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  1. If you have any questions or problems relating to our service, or this website, please fill in the form below. Be sure to include a contact name, email address, subject line and your message below. Once you've filled in the form, click on the send button; the message will be sent and you'll receive a response within a reasonable amount of time.
  2. <form action='/includes/contact.php'>
  3. <table>
  4. <tr><td>Contact Name:</td> <td> <input type='text' name='contact_name'></td></tr>
  5. <tr><td>Email Address:</td> <td> <input type='text' name='email_address'></td></tr>
  6. <tr><td>Phone Number:</td><td> <input type='text' name='ph_number'></td></tr>
  7. <tr><td>Subject:</td> <td>
  8. <select name="type">
  9. <option value="sales">Sales</option>
  10. <option value="support">Support</option>
  11. <option value="abuse">Abuse</option>
  12. <option value="join">Join the Coop</option></td></tr>
  13. </select><br> </td></tr>
  14. <tr><td>Type the word 'coop' here:</td> <td> <input type='textarea' name='tv'></td></tr>
  15. <tr><td>Message:</td><td><textarea name='message' rows = "10" cols = "80"></textarea><td>
  16. </table>
  17. <input type='submit'>
  18. </form>