gistfile1.txt

.container
  #contact_form.row
    .col-12.col-sm-12.col-lg-12
      h2 Tell Us What You Think...
      p We appreciate any feedback about your overall experience on our site or how to make it even better.  Please fill in the below form with any comments and we will get back to you.
      form#feedbackForm role="form" 
        .form-group.has-feedback
          label.control-label for="name"  Name
          input#name.form-control.input-sm name="name" type="text" /
          span.help-block style=("display: none;")  Please enter your name.
        .form-group
          label.control-label for="title"  Title
          input#title.form-control.input-sm.optional name="title" type="text" /
        .form-group
          label.control-label for="company"  Company
          input#company.form-control.input-sm.optional name="company" type="text" /
        .form-group
          label.control-label for="website"  Website
          input#website.form-control.input-sm.optional name="website" type="url" /
        .form-group.has-feedback
          label.control-label for="phone"  Phone
          input#phone.form-control.input-sm name="phone" type="tel" /
          span.help-block style=("display: none;")  Please enter a valid phone number.  Must be ten digits long.
        .form-group.has-feedback
          label.control-label for="email"  Email Address
          input#email.form-control.input-sm name="email" type="email" /
          span.help-block style=("display: none;")  Please enter a valid e-mail address.
        .form-group.has-feedback
          label.control-label for="message"  Message*
          textarea#message.form-control.input-sm cols="30" name="message" rows="5" 
          span.help-block style=("display: none;")  Please enter a message.
        img#captcha alt=("CAPTCHA Image") src="library/vender/securimage/securimage_show.php" /
        a.btn.btn-info.btn-sm href="#" onclick=("document.getElementById('captcha').src = 'library/vender/securimage/securimage_show.php?' + Math.random(); return false")  Show a Different Image
        br/
        .form-group.has-feedback style=("margin-top: 10px;") 
          label.control-label for="captcha_code"  Text Within Image
          input#captcha_code.form-control.input-sm name="captcha_code" placeholder=("For security), please enter the code displayed in the box." type="text" /
          span.help-block style=("display: none;")  Please enter the code displayed within the image.
        span.help-block style=("display: none;")  Please enter a the security code.
        button#feedbackSubmit.btn.btn-primary.btn-lg data-loading-text="Sending..." style=("display: block; margin-top: 10px;") type="submit"  Send Feedback
      h4 * Indicates a required field.
    /! /span
  /! /row
  hr
/! /.container