{config_load file="$language/lang_$language.conf" section="newsletter"} {config_load file="$language/lang_$language.conf" section="contact_us"}
| {#text_name#} | {$INPUT_NAME} |
| {#text_email#}* | {$INPUT_EMAIL} |
| {#text_phone#} | {$INPUT_PHONE} |
| {#text_fax#} | {$INPUT_FAX} |
| {#text_street#} | {$INPUT_STREET} |
| {#text_postcode#} | {$INPUT_POSTCODE} |
| {#text_city#} | {$INPUT_CITY} |
| {#text_company#} | {$INPUT_COMPANY} |
| {#text_sec_code#} | {$VVIMG} |
| {#text_sec_code#}* | {$INPUT_CODE} |
| {#text_message#}* | {$INPUT_TEXT} |
| {$BUTTON_SUBMIT} | |
| {#text_hint#} |
|---|
{#text_success#}
{$BUTTON_CONTINUE}
{/if}