<div class="block story">
	<h4 class="title">Feedback</h4>
	<ul class="ui-form">
		[not-logged]
		<li class="form-group combo">
			<div class="combo_field"><input placeholder="Your name" type="text" maxlength="35" name="name" id="name" class="wide" required></div>
			<div class="combo_field"><input placeholder="Your e-mail" type="email" maxlength="35" name="email" id="email" class="wide" required></div>
		</li>
		[/not-logged]
			<li class="form-group">
					<label>To {recipient}</label>
			</li>
			<li class="form-group">
				<input placeholder="Topic" type="text" maxlength="45" name="subject" id="subject" class="wide" required>
			</li>
			<li class="form-group">
				<textarea placeholder="Message" name="message" id="message" rows="8" class="wide" required></textarea>
			</li>
		[attachments]
			<li class="form-group">
				<label for="question_answer">Attachments:</label>
				<input name="attachments[]" type="file" multiple>
			</li>
		[/attachments]
		[recaptcha]
			<li class="form-group">{recaptcha}</li>
		[/recaptcha]
		[question]
			<li class="form-group">
				<label for="question_answer">Question: {question}</label>
				<input placeholder="Answer" type="text" name="question_answer" id="question_answer" class="wide" required>
			</li>
		[/question]
	</ul>
	<div class="form_submit">
		[sec_code]
			<div class="c-capcha">
				{code}
				<input placeholder="Enter the code" title="Enter the code" type="text" name="sec_code" id="sec_code" required>
			</div>
		[/sec_code]
		<button class="btn" type="submit" name="send_btn"><b>Send</b></button>
	</div>
</div>