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<div class="module_cont module_feedback_form">
    <div class="feedback_form">
        <input type="text" style="width: 840px;" name="field-name" value="Name" title="Name"
            class="field-name form_field" />
        <div class="clear">
        </div>
        <input type="text" style="width: 840px;" name="field-email" value="Email" title="Email"
            class="field-email form_field" />
        <div class="clear">
        </div>
        <input type="text" style="width: 840px;" name="field-subject" value="Subject" title="Subject"
            class="field-subject form_field" />
        <div class="clear">
        </div>
        <textarea style="width: 840px;" name="field-message" cols="45" rows="5" title="Message"
            class="field-message form_field">Message</textarea>
        <div class="clear">
        </div>
        <input type="reset" name="reset" id="reset2" value="Clear form" class="feedback_reset" />
        <input type="button" name="submit2" class="feedback_go" id="submit2" value="Send!" />
        <div class="ajaxanswer">
        </div>
    </div>
</div>