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<!--includeForm-->
<!-- <h1>Форма в блок</h1> -->


<form method="post">




 
<b>ФИО:</b><SPAN style="color:red">*</SPAN><br /><input type="text" size="30" maxlength="100" value="" name="d[0]" id="d[0]" />

<br /><br />


 
<b>Телефон:</b><SPAN style="color:red">*</SPAN><br /><input type="text" size="30" maxlength="100" value="" name="d[1]" id="d[1]" />

<br /><br />


 
<b>E-mail:</b><SPAN style="color:red">*</SPAN><br /><input type="text" size="30" maxlength="100" value="" name="d[2]" id="d[2]" />

<br /><br />


 
<b>Текст письма:</b><br /><TEXTAREA cols="50" rows="7" name="d[3]" id="d[3]"></TEXTAREA>

<br /><br />





 

<style>img.captcha {
border:1px solid gray;
}</style>


<SPAN style="color:red">*</SPAN><b>Подтвердите, что Вы не робот:</b><br>

<img class="captcha" src=".gif" align="absmiddle">&nbsp;&nbsp;<input type="text" size="5" maxlength="4" name="_cn">

<input type="hidden" value="" name="_cs"><br>

<br>

<input type="submit" value="Отправить"><re-captcha data-captcha="recaptcha"
     data-name="captcha"
     data-sitekey="6LfLhZ0UAAAAAEB4sGlu_2uKR2xqUQpOMdxygQnA"
     data-lang="ru"
     data-rsize="invisible"
     data-type="image"
     data-theme="light"></re-captcha></form>



<!--includeForm-->
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