>